Taking Root: a grounded theory on evidence-based nursing implementation in China.

BACKGROUND: Evidence-based nursing is widely recognized as the critical foundation for quality care. AIM: To develop a middle-range theory on the process of evidence-based nursing implementation in Chinese context. METHODS: A grounded theory study using unstructured in-depth individual interviews was conducted with 56 participants who were involved in 24 evidence-based nursing implementation projects in Mainland China from September 2015 to September 2016. RESULTS: A middle-range grounded theory of 'Taking Root' was developed. The theory describes the evidence implementation process consisting of four components (driving forces, process, outcome, sustainment/regression), three approaches (top-down, bottom-up and outside-in), four implementation strategies (patient-centred, nurses at the heart of change, reaching agreement, collaboration) and two patterns (transformational and adaptive implementation). LIMITATIONS: Certain perspectives may have not been captured, as the retrospective nature of the interviewing technique did not allow for 'real-time' assessment of the actual implementation process. The transferability of the findings requires further exploration as few participants with negative experiences were recruited. CONCLUSION: This is the first study that explored evidence-based implementation process, strategies, approaches and patterns in the Chinese nursing practice context to inform international nursing and health policymaking. The theory of Taking Root described various approaches to evidence implementation and how the implementation can be transformational for the nurses and the setting in which they work. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing educators, managers and researchers should work together to improve nurses' readiness for evidence implementation. Healthcare systems need to optimize internal mechanisms and external collaborations to promote nursing practice in line with evidence and achieve clinical outcomes and sustainability.

Focus groups with African American adolescents: enhancing recruitment and retention in intervention studies.

This study explores African American adolescents' perceptions about recruitment and retention strategies for intervention studies. Fifteen African American adolescents, ages 13 and 17 years, participated in this focus group study. Adolescents attended one of three groups which varied by size, gender, and the type of chronic condition: well adolescents (n = 7), adolescents with sickle cell disease (n = 5), and adolescents with diabetes (n = 3). Each group of adolescents participated in two group sessions. Content analyses of the two major categories in the study, recruitment and retention, yielded 10 themes. These themes included adolescents' (1) knowledge about their disease; (2) attitudes and expectations of self-care classes; (3) expectations about the research interventions; (4) instructor characteristics; (5) relationships with the researchers; (6) logistical considerations, such as time, location, and setting of interventions; (7) involvement and choice during the intervention; (8) relationships with other teens; (9) incentives for participation, such as food, fun, and money; and (10) the role of health care providers in recruitment and retention for research studies.

Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center.

OBJECTIVES: The purpose of this study was to examine the relationships between work satisfaction, stress, age, cohesion, work schedule, and anticipated turnover in an academic medical center. BACKGROUND DATA: Nurse turnover is a costly problem that will continue as healthcare faces the impending nursing shortage, a new generation of nurses enter the workforce, and incentives provided to nurses to work for institutions increase. A variety of factors influence the retention of nurses in adult care settings, including work satisfaction, group cohesion, job stress, and work schedule. In general, previous research has documented positive relationships between work satisfaction, group cohesion, strong leadership, and retention rates and a negative relationship between stress, work schedule, and retention. In addition, age and experience in nursing are related to job satisfaction. METHODS: This study used a cross-sectional survey design in which nurses from 12 units in a 908-bed university hospital in the Southeast completed questionnaires on one occasion. The following factors were measured using self-report questionnaires: nurse perception of job stress, work satisfaction, group cohesion, and anticipated turnover. RESULTS: The more job stress, the lower group cohesion, the lower work satisfaction, and the higher the anticipated turnover. The higher the work satisfaction, the higher group cohesion and the lower anticipated turnover. The more stable the work schedule, the less work-related stress, the lower anticipated turnover, the higher group cohesion, and the higher work satisfaction. Job Stress, work satisfaction, group cohesion, and weekend overtime were all predictors of anticipated turnover. There are differences in the factors predicting anticipated turnover for different age groups. CONCLUSIONS: As healthcare institutions face a nursing shortage and a new generation of nurses enter the workforce, consideration of the factors that influence turnover is essential to creating a working environment that retains the nurse.

Adolescents' perception of living with end stage renal disease.

