The Pathway Building Technique in Implementation Research Using Mixed Methods Design.

BACKGROUND: Data integration refers to combining quantitative and qualitative data in mixed methods. It can be achieved through several integration procedures. The building integration procedure can be used for developing quantitative instruments by integrating data from the qualitative phase. There are limited examples of data integration using the building procedure in mixed methods and implementation science. PURPOSE: The purpose of this article is to illustrate how the pathway building technique can be used to integrate data in mixed methods research through concurrent use of implementation science models and frameworks. METHODS: This two pathway building technique was developed based on a mixed methods implementation project of developing implementation strategies to promote compassionate nursing care of complex patients. RESULTS: The first pathway is the integration of qualitative data from the first phase of mixed methods study with implementation models and frameworks to create a quantitative instrument (i.e., a Q-sort survey) for the subsequent phase. The second pathway is the operationalization of the Q-sort survey results (i.e., implementation strategies) using an implementation science specification framework. CONCLUSION: The pathway technique is valuable for mixed methods research and implementation science as it offers a theory-based innovative method to tackle integration challenge.

Ethical conflicts experienced by community nurses: A qualitative study.

BACKGROUND: Despite news reports of morally distressing situations resulting from complex and demanding community-care delivery in Canada, there has been little research on the topic of ethical conflicts experienced by community-based health care professionals. RESEARCH AIM: To identify ethical conflicts experienced by community nurses. RESEARCH DESIGN: Data were collected using semi-structured interviews and then relevant text was extracted and condensed using qualitative content analysis. This research was part of a larger grounded theory project examining how community nurses manage ethical conflict. RESEARCH CONTEXT AND PARTICIPANTS: Community nurses, including 13 public health nurses and 11 home care nurses from two Canadian provinces, were interviewed. ETHICAL CONSIDERATIONS: Study approval was granted by the Health Research Ethics Authority of Newfoundland and Labrador and by provincial health authorities. FINDINGS: Seven ethical conflicts were identified and assigned to one of two groups. In the grouping categorized as challenges with obligations or risks, the ethical conflicts were: (1) screening for child developmental issues knowing there is a lack of timely early intervention services; (2) encountering inequities in the health care system; (3) not fulfilling principles, goals, and initiatives of primary and secondary prevention; and (4) feeling powerless to advocate for clients. The remaining ethical conflicts were categorized as challenges with process, risks, and consequences, and were: (5) jeopardizing therapeutic relationships while reporting signs of a child at risk; (6) managing confidentiality when neighbors are clients; and (7) supporting client autonomy and decision-making but uncertain of the consequences. CONCLUSIONS: Research investigation will continue to be important to raise awareness and mobilize ethics supports as health care services are steadily shifted from institutional to community settings. Moreover, with heightened potential for communicable disease outbreaks across international borders from global warming, community nurses around the world will continue to be required to address ethically-difficult care situations with competence and compassion.

Elucidating the Ruling Relations of Nurses' Work in Labor and Delivery: An Institutional Ethnography.

Obstetrics is a well-known area for malpractice and medical-legal claims, specifically as they relate to injuries the baby suffers during the intrapartum period. There is a direct implication for nurses' work in labor and delivery because the law recognizes that monitoring fetal well-being during labor is a nursing responsibility. Using institutional ethnography, we uncovered how two powerful ruling discourses, namely biomedical and medical-legal risk discourses, socially organize nurses' fetal surveillance work in labor and delivery through the use of an intertextual hierarchy and an ideological circle.

Implementation strategies to promote compassionate nursing care of complex patients: An exploratory sequential mixed methods study.

