Nursing Research Studies Research Articles

Liberating burdensomeness of suicide survivorship loss: A Critical Interpretive Synthesis.

What is an interpreted and synthesised understanding of responses of survivors to a suicide death of a close person? It is well known that survivors of suicide loss who are in a close relationship with the deceased are at high risk for suicidality and health conditions. Nurses in various settings need evidenced-informed approaches to encounter these vulnerable persons and support their healing journey from postvention to prevention. The design is reflexive and iterative. A Critical Interpretive Synthesis comprised of six phases: formulating the review question; searching literature; sampling; determining quality; extracting data; interpretive synthesis. Qualitative content analysis was also. Based on a sample of 15 published full-text qualitative and quantitative nursing research studies published between 1990 and 2016, an aggregated, interpreted and synthesised understanding of responses of survivors of suicide loss to the suicide death of a close person emerged. Four synthesised concepts were: dreading burden of suicide risk and stigma; facing burdensomeness in the aftermath of suicide death; enduring being burdened-unburdened, striving to invest in living; and liberating burdensomeness, journeying toward healing. Contextually, geo-cultural gaps exist in published nursing studies. Most studies were from North American and a few from Asia. The reported suicide deaths occurred over a wide range of time. Conceptually, four synthesised concepts can be viewed as a process of moving from burdensomeness to liberating burdensomeness. Methodologically, a small body of knowledge that met quality appraisal was interpreted and synthesised into an understanding of an evidenced-informed approach to guide nurses' encounters with survivors of suicide loss. The results contribute to an evidenced-informed approach for nurses in practice to support survivors of suicide loss journeying from burdensomeness to liberating burdensomeness. Results also serve as a foundation for further research.

アムスラーチャートを用いた血液透析患者の視覚障害に対する看護研究

アムスラーチャートを用いた血液透析患者の視覚障害に対する看護研究

Research-active clinical nurses: against all odds.

To develop a theoretical understanding of factors that impact decisions of clinical nurses to conduct a research study. Only a small percentage of all nurses are research-active and even fewer clinical nurses are research-active. Several researchers have explored barriers to research activity by clinical nurses, but few have examined why, in spite of all odds, some clinical nurses are research-active. As the purpose of this study was to develop a theoretical understanding of the research-active nurse, a grounded theory approach was used. The sample interviewed for this study consisted of registered nurses (n=26) who worked in a hospital or ambulatory setting, had daily direct patient contact and had participated as principal investigator on at least one completed clinical nursing research study that was not in fulfilment of an educational requirement. The interviews were digitally recorded and analysed by two researchers using the constant comparative method. The findings from this study suggest that the conduct of research by clinical nurses was the direct result of a clinical trigger, characteristics and beliefs of the nurse about research and their role in generating knowledge, and the presence of support conditions, such as a research mentor. Clinical nurses can and do conduct research, in spite of constraints due to a lack of time, money and/or knowledge, if they have access to research mentors and are practising in a research-supportive environment. Nurses at the bedside are in a unique position to identify problems most in need of solutions. Findings from this study provide a foundation upon which to develop and test various programmes that seek to increase the number of clinical nurses who are research-active.

Riptide.

In this article the author describes her experience of being diagnosed with breast cancer as a riptide experience. The ocean and many of its characteristics, such as the riptide, are used to describe the powering necessary to prevail during a cancer diagnosis and treatment. Five themes or currents within this riptide experience are identified: a shattered sense of well-being; feelings of anxiety, fear and uncertainty; learning to live one day at a time; the loving attention of family and friends; and,swimming with the turbulent sea. Concepts of powering uncovered in nursing research studies along with other theoretical concepts are presented to develop further these currents.

Empowering Patients With A Hotline To The Chief Nursing Officer

The purpose of this nursing research study was to explore the perceptions of patients who were provided with a direct line of communication via a “hotline” to the Chief Nursing Officer in order to provide them with a voice in decisions which directly involve their care.Qualitative analysis revealed recurring themes identifying the “hotline” as reassuring, and offering a level of security. Another theme involved the patients relating situations that needed to be remedied including noise within the hospital environment, waiting for pain medication or using the call light without receiving assistance in a timely manner. Some calls to the hotline centered on compliments for the nursing staff. The findings from this phenomenological study which viewed the hospital world through the lens of patients' eyes have many implications for nursing practice. Implications for nursing practice include enhanced communication among nurses and patients, increased patient satisfaction with their health care experience and improved staff satisfaction in the acute care environment. A hotline to the chief nursing officer is only one way to ensure that the patients’ voices are heard and acted upon but this direct line of communication was found to be an effective tool.

