International Journal of Nursing Studies

Editorial Board

2012-02-01

Post-registration ICU nurses education: Plea for a European curriculum

Sonia Labeau, Jean-Daniel Chiche, Stijn Blot — 2011-08-25

During the past decades, the nursing profession has succeeded in developing a substantial and distinctive body of knowledge, and in placing great emphasis on optimising the delivery of high quality patient care. Also, as healthcare has increased in complexity, various specialised areas of nursing practice have emerged, among which the provision of care to critically ill patients.

A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: A randomized controlled trial

Ping Guo, Linda East, Antony Arthur — 2011-09-23

Abstract: Background: Patients awaiting cardiac surgery typically experience significant physical and psychological stress. However, although there is evidence that preoperative education interventions can lead to positive postoperative outcomes for surgical patients in general, less is known about the effectiveness among patients undergoing cardiac surgery, especially Chinese cardiac patients.Objectives: To determine whether a preoperative education intervention designed for Chinese cardiac patients can reduce anxiety and improve recovery.Design: Randomized controlled trial.Settings: Cardiac surgical wards of two public hospitals in Luoyang, China.Methods: 153 adult patients undergoing cardiac surgery were randomized into the trial, 77 to a usual care control group and 76 to preoperative education group comprising usual care plus an information leaflet and verbal advice. Measurement was conducted before randomization and at seven days following surgery. The primary outcome was change in anxiety measured by the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes were change in depression (HADS), change in pain as measured by subscales of the Brief Pain Inventory-short form (BPI-sf), length of Intensive Care Unit stay and postoperative hospital stay.Results: Of 153 participants randomized, 135 (88.2%) completed the trial. Participants who received preoperative education experienced a greater decrease in anxiety score (mean difference −3.6 points, 95% confidence interval −4.62 to −2.57; P<0.001) and a greater decrease in depression score (mean difference −2.1 points, 95% CI −3.19 to −0.92; P<0.001) compared with those who did not. There was no difference between groups in average pain, current pain, and interference in general activity, mood and walking ability. Patients randomized to the preoperative education group reported less interference from pain in sleeping (mean difference −0.9 points, 95% CI −1.63 to −0.16; P=0.02). There was some evidence to suggest a reduced number of hours spent in the Intensive Care Unit among preoperative education patients (P=0.05) but no difference in length of postoperative hospital stay (P=0.17).Conclusions: This form of preoperative education is effective in reducing anxiety and depression among Chinese cardiac surgery patients. Based upon existing evidence and international practice, preoperative education should be incorporated into routine practice to prepare Chinese cardiac patients for surgery.

Comparison of a theory-based (AIDS Risk Reduction Model) cognitive behavioral intervention versus enhanced counseling for abused ethnic minority adolescent women on infection with sexually transmitted infection: Results of a randomized controlled trial

Jane Dimmitt Champion, Jennifer L. Collins — 2011-09-22

Abstract: Background: Ethnic minority adolescent women with a history of sexual or physical abuse and sexually transmitted infections represent a vulnerable population at risk for HIV. Community-based interventions for behavior modification and subsequent risk reduction have not been effective among these women.Objectives: To evaluate the effects of a theory-based (AIDS Risk Reduction Model) cognitive behavioral intervention model versus enhanced counseling for abused ethnic minority adolescent women on infection with sexually transmitted infection at 6 and 12 months follow-up.Design: Controlled randomized trial with longitudinal follow-up.Settings: Southwestern United States, Metropolitan community-based clinic.Participants: Mexican-and-African American adolescent women aged 14–18 years with a history of abuse or sexually transmitted infection seeking sexual health care.Methods: Extensive preliminary study for intervention development was conducted including individual interviews, focus groups, secondary data analysis, pre-testing and feasibility testing for modification of an evidence-based intervention prior to testing in the randomized controlled trial. Following informed consents for participation in the trial, detailed interviews concerning demographics, abuse history, sexual risk behavior, sexual health and physical exams were obtained. Randomization into either control or intervention groups was conducted. Intervention participants received workshop, support group and individual counseling sessions. Control participants received abuse and enhanced clinical counseling. Follow-up including detailed interview and physical exam was conducted at 6 and 12 months following study entry to assess for infection. Intention to treat analysis was conducted to assess intervention effects using chi-square and multiple regression models.Results: 409 Mexican-(n=342) and African-(n=67) American adolescent women with abuse and sexually transmitted infection histories were enrolled; 90% intervention group attendance; longitudinal follow-up at 6 (93%) and 12 (94%) months. Intervention (n=199) versus control (n=210) group participants experienced fewer infections at 0–6 (0% versus 6.6%, p=.001), 6–12 (3.6% versus 7.8%, p=.005, CI 95% lower-upper .001–.386) and 0–12 (4.8% versus 13.2%, p=.002, CI 95% lower-upper, .002–.531) month intervals.Conclusions: A cognitive behavioral intervention specifically designed for ethnic minority adolescent women with a history of abuse and sexually transmitted infection was effective for prevention of infection. These results provide evidence for development of evidence-based interventions for sexually transmitted infection/HIV. Implications include translation to community-clinic-based settings for prevention of adverse outcomes regarding sexual health of adolescent women.

