Factors influencing nursing professional identity development: A qualitative study.

This research focuses on approaches that best support nursing professional identity formation, particularly by providing the insights of nursing students in their own words. This report reflects qualitative phenomenological research on nursing professional development from the perspective of both associate degree and baccalaureate degree student nurses in their final semester of study and describes factors that support or detract from the experience of nursing professional identity development. Participants were guided through individual interviews using semi-structured interview questions and later invited to facilitated focus groups with other students to clarify and elaborate on previous comments. The approach participants most often described as helping them develop into a professional nurse was clinical experience and the ability to practice independently. It was mentioned far more than the next most common response: role models and mentors. Other methods include reflection, critical thinking, and confidence. This research adds to a limited body of literature on the factors that influence nursing professional identity.

A longitudinal study of student nurse anxiety and distress during transitions in learning due to the COVID-19 pandemic.

This longitudinal study investigated anxiety, distress, and related symptoms experienced by undergraduate student nurses as they transitioned in March of 2020 to a virtual classroom due to the COVID-19 pandemic and in August of 2021 back to in-person learning. Qualtrics survey links were distributed at the end of the spring 2020 and fall 2021 semesters; survey response rates were 63% (n = 50) and 42% (n = 21), respectively. The 2020 cohort had a mean symptom rate of 4.32 out of 13 symptoms; the 2022 mean decreased to 2.47. Overall, symptoms decreased during the study period, but issues of anxiety and distress remained, particularly over academic-related issues.

Professional Identity in Graduating Nursing Students.

BACKGROUND: This research examines the meaning of nursing professional identity development from the perspectives of both associate degree nursing students and baccalaureate degree nursing students in their final semester. It provides insight into the student's understanding of nursing professional identity and the factors students identified as supporting or detracting from it. METHOD: Participants were guided through individual interviews using semistructured interview questions and later invited to focus groups with other students to clarify and elaborate on previous comments. RESULTS: Results demonstrated both groups shared many descriptions of what it means to be a nursing professional, including knowledge, caring, team-work, and integrity. Good communication, confidence, competence, critical thinking, advocacy, and leadership were concepts the participants frequently used to describe the professional nurse. CONCLUSION: This research helps to further the understanding of this significant topic in nursing education and to serve as a basis for student activities that help foster nursing professional identity formation. [J Nurs Educ. 2021;60(2):74-80.].

Transition in learning during COVID-19: Student nurse anxiety, stress, and resource support.

The purpose of this study was to explore anxiety and stress experienced by first-semester nursing students and identify sources of support during a transition from a face-to-face to an online learning platform during the first months of the COVID-19 pandemic. This descriptive study used a web-based survey distributed to nursing students 2 months after the completion of their first semester. The survey questions were adapted from the Anxiety Symptoms Checklist and the College Student Stress Scale. The survey link was emailed to 79 students, with 56 consenting, and 50 completing the survey. The most commonly reported symptoms were difficulty concentrating (90%) and feeling anxious or overwhelmed (84%). Most respondents reported anxiety related to the pandemic, with 84% being concerned about a friend or relative contracting COVID-19, and with 70% fearful of becoming infected themselves. The majority of respondents expressed concerns related to difficulty handling academic workload (62%), and the need to perform well in school (56%). To decrease anxiety and stress, the faculty should foster a structured learning environment; abide by the course schedule; communicate changes or updates in a timely fashion; adapt assignments to fit the learning environment; utilize campus, local, state, and national resources; practice self-care; and extend grace.

Nursing fundamentals - supporting clinical competency online during the COVID-19 pandemic.

During the Spring of 2020, due to the COVID-19 pandemic, many schools of nursing were challenged to change their educational delivery methods from a face-to-face to an online format. This article discusses educational strategies utilized to support clinical competency using an online format for a fundamentals of nursing clinical course. Discussions of regulatory considerations, faculty planning, and teaching pedagogy utilized during this transition are presented. The authors also discuss future implications and suggestions for attaining learning objectives for a clinical course using an online format.

Professional identity: A concept analysis.

