"Permission to Touch": Nurses' Perspectives of Interpersonal Contact during Patient Care.

The purpose of this study was to describe nurses' perceptions about the use of interpersonal touch in their clinical practice. A qualitative descriptive approach with content analysis method was used to identify common themes. Registered nurses (N = 22) participated in focus groups and individual interviews. Three themes emerged from the analysis: (a) touch and massage as a resource, (b) individualized boundaries, and (c) professional role conflict. While the approach to touch varied, stories about the positive impacts that touch can have on patient care were consistently evident throughout the data. Implications for practice include incorporating areas from the themes into the development of educational programs focusing on how to integrate touch into practice as a comforting resource, while keeping individual's preferences in mind.

Multiple family group intervention for spinal cord injury: Quantitative and qualitative comparison with standard education.

Objective: To evaluate a Multiple Family Group (MFG) education and support intervention for individuals with Spinal Cord Injury (SCI) and their primary caregivers. We hypothesized that MFG would be superior to an Education Control Group (EC) for improving patient activation and coping skills, social supports, and relationship functioning.Setting: A large free-standing inpatient and outpatient rehabilitation facility.Participants: Community dwelling adults with SCI and their caregivers living in the Northwest United States.Interventions/Methods: Nineteen individuals with SCI who had been discharged from inpatient rehabilitation within the previous three years, and their primary caregivers participated. Patient/caregiver pairs were randomized to the MFG intervention or an active SCI EC condition in a two-armed clinical trial design. Participants were assessed pre- and post-program and 6 months post-program. Qualitative and quantitative outcomes were evaluated. Focus groups were conducted with each group to determine benefits and recommendations for improvement.Results: Relative to EC, MFG reduced passive coping and increased subjective and overall social support in participants with SCI. Relative to EC, MFG also reduced passive coping in caregivers. Patient activation relative to EC was non-significantly increased. Content analysis identified four themes describing participants' experiences: enhanced sense of belonging, increased opportunities for engagement, knowledge, and team work; results that were generally congruent with quantitative measures of improved social support.Conclusions: Relative to EC, MFG assisted participants with SCI and their caregivers to manage the difficult, long-term, life adjustments by improving coping and strengthening social support.Trial registration: ClinicalTrials.gov NCT02161913. Registered 10 June 2014.

Professional identity and hospital-based registered nurses: A phenomenological study.

INTRODUCTION: Nurses continue to struggle to define their role as professionals in the hospital-setting often being represented in media as less competent than other health care providers. Paradoxically, an annual poll of the public consistently identifies nursing as the most trusted profession. This dichotomy of simultaneously being considered incompetent yet holding a high level of trust leads nurses to question their own professional identity. A gap exists in the literature about the professional identity of nurses who work directly with patients in the hospital environment. METHODOLOGY: Therefore, the aim of this interpretive phenomenology study was to describe the lived experience of nurses working with patients in the hospital environment and the meaning of this phenomenon as it relates to their professional identity. RESULTS: Four themes were identified: (a) being validated as an expert by providers within the healthcare system; (b) working well as a valued member of a team; (c) advocating for the patient's needs despite opposition; and (d) Valuing human-ness in the patient. IMPLICATIONS: The findings provide a deeper representation of the practice of hospital-based nurses and implications for Anchornurses to be empowered in their workplace.

Benefits and adverse effects of cannabis use among adults with persistent pain.

BACKGROUND: Increasingly, states are legalizing cannabis for recreational use. Improved accessibility may allow adults with pain to use cannabis more liberally. Greater understanding is needed about how adults with pain perceive the effects of cannabis, particularly those who also use opioid analgesics. PURPOSE: To examine the perceived effects of cannabis among adults who have been prescribed opioids for persistent pain. METHODS: A survey-based study was conducted on 150 adults with persistent pain. Data from two open-ended questions were analyzed using a qualitative descriptive approach and content analysis. FINDINGS: Data analysis led to identification of two main categories and five subcategories: (a) cannabis benefits with two subcategories of "physiological" and "mental health"; (b) adverse effects with three subcategories of "physiological," "mental health," and "social and economic concerns." DISCUSSION: Both positive and negative effects of cannabis were described. Nursing practice, including open communication with patients, can be guided by patient perspectives surrounding benefits and adverse effects of cannabis use.