INTRODUCTION: Individuals with multiple physical and, or, mental health issues and, or, drug-related problems are known as complex patients. These patients are often recipients of poor-quality care. Compassionate nursing care is valuable to promote better care experiences among this patient population. Implementation strategies should be designed to enhance compassionate nursing care delivery. The study aimed to gain understanding of barriers to compassionate care delivery to propose implementation to promote compassionate nursing care of complex patients. DESIGN: An exploratory sequential mixed methods study was conducted. METHODS: Phase 1 was the qualitative component during which 23 individuals with multimorbidities were interviewed for exploring their perceptions of barriers to compassionate nursing care. The barriers were integrated with implementation science frameworks using the building technique during phase 2 to develop a Q-sort survey of implementation strategies for phase 3. Nurses, nurse managers, health care administrators, policymakers, and compassionate care experts responded to the survey by ranking the 21 implementation strategies, out of which five met the Q-factor analysis criteria. RESULTS: Participant-perceived barriers to nurse compassion could be categorized under knowledge, intentions, skills, social influences, behavioral regulation, reinforcement, emotion, and environmental context and resources. The five highest-ranked strategies included facilitation, consultation with stress experts, involvement of patients and families, modeling compassion through shadowing, and utilizing implementation teams. CONCLUSIONS: Enablement and modeling were the integration functions represented by the highest-ranked implementation strategies. Enabling nurses to provide compassionate care through emotional support and mental health counseling, and, modeling compassion and compassionate care through shadowing were recommended and rated as highly relevant by the majority of stakeholders. CLINICAL RELEVANCE: Enhancing nurses compassionate behaviors toward complex patients requires facilitating them in enacting compassion in practice through modeling and support from organizations and nurse managers.

The Understanding of Maternal Smoking among Women who were Smoking or had Quit Smoking during Pregnancy.

BACKGROUND: Maternal tobacco smoking during pregnancy is associated with adverse health effects for the woman, fetus, and child, including such serious effects as preterm birth, low birth weight, stillbirth, and neonatal and sudden infant death. Smoking cessation during pregnancy reduces health risks. PURPOSE: In order to support pregnant women to quit smoking, it is essential to know determinants of quitting smoking in pregnancy. The purpose of this research was to examine women's understanding of maternal smoking, in terms of their beliefs, in relation to quitting smoking during pregnancy. METHODS: The study was a cross-sectional survey with anonymous questionnaires. The sample consisted of 161 pregnant and postnatal women who were continuing or had continued to smoke during pregnancy or had quit smoking during pregnancy. Logistic regression was used to determine the impact of women's understanding of maternal smoking on quitting smoking in pregnancy. RESULTS: A large majority of the women had low to moderate understanding of maternal smoking. Those with higher levels of understanding were more likely to quit smoking during pregnancy than were those with a low level of understanding. Not having children prior to the current pregnancy or childbirth also increased the likelihood of quitting smoking during pregnancy while being without a partner combined with having a longer duration of smoking decreased the likelihood of quitting smoking during pregnancy. CONCLUSION: As a modifiable factor, pregnant women's understanding of maternal smoking can be readily targeted with informational interventions in an effort to help them quit smoking.

Behavioural indicators of compassionate nursing care of individuals with complex needs: A naturalistic inquiry.

AIMS AND OBJECTIVES: To explore behavioural indicators of compassionate nursing care from the perspectives of individuals with multimorbidities and complex needs. BACKGROUND: Complex patients are individuals with multimorbidity and/or mental health concerns, andoften with medication and drug-related problems requiring ongoing person-centered care, mental health interventions, and family and community resources. They are frequent consumers of health-care services and it is documented that these patients experience discrimination and substandard care. Compassionate care can improve patient care experiences and health outcomes. However, missing is the guidance on how to provide compassionate care for this population from the perspectives of complex patients. DESIGN: A qualitative descriptive approach was conducted in eastern Canada from December 2020-April 2021. The COREQ guidelines were followed for reporting. METHODS: Data from in-person and virtual semi-structured interviews with 23 individuals having experiences as complex patients were analysed using reflexive thematic analysis. Among them 19 were homeless and lived in a shelter. FINDINGS: Six indicators of compassionate nursing care were generated: sensitivity, awareness, a non-judgmental approach, a positive demeanour, empathic understanding, and altruism. CONCLUSIONS: Individuals perceived that nurses who acknowledge personal biases are better at providing compassionate care by manifesting compassion through their genuine and selfless interest in the complicated health problems and underlying socio-cultural determinants of each patient. Kindness, positivity, and a respectful nursing approach elicit openness and the sharing of heartfelt concerns. RELEVANCE TO CLINICAL PRACTICE: Comprehensive health assessment, dedicated efforts to know the patient as a human being, and listening to the patient's preferences can improve health outcomes among individuals with complex needs. Healthcare administrators can effect the change by supporting nurses to address complex health and social care needs with compassion. PATIENT OR PUBLIC CONTRIBUTION: Patients and healthcare professionals helped in data collection at the community care centre.