The Lively Legs self-management programme increased physical activity and reduced wound days in leg ulcer patients: Results from a randomized controlled trial

2011-09-30

Abstract: Objective: Investigating the effectiveness of the Lively Legs program for promoting adherence with ambulant compression therapy and physical exercise as well as effects on leg ulcer recurrence.Design: A randomized controlled trial.Setting: Eleven outpatient clinics for dermatology in the Netherlands participated in the study.Patients: 184 patients attending the outpatient clinic with leg ulcers based dominantly on a venous aetiology. Randomization was stratified by centre, age, sex and aetiology (purely venous or mixed).Intervention: The intervention group received additionally to usual care, lifestyle counselling according to the Lively Legs program, the control group received care as usual. Patient behaviour on physical activity (IPAQ), adherence to compression therapy and wound status were assessed every 6 months during a follow-up period of 18 months. Data analysis was based on the intention to treat principle, using a generalized linear model with additive link function and Bernouilli distributions. Effects on recurrence were analyzed after the first ulcer had healed using proportional hazard regression.Results: The results showed an increase in adherence with compression therapy in both groups, with no significant difference between the groups. The intervention group performed significantly better on conducting leg exercises (p<0.01) and 10min walks at five days a week (p<0.01). There was no difference on reaching 30min of walking on 5 days a week. The intervention group had less wound days (p<0.01), time till recurrence did not differ significantly (p=0.07).Conclusion: The Lively Legs program effectively increased the use of leg exercises and walking behaviour, and decreased wound time, however it did not significantly enhance use of compression stockings. Non significant effects regarding secondary outcomes may relate to the frailty of the sample.

Nurse-led central venous catheter insertion—Procedural characteristics and outcomes of three intensive care based catheter placement services

2011-09-26

Abstract: Background: Nurse-led central venous catheter placement is an emerging clinical role internationally. Procedural characteristics and clinical outcomes is an important consideration in appraisal of such advanced nursing roles.Objectives: To review characteristics and outcomes of three nurse-led central venous catheter insertion services based in intensive care units in New South Wales, Australia.Design: Using data from the Central Line Associated Bacteraemia project in New South Wales intensive care units. Descriptive statistical techniques were used to ascertain comparison rates and proportions.Participants: De-identified outcome data of patients who had a central venous catheter inserted as part of their therapy by one of the four advanced practice nurses working in three separate hospitals in New South Wales.Results: Between March 2007 and June 2009, 760 vascular access devices were placed by the three nurse-led central venous catheter placement services. Hospital A inserted 520 catheters; Hospital C with 164; and Hospital B with 76. Over the study period, insertion outcomes were favourable with only 1 pneumothorax (1%), 1 arterial puncture (1%) and 1 CLAB (1%) being recorded across the three groups. The CLAB rate was lower in comparison to the aggregated CLAB data set [1.3 per 1000 catheters (95% CI=0.03–7.3) vs. 7.2 per 1000 catheters (95% CI=5.9–8.7)].Conclusion: This study has demonstrated safe patient outcomes with nurse led CVC insertion as compared with published data. Nurses who are formally trained and credentialed to insert CVCs can improve organisational efficiencies. This study adds to emerging data that developing clinical roles that focus on skills, procedural volume and competency can be a viable option in health care facilities.