BACKGROUND: End stage renal disease (ESRD) is a serious chronic condition, requiring life-long treatment and management to survive. It is unclear how the unique developmental needs of adolescents influence their ability to maintain the complex medical treatment regimen associated with ESRD. PURPOSE: The purpose of this study was to explore the perception of adolescents living with ESRD. Ascertaining the subjective perspectives of the adolescent provides insight into the effects of the chronic condition on their development and well-being. METHOD: Q-methodology was used to assess the adolescent's perception of living with ESRD. Thirty-five adolescents, 13 to 18 years, who were on renal dialysis or had received a renal transplant served as participants. FINDINGS: The results of the analysis identified four significant factors. The factors represented four distinct perspectives held by these adolescents living with ESRD: (a) normalization, (b) illness intrusion: barrier to normalcy; (c) illness management: parent-focused; and (d) illness management: self-focused. CONCLUSION: Overall, the majority of the adolescents in this study held a more positive perspective of living with ESRD than what has been described previously in the literature. The findings of this exploratory study provide direction for future research and nurses in practice.

Childrens' and adolescents' use of diaries for sickle cell pain.

ISSUES AND PURPOSE: To evaluate the characteristics of vaso-occlusive episodes, home management of pain and its impact on the daily activities, and a diary as a method of data collection. DESIGN AND METHODS: Forty-six adolescents and 75 children were asked to complete daily diaries during the intervention period of a larger study. RESULTS: Mild pain was recorded 95% of the time; moderate pain, 3%; and severe pain, 1%. The pattern and location of pain varied greatly. Adolescents used more interventions than did children. When pain intensity was mild, 80% of the children/adolescents maintained school, social, and home activities, but decreased play/sport activities. When pain intensity was high, they decreased their participation in all activities. PRACTICE IMPLICATIONS: Sickle cell pain episodes are unpredictable and highly variable. Diaries can enhance children's and adolescents' documentation and communication about their pain experiences.

An intervention to increase coping and reduce health care utilization for school-age children and adolescents with sickle cell disease.

The purpose of this study was to examine whether coping with pain changed immediately and one year after a self-care intervention for school-age children and adolescents with sickle cell disease (SCD). Sixty-five children and 32 adolescents attended an educational program for living with SCD. They were then randomly assigned to relaxation, art therapy or attention-control groups. Coping was measured before, after the intervention, and 12 months later. Thirty-three children and 14 adolescents completed the one year follow-up. Although there was no significant increase in the overall number of coping strategies school-age children and adolescents used from baseline to 12 months, there was a significant increase in those strategies specifically targeted by the intervention. For adolescents, there was a significant increase in the total number of coping scores used before the intervention and one year later. When compared to well African-American adolescents, overall coping scores in this sample were significantly lower. Health care utilization related to clinic visits, emergency department visits and hospitalizations decreased significantly for all participants in the study.

Exploration of migraine pain, disability, depressive symptomatology, and coping: a pilot study.

As many as 29% of women suffer from migraine headache, yet it remains a poorly understood phenomenon. Our purpose in conducting this pilot study was to determine the relationships among migraine pain, disability, depressive symptomatology, and coping in women. A convenience sample of 34 women was recruited from university and workplace populations. Nineteen women met the International Headache Society criteria for migraine, while 15 women served as a nonmigraine comparison group. Participants completed eight instruments measuring migraine pain, disability, depressive symptomatology, and coping. The two groups of women were not significantly different on demographic variables. Migraineurs scored significantly higher for pain characteristics, disability, depressive symptomatology, and total coping scores.

Tool for planning the grant application process.

The purpose of this article is to describe and justify the use of a tool to assist faculty who want to submit a major extramural grant application. Full-support and limited-support research resource services are described.

Predicting disability and quality of life in a community-based sample of women with migraine headache.