New Brunswick nurses' views on nursing research, and factors influencing their research activities in clinical practice.

New Brunswick became the first province in Canada to require a baccalaureate degree in nursing as the entry to practice, yet nursing research in hospital settings remains quite low. This study examined clinical nurses' views on nursing research, and identified some contributing factors to the research-practice gap. This descriptive, cross-sectional multicenter study involved 1081 nurses working in the Francophone Regional Health Authority in New Brunswick, Canada. Nurses were eager to identify nursing-care problems to improve patient care (92.9%), and to be involved in collecting data for nursing research studies (95.2%). However, without research supervision, few had engaged in basic research activities, such as formulating or refining research questions (24.5%), presenting at research conferences (6.9%), or changing their practice based on research findings (27.2%). Younger, more educated nurses, nurse managers, and educators participated more readily in research. Sharing research and clinical expertise, as well as infrastructures between academic and clinical institutions is the key to enduring successful patient-centered nursing research in clinical settings. Concrete actions are proposed to build clinical nursing research.

Narrative analysis: how students learn from stories of practice.

To describe and recommend a variety of data analysis methods when engaging in narrative research using story as an aid to nursing students' learning. Narrative research methodology is used in many nursing research studies. However, narrative research reports are generally unspecific regarding the analysis and interpretive process. This article examines the qualitative analytical approaches of Lieblich et al's ( 1998 ) narrative processes of holistic content and analysis of form, incorporated as overarching theories. To support these theories and to provide a more rounded analytical process, other authors' work is included. Approaching narrative analysis from different perspectives is recommended. For each cycle of analysis, it is important to conceptualise the analysis using descriptors drawn from the initial literature review and the initial text. Rigour and transparency are foremost, and tables are generated that reflect each stage of the analysis. The final stage of analysis is to clearly report, organise and present findings to reflect the richly varied and diverse potential of stories. Engaging in narrative research and then dealing with the large quantities of data to analyse can be daunting, difficult to manage and appear complex. It is also challenging and rewarding. With clear descriptors, examining the data using multiple lenses can serve to develop a greater level of insight into understanding nursing students' learning from their clinical experiences, presented as stories, when involved in the care of individuals. There are many approaches to narrative analysis in nursing research and it can be difficult to establish the main research approach best suited to the study. There is no single way to define narrative analysis and a combination of strategies can be applied.

What Factors Are Associated With the Development of Pressure Ulcers in a Medical Intensive Care Unit?

Instruments used to determine the risk of pressure ulcer development are universally applied to adult patients. These instruments do not differentiate between intensive and acute care patients. Pressure ulcers contribute to negative outcomes such as increases in pain and discomfort, risk of infection, hospital length of stay and costs, and a decrease in quality of life. Appropriately identifying risk factors is paramount to implementing a targeted care plan to avoid pressure ulcer development as well as pinpointing appropriate treatments if an ulcer develops. The purpose of this nursing research study was to identify factors associated with pressure ulcer development in a medical intensive care unit. A 15-month retrospective chart review of patients with pressure ulcers in a medical intensive care unit was performed. Statistics were computed on demographics and variables of interest including: pressure ulcer stage, vasopressor infusion, oxygen requirement, comorbidities, primary diagnosis, length of stay, mortality, age, gender, weight, Braden scores, and albumin level. The characteristics of 76 patients who developed pressure ulcers were evaluated. An equal number of men (n = 38) and women (n = 38) were included. Forty-seven percent had a stage II pressure ulcer. The presence of hemodynamic support with vasopressor administration (P = .016) and the length of stay (P = .021) were noted as the most significant factors in pressure ulcer development in this study. Vasopressor use and length of stay are not factors that are accounted for in current pressure ulcer risk assessment instruments. The administration of vasopressor support and patient length of stay are potential contributory factors that need to be considered when assessing patients. Instruments specific to intensive care unit pressure ulcer risk stratification are warranted and should include the unique characteristics of a critically ill patient.

Impact Of Inter-Professional Education On Nursing Student Outcomes In The Online Environment

The implementation and integration of inter-professional education (IPE) into a curriculum is supported by the National Council of State Boards of Nursing (NCSBN), the Inter-professional Education Collaborative (IPEC), and the Institute of Medicine’s (IOM) Future of Nursing report. While there is support for implementation, there is a lack of data and guidelines which to follow currently. The purpose of this nursing research study was to investigate the impact of inter-professional collaboration on nursing student outcomes in the online environment. A co-teaching model was implemented within an online environment to provide inter-professionally lead nursing sciences courses to nursing students in a baccalaureate program. In the four sessions following the implementation of interdisciplinary collaborative teaching, 605 students completed the courses with 179 submitting the end of course survey. Results indicated that the overall student satisfaction rating with the pathophysiology online course was significant at p < 0.05 following the implementation of inter-professional teaching methodology. Prior to implementation of collaborative teaching, the total enrollment in pathophysiology was 194. After the institution of collaborative teaching, the total student enrollment was 605. This reflected a significant increase in student enrollment of 311%. Today, the complex healthcare delivery system necessitates a shift from traditional education to an inter-professional collaborative teaching model that generates knowledge from interaction with a variety of educators from a variety of disciplines (Hean, Craddock, & Hammick, 2012). Nursing curricula is needed which fosters both an inter-professional learning of shared knowledge and the discipline-specific learning essential for professional practice.