The purpose of this study is to give clarity to the concept of professional identity, drawing from health-related fields to help provide a common language and understanding for research and practice. Professional identity, professionalism, professional socialization, and other related terms are often used without a clear definition or with conflicting definitions. This can lead to misunderstandings and assumptions that complicate research and confuse educators and professionals in guiding novice members. Concept analysis. Initially, 737 articles were identified by searching CINAHL, PubMed Central, Google Scholar, Academic Search Complete, PsyINFO, and SocINDEX for the period 2000 to 2019. Finally, 68 studies met the inclusion criteria, 60 of which are discussed in this concept analysis. This concept analysis uses the method described by Walker and Avant. This concept analysis clarifies the definition of professional identity, using literature from health and related professions, as containing the attributes: skills and functions; knowledge values and ethics; personal identity; group identity; and the influence of the context of care. A more clear definition of professional identity will help researchers to have more precision in their analyses and provide mentors and educators with a clear goal.

How does it feel to be a problem? Patients' experiences of self-management support in New Zealand and Canada.

BACKGROUND: The impact of long-term conditions is the "healthcare equivalent to climate change." People with long-term conditions often feel they are a problem, a burden to themselves, their family and friends. Providers struggle to support patients to self-manage. The Practical Reviews in Self-Management Support (PRISMS) taxonomy lists what provider actions might support patient self-management. OBJECTIVE: To offer providers advice on how to support patient self-management. DESIGN: Semi-structured interviews with 40 patient-participants. SETTING AND PARTICIPANTS: Three case studies of primary health-care organizations in New Zealand and Canada serving diverse populations. Participants were older adults with long-term conditions who needed support to live in the community. MAIN OUTCOME MEASURES: Qualitative description to classify patient narratives of self-management support according to the PRISMS taxonomy with thematic analysis to explore how support was acceptable and effective. RESULTS: Patients identified a relationship-in-action as the mechanism, the how by which providers supported them to self-manage. When providers acted upon knowledge of patient lives and priorities, these patients were often willing to try activities or medications they had resisted in the past. Effective self-management support saw PRISMS components delivered in patient-specific combinations by individual providers or teams. DISCUSSION AND CONCLUSIONS: Providers who establish relationships with patients can support them to self-manage and improve health outcomes. Delivery of taxonomy components, in the absence of a relationship, is unlikely to be either acceptable or effective. Providers need to be aware that social determinants of health can constrain patients' options to self-manage.

Misuse and/or treatment delivery failure of inhalers among patients with asthma or COPD: A review and recommendations for the conduct of future research.

BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) are widespread chronic conditions with medication frequently delivered by inhalers. These can be challenging to use correctly, but the scale of misuse and the specific aspects of failure are unclear. METHODS: We used systematic review methods to search 9 databases in May 2015 to identify and review studies that assessed adults (18 years or older) with asthma or COPD using inhalers of various types including pressurised metered dose inhalers (pMDIs), dry powder inhalers and the Respimat inhaler. Studies must have reported the scale of inhaler misuse, variation by type of inhaler or which steps patients had difficulty completing accurately. RESULTS: The types of inhalers, inhaler interventions and definitions of failure and misuse varied widely in the 38 studies identified. It was not possible to draw conclusions on the differential failure rates between different types of inhalers or any patient characteristics. Of the studies reporting failure or misuse rates, the majority ranged between 0 and 20%. Studies were inconsistent regarding the number of inhaler steps collected, reported and labelled as critical. CONCLUSIONS: There is evidence for all identified inhalers that some people may be using them incorrectly, but it is unclear which inhalers have higher rates of misuse or which steps within the inhaler technique are most difficult for patients. The optimal techniques for using inhalers are not standardised. Researchers undertaking future inhaler studies are respectfully directed to our recommendations for future research.

Revision of an undergraduate older adult health care nursing education course.

As the number of older adults continues to increase worldwide, nursing education needs to focus on this population. A revision of an undergraduate nursing course focusing on the care of older adults was completed. Content for the revised course was based on the recommendations of major nursing education organizations. Seventeen topic areas were identified, and objectives for each topic were written. Based on the objectives, classroom and clinical assignments were developed. Assignments were varied to address multiple learning styles using evolving standards of education for nursing students. The revision was piloted with one group of approximately 45 second-semester nursing students. Survey results from the students showed an increase in their comfort level with older adults. Further studies could evaluate the activities after they have been implemented longer to make further adjustments as needed to ensure the best learning for students.

Effectiveness of probiotics on the duration of illness in healthy children and adults who develop common acute respiratory infectious conditions: a systematic review and meta-analysis.