Migraine is a significant pain problem for almost one third of women in the United States. Little previous research has been conducted regarding the effects of migraine headache on the lives of women migraineurs. The purpose of this report is to determine the contribution of coping, depressive symptomatology, and the chronic pain experience on disability and quality of life in women with migraine. Two hundred and forty-seven women responded to a mailed survey about migraine headache, the chronic pain experience, coping, depressive symptomatology, and quality of life. Data were collected with the following: the Classification and Diagnostic Criteria for Headache Disorders, Cranial Neuralgias, and Facial Pain; the McGill Pain Questionnaire; the Chronic Pain Experience Instrument-Headache; the Coping Strategies Questionnaire; the Center for Epidemiologic Studies-Depression Scale; the Henry Ford Hospital Disability Inventory; and the Migraine-Related Quality of Life Questionnaire. Multiple regression analyses were conducted to determine the amount of variance that could be explained by selected predictor variables. Women ranged in age from 18 to 66 years and migraineurs reported suffering from migraine from 1 to 54 years. Nearly half of the migraineurs (41.5%) reported migraine headaches occurring monthly, and almost a quarter of the sample reported weekly migraines. Migraines were reported to last for several hours (53.4%). Results indicate that migraine headache pain was typically severe and throbbing, lasting for hours to days. The coping, depressive symptomatology, disability, and quality-of-life variables were all significantly correlated. Two separate regression analyses that examined predictor variables and the criterion variables, disability and quality of life, showed that a significant amount of both constructs could be explained by the predictor variables in the model tested. In the first regression analysis, depressive symptomatology, the chronic pain experience, and migraine headache pain accounted for 62.9% of the variance in disability. In the second regression analysis, 64.8% of the variance in quality of life was accounted for by depressive symptomatology, migraine headache pain, and the chronic pain experience. The variance in both outcome variables, disability and quality of life, was accounted for by similar predictor variables: depressive symptomatology, the chronic pain experience, and migraine headache pain. Further study is needed to determine specific personal and illness-related factors, pain characteristics, and coping strategies used that may predict outcomes of migraine headache such as disability, quality of life, helplessness, and other as yet unidentified effects of migraine headache.

School re-entry for the child with chronic illness: parent and school personnel perceptions.

PURPOSE: The number of children returning to school with chronic illnesses has increased during the past decade. Studies have suggested that school personnel are not well informed about chronic illness, receive little or no training, and feel unprepared to deal with these children in the classroom. Few studies address the concerns of parents when their children return to school. The purpose of the study was to identify and describe specific concerns and educational needs of parents and school personnel. METHOD: Telephone interviews were conducted with 21 parents. Twenty-four questionnaires were completed by school personnel, social workers, principals, psychologists, teachers, and school nurses. Content analysis was used to explore the data for recurrent themes. FINDINGS: Five areas of concern were evident in the survey responses of parents and school personnel: (a) how parents informed the school about the child's illness (breaking the news), (b) the processes related to the child's actual re-entry into the school (making the transition), (c) the ongoing monitoring of the child's health status both parents and teachers felt necessary (watching the child), (d) the need to teach school personnel about unexpected health problems (teaching the teachers), and (e) school personnel's expectations for the child (working with the child). Specific examples of positive and negative experiences related to these themes are provided.

Helping parents support their child in pain.

Children who are experiencing pain in health care settings require the supportive presence of a parent to help them cope effectively. In fact, 99% of children state that "having their parent" present provides the most comfort when in pain. Yet, parents are often excluded from providing this support. Health professionals often encourage parents to "wait outside" until a procedure is over, believing that this facilitates the child's cooperation, especially for more invasive procedures. In fact, parents can use a variety of comforting and distracting strategies to support their child during a painful procedure. This manuscript presents research findings about parents' and health care professionals' attitudes and practices related to children in pain. Finally, strategies are presented for nurses to use in assisting parents who want to support their child during a painful experience.

Consent (assent) for research with pediatric patients.

OBJECTIVES: To discuss the unique terms and conditions relative to the assent of children and the consent of their parents for research participation, to describe the capabilities of children as they influence understanding of and willingness to participate in research, and to discuss issues related to research participation. DATA SOURCES: Research articles, review articles, clinical experience, and government policies. CONCLUSIONS: The participation of children in research is complex. Developmental limitations, the imbalance of power between children and adults, and, in some cases, their compromised health status can influence the willingness of children to participate in clinical research. IMPLICATIONS FOR NURSING PRACTICE: Health care providers and researchers must be aware of the need of children to have full disclosure and clear descriptions about research in age-appropriate language. Obtaining a child's agreement to participate in research should be carefully planned and implemented.