Continuing Nursing Research During a Pandemic.

The coronavirus disease-2019 pandemic disrupted traditional research practices with the cessation of face-to-face contact with study participants. Researchers needed to respond with alternative methods to continue nurse-led clinical research. A rapid pivot to remote processes for recruitment, enrollment, data collection, and participant incentives can enable research to continue despite restrictions on in-person activities. Technology offers innovative methods in meeting current research needs but is not without challenges and continued need for ethics evaluation.

Nursing ethics in an era of pandemic.

BACKGROUND: The ANA Code of Ethics for Nurses, regularly revised since 1896, may not provide guidance in an era of pandemic and sociopolitical unrest. PURPOSE: This study explored whether the Code of Ethics comprehensively address current nursing challenges. METHODS: 23 nurses participated in six Zoom focus groups to discuss whether provisions were applicable to their current practice. An iterative approach was used to review transcripts independently and then merge findings to identify ethical themes. FINDINGS: Provisions 4, 6, and 8 were most relevant. None of the provisions addressed the guilt secondary to isolating patients from support systems and not being "on the front lines" of COVID care. DISCUSSION: The co-occurring crises of COVID-19 and social unrest created an ethical crisis for many nurses. The Code of Ethics provided a useful guide for framing discussion and formulating strategies for change, but did not eliminate distress during a time of novel challenges.

Sustaining the Development of Clinical Nurses Within a Magnet Organization.

Development of clinical nurses in Magnet-designated organizations is enhanced through a commitment to shared governance principles, a relevant and visible professional practice model, and engagement of clinical nurses in shared decision making. Cultivating practice innovations and reward and recognition programs further assist to sustain this development and leads to growth of future leaders.

Nurses and nursing assistants decision-making regarding use of safe patient handling and mobility technology: A qualitative study.

AIM: This study explored decision-making regarding use of safe patient handling and mobility (SPHM) technology among registered nurses (RN) and nursing assistants (NA). BACKGROUND: Lifting injuries are common among healthcare workers. Despite development of standards for SPHM, the introduction of regulation for monitoring access to SPHM technology, and implementation of education programs and process improvements, threat of injury remains a concern. Although access to SPHM equipment is associated with decreased workplace injuries, access alone does not guarantee use. Questions remain concerning how healthcare workers make decisions to use SPHM equipment, and how they weigh decisions against personal safety. METHODS: A qualitative descriptive study was conducted. Data collection consisted of four 60min focus groups. Two focus groups consisted of all RNs (n=14) and two consisted of all NAs (n=11). Each focus group was audiotaped and transcribed verbatim. Transcripts were coded, repeating concepts identified, and codes collapsed into themes and subthemes. RESULTS: Qualitative analysis revealed three major themes: barriers to use, perceived risk, and coordination of care. Barriers to use include subthemes of physical barriers, knowledge and skill, and unit culture. Perceived risk includes patient risk and perceived risk to self. Coordination of care includes patient factors and characteristics, assessment of patient needs and abilities, and interprofessional collaboration. CONCLUSIONS: These findings provide new knowledge about the complexity of decision making among care providers in the use of SPHM technology. Interprofessional team approaches to patient assessment and care are important components of confident decision making in use of SPHM technology.

Implementing and Sustaining Evidence Based Practice Through a Nursing Journal Club.

BACKGROUND: The outcomes based emphasis in nursing and health care delivery requires identification of best available evidence in order to produce quality, safe, and effective patient care. Finding, critiquing, and ultimately implementing the best available evidence for practice is a formidable task for many clinical nurses. Development and implementation of a nursing journal club (NJC) became one organization's successful attempt to help clinical nurses better understand and use best available evidence in actual practice. METHODS: The process and structure for the NJC evolved from an additional activity scheduled outside of work to a fully established endeavor of Nursing Research and Evidence Based Practice Council (NR&EBP). The Nursing Professional Practice Model was foundational to establishing the NJC as a formal component within the NR&EBP Council shared governance structure. Efforts to embed the NJC included taking advantage of resources available at an academic medical center and incorporating them into the council structure. RESULTS: Successful outcomes of the NJC include a quarterly schedule, with topics selected in advance that are based on nursing department as well as organizational driven goals and initiatives. The structure and process in place has eliminated frequently mentioned deterrents to evidence based practice such as not enough time, lack of knowledge, or no immediate application to practice. CONCLUSIONS: Incorporating the NJC as a component of NR&EBP Council has provided clinical nurses time away from clinical care that supports scholarship for nursing practice. Committed leadership and garnering of available resources have been key factors for success.

ICU family communication and health care professionals: A qualitative analysis of perspectives.

OBJECTIVES: Although ineffective communication is known to influence patient and family satisfaction with care in intensive care unit [ICU] settings, there has been little systematic analysis of the features of the perceived problem from a communication theory perspective. This study was undertaken to understand perceptions of miscommunication and the circumstances in which they present. RESEARCH METHODOLOGY AND DESIGN: Semi-structured interviews were conducted with 22 health care professionals [HCPs] in five adult ICUs at an academic medical centre in the United States. FINDINGS: From qualitative analysis of the transcribed interviews, four themes emerged, each containing multiple subthemes. Person factors are problems that originate within individuals, related to education, cultural background and emotion. Structural factors are associated with boundaries and coordination of institutional roles. Information management problems result from social and psychological processes by which HCPs and family members seek, distribute and understand information. Relationship management problems arise from difficulties in interpersonal interactions. CONCLUSIONS: Ineffective communication is not a single problem, but rather several distinct problems that exist at different levels of abstraction and vary in over-time stability. These findings provide a framework for designing interventions to improve the well-being of patients and family members.

