Implications For Nursing Practice Research Articles

Sexually Transmitted Disease in a Female Young Adult

This case study demonstrates the sexual health challenges experienced by a woman newly married and recently migrated to the United States. Data were obtained through the author's clinical experiences in primary healthcare nursing and published sources. The nursing diagnoses, nursing interventions, and patient outcomes for this woman were identified using the classifications of NANDA-International, the Nursing Interventions Classification, and the Nursing Outcomes Classification. This case study demonstrates the appropriate nursing diagnoses, interventions, and outcomes that are relevant for an individual with a sexually transmitted infection. It provides a framework for nurse practitioners in primary health care when caring for individuals with sexually transmitted infections. Based on the NANDA-International standardized nursing diagnoses, the Nursing Interventions Classification, and the Nursing Outcomes Classification provided the needed structure to improve the care of a woman with issues involving sexual health.

The ethical component of professional competence in nursing: An analysis

The purpose of this article is to initiate a philosophical discussion about the ethical component of professional competence in nursing from the perspective of Brazilian nurses. Specifically, this article discusses professional competence in nursing practice in the Brazilian health context, based on two different conceptual frameworks. The first framework is derived from the idealistic and traditional approach while the second views professional competence through the lens of historical and dialectical materialism theory. The philosophical analyses show that the idealistic view of professional competence differs greatly from practice. Combining nursing professional competence with philosophical perspectives becomes a challenge when ideals are opposed by the reality and implications of everyday nursing practice.

Determinants of Altered Life Perspectives Among Older-Adult Long-term Cancer Survivors

In the recent literature on cancer survivorship, positive changes are emphasized in the aftermath of trauma. However, there is insufficient research on older-adult survivors and more complex transformations. Consistent with nursing researchers' views about the duality of cancer survivor experiences, this research examined both positive and negative posttraumatic transformations (PTTs) among long-term survivors. Demographic, stress, and appraisal-related predictors of transformations were considered. Using cross-sectional survey design, interviews were conducted with 288 survivors of breast, colorectal, and prostate cancer. The sample, obtained from a hospital tumor registry, was 58% female, 33% African American, and 67% white (mean age, 72.5 [SD, 7.6] years). Demographic characteristics, cumulative stress exposure, appraisals of stress, and self-reported PTTs were measured. Most respondents reported diverse transformations attributed to their illness experience. Demographic characteristics and stress appraisals were more strongly associated with PTT outcomes than was cumulative stress exposure. Appraisals of the cancer experience as stressful, as generating worry, and as stigmatizing were significantly associated with diverse PTT outcomes. Many long-term older cancer survivors report PTT reflecting altered perspectives on life. Posttraumatic transformations are related to the view that cancer is a continuing worrisome and stigmatizing experience. Nurses have a unique opportunity to discuss with patients the potentially life-changing nature of the cancer experience in a manner that allows for understanding and acceptance of complex changes, incorporating benefit finding along with acknowledgement of loss and suffering. This type of discussion can enhance cancer survivors' mental health.

Differences in Pain Location, Intensity, and Quality by Pain Pattern in Outpatients With Cancer

Pain pattern represents how the individual's pain changes temporally with activities or other factors, but researchers have studied less the pattern of pain than its location, intensity, and quality parameters. The aim of this study was to explore differences in pain location, intensity, and quality by pattern groups in outpatients with cancer. We conducted a comparative, secondary data analysis of data collected from 1994 to 2007. Seven hundred sixty-two outpatients with cancer completed the 0- to 10-point Pain Intensity Number Scale and the McGill Pain Questionnaire to measure pain location, quality and pattern. From all possible combinations of the 3 types of pain patterns, we created 7 pain pattern groups. Pain pattern group distribution was as follows: pattern 1 (27%), 2 (24%), 3 (8%), 4 (12%), 5 (3%), 6 (18%), and 7 (8%). A significant higher proportion of patients with continuous pain pattern (patterns 1, 4, 5, and 7) reported pain location in 2 or more sites. Patients with patterns 1, 4, and 7 reported significantly higher worst pain mean scores than did patients with patterns 2, 3, and 6. Patients with pattern 7 reported significantly higher mean scores for the Pain Rating Index-sensory and total number of words selected than did patients with patterns 1, 2, 3, 4, and 6. Using pain pattern groups may help nurses to understand temporal changes in cancer pain and to provide more effective pain management, especially if the pain has a continuous component. Nurses or clinicians who are taking care of patients with cancer should recognize that pain patterns are associated with pain location, intensity, and quality.

