Formative evaluation of a collaborative community-based child abuse prevention project.

OBJECTIVE: Together for Kids is a child abuse prevention project that serves children and families in two neighboring communities in a mid-sized Canadian city. The project, a collaborative endeavor of various agencies in the health, social services, and law enforcement sectors, focuses on preventing child abuse and neglect through family support and programming. This article presents the results of a formative evaluation of the project focusing on client and team member views on project implementation. METHOD: The evaluation strategy was primarily qualitative. In-person interviews following a semi-structured format were conducted with 17 clients and 10 team members by an external evaluator. In addition a review of all client records was conducted. RESULTS: The community-based approach, the multidisciplinary composition of the team, the ability to seek services when needed, the immediacy of the response time and the availability of support during stressful times were all aspects of the project that clients found beneficial. The most beneficial aspect of the project, however, was the informal support received from team members who were accepting, non-threatening, and non-judgmental. Team members found the collaborative approach made access to services easier for clients, particularly for those who were more socially isolated. CONCLUSIONS: Multidisciplinary, community-based models of service delivery contribute to a more effective and compassionate response to vulnerable families. Attention to the variables identified as important aspects of the project from the clients' perspective in this evaluation may assist others in developing similar programs.

A systematic overview of interventions to reduce physical restraint use in long-term care settings.

PURPOSE: The purpose of this systematic integrative review was to summarize the empirical evidence regarding the effectiveness of interventions or programs to reduce physical restraint use in long-term care facilities. CONCLUSIONS: Research findings indicate that physical restraint reduction programs which included an educational component, restraint removal, and interventions individualized to residents' specific needs were successful in decreasing restraint use. There were no significant negative consequences for residents or staff associated with the implementation of restraint reduction programs or interventions. Educational programs had a positive impact on nurses' knowledge, attitudes, and practices regarding restraint use. Findings, however, must be considered in light of the methodological weaknesses noted in the studies. IMPLICATIONS: The practice goal of achieving least-restraint or restraint-free long-term care facilities is an appropriate and achievable one. This objective can be facilitated through ongoing mandatory educational programs for staff, individualized assessment and implementation of appropriate interventions for residents, and adequate administrative support. Well-designed research studies investigating the efficacy of specific interventions, cross-cultural issues, and longitudinal outcomes would all contribute to the further development of evidence-based practice regarding restraint use in long-term care facilities.

Meta-analysis of arterial oxygen saturation monitoring by pulse oximetry in adults.

OBJECTIVE: The purposes of the study were to: (1) describe the aggregate strength of the relationship of arterial oxygen saturation as measured by pulse oximetry with the standard of arterial blood gas analysis as measured by co-oximetry, (2) examine how various factors affect this relationship, and (3) describe an aggregate estimate of the bias and precision between oxygen saturation as measured by pulse oximetry and the standard in vitro measures. DESIGN: A meta-analysis was conducted. SAMPLE: Seventy-four studies from 1976 to 1994 met the inclusion criteria of: (1) adult study population, (2) quantitative analysis of empirical data, and (3) bivariate correlations or bias and precision estimates between pulse oximeter and co-oximeter values. RESULTS: There were a total of 169 oximeter trials on 41 oximeter models from 25 different manufacturers. Studies were conducted in various settings with a variety of subjects, with most being healthy adult volunteers. The weighted mean r, based on 39 studies (62 oximeter trials) for which the r statistic and number of data points were available, was 0.895 (var [r] = 0.014). Based on 23 studies (82 oximeter trials) for which bias and precision estimates and number of data points were available, the mean absolute bias and precision were 1.999 and 0.233, respectively. Several factors were found to affect the accuracy of pulse oximetry. CONCLUSION: Pulse oximeters were found to be accurate within 2% (+/- 1 SD) or 5% (+/- 2 SD) of in vitro oximetry in the range of 70% to 100% Sao2. In comparing ear and finger probes, readings from finger probes were more accurate. Pulse oximeters may fail to record accurately the true Sao2 during severe or rapid desaturation, hypotension, hypothermia, dyshemoglobinemia, and low perfusion states.

Past childhood experiences and current parent-infant interactions.

To examine the relationships between adults' childhood experiences in their family of origin, current level of marital support, and quality of parenting interactions, 66 mothers and fathers were observed individually interacting with their infants during home visits using a standardized observational measure (Nursing Child Assessment Teaching Scale). Parents completed questionnaires on marital support (Dyadic Adjustment Scale) and on childhood experiences in the family of origin (Parental Acceptance-Rejection Questionnaire). For mothers, there was no relationship between childhood experiences and the quality of parenting interactions. For fathers, the relationship varied as a function of marital support. Fathers who perceived less positive childhood experiences but who had more optimal levels of marital support were predicted to have more responsive parenting interactions.

The meta-analytic approach to research integration.

A quantitative research method for aggregating findings from empirical research, meta-analysis is useful for systematically integrating findings gleaned from individual studies. Meta-analysis goes beyond the mere summarization and critique of research findings, to conducting statistical analyses on the outcomes of similar studies. Overall, meta-analysis represents a vast improvement over traditional methods of research review, by providing a more thorough description of the current status of research in an area and a more precise estimate of the effects of treatments or interventions. This article describes the meta-analytic approach to research integration, discusses the advantages that it offers for integrating nursing research, and highlights some of the methodological issues surrounding this approach.