A computer-based education intervention to enhance surrogates' informed consent for genomics research.

BACKGROUND: Many research studies conducted today in critical care have a genomics component. Patients' surrogates asked to authorize participation in genomics research for a loved one in the intensive care unit may not be prepared to make informed decisions about a patient's participation in the research. OBJECTIVES: To examine the effectiveness of a new, computer-based education module on surrogates' understanding of the process of informed consent for genomics research. METHODS: A pilot study was conducted with visitors in the waiting rooms of 2 intensive care units in a Midwestern tertiary care medical center. Visitors were randomly assigned to the experimental (education module plus a sample genomics consent form; n = 65) or the control (sample genomics consent form only; n = 69) group. Participants later completed a test on informed genomics consent. RESULTS: Understanding the process of informed consent was greater (P = .001) in the experimental group than in the control group. Specifically, compared with the control group, the experimental group had a greater understanding of 8 of 13 elements of informed consent: intended benefits of research (P = .02), definition of surrogate consenter (P= .001), withdrawal from the study (P = .001), explanation of risk (P = .002), purpose of the institutional review board (P = .001), definition of substituted judgment (P = .03), compensation for harm (P = .001), and alternative treatments (P = .004). CONCLUSIONS: Computer-based education modules may be an important addition to conventional approaches for obtaining informed consent in the intensive care unit. Preparing patients' family members who may consider serving as surrogate consenters is critical to facilitating genomics research in critical care.

Energy expenditure in preterm infants during periods of environmental stress in the neonatal intensive care unit.

AIM: To explore the energy expenditure (EE) in a group of preterm infants during the periods of environmental stress, and to explore the relationship between EE and physiological stress signals of preterm infants. METHODS: Research design was an explorative secondary analysis of 4164 research data from 37 preterm infants which included physiological signals and environmental stressors in neonatal intensive care units. The current study investigated the data of EE calculated using heart-rate-based EE estimate. RESULTS: A significantly positive relationship between EE and different levels of nursing intervention was found (P < 0.005). In addition, there was a significantly negative relationship between EE and oxygen saturation (P < 0.001). CONCLUSION: These research results confirmed that environmental stressors may impact the growth and developmental outcomes in preterm infants by increasing their EE. Neonatal clinicians should minimize excessive stimulations in order to conserve energy for the growth and developmental needs of preterm infants. Research found a significant relationship between an increase in EE and a decrease in oxygen saturation in preterm infants. The authors further hypothesized that EE of preterm infants may be predicted by estimating the oxygen saturation. Further study using different research methods and an enlarged sample size is needed.

Relationship between energy expenditure and stress behaviors of preterm infants in the neonatal intensive care unit.

PURPOSE: This research evaluated the relationship between behaviors and energy expenditure in preterm infants receiving nursing interventions. DESIGN AND METHODS: This study was an explorative secondary data analysis from a previous study. The current study investigated energy expenditure calculated using heart rate-based energy expenditure-estimate across 500 repeated measures for 37 infants. RESULTS: Research results indicate that preterm infants expend more energy when they show the following seven behaviors: grimace, sucking, diffusion squirm, fist, gape face, salute, and sneezing. PRACTICE IMPLICATIONS: The interventions for preterm infants should be flexible, according to the infant's stress behaviors and conditions of energy expenditure.

A comparison of medication management between older and younger adults living with HIV.

The aims of this study were to examine differences in medication management between older and younger adults living with HIV and to examine the relationship between age and cognitive ability, depressive symptoms, and self-efficacy on medication management. This research utilized a descriptive-correlational, cross-sectional design to compare medication management between older and younger adults living with HIV and to describe differences in predictive factors of cognition, depressive symptoms, and self-efficacy on medication management. Results indicated that both older and younger adults had poor medication management skills and high rates of mild cognitive impairment. While older adults performed worse on the medication management test than younger adults, the results were not statistically significant. In both older and younger adults, cognitive ability and depressive symptoms were predictors of medication management, with cognitive ability being the strongest predictor for both groups. Cognitive ability was a stronger predictor for older adults than for younger adults.

An oral health program for children.

Caries, the most infectious chronic disease of childhood in America, leads to health, learning, and quality-of-life issues. Using the Missouri Preventive Service Program model, a pilot oral health program for children from ages birth to 5 years in a rural health clinic was the first to implement the application of fluoride varnish.

Mechanisms through which reciprocal filial values protect wellbeing of Chinese adult-child caregivers in the US.

In this study, we explored the role of reciprocal filial values in protecting the wellbeing of Chinese adult-child caregivers in the US. Using survey data obtained from 137 Chinese adult-child caregivers living in seven US cities, we tested a latent variable model using structural equation modeling. In this model, informed by role theory, social exchange theory and stress-coping theory, reciprocal filial values affect caregiver wellbeing in the face of caregiver role strain, both directly and indirectly through protective effects of role rewards and coping. In the final model, reciprocal filial values had both direct and indirect protective effects on caregivers' wellbeing, offering evidence to address culturally sensitive issues in family caregivers with similar filial values.

