Trends in hypothesis testing and related variables in nursing research: a retrospective exploratory study.

AIM: To compare the inclusion and the influences of selected variables on hypothesis testing during the 1980s and 1990s. BACKGROUND: In spite of the emphasis on conducting inquiry consistent with the tenets of logical positivism, there have been no studies investigating the frequency and patterns of hypothesis testing in nursing research DATA SOURCES: The sample was obtained from the journal Nursing Research which was the research journal with the highest circulation during the study period under study. All quantitative studies published during the two decades including briefs and historical studies were included in the analyses REVIEW METHODS: A retrospective design was used to select the sample. Five years from the 1980s and 1990s each were randomly selected from the journal, Nursing Research. Of the 582 studies, 517 met inclusion criteria. DISCUSSION: Findings suggest that there has been a decline in the use of hypothesis testing in the last decades of the 20th century. Further research is needed to identify the factors that influence the conduction of research with hypothesis testing. CONCLUSION: Hypothesis testing in nursing research showed a steady decline from the 1980s to 1990s. Research purposes of explanation, and prediction/ control increased the likelihood of hypothesis testing. IMPLICATIONS FOR PRACTICE: Hypothesis testing strengthens the quality of the quantitative studies, increases the generality of findings and provides dependable knowledge. This is particularly true for quantitative studies that aim to explore, explain and predict/control phenomena and/or test theories. The findings also have implications for doctoral programmes, research preparation of nurse-investigators, and theory testing.

Assessing students' learning needs and attitudes: considerations for gerontology curriculum planning.

The growing number of older adults with multiple healthcare needs underscores the importance of teaching gerontological content to students in healthcare fields. To effectively accomplish this educational goal, it is essential to consider students' attitudes and learning needs related to caring for elderly persons. The purpose of this study was to identify prelicensure undergraduate nursing students' (N=200) perceived learning needs and attitudes toward older adults. Current knowledge of gerontology and attitudes were correlated with multiple variables including comfort and confidence in caring for older persons. Students identified their desire for more information on selected topics such as supportive resources for elders and their caregivers. Students who intended to learn more about gerontological nursing chose more topics; the two most commonly chosen topics were end-of-life issues and specific disorders. The data from this study can be used to design courses and curricula related to the care of elderly persons. Similar approaches to obtain student input can be adopted in designing other gerontology curricula.

Has the BARRIERS Scale changed nursing practice? An integrative review.

AIM: This paper is a report of a review to analyse studies using the BARRIERS Scale to determine (a) if the identification of perceived barriers to research utilization influences nurses' use of research, (b) if the extent of nurses' perceived barriers to research utilization and most frequently cited barriers have changed over the past 15 years and (c) if nurses' most frequently cited barriers to research utilization differ across countries. BACKGROUND: The BARRIERS Scale has been used to identify nurses' untoward perceptions or barriers to research utilization. DATA SOURCES: A computer search was conducted using the Cumulative Index of Nursing and Allied Health Literature, MEDLINE, Dissertation Abstracts International and Academic Abstracts to identify relevant literature from 1991 to 2006. The Internet and citations within studies were also searched. REVIEW METHODS: Studies were included if they were in English, used the entire BARRIERS Scale and reported nurses' responses. Studies were coded for author(s), publication year, country, population, sample size, response rate, the three-most frequently cited barriers, mean per cent of items rated as moderate or greater, and number of items identified as a barrier by 50% or more of respondents. Quality appraisal of the included papers was not performed. RESULTS: Forty-five studies met the inclusion criteria and predominantly identified the same barriers. No evidence was found that identification of barriers to nurses' use of research influenced nursing practice. CONCLUSIONS: It appears that there would be minimal benefit from further descriptive research using the BARRIERS Scale. Research is needed to investigate whether relationships exist between perceptions of barriers to nurses' use of research and the use evidence-based practice.

Lifestyle physical activity of older rural women.

The purpose of this study was to describe and examine the lifestyle physical activity behaviors (household, leisure, occupational) of older rural women. Background characteristics included demographics, environment, social support, and health. Intrapersonal characteristics included motivation and self-efficacy. The majority of the women's energy expenditure was in the household dimension. Social support was positively associated with household activities. A higher level of leisure physical activity was associated with living within the two small cities and reporting lower levels of health and lower motivation. This research highlights the importance of household physical activity and the contribution of social support for household physical activity, both of which may be important in developing interventions to promote physical activity in older rural women.

Hormone therapy in perimenopausal and postmenopausal women: examining the evidence on cardiovascular disease risks.

Women may live for 30 years or longer after menopause with cardiovascular disease as their highest mortality risk. Menopause may correspond to health alterations for women, yet the use of estrogen during and after this transition has been controversial for the past four decades. The evidence from recent scientific studies does not support the use of hormone therapy for the prevention or treatment of cardiovascular disease, which has resulted in its removal from national guideline recommendations. However, because of concerns related to specific aspects of the research, there are gaps in the evidence. Studies are under way to evaluate alternate methods for hormone delivery, low-dose hormone therapy, and selective estrogen receptor modulators (SERMs) in reducing cardiovascular risks in perimenopausal and postmenopausal women. Implications for clinical nursing practice include education as well as assessment and counseling related to individual risk factors.

Evaluation of a protocol for prevention of facility-acquired heel pressure ulcers.