Critical realism in nursing: an emerging approach.

Critical realism, a philosophical framework originally developed by Roy Bhaskar in the 1970s, represents a relatively new approach to research generally and to nursing research in particular. This article explores the ontological and epistemological tenets of critical realism and examines the application of critical realist principles to nursing research and practice through a review of the literature. It is evident that few published nursing research studies have, as of yet, utilized critical realism as their paradigm of choice. Both the strengths and limitations of the presentation and use of critical realism in these studies are discussed in this article. Given the varying degrees of success of the authors in explicating critical realism as a philosophical framework, the value of critical realism to the research study, and the ways in which usage of the critical realist framework influenced development of the study and interpretation of findings, it is evident that the quality of future publications espousing the use of critical realism must continue to be strengthened significantly.

Using Grounded Theory as a Method of Inquiry: Advantages and Disadvantages

There are many challenges and criticisms attached to the conduct of research, none the least of which is a notion that much of the research undertaken in professional disciplines such as nursing may not have clinical and/or practical relevance. While there are a plethora of qualitative research methods that individuals must consider when designing research studies, one method stands out - Grounded Theory (GT). Grounded theory was developed in the early 1960’s by Glaser and Strauss. With its theoretical orientation based in sociology, GT strives to understand and explain human behavior through inductive reasoning processes (Elliott & Lazenbatt, 2005). Because of its emphasis on the utilization of a variety of data sources that are grounded in particular contexts, GT provides a natural theoretical fit when designing nursing research studies. In this article, the authors provide an overview of GT and then describe the appropriateness, advantages, and disadvantages of applying it as part of the research design process. Additionally, the authors highlight the importance of taking a reflexive position to stay engaged while interacting with the data, and explore how to apply GT theory to particular research questions and studies. Finally, the strengths and limitations of this method of inquiry as applied to nursing research using a brief case study approach is presented.

Preparing British Military nurses to deliver nursing care on deployment. An Afghanistan study

This paper forms part of the first British Armed forces qualitative nursing research study undertaken on deployment. To provide an analysis of the impact and effectiveness of the pre-deployment educational preparation and clinical placements provided for military nurses. A Constructivist Grounded Theory was utilised with data collected through semi-structured interviews with 18 nurses based in Camp Bastion Hospital, Afghanistan during 2013. Initial coding indicated 21 educational preparation and clinical placement categories that influenced the delivery of nursing care. Analysis of these elements led to the identification of four major clusters: Military Nursing Care; Military Nurse Education; Unique Hospital Environment and Clinical Placements. Educational preparation consists of completing deployable operational nursing competencies, specialist training and individual tailored courses. This strategy was viewed as proving the appropriate academic requirement. However, training would be enhanced by introducing a formalised military preceptorship programme focussing on fundamental nursing skills. Caring for children was a particular concern, and it was emphasised that educational courses must be combined with a standardised clinical placement policy. Adequate clinical exposure can be challenging as nurses are not routinely exposed to War Zone levels of trauma in the UK. Clinical placements need to be standardised and harmonised, and located in areas where nurses cared for patients with similar injury patterns to those witnessed on deployment. Current NHS Trust placements can reduce the opportunities for employment in suitable clinical environments and diminishing the openings for collective military training. Better use should be made of clinical rotation programmes, including high dependency units, elective surgery, medical assessment units, paediatrics, and outreach teams such as burns and plastic surgery and pain management. Practice Educators should be utilised to provide education, mentorship, supervision and continuing personal development in the operational arena. The paper considers post-Afghanistan future options.

Exploring evidence-based practice research

Exploring evidence-based practice research

Self-compassion and risk behavior among people living with HIV/AIDS.