The experience of cognitive change in women with breast cancer following chemotherapy.

PURPOSE: Change in cognitive function is one side effect of chemotherapy reported in some breast cancer survivors sometimes years after treatment. These symptoms include subtle changes in memory, concentration, and executive functioning. The purpose of this study was to uncover the meaning of cognitive change in women with breast cancer, how symptoms are experienced and become evident, how symptoms impact roles in personal and professional lives, and how women cope with these changes. METHODS: An interpretive phenomenological study was conducted with seven women with breast cancer, between the ages of 42-59, who had completed standard chemotherapy treatment within the past 12 months. Participants completed two in-depth semistructured interviews 1 month apart and maintained a written journal. RESULTS: van Manen's framework for interpretive phenomenology revealed five essential themes: noticing the difference, experiencing cognitive changes, interacting socially, coping, and looking forward. Analysis also includes a description of the phenomenon in relation to the lifeworld existentials of lived space, lived body, lived time, and lived human relation. CONCLUSIONS: The experience of cognitive change could not be isolated or studied separately from the context of the women's reality of having breast cancer. IMPLICATIONS FOR CANCER SURVIVORS: This study provides clarity related to the impact of cognitive change and how women cope with these changes in relation to their daily roles and responsibilities. Information is provided that elucidates the effect on employment issues that can influence financial and social well-being of women who are breast cancer survivors living with chemotherapy-related cognitive changes.

Measuring the impact of an educational program on nurses: teaching an evidence-based approach to oral mucositis.

Oral mucositis, a cancer therapy side effect, can negatively affect quality of life. This study evaluated the effect of an educational program on nurses' knowledge and perceived need to change oral mucositis management practice. This study revealed that nurses' knowledge and perceived need to change practice were positively affected by the educational program.

Chemotherapy-related cognitive change: a principle-based concept analysis.

PURPOSE/OBJECTIVES: To present the results of a principle-based concept analysis of cognitive change in patients with cancer following chemotherapy treatment. DATA SOURCES: 86 English-language articles retrieved through OVID, PubMed, CINAHL®, and Web of Knowledge searches through June 2010. No time limits were imposed. DATA SYNTHESIS: Analysis was based on the philosophical principles: epistemologic, pragmatic, linguistic, and logical. Conceptual components were identified and a theoretical definition of chemotherapy-related cognitive change emerged; the term was not clearly defined or well differentiated in the scientific literature. Implicit meanings are found in patients' subjective accounts, descriptions of the cognitive domains studied, and the choice of neuropsychological assessment instruments. Antecedents relative to chemotherapy-related cognitive change include disease and treatment factors. Moderators may include anxiety, depression, and fatigue. Consequences or outcomes of the experience of chemotherapy-related cognitive change include adjustment to illness, impact on quality of life, and potential for emotional distress. CONCLUSIONS: The principle-based concept analysis generated conceptual insights about chemotherapy-related cognitive change that are based on sound scientific evidence. The product of this method of analysis is a theoretical definition that reflects the state of the science. IMPLICATIONS FOR NURSING: When the impact of cognitive change following chemotherapy is better understood, meaningful and timely interventions can be developed to improve quality of life for cancer survivors.

Incorporating café design principles into End-of-Life discussions: an innovative method for continuing education.

Café design provides an innovative method for conducting continuing education activities. This method was chosen to elicit meaningful conversation based on issues related to End-of-Life care. Café design principles incorporate the following: setting the context, creating hospitable space, exploring questions that matter, encouraging everyone's contributions, connecting diverse perspectives, listening together for insights, and sharing collective discoveries. Key discussion questions were identified from the End-of Life Nursing Education Consortium Core Curriculum. Questions were revised to incorporate the principles of appreciative inquiry, which encourage a shift from traditional methods of problem identification to creation of a positive vision. Participants rated the café design method as an effective way to share their ideas and to stimulate conversation.

Promoting quality of life for geriatric oncology patients in acute care and critical care settings.

In 2004, the Oncology Nursing Society published a position paper on cancer in the elderly identifying cancer as a disease of aging. The National Cancer Institute Surveillance Epidemiology End Results data report that more than 50% of all cancers are diagnosed in individuals who are aged 65 or greater. Comorbidities prevalent in the elderly population place them at increased risk of developing side effects and toxicities from cancer treatment. This article presents 2 case studies that demonstrate the complex nature of treatment decisions related to advanced cancer diagnoses. Real and potential nursing problems are identified. Evidence-based practice and interdisciplinary collaboration for the purpose of achieving comprehensive patient- and family-centered care are outlined. Quality-of-life concerns, including decisional capacity, are addressed. The role of the critical care nurse in promoting quality of life in the care of the oncology geriatric patient in the acute care and critical care settings is discussed.

Mentoring--a staff retention tool.

Staff retention presents a common challenge for hospitals nationwide. Mentorship programs have been explored as one method of creating environments that promote staff retention. Successful achievement of nurse competencies identified in the Synergy Model for Patient Care can best be achieved in an environment that encourages and facilitates mentoring. Mentoring relationships in critical care provide the ongoing interactions, coaching, teaching, and role modeling to facilitate nurses' progression along this continuum. Mentoring relationships offer support and professional development for nurses at all levels within an organization as well as an optimistic outlook for the nursing profession.