Caring Behavior Coding Scheme based on Swanson's Theory of Caring - development and testing among undergraduate nursing students.

RATIONALE: To maintain patients' dignity and well-being and alleviate suffering, it is essential that healthcare providers engage in caring behaviours. Yet, every year patient boards receive an increasing number of complaints from patients and significant others regarding healthcare providers' non-caring behaviours. Defining and measuring both verbal and nonverbal caring and non-caring behaviour in healthcare delivery is vital to address such complaints. However, no studies were found that incorporated a comprehensive theory of caring to code encounters between healthcare providers and patients. AIM: The aim was to develop and test a Caring Behavior Coding Scheme based on Swanson's Theory of Caring. METHOD: An instrument development process was used for behavioural coding including observational data from thirty-eight video recordings collected in an undergraduate nursing course at a Swedish University. The observational data involved interactions between undergraduate nursing students and a standardised patient. RESULT: The Caring Behavior Coding Scheme (the CBCS), contains seventeen verbal and eight nonverbal behavioural codes, categorised as caring and non-caring in accordance with Swanson's Theory of Caring. Content and face validity were assessed. Timed-event sequential continuous coding was performed in INTERACT software. The coder achieved excellent agreement with the developed gold standard (k = 0.87) and excellent mean inter-rater reliability (k = 0.82). All domains in Swanson's Theory of Caring were observed and coded in the interaction. DISCUSSION/CONCLUSION: The CBCS is a theory-based instrument that contributes to research on healthcare providers' behavioural encounters. It uses verbal and nonverbal caring and non-caring behavioural codes to assess the alignment of both the theory and practice of caring. The CBCS can contribute to both development and measurement of interventions focused on improving healthcare providers' caring behaviour with the intended outcome of patient well-being.

The DNP Degree: Are We Producing the Graduates We Intended?

OBJECTIVE: This study addressed how recently graduated doctor of nursing practice (DNP) nurses describe their current practice, how their supervisors describe the DNP's current practice, and whether nurse and supervisor descriptions of the practices reflect the American Association of Colleges of Nursing (AACN) DNP Essentials and, if so, how? BACKGROUND: Introduced in 2004, the goal of DNP programs was to educate advanced practice RNs for effective leadership in complex healthcare environments. The value of the DNP degree for nurses in healthcare systems is evolving. METHODS: We used conventional content analysis to inductively describe how DNP graduates from 7 different schools and their supervisors described the practice of the recently graduated DNPs. Interviews were reviewed to assess whether the AACN DNP Essentials were enacted in practice. RESULTS: The overarching theme was "becoming more: re-envisioning self as an agent of change." CONCLUSIONS: Results support the claim that DNP education prepares advanced practice nurses for leadership across complex healthcare systems. Evidence of the DNP Essentials is realized when graduates perceive themselves as equal to other leaders and capable of driving change using evidence and effective collaboration.

Caring Cards: Preventing Patient Harm Through the Heart of Nursing.

The use of "Caring Cards" is a unique innovation, which builds on reliable Lean processes. It adds the way we emotionally care for people to a Lean methodology. This article describes how the foundational constructs of nursing theory are paired with aspects of universal fall precautions. In a pilot prioritizing Caring Cards, conversations between leaders and staff provide a way for the nurse to describe his or her critical thinking about fall prevention that is individualized to a patient. Leaders collect information on barriers to care and demonstrate follow-up actions to staff members who raise concerns. The system allows for structured leader and staff interactions that are coaching and mentoring in nature. These support an environment where nurses care for patients, while leaders also care for staff. By partnering Lean methodology with the heart of nursing, patient care can be improved. The pilot project utilizing this methodology was performed on a neurological unit. It resulted in a dramatic reduction in falls. The unassisted patient fall rate per 1000 patient-days dropped from 11.60 to 5.81 falls, a 50% reduction.

Longitudinal Analysis of Parent Communication Behaviors and Child Distress during Cancer Port Start Procedures.

BACKGROUND: The roles parents play in supporting their child during painful cancer procedures have been studied as communication strategies versus a broader caring framework and from a cross-sectional versus longitudinal perspective. OBJECTIVES: To examine the longitudinal change in parent communication behaviors over repeated cancer port start procedures experienced by their children. METHODS: This study used a longitudinal design. Two trained raters coded 104 recorded videos of port starts from 43 children being treated for cancer. This included 25 children with two video-recorded port starts and 18 children with three (T1, T2, T3). The Parent Caring Response Scoring System derived from Swanson's Caring Theory was used to code parent communication behaviors as caring responses during their children's port starts. Three 3- to 5-minute slices (pre-port start, during, and post-port start) were coded for each video. Mixed modeling with generalized estimating equations and Friedman test were used to analyze longitudinal change in parent behaviors. RESULTS: Significant differences were found between T1 versus T3 in eye contact (ß = -1.05, p = .02), distance-close-enough-to-touch (ß = -0.81, p = .03), nonverbal comforting (ß = -1.34, p = .04), and availability (ß = -0.92, p = .036), suggesting that more parents used communication behaviors at T3 compared with T1. Parent burdensome or intrusive questions (e.g., Why do you cry? ß = -1.11, p = .03) and nonverbal comforting (ß = -1.52, p = .047) increased from T2 to T3. The median values of parent communication behaviors overall had no significant changes from T1 to T3. CONCLUSION: Parents adjusted to use more nonverbal caring behaviors as their child experienced additional port starts. Experimental studies should be designed to help parents use caring behaviors to better support their children during cancer procedures.