Recent systematic reviews have reported a positive, although modest, effect of probiotics in terms of preventing common cold symptoms. In this systematic review, the effect of probiotics, specifically Lactobacillus and Bifidobacterium strains, on the duration of acute respiratory infections in otherwise healthy children and adults was evaluated. To identify relevant trials, eight databases, including MEDLINE, Embase, the Cochrane Database of Systematic Reviews (CDSR), the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA), Science Citation Index (SCI) and OAISTER, were searched from inception to 20 July 2012. Details regarding unpublished studies/databases were also obtained from probiotic manufacturers. Study selection, data extraction and quality assessment were carried out by two reviewers. Risk of bias was assessed using criteria adapted from those published by the Centre for Reviews and Dissemination. In this review, twenty randomised controlled trials (RCT) were included, of which twelve were considered to have a low risk of bias. Meta-analysis revealed significantly fewer numbers of days of illness per person (standardised mean difference (SMD) - 0·31 (95% CI - 0·41, - 0·11), I²= 3%), shorter illness episodes by almost a day (weighted mean difference - 0·77 (95% CI - 1·50, - 0·04), I²= 80%) (without an increase in the number of illness episodes), and fewer numbers of days absent from day care/school/work (SMD - 0·17 (95% CI - 0·31, - 0·03), I²= 67%) in participants who received a probiotic intervention than in those who had taken a placebo. Reasons for heterogeneity between the studies were explored in subgroup analysis, but could not be explained, suggesting that the effect sizes found may differ between the population groups. This systematic review provides evidence from a number of good-quality RCT that probiotics reduce the duration of illness in otherwise healthy children and adults.

Antibiotics for treating lower urinary tract infection in children.

BACKGROUND: Urinary tract infection (UTI) is one of the most common bacterial infections in infants and children. Lower UTI is the most commonly presenting and in the majority of cases can be easily treated with a course of antibiotic therapy with no further complications. A number of antimicrobials have been used to treat children with lower UTIs; however is it unclear what are the specific benefits and harms of such treatments. OBJECTIVES: This review aims to summarise the benefits and harms of antibiotics for treating lower UTI in children. SEARCH METHODS: We searched the Renal Group's Specialised Register (April 2012), CENTRAL (The Cochrane Library 2012, Issue 5), MEDLINE OVID SP (from 1966), and EMBASE OVID SP (from 1988) without language restriction. Date of last search: May 2012. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs in which antibiotic therapy was used to treat bacteriologically proven, symptomatic, lower UTI in children aged zero to 18 years in primary and community healthcare settings were included. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratios (RR) with 95% confidence intervals (CI). MAIN RESULTS: Sixteen RCTs, analysing 1,116 children were included. Conventional 10-day antibiotic treatment significantly increased the number of children free of persistent bacteriuria compared to single-dose therapy (6 studies, 228 children: RR 2.01, 95%CI 1.06 to 3.80). No heterogeneity was observed. Persistent bacteriuria at the end of treatment was reported in 24% of children receiving single-dose therapy compared to 10% of children who were randomised to 10-day therapy. There were no significant differences between groups for persistent symptoms, recurrence following treatment, or re-infection following treatment. There was insufficient data to analyse the effect of antibiotics on renal parenchymal damage, compliance, development of resistant organisms or adverse events. Despite the inclusion of 16 RCTs, methodological weakness and small sample sizes made it difficult to conclude if any of the included antibiotics or regimens were superior to another. AUTHORS' CONCLUSIONS: Although antibiotic treatment is effective for children with UTI, there are insufficient data to answer the question of which type of antibiotic or which duration is most effective to treat symptomatic lower UTI. This review found that 10-day antibiotic treatment is more likely to eliminate bacteria from the urine than single-dose treatments. No differences were observed for persistent bacteriuria, recurrence or re-infection between short and long-course antibiotics where the antibiotic differed between groups. This data adds to an existing Cochrane review comparing short and long-course treatment of the same antibiotic who also reported no evidence of difference between short and long-course antibiotics.

Thermography as a screening and diagnostic tool: a systematic review.