Relationships between environmental stressors and stress biobehavioral responses of preterm infants in NICU.

Although research has demonstrated that the neonatal intensive care unit (NICU) is a stressful environment for preterm and high-risk infants, little research validates the suspected relationships between infant biobehavioral responses and environmental stress in the NICU. This exploratory study examined the relationship between environmental stress and biobehavioral responses of preterm infants. The study used a repeated-measures research design to examine research variables in one group of preterm infants. Measurements of research variables were recorded every 2 minutes during two 60-minute observation periods for each research day (1 hour in the morning and 1 hour in the afternoon) and conducted over 2 days. A convenience sample of 37 preterm infants was recruited from 2 medical centers in Taiwan. A total of 4164 observations were made and recorded during the study. There was a statistically significant (P < .05) relationship between environmental stressors and changes in physiological signals. There were also statistically significant (P < .05) relationships between environmental stress and some specific stress behaviors. This research is applicable to neonatal clinical practice because it demonstrates the importance of recognizing the preterm infant's biological stress responses to environmental stressors, allowing for early interventions to reduce the possibility of more serious physiological or pathological changes in the status of the preterm infant.

Cultural practices and end-of-life decision making in the neonatal intensive care unit in Taiwan.

The purpose of this research was to describe conditions of decision making for dying infants and cultural effects on the process of infant death in the neonatal intensive care unit. A retrospective chart review was used in this research. Fifty charts were reviewed; the major cause of death for the research subjects was complications of prematurity (52%). Eighty-two percent of the charts documented a do not resuscitate order, and 16% of parents allowed discontinuation of ventilator support when they realized the futility of continued care. In 30 nursing records, parents and their dying infants were offered a quiet place in which to grieve. In 10 cases, nurses accompanied these parents and allowed them to express their emotions. Research findings showed great outward expression of religion at the time of death. Various cultural issues affected both the grieving process of the families and the dying process of their infants.

Wellness in community living adults: the Weigh to Life program.

OBJECTIVE: To examine physiological and health-related quality of life (HRQOL) outcomes in community living adults attending a 12-week combined lifestyle wellness program. METHODS: A sample of overweight and obese adults (n=319) and a subgroup who also had diabetes (n=46 of 319) were studied. The program focuses on dietary, physical activity, and behavioral strategies to promote cardiovascular health. Baseline and 12-week measures were obtained. RESULTS: In the total sample, all physiological and HRQOL outcomes improved (p<.05), except HDL. High attendance was associated with the highest weight loss. In the diabetic subgroup, weight, steps/day, low density lipoprotein, and most aspects of HRQOL improved significantly. CONCLUSION: Physiological and HRQOL benefits can be gained from a 12-week combined lifestyle program; greater benefits were obtained with higher attendance. Although the diabetic subgroup was not large, positive outcomes were realized. PRACTICE IMPLICATIONS: The 12-week combined lifestyle program shows promise for improving outcomes in community living overweight and obese adults who may also be diabetic. By attending class, participants are reminded about strategies they are to apply during the 12-week program and, by program end, they are equipped with a tool kit of strategies for use in everyday life.

To explore relationships between physiological stress signals and stress behaviors in preterm infants during periods of exposure to environmental stress in the hospital.

The purpose of this exploratory descriptive study was to examine relationships among physiological stress signals (heart rate (HR), respiratory rate (RR), and oxygen saturation) and stress behaviors (6 stress behaviors related to sleep-wake states, 10 self-regulatory behaviors, and 17 behavioral stress cues) in preterm infants during periods of environmental stress. This research used a prospective repeated-measures design in a convenience sample of preterm infants of <37 weeks' gestational age and <28 days' postnatal age. All infants were in the incubator in a neonatal intensive care unit or a sick baby care unit in one of two hospitals at the time of data collection. Multiple linear regressions of generalized estimating equations were used to determine relationships. Variables were measured every 2 min over 4 hr, for a total of 4,164 observations in 37 preterm infants. There were statistically significant relationships between 9 stress behavioral responses and changes in HR (seven stress behaviors and two self-regulatory behaviors; p < .05), between 9 stress behavioral responses and changes in RR (seven stress behaviors and two self-regulatory behaviors; p < .05), and between 11 stress behavioral responses and changes in oxygen saturation (seven stress behaviors and four self-regulatory behaviors; p < .05). Findings demonstrate that the functions of self-regulatory behaviors and some special behaviors in preterm infants during environmental stress are related to physiological stress signals. However, results should be investigated further in larger samples.

Systematic review of educational interventions for improving advance directive completion.