OBJECTIVE: We sought to determine whether identification of comorbidities (in addition to daily Braden scale assessment and early aggressive pressure reduction interventions) would impact the development of facility-acquired pressure ulcers (FAPU) of the heel. METHODS: Patients admitted to a 333-bed community hospital located 20 miles west of Chicago. Overall, 70 medical records were reviewed, while 242 adult patients (46 in the intervention groups and 196 in the control groups) and 24 nurses participated in the study. The study was conducted in 4 phases, including a retrospective chart audit, 2 prospective interventions, and a product evaluation. Phase 1 entailed a retrospective chart review of patients who were admitted with or developed heel pressure ulcers over a 2-year period to identify factors most predictive of skin breakdowns. Phase 2 included two 10-day aggressive assessment and tailored intervention periods. Phase 3 involved prevalence day assessments of effectiveness of interventions as compared to patients on control nursing units. Phase 4 involved a staff survey comparing effectiveness and satisfaction of the current and trial heel pressure-relieving products. FINDINGS: Risk factors for development of heel ulcers during hospital stay or prior to admission included type 2 diabetes mellitus (T2DM), peripheral vascular disease (PVD), low albumin, and Braden scale score. During implementation of phase 2 (two 10-day assessment and tailored intervention periods), no heel FAPU were associated with the intervention. During the phase 3 FAPU prevalence assessment, 3 patients had facility-acquired heel ulcers; 2 were in the control group and would have met inclusion criteria if included in the intervention. One patient was in the intervention group but was not following the protocol. During phase 4, there were significant preferences for the trial heel pressure relief device on effectiveness, as well as patient and staff satisfaction. CONCLUSION: A pressure ulcer prevention protocol that incorporated accurate assessment of risk factors (Braden Scale and comorbidities) with frequent documentation of heel skin integrity had a positive impact on the incidence of heel FAPU. In addition, early aggressive implementation of pressure-reducing and pressure-relieving devices was effective in reducing FAPU rates.

Ensuring a knowledgeable and committed gerontological nursing workforce.

There is a growing societal need for professional nurses who are knowledgeable and committed to working with older adults. In order to address this need, a small study that included self-evaluation and curriculum review was conducted by faculty at one Midwestern nursing program in the United States. A moderately positive attitude, moderately high knowledge, and moderate pursuit of knowledge of older adults were identified with the faculty in the presence of limited curricular content of gerontology. Implications for nursing education included continuing education for nursing faculty and program support in nursing curricula.

Collaboration to promote best practices in care of older adults.

A successful grassroots collaboration of faculty members from one Midwestern school of nursing to promote best practices in gerontological nursing is described. Recommendations are made for developing similar collaborations in other settings.

Wise use of perioperative antibiotics.

NOSOCOMIAL SURGICAL SITE INFECTIONS (SSIs), especially those caused by antibiotic-resistant organisms, are a major concern for perioperative nurses. Administering the correct antibiotic at its effective dose within the optimal time frame can help prevent SSIs. THE SIGNIFICANT RELATIONSHIP between microbial resistance and overuse of antibiotics justifies an examination of practices and a move away from widespread antibiotic administration. NEW ANTIBIOTIC GUIDELINES and research support recommendations for antibiotic administration for specific cardiac, colorectal, gynecologic, ophthalmologic, orthopedic, and urinary surgical procedures. Perioperative nurses can help protect their patients from nosocomial SSIs by using this clinical evidence.

Antibiotic resistance: the impact on care of hospitalized patients.

Incidence of antibiotic-resistant infections is increasing at an alarming rate. The concern about antibiotic resistance has been propelled by increasing questions over the effectiveness of current therapies in the treatment and prevention of severe infections in hospitalized patients. Nurses influence antibiotic resistance in the hospital through infection control procedures, knowledge of evidence-based antibiotic administration protocols, and surveillance of infection incidence and treatments.

Physical activity determinants of older women: what influences activity?

The dramatic increase in the older adult population necessitates health promotion efforts to maintain and improve the health of this vulnerable population. The majority of older adults are women who experience unique social and personal factors that influence their health behaviors. Increased physical activity is associated with reduced cardiovascular disease morbidity and mortality; however, few older adults participate in regular physical activity. This lack of participation is more prevalent in older women. The purpose of this literature review is to identify the determinants of physical activity of older women. Only after identifying the unique intrapersonal characteristics that influence women's physical activity can interventions be developed to meet their unique needs.

Environmental, policy, and cultural factors related to physical activity in urban, African American women.

This study was part of a multi-site project carried out with seven universities throughout the United States to identify cultural, environmental, and policy determinants of physical activity in ethnic minority women aged 20 to 50 years. Following an extensive literature review, nine core research questions were created to examine potential barriers to physical activity as well as enabling factors. Methods and findings presented are from six focus groups of low-income, urban African American women. These focus groups were held at each of two health centers serving communities in Chicago, Illinois, that are predominantly African American and low income and have households usually headed by women. Forty-eight women participated, with 5 to 11 in each group. Most (85%) were unmarried, 40% had less than a high school education, and 33% were neither employed nor attending school. Findings reflected the influence of a culture of poverty and the importance of environmental safety and community support. The findings will be used to inform the development of community-based exercise interventions and policies that are culturally and socially sensitive to the needs of low-income, urban African American women.