Sexual risk behavior and illicit drug use among people living with HIV/AIDS (PLWHA) contribute to poor health and onward transmission of HIV. The aim of this collaborative multi-site nursing research study was to explore the association between self-compassion and risk behaviors in PLWHA. As part of a larger project, nurse researchers in Canada, China, Namibia, Puerto Rico, Thailand and the US enrolled 1211 sexually active PLWHA using convenience sampling. The majority of the sample was male, middle-aged, and from the US. Illicit drug use was strongly associated with sexual risk behavior, but participants with higher self-compassion were less likely to report sexual risk behavior, even in the presence of illicit drug use. Self-compassion may be a novel area for behavioral intervention development for PLWHA.

ANF Scholars (1955–2012): Stepping Stones to a Nursing Research Career

The American Nurses Foundation (ANF) grant program has been successful in funding nurse researchers' initial research studies for nearly 60 years. (ANF, 2013). From 1955-2012, over 1,000 ANF scholars have been identified through this historical nursing research study. Over the years, obtaining an ANF grant has become increasingly competitive for scholars. The environment supportive of research is evident from the schools that are the top recipients of grants. The ANF has a proud legacy of scholars who have and continue to make contributions to the advancement of nursing science. The paths forged by the ANF scholars illustrate the significant role that small grant programs play in the evolvement of nursing research and the expansion of nursing science.

Comment on: Stanley D. (2012) Celluloid devils: a research study of male nurses in feature films. Journal of Advanced Nursing 68(11), 2526–2537

Comment on: Stanley D. (2012) Celluloid devils: a research study of male nurses in feature films. <i>Journal of Advanced Nursing</i> 68(11), 2526–2537

Cost Effectiveness Analysis for Nursing Research

With ever-increasing pressure to reduce costs and increase quality, nurses are faced with the challenge of producing evidence that their interventions and care provide value. Cost effectiveness analysis (CEA) is a tool that can be used to provide this evidence by comparative evaluation of the costs and consequences of two or more alternatives. The aim of this article is to introduce the essential components of CEA to nurses and nurse researchers with the protocol of a recently funded cluster randomized controlled trial as an example. This article provides (a) a description of the main concepts and key steps in CEA and (b) a summary of the background and objectives of a CEA designed to evaluate a nursing-led pain and symptom management intervention in rural communities compared with the current usual care. As the example highlights, incorporating CEA into nursing research studies is feasible. The burden of the additional data collection required is offset by quantitative evidence of the given intervention's cost and impact using humanistic and economic outcomes. At a time when U.S. healthcare is moving toward accountable care, the information provided by CEA will be an important additional component of the evidence produced by nursing research.

Comorbidities in the Context of Care Transitions

The growing number of individuals with comorbidities experiencing care transitions represents a challenge to the current health care system. A qualitative study of empirical literature, using the Dimensional Analysis approach, was conducted to elucidate the theoretical underpinnings of the phenomenon of individuals with comorbidities undergoing care transitions. The findings were arranged in a novel schematic demonstrating that the relationship among individual attributes, comorbidities, and care processes informed the individual's risk for adverse outcomes. This schematic is useful for future nursing research studies evaluating innovative programs implemented to improve health outcomes among vulnerable populations undergoing care transitions.

Challenges and Solutions for Using Informatics in Research

Computer technology provides innovations for research but not without concomitant challenges. Herein, we present our experiences with technology challenges and solutions across 16 nursing research studies. Issues included intervention integrity, software updates and compatibility, web accessibility and implementation, hardware and equipment, computer literacy of participants, and programming. Our researchers found solutions related to best practices for computer-screen design and usability testing, especially as they relate to the target populations' computer literacy levels and use patterns; changes in software; availability and limitations of operating systems and web browsers; resources for on-site technology help for participants; and creative facilitators to access participants and implement study procedures. Researchers may find this information helpful as they consider successful ways to integrate informatics in the design and implementation of future studies with technology that maximizes research productivity.

Linking aims, paradigm and method in nursing research

To explore the use of paradigms as ontological and philosophical guides for conducting PhD research. A paradigm can help to bridge the aims of a study and the methods to achieve them. However, choosing a paradigm can be challenging for doctoral researchers: there can be ambiguity about which paradigm is suitable for a particular research question and there is a lack of guidance on how to shape the research process for a chosen paradigm. The authors discuss three paradigms used in PhD nursing research: post-positivism, interpretivism and pragmatism. They compare each paradigm in relation to its ontology, epistemology and methodology, and present three examples of PhD nursing research studies to illustrate how research can be conducted using these paradigms in the context of the research aims and methods. The commonalities and differences between the paradigms and their uses are highlighted. Creativity and flexibility are important when deciding on a paradigm. However, consistency and transparency are also needed to ensure the quality and rigour necessary for conducting nursing research. When choosing a suitable paradigm, the researcher should ensure that the ontology, epistemology and methodology of the paradigm are manifest in the methods and research strategies employed.