A Retrospective Study of Nursing Diagnoses, Outcomes, and Interventions for Patients Admitted to a Cardiology Rehabilitation Unit

The aim of this study was to describe the use of nursing terminologies in the care plans made for patients in a cardiology rehabilitation unit. We retrospectively examined the clinical documentation for all patients admitted to a cardiology program in a small hospital in the northeast of Italy in 2008. The sample included 76 patients (87% male) with an average age of 60 years. Care plans included 21 NANDA-I nursing diagnoses and three collaborative problems, 45 Nursing Outcomes Classifications (NOC) and 46 Nursing Intervention Classifications (NIC). The most frequent diagnoses were the following: decreased cardiac output, activity intolerance, and risk for or presence of imbalanced nutrition (more than body requirements). The prevalent outcomes were related to cardiopulmonary physiological health and knowledge about cardiac disease management and diet. The most frequent nursing interventions were the following: exercise promotion, energy management, weight management, medication management, cardiac precautions, cardiac care (rehabilitative), teaching (prescribed activity/exercise and diet), and vital signs monitoring. CONCLUSIONS AND IMPLICATIONS FOR NURSING PRACTICE: Nurses in rehabilitative cardiology care are aware of patients' problems, but projects can improve the coherence between concepts, the attention to psychological problems, and self-care.

The Nature of Occupational Violence Against Taxicab Drivers

This research sought to expand evidence about the nature of occupational violence against taxicab drivers and provide further understanding of occupational violence from their perspective. Qualitative research using hermeneutic analysis was conducted. Sixteen taxicab drivers were interviewed, transcripts were analyzed, and the themes describing the nature of occupational violence were identified. Study participants reported exposure to violence, including incidents that involved money, interpersonal violence, encounters during night shift, and physical violence and weapons. Verbatim quotes illustrated violent acts that taxicab drivers experienced. The study findings reveal that taxicab drivers are commonly exposed to violence on the job. Acts that the participants reported as violence included racism, disrespect, verbal abuse, and physical violence. These incidents highlighted the perception of foreign-born drivers that their risk for violence on the job is increased because they are members of a visible minority. Community/public health nursing practice implications include actions that: (a) reduce psychosocial risks and disparities from exposure to occupational violence, (b) develop effective prevention measures that reduce exposure of taxicab drivers to violence, (c) consider this worker population when planning community violence prevention programs, and (d) influence public policy related to taxicab driver safety. The investigator advocates and offers recommendations for future research about the nature, effects, and prevention of occupational violence against taxicab drivers.

Defining the boundaries: How sexual assault nurse examiners (SANEs) balance patient care and law enforcement collaboration

Forensic nursing is multidisciplinary in nature, which can create tensions for practitioners between their responsibilities to patient care and collaborations with law enforcement and prosecutors. Because there are compelling reasons grounded in both nursing theory and legal precedent to maintain separation, there is a pressing need to understand how sexual assault nurse examiner (SANE) programs successfully negotiate these potentially conflicting roles. The purpose of this study was to examine how SANEs define their work with their patients, how they collaborate with law enforcement, and how they negotiate roles differentiation. As part of a mixed methods evaluation of a community-based SANE program, qualitative interviews were conducted with forensic nurses regarding their interactions with patients and members of the legal community. Results indicated that a strong patient care practice had positive indirect effects on victims' participation in the criminal justice system. Implications for forensic nursing practice are discussed.