Using Institutional Ethnography to Explicate the Everyday Realities of Nurses' Work in Labor and Delivery.

Fetal health surveillance is a significant everyday work responsibility for labor and delivery nurses. Here, nursing care is increasingly focused on technological interventions, particularly with the use of continuous electronic fetal monitoring. Using Institutional Ethnography, we explored how nurses conduct this work and uncovered the ruling relations coordinating how nurses "do" fetal health surveillance. Analysis revealed how these powerful ruling relations associated with the biomedical and medical-legal discourses coordinated nurses' fetal monitoring work. Forms requiring documentation of biophysical data caused nurses to focus on technological interventions with much less attention given to holistic and supportive care measures. In doing so, nurses inadvertently activated and participated in these powerful ruling discourses. The practice of ensuring the safe birth of the baby through advances in technological surveillance and medical interventions took priority over well-established approaches to holistic nursing care.

Indigenous Women's Experiences of Smoking and Quitting Smoking in Pregnancy: A Phenomenological Study.

BACKGROUND: Maternal smoking during pregnancy (MSDP) is an important public health concern because of potential adverse health effects to the woman, fetus, and child after birth. Prevalence rates are high among groups with socioeconomic disadvantage, including Indigenous women. PURPOSE: This study was conducted to understand experiences of MSDP for Indigenous women. METHODS: The study was conducted using phenomenology. Data were collected through interviews with 15 pregnant and postnatal Indigenous women who had smoked during pregnancy. The data were analyzed for themes using phenomenological methods. RESULTS: The women's narratives revealed four experiences: quitting smoking during pregnancy to protect the unborn baby from harm; quitting smoking during pregnancy because of personal adverse health effects; cutting down smoking during pregnancy and feeling remorse for not quitting; and keeping on smoking during pregnancy and not planning to try to quit. The women's experiences also indicated several impediments to quitting smoking. CONCLUSIONS: There is need for health care policy to ensure adequate smoking cessation services and support for Indigenous women who smoke in pregnancy. Health care professionals should provide individualized interventions that take into account the challenges to quitting that pregnant women experience and that are in accordance with clinical practice guidelines for MSDP.

The effects of recreational cannabis use on glycemic outcomes and self-management behaviours in people with type 1 and type 2 diabetes: a rapid review.

BACKGROUND: Recent surveys of Canadian cannabis users reflect increasing consumption rates, some of whom may have diabetes. However, healthcare providers have limited information resources on the effects of recreational cannabis in people with diabetes. This rapid review was commissioned by Diabetes Canada to synthesize available evidence to guide recommendations for care of people 13 years of age and older who live with diabetes. METHODS: PubMed, Embase and PsycINFO databases were searched from January 2008 to January 2019. Study selection, data abstraction and quality appraisal were completed by pairs of reviewers working independently and discrepancies were resolved by a third reviewer with pilot tests completed before each stage to ensure consistency. Data collected from included studies were tabulated and summarized descriptively. RESULTS: The search resulted in 1848 citations of which 59 publications were selected for screening, resulting in six observational studies (2 full-text articles and 4 conference abstracts) that met the pre-defined criteria for inclusion. Five studies reported higher glycated hemoglobin (HbA1c) in people with type 1 diabetes (T1D) who consumed recreational cannabis. In one study, students aged 17 to 25 years living with T1D self-reported poorer glycemic control and higher HbA1c when smoking cannabis. In one study of adults with T1D, cannabis use within the previous 12 months was associated with almost double the risk of diabetic ketoacidosis compared with no cannabis use (odds ratio [OR] 1.98; confidence interval [CI] [95% CI] 1.01-3.91). Risks for peripheral arterial occlusion and myocardial infarction were found to be higher in people with type 2 diabetes (T2D) who consumed recreational cannabis, and worse renal parameters were also reported in two separate studies of T1D and T2D. CONCLUSIONS: Recreational cannabis use may negatively impact diabetes metabolic factors and self-management behaviours in people with T1D. In people with T2D, recreational cannabis may increase risks for peripheral arterial occlusion, myocardial infarction and renal disease. However, the evidence base of this rapid review was limited to six observational studies of poor to fair methodological quality, and thus, further robust, higher quality research is required to confirm the potential impact of cannabis on diabetes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019122829.