Opioid Initiation to Substance Use Treatment: "They Just Want to Feel Normal".

BACKGROUND: Opioid use disorder has drastically increased in recent years within adult populations. Limited understanding exists regarding how people enter medication-assisted treatment (MAT) for opioid use disorder-particularly those who initiate opioid use to treat a painful condition. OBJECTIVES: This research examines the process involved when adults first initiate the use of opioid medicines to treat pain through enrollment in an outpatient MAT program. METHODS: Grounded theory methodology guided the study. Data analysis included interpretation of interview transcripts from 10 adults who were enrolled in a single outpatient MAT program in the Pacific Northwest. Inclusion criteria were adults in MAT reporting that their initial use of opioids was to treat their pain. Corbin and Strauss' approach to theory development was followed. RESULTS: A newly developed theory titled Living With Persistent Pain: From Opioid Initiation to Substance Use Treatment was supported by three predominant categories emerging from the data: "addiction pathway," "becoming normal," and "relationship spectrum." The core category "living with pain" was described as a complex and tumultuous process spanning the emergence of pain, to the initial use of opioid medicines, through opioid addiction and MAT. A notable aspect of this process was the turning point to enter MAT, which was both helped and hindered by significant relationships. CONCLUSIONS: The decision to enter MAT for opioid addiction was key to helping participants gain a sense of normalcy. Insights gained from participants' experiences-particularly in relationships with healthcare providers-can be used to guide treatment approaches.

Assessing the value of the Meaningful Use Clinical Summary for patients and families with pediatric asthma.

Electronic clinical summaries are innovations supported by the Electronic Health Record Incentive Program, known as "Meaningful Use" (MU). The MU clinical summary documents the shared understanding of the plan of care for patients and assists families in managing asthma-related health care. The purpose of this analysis was to identify the communicative value of the summaries to patients and families. Readability measurements, content analysis, and descriptive statistics were employed in a review of twenty clinical summaries and compared with provider encounter notes. The average age of the patients from whom we collected clinical summaries was six years old. The average reading level of the summaries was ninth grade. Neither summaries nor health education contained visual images. There was a total of nine different asthma diagnoses. A full list of diagnoses was present in 45% of summaries. The average medications per patient was 5.75, and there were multiple medication changes noted (dosage adjustment, add, discontinued). Allergies, vital signs, and smoking status were reliably reported (99-100%). Provider orders present included medication, follow up, and return to the clinic instructions. The plan of care was replicated on 45% of summaries. There was variable reporting of various asthma guidelines. Opportunities to improve the clinical summary include using plain language to promote readability, action, understanding, and health literacy, training providers to standardize their documentation and include asthma action plans, and configuring EHR settings to ensure diagnoses and plan of care is carried over from provider notes to the summary.

Review of the Effectiveness of Enteral Feeding in Pediatric Oncology Patients [Formula: see text].

Enteral supplementation for nutritional support in pediatric oncology patients remains nonstandardized across institutions and between providers. Pediatric oncology patients frequently fail to meet their growth curve percentiles, lose weight, and/or are malnourished due to both the oncologic process as well as side effects from chemotherapy and radiation treatments. Methods of increasing weight include enteral feeding (nasogastric, nasoduodenal/jejunal, or gastrostomy), parenteral intravenous feeding, and oral supplementation. Indications for feeding and feeding protocols are highly variable, in part due to parental and familial choices, and in part due to the lack of guidelines available for providers. This article provides a comprehensive literature review of 8 published studies regarding the effectiveness and safety of enteral feeding in maintaining or increasing weight in pediatric oncology patients to help inform practice. The review concludes that enteral feeding in pediatric oncology patients is an effective and safe method to affect weight positively. However, further research is needed for developing treatment guidelines, including establishing a timeline for initiation of feeding, and determining which patients are most likely to benefit from enteral feeding.

Views on Exercise.