HIV and Mexican Migrant Workers in the United States: A Review Applying the Vulnerable Populations Conceptual Model

Mexican migrant workers residing in the United States are a vulnerable population at high risk for HIV infection. This article critically appraises the published data surrounding HIV prevalence in this vulnerable group, as seen through the lens of the Vulnerable Populations Conceptual Model. This model demonstrates how exposure to risk and resource availability affect health status. The health status of Mexican migrants in the United States is compromised by a number of factors that increase risk of HIV: limited access to health services, multiple sexual partners, low rates of condom use, men having sex with men, and lay injection practices. Migration from Mexico to the United States has increased the prevalence of HIV in rural Mexico, making this an issue of urgent binational concern. This review highlights the implications for further nursing research, practice, and policy.

Doing the right thing at the right time

To identify factors that clinicians consider when a patient is dying, enabling implementation of the Liverpool Care Pathway. In order to improve the care of the dying patient and their families it is helpful to implement the Liverpool Care Pathway for the dying. It therefore is necessary to identify the dying patient in a timely fashion. A phenomenological study using semi-structured interviews (n=five nurses and five doctors) conducted on a hospice inpatient unit. There was a prominent theme of anxiety about getting the timing of diagnosing dying right, with an emphasis how the dying patient and their families would cope if this were wrong. The main factors identified were: support for decision making, understanding the patient's journey and concern that the care given is appropriate. CONCLUSIONS AND IMPLICATIONS FOR NURSING PRACTICE: All clinicians interviewed for this study had concerns about increasing the patient's/carers' distress if the Liverpool Care Pathway implementation was mistimed. There is a risk that clinicians are avoiding difficult conversations with families and there may be a lack of understanding around the reasons for use of the Liverpool Care Pathway. Specific communications training may help clinicians in this role.

The Relationship Between Educational Attainment and Lung Cancer Mortality in Kentucky: Implications for Nurses

Context: The professional literature indicates health has a positive correlation with socioeconomic status. More specifically, prior research documents heightened rates of lung cancer incidence and mortality in Appalachia, a region plagued by persistent poverty and below-average educational attainment. This study analyzed predictors of lung cancer mortality within Kentucky, a predominantly rural state in central Appalachia. Purpose: To determine whether county-level lung cancer mortality is related to counties’ high school graduation rates, per capita personal income levels and adult smoking rates. Also, to test whether significant differences exist among these variables between Kentucky’s Appalachian and nonAppalachian counties. Methods: Data from the Kentucky Institute of Medicine’s 2007 report The Health of Kentucky: A County Assessment were analyzed using independent samples t tests, bivariate correlations and regression analyses. Results: On a statewide basis, inverse associations were found between county-level lung cancer mortality and counties’ graduation rates (p < .001) and per capita personal income (p < .01). Statistically significant differences were detected between Kentucky’s Appalachian and non-Appalachian regions for each variable except adult smoking rates. Conclusions: In the context of similar adult smoking rates between the state’s Appalachian and nonAppalachian counties, high school graduation rates showed the strongest statistical association with lung cancer mortality. This indicates that continued improvements in Kentucky’s rate of diploma attainment may contribute to future reductions in lung cancer mortality statewide. These findings suggest practice and policy implications for nurses in Kentucky and, potentially, other states with low educational attainment and high lung cancer mortality.

Operating room nurses' perceptions of the effects of physician‐perpetrated abuse

Operating room (OR) nurses experience abuse perpetrated by physicians; however, little research has been conducted to examine nurses' perceptions of the effects of such abuse. The aim of this research was to understand participants' perceptions of physician-perpetrated abuse on their health and ability to provide patient care. In this qualitative descriptive study, ten operating room nurses working in Eastern Canada participated in open-ended, individual audiotaped interviews that were transcribed for analysis using Boyatzis' method for code development. Three categories of factors contributing to abuse were developed. The first, culture of the OR, included environment and hierarchy. The second, catalysts of abuse, included nurses' positions and experience as well as non-nurse factors such as resources and interpersonal relationships among physicians. The third category, perceived effects, included psychological, physical and social health consequences for nurses. Effects on patient care consisted of safety and potential challenges to access. Nursing practice implications included mentoring, support and accountability for action. Educational implications related to interdisciplinary education and increased education on communication, assertiveness, and awareness of abuse. Implications for research included studying perceptions of other health-care providers including physicians, studying recruitment and retention in relation to abuse, and studying other abuse in health care such as horizontal violence. We suggest a proactive approach for empowering OR nurses to address abuse and an increased focus on interdisciplinary roles.