Diabetes Canada Position Statement on Recreational Cannabis Use in Adults and Adolescents With Type 1 and Type 2 Diabetes.

OBJECTIVE: Pursuant to the legalization of recreational cannabis in Canada, a rapid review was undertaken to develop a position statement concerning the effects of cannabis consumption on Canadians living with diabetes. METHODS: An expert committee of 1 adult endocrinologist and 1 pediatric endocrinologist, with the help of coauthors, collaborated to develop the position statement using the same evidence-based principles as the Diabetes Canada Clinical Practice Guidelines (with the exception of an independent methods review). A rapid review was conducted by researchers with the Strategic Patient-Oriented Research Evidence Alliance. The scope of the review was limited to evaluating the effects of recreational cannabis use on: 1) metabolic factors and diabetes complications, and 2) diabetes self-management behaviors in people ≥13 years of age. An informed person with diabetes, Canadian health-care providers and scientific advisors performed independent external reviews. RESULTS: The review found a limited amount of published or presented literature for the review questions, with gaps in direct evidence linking cessation of cannabis use to improved outcomes in diabetes. However, there were sufficient data to begin developing recommendations for type 1 and type 2 diabetes about education, counseling and management related to recreational cannabis usage. CONCLUSIONS: This is the first attempt in the world to generate an evidence-based guidance document on the topic of recreational cannabis use and diabetes. It provides guidance for health-care providers, so that they can assist and counsel Canadians living with diabetes on recreational cannabis. Further, higher quality research is required to provide more robust and evidence-informed guidance.

Developing Student Evidence-Based Practice Questionnaire (S-EBPQ) for undergraduate nursing students: Reliability and validity of a Chinese adaptation.

RATIONALE, AIMS, AND OBJECTIVES: The assessment of evaluating undergraduate nursing students' evidence-based practice engagement is an important issue, yet few tools have been developed specifically in Mainland China. The purpose of this study was to adapt the Student Evidence-based Practice Questionnaire (S-EBPQ) to Mainland China's cultural context and to evaluate the psychometric properties of the newly adapted Chinese S-EBPQ. METHODS: Cross-cultural adaptation, including translation of the original S-EBPQ into Mandarin Chinese language, was performed according to published guidelines. A pilot study was conducted in Mainland China with 25 Chinese undergraduate nursing students. A subsequent validation study was conducted with 400 undergraduate nursing students from Mainland China. Construct validity was assessed by exploratory factor analysis (n = 190) and confirmatory factor analysis (n = 210). Reliability was determined using internal consistency and test-retest reliability. RESULTS: The split-half coefficient for the overall Chinese S-EBPQ was 0.858. A content validity index of 0.986 was achieved. Principal component analysis resulted in a 4-factor structure explaining 68.285% of the total variance. The comparative fit index was 0.927, and the root mean squared error of approximation was 0.072 from the confirmatory factor analysis. Known-group validity was supported by the significant differences according to various characteristics of participants. Internal consistency was high for the Chinese S-EBPQ reaching a Cronbach α value of 0.934. Test-retest reliability was 0.821. CONCLUSION: The newly cross-culturally adapted S-EBPQ possesses adequate validity, test-retest reliability, and internal consistency and therefore may be utilized in nursing education to assess EBP of undergraduate nursing students in Mainland China.

How Community Nurses Manage Ethical Conflicts: A Grounded Theory Study.