INTRODUCTION: There is a large prevalence of asthma, particularly among Hispanic children. Although physical activity is a good way to manage asthma, more Hispanic children with asthma lack activity than their healthy classmates. Given this, the purpose of this study was to explore the development of exercise perceptions in Hispanic children with asthma and to further develop an existing explanatory theory. METHOD: Grounded theory was the approach for the study. Grounded theory illuminated components of exercise perceptions from participants. Participants included Hispanic children with asthma, their families, and professionals who work with Hispanic children with asthma ( n = 29). RESULTS: Findings from this study supported the previously identified grounded theory called The Process of Creating Perceptions of Exercise. In addition, two new concepts ( cultural and peer influences) were identified that further explain the category of exercise influences. CONCLUSION: The revised theory can be used to assist in developing nursing interventions aimed at increasing exercise participation among Hispanic children with asthma.

Grand Multiparous Mothers' Embodied Experiences of Natural and Technological Altered Births.

In-depth interviews of a purposive sample (n = 14) of grand multipara mothers (five or more births) was conducted to investigate the mothers' embodied experiences of natural, technologically altered births and oxytocin inductions in U.S. hospitals from 1973 to 2007. A comprehensive secondary analysis of the lived experiences of natural birth and the high use of technology and oxytocin during birth, which was found in an original theme of a previous study, was explored. An overarching theme emerged of Embodiment of Birthing in U.S. Hospitals. Two patterns: Embodied Technological Altered Natural Births and Embodied Technologically Altered Induced Births were uncovered. Childbirth educators, doulas, and nurses are an integral part of creating changes in hospital settings, which discourage nonmedically indicated inductions and encourages changes in hospitals.

Nurses' Perceptions of Caring for Childbearing Women who Misuse Opioids.

PURPOSE: This study explored obstetric nurses' perceptions of providing inpatient care during labor, birth, and postpartum to pregnant and parenting women with histories of misusing opioids. Specific aims included to 1) describe common themes associated with nurses' perceptions of caring for this population, and 2) identify specific areas for intervention development. STUDY DESIGN AND METHODS: Grounded theory methods, as described by Corbin and Strauss, were used to guide data collection and to identify common themes. Initially, eight inpatient obstetric nurses working in large, urban birthing centers in Washington State were interviewed using semistructured interviews. Follow-up interviews with four of the nurses were conducted to validate emergent themes. RESULTS: Four themes were derived: needing more knowledge, feeling challenged, expressing concern for mother and infant, and knowing the truth. CLINICAL IMPLICATIONS: The four themes can have an impact on nursing practice and patient outcomes by providing specific areas for intervention development focusing on this population of vulnerable women. Nurses described several ideas for intervention development including continuing education offerings relevant to caring for mothers who misuse opioids, collaborating with providers to design education, reevaluating pain-management philosophies and practices at all levels, and working with social workers to explore available and needed community resources. Future research includes the evaluation of newly developed personalized interventions; the examination of the empirical linkages among key mother and child health outcomes; the delivery of specific nursing therapeutics; and the exploration of providers' and patients' perceptions and knowledge of opioid misuse during pregnancy, birth, and beyond.

Intervention with substance-abusing mothers: are there rural-urban differences?

OBJECTIVE: The purpose of this study was to examine rural-urban differences among substance-abusing mothers enrolled in the Parent-Child Assistance Program (PCAP) from 1998 to 2008 in Washington State. METHODS: This was a longitudinal study utilizing PCAP data reports of 773 women enrolled from 1998 to 2008. Differences across urban-rural PCAP participants were examined. RESULTS: Rural participants were more likely to report alcohol use and binge drinking at program intake and at the 3-year program exit. In addition, throughout the program, rural women were less likely to complete outpatient substance abuse treatment compared to urban participants. Rural women also used less services during the last year including alcohol/drug support and mental health provider services. Findings are troubling when we consider that at program exit, rural participants also reported higher use of alcohol and more suicidal thoughts than those residing in urban areas. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Data presented indicate there are important differences between urban and rural residing participants. Findings highlight the importance of considering the barriers that rural or remote locations might create. Identifying community-specific needs of substance abusing pregnant or parenting women in both rural and urban settings is crucial for the successful development and improvement of treatment and intervention programs for this vulnerable population of women.

A systematic review of the literature on screening for exercise-induced asthma: considerations for school nurses.