The Spanish version of the Breastfeeding Self-Efficacy Scale-Short Form: Reliability and validity assessment

2011-09-19

Abstract: Background: Only a minority of infants are exclusively breastfed for the recommended 6 months postpartum. Breastfeeding self-efficacy is a mother's confidence in her ability to breastfeed and is highly predictive of breastfeeding behaviors. The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) was developed among English-speaking mothers to measure breastfeeding self-efficacy.Objectives: To translate the BSES-SF into Spanish and assess its psychometric properties.Design: Methodological study.Setting: One public hospital in Orihuela, Spain.Participants: A convenience sample of 135 in-hospital breastfeeding women was recruited on their second day postpartum.Methods: The BSES-SF was translated into Spanish using forward translation, back-translation and pilot testing. Internal consistency, construct validity and predictive validity were assessed. A battery of self-report questionnaires was administered on the second day postpartum including: a questionnaire on sociodemographic variables and breastfeeding status, the translated BSES-SF, the Spanish adaptation of the General Self-Efficacy Scale and the Stress Management Self-Efficacy Scale. Also, data on breastfeeding status at three weeks postpartum were collected by telephone interviews.Results: The Cronbach's alpha coefficient for internal consistency was 0.92. The translated BSES-SF presented a unidimensional structure with factor loadings of >0.30. In addition, demographic response patterns and correlations with self-efficacy scales provided further evidence of construct validity. In-hospital BSES-SF scores significantly predicted exclusive breastfeeding at 3 weeks postpartum.Conclusions: The results of this study indicate that the Spanish translation of the BSES-SF can be considered a valid and reliable measure of maternal breastfeeding self-efficacy in Spain.

Diabetes-related emotional distress in adults: Reliability and validity of the Norwegian versions of the Problem Areas in Diabetes Scale (PAID) and the Diabetes Distress Scale (DDS)

2011-09-19

Abstract: Background: Regular assessment of diabetes-related emotional distress is recommended to identify high-risk people with diabetes and to further prevent negative effects on self-management. Nevertheless, psychological problems are greatly under diagnosed. Translating and testing instruments for psychosocial assessment across languages, countries and cultures allow for further research collaboration and enhance the prospect of improving treatment and care.Objectives: To examine the psychometric properties of the Norwegian versions of the Problem Areas in Diabetes Scale and the Diabetes Distress Scale.Design: Cross-sectional survey design.Settings: A sample comprising adults with diabetes (response rate 71%) completed the Problem Areas in Diabetes Scale and the Diabetes Distress Scale, which were translated into Norwegian with standard forward–backwards translation.Participants: The study included 292 participants with type 1 (80%) and type 2 diabetes (20%) aged 18–69 years, 58% males, mean diabetes duration 17.3 years (11.6), mean HbA1c 8.2% (1.6).Methods: We used exploratory factor analysis with principal axis factoring and varimax rotation to investigate the factor structure and performed confirmatory factor analysis to test the best fit of a priori-defined models. Convergent and discriminate validity were examined using the Short Form-36 Health Survey, Hospital Anxiety and Depression Scale and demographic and disease-related clinical variables. We explored reliability by internal consistency and test–retest analysis.Results: Exploratory factor analysis supported a four-factor model for the Diabetes Distress Scale. Confirmatory factor analysis indicated that the data and the hypothesized model for the Diabetes Distress Scale fit acceptably but not for the Problem Areas in Diabetes Scale. Greater distress assessed with both instruments correlated moderately with lower health-related quality of life and greater anxiety and depression. The instruments discriminated between those having additional health conditions or disabilities, foot problems or neuropathy. Women and participants with higher HbA1c levels reported significantly higher diabetes-related emotional distress.Conclusions: The Norwegian versions of the Problem Areas in Diabetes Scale and the Diabetes Distress Scale have satisfactory psychometric properties and can be used to map diabetes-related emotional distress for diagnostic or clinical use. The Diabetes Distress Scale also contributes to identifying sub-domains of distress and seems promising for use in clinical trials.

Caring behaviors perceived by elderly residents of long-term care facilities: Scale development and psychometric assessment

Huei-Lih Hwang, Chin-Tang Tu, Shiue Chen, Hsiu-Hung Wang — 2011-09-26

Abstract: Background: To meet the growing need for relationship-centered nursing practice and for nursing school accreditation in Taiwan, nursing school curricula must include training in care for elderly populations in institutional settings. However, educators lack tools for evaluating student performance in such settings. The few tools currently available for measuring the caring in nurses perceived by elderly residents of long-term care facilities (LTCFs) are either inappropriate for education purposes or are culturally inappropriate for elderly populations in Taiwan.Objectives: To develop a scale for measuring the caring behaviors of caregivers or student volunteers as perceived by a Taiwanese population of elderly residents of LTCFs and to establish the psychometric characteristics of the scale.Methods: This study was conducted in two phases. In Phase 1, the researchers comprehensively reviewed the literature on caring. Based on the review, an Elderly Resident-Perceived Caring Scale (EPCS) was developed to measure the caring behaviors perceived by LTCF residents. To establish content and face validity, the items on the scale were reviewed by six experts in two rounds of Delphi study and by four elderly laypersons. In Phase 2, a convenience sample of 297 elderly residents from 18 representative elderly care facilities (i.e., skilled nursing facilities, independent living facilities, and assisted living facilities) in Taiwan were recruited to test the construct validity and reliability of the EPCS.Results: The 14-item, 2-dimension questionnaire developed in this study explained 64.33% of the variance in caring perceived by the residents. Factor I, Comforting, included 11 items. Factor II, Encouraging, included 3 items. Cronbach's α values were .924 for the total scale and .930 and .844 for the Comforting and Encouraging, respectively.Conclusion: The psychometric qualities of the EPCS were supported. However, further testing of the scale is needed to confirm its psychometric properties in a larger sample.