AIMS: To determine the effectiveness of digital infrared thermography for the detection of breast cancer in a screening population, and as a diagnostic tool in women with suspected breast cancer. METHODS: A comprehensive search of electronic databases together with a search of international websites was conducted. Diagnostic studies comparing thermography with mammography for screening in asymptomatic populations; or comparing thermography with histology in women with suspected breast cancer; were eligible for inclusion. Quality of included studies was appraised using the QUADAS criteria. RESULTS: One study reported results for thermography in screening population and five studies reported diagnostic accuracy of thermography in women with suspected breast cancer. Overall, studies were of average quality. Sensitivity for thermography as a screening tool was 25% (specificity 74%) compared to mammography. Sensitivity for thermography as a diagnostic tool ranged from 25% (specificity 85%) to 97% (specificity 12%) compared to histology. CONCLUSIONS: Currently there is not sufficient evidence to support the use of thermography in breast cancer screening, nor is there sufficient evidence to show that thermography provides benefit to patients as an adjunctive tool to mammography or to suspicious clinical findings in diagnosing breast cancer.

Interventions for covert bacteriuria in children.

BACKGROUND: Many studies investigating covert bacteriuria in children were conducted in the 1970s, but uncertainty remains about whether treatment is beneficial, because results are mixed in terms of treatment effectiveness. It is important to establish the effectiveness of antibiotics and other treatments to eliminate infection, reduce recurrence, and prevent long-term kidney damage. It is essential that treatment benefit to individual children outweigh any harm. OBJECTIVES: This review aims to evaluate the benefits and harms of treating covert bacteriuria in children. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE (from 1966) and EMBASE (from 1988) without language restriction.Date of last search: 28 December 2011 SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials that investigated any intervention for covert bacteriuria in children aged up to 18 years with culture-proven urinary tract infection (UTI) and no known urinary symptoms at the time of diagnosis. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random-effects model and the results were expressed as risk ratios (RR) with 95% confidence intervals (95% CI) for dichotomous outcomes and mean difference (MD) for continuous outcomes. MAIN RESULTS: This review included three randomised controlled trials (RCTs) that involved 460 children (all girls). Overall, the studies were not methodologically strong. Gaps in reporting among the included studies made assessment of methodological quality challenging. One study reported that the number of children with bacteriuria was significantly reduced at follow-up six months after antibiotic treatment (RR 0.33; 95% CI 0.13 to 0.83). At follow-up two years after treatment, two studies reported that there was no evidence of a reduction in persistent bacteriuria (RR 0.32; 95% CI 0.03 to 3.44). At follow-up four to five years after initial treatment, all included studies reported that antibiotic treatment was effective in reducing the number of children with bacteriuria (RR 0.54; 95% CI 0.42 to 0.70). There were no differences in kidney growth between treated and untreated groups (MD 0.62; 95% CI -0.43 to 1.68).None of the included studies reported data on compliance or adverse effects. AUTHORS' CONCLUSIONS: The included studies do not provide sufficient detail about the harms and benefits of treating covert bacteriuria to enable formation of reliable conclusions. It appears that antibiotic treatment for covert bacteriuria is unlikely to benefit children in the long term.

Urinary tract infections in children and the risk of ESRF.

AIMS: Paediatric guidance on diagnosis and treatment of urinary tract infections (UTIs) has in the past largely focused on identifying children with vesicoureteral reflux, thought to be at greatest risk of renal scarring. This practice has been questioned, specifically the accepted association between UTI and end-stage renal failure (ESRF) through renal scarring. The aim of this article is to ascertain whether we can predict with confidence the true level of risk that a child with a first-time UTI will subsequently develop ESRF attributable to UTI. METHODS: Using data available from renal registries, an analytical approach based on previous estimates of risk is used to demonstrate the range of plausible estimates of risk that can be generated and levels of uncertainty that surrounds those estimates. RESULTS: Estimates of the perceived risk of developing ESRF following UTI range from 1/154 to 1/199,900 and are heavily dependent on the assumptions made and the source of data. CONCLUSION: There is considerable uncertainty in the relationship between childhood UTI and risk of ESRF based on the data currently available. Until further evidence is available, clinicians will continue to debate the risk of UTI and ESRF and consensus opinion will continue to guide management.

Stapled versus handsewn methods for ileocolic anastomoses.