Asthma is a major cause of illness, missed school days, and hospitalization in children. One type of asthma common in children is exercise-induced asthma (EIA). EIA causes airway narrowing with symptoms of cough and shortness of breath during exercise. The purpose of this article is to review the literature relevant to screening children and adolescents for EIA and to inform development of a school nurse-led EIA screening program. A systematic review of EIA screening tests was conducted by searching PUBMED for key terms. Sixty-seven articles were identified; after review only seven met the inclusion criteria. The most common screening test was the 6-min exercise challenge. School-based screening programs have the potential to identify EIA among undiagnosed children and adolescents. School nurses are health professionals with the knowledge and skills necessary to develop successful screening programs in the school setting. Based on results of the literature review, we present implications for developing screening programs in schools to identify children with undiagnosed EIA.

Intervention with substance-abusing mothers: Are there rural-urban differences?

OBJECTIVE: The purpose of this study was to examine rural-urban differences among substance-abusing mothers enrolled in the Parent-Child Assistance Program (PCAP) from 1998 to 2008 in Washington State. METHODS: This was a longitudinal study utilizing PCAP data reports of 773 women enrolled from 1998 to 2008. Differences across urban-rural PCAP participants were examined. RESULTS: Rural participants were more likely to report alcohol use and binge drinking at program intake and at the 3-year program exit. In addition, throughout the program, rural women were less likely to complete outpatient substance abuse treatment compared to urban participants. Rural women also used less services during the last year including alcohol/drug support and mental health provider services. Findings are troubling when we consider that at program exit, rural participants also reported higher use of alcohol and more suicidal thoughts than those residing in urban areas. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Data presented indicate there are important differences between urban and rural residing participants. Findings highlight the importance of considering the barriers that rural or remote locations might create. Identifying community-specific needs of substance abusing pregnant or parenting women in both rural and urban settings is crucial for the successful development and improvement of treatment and intervention programs for this vulnerable population of women. (Am J Addict 2014;XX:1-9).

Living on the edge of asthma: A grounded theory exploration.

PURPOSE: Most asthma-related emergency department (ED) visits and hospitalizations for asthma are preventable. Our purpose was to develop a grounded theory to guide interventions to reduce unnecessary hospitalizations and ED visits. DESIGN AND METHODS: Grounded theory inquiry guided interviews of 20 participants, including 13 parents and 7 children. RESULTS: Living on the edge of asthma was the emergent theory. Categories included: balancing, losing control, seeking control, and transforming. PRACTICE IMPLICATIONS: The theory provides the means for nurses to understand the dynamic process that families undergo in trying to prevent and then deal with and learn from an acute asthma attack requiring hospitalization or an ED visit.

Pediatric patients with asthma: a high-risk population for subsequent hospitalization.

OBJECTIVES: Asthma is one of the most common chronic conditions among children and is one of the leading causes for pediatric hospitalizations. More evidence is needed to clarify the risks of repeat hospitalization and the underlying factors contributing to adverse health outcomes among pediatric patients hospitalized with asthma. The purpose of this study was to examine the risk of subsequent hospitalizations among pediatric patients hospitalized with asthma compared to a reference cohort of children hospitalized for all other diagnoses. METHODS: The Washington State (WA) Comprehensive Hospital Abstract Reporting System (CHARS) was used to obtain data for the study. Data describing 81,946 hospitalized pediatric patients admitted from 2004 to 2008 were available. The risk of subsequent hospitalization among children admitted for asthma as compared to a reference cohort was examined. RESULTS: The asthma cohort had a 33% (HR = 1.33 [99% confidence interval (CI) 1.21-1.46]; p < .001) increased risk of subsequent hospitalization from 2004 to 2008. Children in the asthma cohort under the age of 13 years demonstrated a significant increased risk of subsequent hospitalization as compared to the age-matched reference cohort of children without asthma. Those in the asthma cohort who were 3-5 years old demonstrated the highest risk (50%) of subsequent hospitalization (HR = 1.50 [99% CI 1.23-1.83]; p < .001). CONCLUSIONS: Study results can be utilized in the development of appropriate interventions aimed at preventing and reducing hospital admissions, improving patient care, decreasing overall costs, and lessening complications among pediatric patients with asthma.