A survey of European intensive care nurses’ knowledge levels

Paul Fulbrook, John W. Albarran, Birte Baktoft, Ben Sidebottom — 2011-07-13

Abstract: Background: The application of knowledge to the care of critically ill patients is a hallmark of professional nursing practice. However, the educational preparation of intensive care nurses varies from country to country, and there has been little research that has investigated knowledge levels of European critical care nurses.Objective: The aim of this study was to examine the knowledge levels of European intensive care nurses.Design: The study was an international cross-sectional survey, with data collected from 20 European countries.Setting and participants: 318 European intensive care units participated, and data were collected from 1142 intensive care nurses.Methods: Data were collected between May and December 2009 using a 100-item multiple choice online questionnaire to assess intensive care nursing knowledge. The questionnaire was available in 16 languages, and data were collected in 11 knowledge areas.Results: A response rate of 60% was achieved; the majority of participants was female (77%). The largest groups of nurses had more than five years’ experience and were under 30 years of age. The overall mean knowledge score was 66% (SD 12). The main factor that contributed to variance in scores was nurses’ length of intensive care experience; in ten categories knowledge scores were progressively higher according to experience. If 50% is considered to be a pass mark, 90% of participants would have passed. However, in only six countries did all participants achieve a ‘pass’ score, and in five countries more than 10% of participants failed to meet this ‘pass’ criterion. The knowledge category which scored lowest was respiration and ventilation (mean score 56%, SD 15).Conclusions: Although knowledge levels differed among countries, there were no major differences. However, the relatively low scores achieved in the respiration/ventilation category are a cause of concern, and suggest that this is an education area that should be prioritised. The results should be considered within the context of each country's healthcare and professional education systems, and strategies should be developed to improve knowledge in several key areas.

Evaluation of the Scrub Practitioners’ List of Intraoperative Non-Technical Skills (SPLINTS) system

2011-10-05

Abstract: Background: The Scrub Practitioners’ List of Intraoperative Non-Technical Skills (SPLINTS) system is a new tool for training and assessing scrub practitioner (nurse, technician) behaviours during surgical operations.Objectives: The aim of the study was to test the psychometric properties including inter-rater reliability of the prototype SPLINTS behavioural rating system.Methods: Experienced scrub practitioners (n=34) attended a one-day session where they received background training in human factors and non-technical skills and were also trained to use the SPLINTS system. They then used SPLINTS to rate the scrub practitioners’ non-technical skill performance in seven standardized simulated, surgical scenarios.Results: Reliability, measured by within-group agreement (rwg) for the three skill categories and six out of nine elements, was acceptable (rwg>0.7). Participants were within one scale point of expert ratings in >90% of skill categories and elements, and could use SPLINTS to score performance with a reasonable level of accuracy. There was good internal consistency of the system: absolute mean difference was M<0.2 of a scale point for all three categories. Participants were surveyed and they indicated that the system was complete and usable as an assessment tool.Conclusion: The reliability of the SPLINTS system was deemed to be adequate for assessing scrub practitioners’ non-technical skills in simulated, standardized, video scenarios. On the basis of these results, the system can now move on to usability testing in the real operating theatre.

Surveillance technology: An alternative to physical restraints? A qualitative study among professionals working in nursing homes for people with dementia

2011-10-03

Abstract: Background: Working with surveillance technology as an alternative to traditional restraints creates obvious differences in the way care is organised. It is not clear whether professional caregivers find working with surveillance technology useful and workable and whether surveillance technology is indeed used to diminish restraint use.Objectives: The aim of this study was to obtain an insight into the view of Dutch dementia care professionals on the feasibility of surveillance technology as an alternative to physical restraints.Design: Qualitative study.Setting: The study was carried out in seven nursing homes for people with dementia in The Netherlands.Participants and methods: Semi-structured interviews were held with nine key persons from seven nursing homes for people with dementia. Also, six focus group discussions were held with groups of nurses and two focus group discussions were held with multidisciplinary teams.Results: The dementia care professionals named three different ways in which surveillance technology can be used: to provide safety in general, to provide additional safety, and to provide more freedom for the residents. In addition to this, the dementia care professionals mentioned four limitations in the use of surveillance technology: it is unable to prevent falling, it cannot guarantee quick help, it does not always work properly, and it could violate privacy.Conclusion: Dementia care professionals consider surveillance technology supplemental to physical restraints, rather than as an alternative. Improvement of devices and education of care professionals might increase the support for using surveillance technology as an alternative to physical restraints.