Research is limited on how nurses in community settings manage ethical conflicts. To address this gap, we conducted a study to uncover the process of behaviors enacted by community nurses when experiencing ethical conflicts. Guided by Glaserian grounded theory, we developed a theoretical model (Moral Compassing) that enables us to explain the process how 24 community nurses managed challenging ethical situations. We discovered that the main concern with which nurses wrestle is moral uncertainty ("Should I be addressing what I think is a moral problem?"). Moral Compassing comprises processes that resolve this main concern by providing community nurses with the means to attain the moral agency necessary to decide to act or to decide not to act. The processes are undergoing a visceral reaction, self-talk, seeking validation, and mobilizing support for action or inaction. We also discovered that community nurses may experience continuing distress that we labeled moral residue.

Psychometric Testing of the Evidence-Based Practice Nursing Leadership Scale and the Work Environment Scale After Cross-Cultural Adaptation in Mainland China.

Implementation and sustainability of the evidence-based practice (EBP) approach within systems of health-care delivery require leadership and organizational support, yet few instruments have been developed specifically in Mainland China. The purpose of this study was to adapt the EBP Nursing Leadership Scale and the EBP Work Environment Scale to Mainland China's cultural context and to evaluate the psychometric properties of the newly adapted Chinese version. A pilot study was conducted in Mainland China with 25 clinical nurses. A subsequent validation study was conducted with 419 nurses from Mainland China. A content validity index of .985 and .982 was achieved. The split-half coefficient was .890 for the EBP Nursing Leadership Scale and .892 for the EBP Work Environment Scale. Test-retest reliability was .871 and .855, respectively. Principal component analysis resulted in a one-factor structure explaining 62.069% of the total variance for the EBP Nursing Leadership Scale and 62.242% of the total variance for the EBP Work Environment Scale. Both of the newly cross-culturally adapted scales possess adequate internal consistency and test-retest reliability and validity and therefore may be utilized in health-care environments to assess leadership and organizational support for EBP in Mainland China.

A step-by-step approach to developing scales for survey research.

BACKGROUND: While questionnaires and scales are some of the simplest methods of collecting data, their development requires a rigorous process. In recent years, several new questionnaires and scales have been developed. Although various papers have outlined how to develop questionnaires, their use in survey research, as well as how to ensure their validity and reliability, the actual development of scales - including the generation of items, scaling, the testing of validity and reliability, and refinement of the scale - is missing in the literature. AIM: To outline a systematic and rigorous process for developing scales for survey research and to differentiate between three interchangeably used terms: scale, questionnaire and inventory. DISCUSSION: Developing a valid and reliable scale is daunting because of the challenges associated with the conceptualisation, contextualisation and operationalisation of the phenomenon of interest. Researchers should use multiple approaches at each step of development to tackle these challenges. CONCLUSION: This paper provides a step-by-step approach to developing scales by providing explicit instructions and practical examples. This six-step process can enable nurse researchers to develop a scale applicable to their study's intended population, which is also valid and reliable for measuring the phenomenon of interest. IMPLICATIONS FOR PRACTICE: Rigorous nursing research demands that instruments be valid and reliable measures. Systematic development of scales is key to ensuring that nurse researchers accurately measure abstract concepts when conducting surveys with a given population. This paper is a first step in addressing the gap in the methodological literature and will contribute to greater rigour in research.

Experiences and cessation needs of Indigenous women who smoke during pregnancy: a systematic review of qualitative evidence.