PURPOSE: To systematically analyze evidence about the outcome and percent of newly completed ADs, focusing on the effectiveness of (a) types of educational interventions versus controls and (b) one educational intervention over another. DESIGN: Systematic review of literature based on Cochrane review criteria. METHODS: Twelve randomized and four nonrandomized studies were selected from the nursing, medical, and social work literature that met the following criteria: described educational interventions, provided information to calculate the percent of newly completed ADs as an outcome, and published between 1991 and 2009. The review focused primarily on randomized studies. Reviewers calculated the percent of newly completed ADs by determining the number of subjects per group without an AD at baseline and the percentage of those who then completed one by the end of the studies. FINDINGS: Findings were inconsistent regarding all types of educational interventions studied versus controls. Sufficient evidence exists to conclude that combined written and verbal educational interventions were more effective than single written interventions in increasing the percent of newly completed ADs in adult clinic outpatients and hospitalized elderly. CONCLUSIONS: Calculating the percent of newly completed ADs was successful in allowing for study result comparisons. Overall, the evidence base regarding the effectiveness of single or combined educational interventions in increasing AD completion is weak. Randomized studies with diverse samples should be conducted against controls before more studies comparing interventions are undertaken. CLINICAL RELEVANCE: This article provides nurses with a summary of research related to educational interventions and AD completion and identifies where future study is needed.

Construct validity of four exercise stage of change measures in adults.

Measuring readiness to exercise, or exercise stage of change (ESOC), is an important first step when counseling adults about exercise. However, minimal construct validity testing of ESOC measures has been reported. With a sample of 95 adults, we estimated the construct validity of four ESOC measures with commonly used response formats (true/false, ladder, 5 choice, interview). Participants completed all four ESOC measures in random order as well as six validation measures: physical activity performed, exercise self-efficacy, decisional balance pros and cons, and behavioral and experiential processes of change. Few participants were in the earliest stage of change. The true/false measure demonstrated the strongest validity. Further studies are needed in diverse samples with more representation across the stages of change.

Relationships between environmental stressors and stress biobehavioral responses of preterm infants in NICU.

Although research has demonstrated that the neonatal intensive care unit (NICU) is a stressful environment for preterm and high-risk infants, little research validates the suspected relationships between infant biobehavioral responses and environmental stress in the NICU. This exploratory study examined the relationship between environmental stress and biobehavioral responses of preterm infants. The study used a repeated-measures research design to examine research variables in one group of preterm infants. Measurements of research variables were recorded every 2 minutes during two 60-minute observation periods for each research day (1 hour in the morning and 1 hour in the afternoon) and conducted over 2 days. A convenience sample of 37 preterm infants was recruited from 2 medical centers in Taiwan. A total of 4164 observations were made and recorded during the study. There was a statistically significant (P < .05) relationship between environmental stressors and changes in physiological signals. There were also statistically significant (P < .05) relationships between environmental stress and some specific stress behaviors. This research is applicable to neonatal clinical practice because it demonstrates the importance of recognizing the preterm infant's biological stress responses to environmental stressors, allowing for early interventions to reduce the possibility of more serious physiological or pathological changes in the status of the preterm infant.

Surrogate consent for genomics research in intensive care.

Surrogate decision makers may be poorly prepared to give informed consent for genomics research for their loved ones in intensive care. A review of the challenges and strategies associated with obtaining surrogates' consent for genomics research in intensive care patients revealed that few well-controlled studies have been done on this topic. Yet, a major theme in the literature is the role of health care professionals in guiding surrogates through the informed consent process rather than simply witnessing a signature. Informed consent requires explicit strategies to approach potential surrogates effectively, educate them, and ensure that informed consent has been attained.

Evaluation of online education about diabetes management in the school setting.

There are a variety of initiatives to provide education to improve the quality of care for children with diabetes in the school setting. This study piloted and evaluated an online continuing education program for school nurses about diabetes management for children in schools using current practice principles. The evaluation determined if objectives of the program were met, if participants believed the education provided would enhance their ability to manage children with diabetes, and participants' opinions about the online delivery method. Nineteen participants were recruited from among school nurses unable to attend statewide face-to-face diabetes workshops. The majority reported that the objectives were met, and 91% reported the education would enhance their ability to manage students with diabetes. Whereas 33% preferred online continuing education, 17% preferred face-to-face education, and 50% were unsure. Because of the increasing prevalence of diabetes in children, it is important that school nurses have access to continuing education that provides current principles for diabetes management for children. The method of delivery should be determined by the learner's learning style preferences.

Design and evaluation of SchoolhealthLink, a Web-based health information resource.

SchoolhealthLink, a Web-based information service for Missouri school nurses, is a promising resource to reach school nurses isolated from traditional professional networks. It also may serve as an important adjunct to stay abreast of the latest health information. Using a strategy to identify the health information needs of school nurses and to test the site early in its development, this pilot study found school nurses reported SchoolhealthLink was an easy-to-use method to find high-quality, up-to-date information relevant to school nursing practice, was better than existing methods to access information, and could change the way they practiced. In order to continue to build SchoolhealthLink, a partnership with Barnes College of Nursing and the Missouri Association of School Nurses has been established to work together to continue to add health information resources useful to school nursing practice.