Overcoming Barriers to Conducting an Intervention Study of Depression in an Older African American Population

The purpose of this article is to describe barriers and strengths of a study testing the effects of reminiscence on depressive symptoms in community-dwelling older African Americans. Primary data sources included debriefing sessions, reflective journals, participant observations, and key informant interviews. Data were analyzed using immersion/crystallization technique. Mistrust between gatekeepers and universities, recruitment and retention of research assistants and participants, culturally insensitive instruments, and stigma associated with depression were barriers. Successful approaches used to overcome the barriers experienced by the research team are described. Implications for transcultural nursing research and practice are discussed.

Characteristics of sex-related homicides in Alaska

The identification and interpretation of anogenital findings postmortem is a critical component of a sex-related homicide investigation. The use of a colposcope to assist in identifying anogenital injuries in living sexual assault victims is well established. The use of a colposcope for postmortem anogenital examination has been briefly mentioned in a few publications, however, no studies were found regarding the types and sites of postmortem anogenital injuries identified with a colposcope in sex-related homicide cases. The purpose of this study was to describe the demographic, physical examination, and victim-suspect relationship characteristics of sex-related homicides in Alaska. Genital findings in living and deceased sexual assault victims in Alaska were compared. Given the results of this study, postmortem sexual assault examinations should be conducted in all suspected intimate partner homicides. Further implications for forensic nursing practice and recommendations for future research are discussed.

Care of patients undergoing intra-vitreal therapy

This article discusses the role of the ophthalmic nurse in the care of patients with wet age-related macular degeneration who are undergoing intra-vitreal therapy. It provides an overview of the condition, its classification, clinical features, aetiology, diagnosis and treatment, and explains the implications for future nursing practice. A proactive, evidence-based and holistic approach to nursing care is emphasised throughout the article.

Aging as a Related Factor of the Nursing Diagnosis Impaired Memory: Content Validation

PURPOSE. The purpose of this study was to conduct a content validation for the elements of the nursing diagnosis Impaired Memory and include aging as a related factor. METHOD. Fehring's (1987) model of diagnosis content validation was used, with the participation of 18 experts. FINDING. The definition, defining characteristics, and related factors of NANDA-I were evaluated by experts, as was the proposed related factor "aging." CONCLUSIONS. Elements of the NANDA-I diagnosis Impaired Memory and the proposed related factor of aging were validated in the Brazilian context. A clinical validation of this related factor will be necessary to build evidence for this relationship. IMPLICATIONS FOR NURSING PRACTICE. NANDA-I diagnoses should be tested and validated in the elderly, in order to take their specific needs into account, thus contributing to quality nursing care for these patients.

Problems Expressed by Caregivers of Children With Fetal Alcohol Spectrum Disorder

The purpose of this study was to determine if use of a standardized classification system could help identify potential nursing sensitive problems for caregivers of children with fetal alcohol spectrum disorder (FASD). This study is a secondary analysis of data obtained from transcripts of public testimonies. Content analysis was conducted using a standardized classification system. The sample consisted of 376 statements from electronic transcripts of first person testimonies given by 48 caregivers of children with FASD in four states. Forty-eight caregivers expressed a total of 53 signs and symptoms. The majority was in the problem areas: communication with community resources, caretaking/parenting, mental health, and income. CONCLUSIONS AND IMPLICATIONS FOR NURSING PRACTICE: Using a nursing classification system, investigators were able to identify nursing sensitive problems expressed by caregivers of children with FASD. The information from this study can be used in future studies to confirm or revise the signs/symptoms identified in this study.