BACKGROUND: Ileocolic anastomoses are commonly performed for right-sided colon cancer and Crohn's disease. The anastomosis may be constructed using a linear cutter stapler or by suturing. Individual trials comparing stapled versus handsewn ileocolic anastomoses have found little difference in the complication rate but they have lacked adequate power to detect potential small difference. This is an update of a Cochrane review first published in 2007. OBJECTIVES: To compare outcomes of ileocolic anastomoses performed using stapling and handsewn techniques. The hypothesis tested was that the stapling technique is associated with fewer complications. SEARCH STRATEGY: MEDLINE, EMBASE, Cochrane Colorectal Cancer Group specialised register SR-COLOCA, Cochrane Library were searched for randomised controlled trials comparing use of a linear cuter stapler with any type of suturing technique for ileocolic anastomoses in adults from 1970 to 2005 and were updated in December 2010. Abstracts presented to the following society meetings between 1970 and 2010 were handsearched: American Society of Colon and Rectal Surgeons, the Association of Coloproctology of Great Britain and Ireland, European Association of Coloproctology. SELECTION CRITERIA: Randomised controlled trials comparing use of linear cutter stapler (isoperistaltic side to side or functional end to end) with any type of suturing technique in adults. DATA COLLECTION AND ANALYSIS: Eligible studies were selected and their methodological quality assessed. Relevant results were extracted and missing data sought from the authors. RevMan 5 was used to perform meta-analysis when there were sufficient data. Sub-group analyses for cancer inflammatory bowel disease as indication for ileocolic anastomoses were performed. MAIN RESULTS: After obtaining individual data from authors for studies that include other anastomoses, seven trials (including one unpublished) with 1125 ileocolic participants (441 stapled, 684 handsewn) were included. The five largest trials had adequate allocation concealment.Stapled anastomosis was associated with significantly fewer anastomotic leaks compared with handsewn (S=11/441, HS=42/684, OR 0.48 [0.24, 0.95] p=0.03). One study performed routine radiology to detect asymptomatic leaks. For the sub-group of 825 cancer patients in four studies, stapled anastomosis led to significantly fewer anastomotic leaks (S=4/300, HS=35/525, OR 0.28 [0.10, 0.75] p=0.01). In subgroup analysis of non-cancer patients (3 studies, 264 patients) there were no differences for any reported outcomes. All other outcomes: stricture, anastomotic haemorrhage, anastomotic time, re-operation, mortality, intra-abdominal abscess, wound infection, length of stay, showed no significant difference. AUTHORS' CONCLUSIONS: Stapled functional end to end ileocolic anastomosis is associated with fewer leaks than handsewn anastomosis.

Summary of guidance for the management of early bowel cancer.

Colorectal cancer is an important public health problem and one of the most common cancers registered in New Zealand. In 2009 the New Zealand Guidelines Group were commissioned to produce and evidence-based summary of current New Zealand and international data to inform best practice in the management of people with early bowel cancer. A guideline development team was convened, representing a range of stakeholder groups who met to discuss and agree on the recommendations for a clinical practice guideline. This article summarises the guideline methods and reports the recommendations from the Management of Early Bowel Cancer guideline, published in 2011.

Antibiotic prophylaxis for children at risk of developing urinary tract infection: a systematic review.

BACKGROUND: Antibiotic prophylaxis in children who have had urinary tract infection (UTI) to prevent further infection is a common practice. The aim of this study is to reduce the development of further renal scarring by the prevention of recurrent acute pyelonephritis. METHODS: A systematic review of randomized controlled trials assessing effectiveness of antibiotic prophylaxis in children who have recovered from a symptomatic UTI and children in whom vesico-ureteric reflux has been identified independent of a history of acute UTI was carried out by systematic search in Medline, EMBASE, the Cochrane Library and CINAHL using keywords and thesaurus terms. Identified trials were independently appraised by two researchers. Data were extracted and synthesized in meta-analyses. RESULTS: A total of 677 children in eight trials were included in the analyses. There was no evidence of difference on meta-analysis of all the included studies, or any of the four subgroups, between the intervention and control groups in recurrence of symptomatic UTI [four trials, RR 0.96 (95% CI: 0.69-1.32]) and incidence of new or progressive renal scarring [four trials, overall RR 1.15 (95% CI: 0.75-1.78)]. CONCLUSION: Given the lack of evidence on positive benefit of using prophylactic antibiotics for children at risk of developing UTI, routine use of antibiotics for these children is not recommended.