OBJECTIVES: The aim of this review was to identify and synthesize the best available evidence to address two questions: i) what is the experience of smoking during pregnancy for Indigenous women? and ii) what are the smoking cessation needs of Indigenous women who smoke during pregnancy? INTRODUCTION: Smoking during pregnancy not only affects pregnant women's general health but also causes such serious problems as pre-term delivery, low birth weight, and sudden infant death. Rates of smoking during pregnancy are particularly high among Indigenous women. Learning about Indigenous women's experiences of smoking during pregnancy and associated smoking cessation needs is important to providing informed health care to them. INCLUSION CRITERIA: The participants of interest were Indigenous women who smoked during a current or past pregnancy. The phenomena of interest were the experiences of smoking during pregnancy for Indigenous women and the smoking cessation needs of Indigenous women during pregnancy. The context was any community worldwide where pregnant Indigenous women live. Studies considered for this review were those in which qualitative data were gathered and analysed on the phenomena of interest, including mixed methods research. METHODS: A comprehensive search was conducted for published studies in academic databases (i.e. PubMed, CINAHL, PsycINFO, Embase, Sociological Abstracts, SocINDEX, and Web of Science), unpublished studies in sources of gray literature (i.e. ProQuest Dissertations and Theses, OAIster, LILACS, MedNar, Google, Google Scholar, OpenGrey and relevant websites), and any additional studies in reference lists. Language and date limiters were not applied. The searches included all studies globally and were carried out on October 31, 2016. Studies that met the inclusion criteria were assessed for methodological quality by two reviewers independently, using the criteria of the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Descriptive details of each study accepted for this review were extracted in accordance with the elements of the JBI Data Extraction Form for Qualitative Research. The research findings that were relevant to the phenomena of interest and had participant voice were extracted from each included study and synthesized using the JBI meta-aggregative approach. The synthesized findings were assigned confidence scores in accordance with the JBI ConQual approach. RESULTS: Thirteen studies were included in this review following careful consideration of the methodological quality of each study. The studies yielded a total of 116 research findings, which were grouped into 19 categories and then aggregated to form five synthesized findings. Confidence in the findings was determined to be low to very low (see ConQual Summary of Findings). CONCLUSION: There is a small body of research evidence on Indigenous women's experiences of smoking during pregnancy and their smoking cessation needs. Confidence in the synthesized findings is constrained due to methodological limitations in many of the primary studies included in this review, along with mixed credibility of the research findings from across primary studies.

Post partum depression and the psychosocial predictors in first-time fathers from northwestern China.

BACKGROUND: there is growing evidence that fathers also experience post partum depression (PPD). However, paternal PPD has been less studied than maternal PPD. Very few studies have investigated PPD in first-time fathers from northwestern China. OBJECTIVE: the purpose of this study was to investigate the occurrence and predictors of depressive symptoms in first-time fathers from northwestern China. METHODS: a longitudinal study was conducted involving 180 couples who were assessed at three time periods: 3 days, 2 weeks and 6 weeks after childbirth. Self-reported questionnaires including Edinburgh Postnatal Depression Scale (EPDS), Parenting Sense of Competence Scale (PSOC), and Kansas Marital Satisfaction Scale (KMSS) were administered to all participants during each time period. FINDINGS: after childbirth 35 (21.1%) of the fathers at 3 days, 32 (20.4%) at 2 weeks and 20 (13.6%) at 6 weeks, indicated that they suffered from PPD. Paternal parental sense of competence, paternal marital satisfaction, and maternal depressive symptoms were among the main predictors for paternal PPD. CONCLUSION: the study results suggest that paternal PPD is a significant public health concern. Health professionals should focus attention on the psychological health among new fathers during the postpartum period; and, the psychosocial predictors should be considered and incorporated into clinical assessment and intervention of paternal PPD.

Cross-cultural adaptation and validation of the osteoporosis assessment questionnaire short version (OPAQ-SV) for Chinese osteoporotic fracture females.

The Osteoporosis Assessment Questionnaire Short Version (OPAQ-SV) was cross-culturally adapted to measure health-related quality of life in Chinese osteoporotic fracture females and then validated in China for its psychometric properties. Cross-cultural adaptation, including translation of the original OPAQ-SV into Mandarin Chinese language, was performed according to published guidelines. Validation of the newly cross-culturally adapted OPAQ-SV was conducted by sampling 234 Chinese osteoporotic fracture females and also a control group of 235 Chinese osteoporotic females without fractures, producing robust content, construct, and discriminant validation results. Major categories of reliability were also met: the Cronbach alpha coefficient was 0.975, indicating good internal consistency; the test-retest reliability was 0.80; and principal component analysis resulted in a 6-factor structure explaining 75.847 % of the total variance. Further, the Comparative Fit Index result was 0.922 following the modified model confirmatory factor analysis, and the chi-squared test was 1.98. The root mean squared error of approximation was 0.078. Moreover, significant differences were revealed between females with fractures and those without fractures across all domains (p < 0.001). Overall, the newly cross-culturally adapted OPAQ-SV appears to possess adequate validity and reliability and may be utilized in clinical trials to assess the health-related quality of life in Chinese osteoporotic fracture females.