The Use of the Nursing Interventions Classification (NIC) with Cardiac Patients Receiving Home Health Care

To identify Nursing Interventions Classification interventions (NICs) commonly provided to cardiac home care patients and to explore differences among patients with coronary artery disease, congestive heart failure, and patients with other cardiac disorders. The NICs provided to cardiac home care patients were recorded and analyzed to determine differences in frequencies across cardiac diagnoses. Frequent NICs provided in cardiac home care are similar across diagnoses, and include tissue perfusion management and patient education NICs. Variations can be detected and involve fluid monitoring/management, exercise promotion/teaching, and cardiac care NICs. Differences in nursing care among patients with similar medical diagnoses can be detected using NIC. Relevant knowledge of nursing care can be gleaned from analyzing NIC data generated in practice and can be used to plan, evaluate, and determine the effectiveness of nursing care.

Student nurses’ experiences of community-based practice placement learning: A qualitative exploration

United Kingdom (UK) health policy has adopted an increasing community and primary care focus over recent years (Department of Health, 1997; Department of Health, 1999. Making a Difference: Strengthening the Nursing, Midwifery and Health Visitor Contribution to Health and Health Care. Department of Health, London; Department of Health, 2004. The NHS Knowledge and Skills Framework (NHS KSF). Department of Health, London). Nursing practice, education and workforce planning are called upon to adapt accordingly (Department of Health, 2004. The NHS Knowledge and Skills Framework (NHS KSF). Department of Health, London; Kenyon, V., Smith, E., Hefty, L., Bell, M., Martaus, T., 1990. Clinical competencies for community health nursing. Public Health Nursing 7(1), 33-39; United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 1986. Project 2000: A New Preparation for Practice. UKCC, London). Such changes have major implications for pre-registration nursing education, including its practice placement element. From an educational perspective, the need for increased community nursing capacity must be balanced with adequate support for student nurses' learning needs during community-based placements. This qualitative study explored six second year student nurses' experiences of 12 week community-based practice placements and the extent to which these placements were seen to meet their perceived learning needs. The data came from contemporaneous reflective diaries, completed by participants to reflect their 'lived experience' during their practice placements (Landeen, J., Byrne, Brown, B., 1995. Exploring the lived experiences of psychiatric nursing students through self-reflective journals. Journal of Advanced Nursing 21(5), 878-885; Kok, J., Chabeli, M.M., 2002. Reflective journal writing: how it promotes reflective thinking in clinical nursing education: a students' perspective. Curationis 25(3), 35-42; Löfmark, A., Wikblad, K., 2001. Facilitating and obstructing factors for development of learning in clinical practice: a student perspective. Issues and innovations in Nursing Education. Journal of Advanced Nursing 34(1), 43-50; Priest, H., 2004. Phenomenology. Nurse Researcher 11(4), 4-6; Stockhausen, L., 2005. Learning to become a nurse: student nurses' reflections on their clinical experiences. Australian Journal of Nursing 22(3), 8-14). The data were analysed using content analysis techniques, exploring their contextual meaning through the development of emergent themes (Neuendorf, K.A., 2002. The Content Analysis Guidebook. Sage Publications, London). The identified themes related to elements of students' basic skill acquisition, the development of their working relationships with mentors, patients and others, the learning opportunities offered by community practice placements and the effects that such placements had on their confidence to practice. These themes are discussed with regard to the published literature, to arrive at conclusions and implications for future nursing education, practice and research.

Forensic nursing education in North America

In the mid 1990s, some of the first formal forensic nursing educational programs were established. Now more than a decade later, courses exist at educational levels from certificate to doctorate programs, with little educational research having been conducted. This recent study explored forensic nursing knowledge as a specialty area of study and factors influencing educational development. This paper reports on social factors that facilitated and impeded educational development in the forensic nursing specialty from the perspective of forensic nurse educators in North America. Changing attitudes to previously sanctioned professional roles in society provided discussion for implications for forensic nursing practice.

The Quality and Outcomes Framework 2009/2010

Gillian Champion outlines the changes to the new QOF which came into effect on 1 April and discusses their implications for practice nurses' clinical work