A comparative qualitative analysis of stories of spousal caregivers of people with dementia: Negative, ambivalent, and positive experiences

Bomin Shim, Julie Barroso, Linda L. Davis — 2011-09-26

Abstract: Background: Caregivers of people with dementia describe a wide spectrum of caregiving experiences, from very negative to very positive. Previous research reveals that differences exist, but how or why the experiences differ has not been well addressed.Objective: The purpose of this study was to explore how the experiences of spousal caregivers of people with dementia differ.Methods: This study was a secondary analysis of interviews collected from a longitudinal caregiver skill training intervention for caregivers of those with degenerative diseases (parent study). For the purpose of this analysis, 57 interviews from 21 spousal caregivers of people with dementia in the control group of the parent study were analyzed. The interviews from the parent study were collected at baseline, 6months, and 12months post-enrollment.Results: Three groups of caregivers were identified based on how they described their experience; a negative group, an ambivalent group and a positive group. The negative group described both past and present relationships with their spouse in negative terms. These caregivers expressed no positives in caregiving. Their focus was on their own unmet needs rather than their spouses’ needs. These caregivers reported significant caregiving burden. The ambivalent group reported that the relationship they had with the spouse was lost, but they still described satisfaction in being able to care for the spouse. They described mixed emotions about caregiving and had difficulty accepting that their partners could no longer reciprocate in the relationship. The positive group described both their past and present relationship with the care recipient in loving terms. They focused on aspects of the relationship they still had, rather than what had been lost. They expressed satisfaction with caregiving, were other-focused, and not highly burdened by caregiving. They understood that their partner could not reciprocate, and expected nothing in return. Descriptions of the positive group suggest target areas for caregiver interventions.Conclusion: Spousal caregivers of people with dementia can be encouraged toward more positive caregiving experiences through empathy-building interventions and enhanced understanding and acceptance of changes in the care recipient.

Factors influencing self-management in chronic obstructive pulmonary disease: An integrative review

R.T. Disler, R.D. Gallagher, P.M. Davidson — 2011-12-08

Abstract: Background: Chronic obstructive pulmonary disease is a common, chronic and burdensome condition requiring the individual to engage in a range of self-management strategies. The capacity to engage in self-management is dependent on a range of internal (e.g. personal) and external (e.g. health service) factors.Objectives: This paper seeks to define self-management, identify the determinants which influence the individual's ability to cope and adjust to living with chronic obstructive pulmonary disease in the community, and identify implications for clinical practice and research.Design: Integrative review.Data sources: Medline, Embase, PubMed, CINAHL, Google Scholar.Review methods: Integrative review using prospective research questions. Papers were included in the review if they were published in peer reviewed journals and written in English between 2000 and 2010. Articles were accepted for inclusion if they discussed the determinants that influenced self-management of chronic obstructive pulmonary disease in the community. Confirmation of results and discussion themes was validated by specialists in chronic obstructive pulmonary disease and complex care.Findings: Self-management is less well characterised in chronic obstructive pulmonary disease compared with other chronic conditions. Functional limitation and the need to balance disease management with everyday life are the two key elements that patients face in managing their condition. Provider characteristics, socioeconomic status and health literacy are sparsely discussed yet are known to influence chronic obstructive pulmonary disease self-management.Conclusions: Chronic obstructive pulmonary disease self-management must be a key focus internationally as the disease incidence increases. Collaborative care is required between patients and health providers in order facilitate patients in confident management of their condition.

Where is the international variation in the protection of the public? Commentary on Cutcliffe and Forster (2010)

Rachael Vernon, Pam Doole, Carolyn Reed — 2011-10-31

John Cutcliffe's guest editorial (Cutcliffe and Forster, 2010) proposes that the continuing competence requirements of some nursing regulatory bodies to safeguard the public have limited legitimacy or credibility. This is based on examples drawn from two regulatory jurisdictions, the United Kingdom and British Columbia.