Observational Coding Systems of Parent-Child Interactions During Painful Procedures: A Systematic Review.

BACKGROUND: Parent interactions with their child can influence the child's pain and distress during painful procedures. Reliable and valid interaction analysis systems (IASs) are valuable tools for capturing these interactions. The extent to which IASs are used in observational research of parent-child interactions is unknown in pediatric populations. OBJECTIVES: To identify and evaluate studies that focus on assessing psychometric properties of initial iterations/publications of observational coding systems of parent-child interactions during painful procedures. METHODS: To identify and evaluate studies that focus on assessing psychometric properties of initial iterations/publications of observational coding systems of parent-child interactions during painful procedures. Computerized databases searched included PubMed, CINAHL, PsycINFO, Health and Psychosocial Instruments, and Scopus. Timeframes covered from inception of the database to January 2017. Studies were included if they reported use or psychometrics of parent-child IASs. First assessment was whether the parent-child IASs were theory-based; next, using the Society of Pediatric Psychology Assessment Task Force criteria IASs were assigned to one of three categories: well-established, approaching well-established, or promising. RESULTS: A total of 795 studies were identified through computerized searches. Eighteen studies were ultimately determined to be eligible for inclusion in the review and 17 parent-child IASs were identified from these 18 studies. Among the 17 coding systems, 14 were suitable for use in children age 3 years or more; two were theory-based; and 11 included verbal and nonverbal parent behaviors that promoted either child coping or child distress. Four IASs were assessed as well-established; seven approached well-established; and six were promising. CONCLUSIONS: Findings indicate a need for the development of theory-based parent-child IASs that consider both verbal and nonverbal parent behaviors during painful procedures. Findings also suggest a need for further testing of those parent-child IASs deemed "approaching well-established" or "promising".

Parent Caring Response Scoring System: development and psychometric evaluation in the context of childhood cancer-related port starts.

RATIONALE: Multiple observational coding systems have been developed and validated to assess parent-child interactions during painful procedures. Most of these coding systems are neither theory-based nor do they well represent parent nonverbal behaviours. AIMS: Develop the Parent Caring Response Scoring System (P-CaReSS) based on Swanson's Theory of Caring and test its psychometric properties in children in cancer port starts. METHODS: A hybrid approach of inductive and deductive coding was used to formulate the preliminary observational codes for the P-CaReSS. Twenty-nine children, each with one video-recording of port start available, were selected from the parent study (R01CA138981) to refine the P-CaReSS, train coders and test inter-rater reliability. Videos of another 43 children were used to evaluate the construct validity of P-CaReSS. Per cent agreement and Cohen's kappa were used to present the inter-rater reliability. Spearman rank-order correlations were used to report the construct validity. RESULTS: The 18-item P-CaReSS includes three types of parent behaviours: verbal, nonverbal and emotional behaviours. These parent interaction behaviours comprise five caring domains - knowing, being with, doing for, enabling, and maintaining belief - and one noncaring domain. On average the per cent agreement was 0.82 for the P-CaReSS overall, with average per cent agreements above 0.80 for both verbal and nonverbal behaviours. Kappa coefficient was 0.81 for the emotional behaviour. The behavioural codes in the P-CaReSS showed significant correlations with independent ratings of parent distress, child distress and child cooperation. CONCLUSIONS: The P-CaReSS is a promising tool that can be used to evaluate parent verbal, nonverbal and emotional behaviours during cancer-related port starts. This observational tool can be used to guide the development of nursing interventions to help parents caring for their child during cancer procedures.

Validation of the Revised Impact of Miscarriage Scale for Swedish conditions and comparison between Swedish and American couples' experiences after miscarriage.

INTRODUCTION: There is a lack of knowledge in women's and men's experience of miscarriage. The Revised Impact of Miscarriage Scale (RIMS) has been used in United States to measure the experiences after miscarriage. The first objective was to test the consistency of RIMS for Swedish conditions. The second purpose of this study was to compare Swedish and American couples' experience of miscarriage by use of the RIMS. METHODS: Forward and back translation was used for translating RIMS into Swedish. This is a hospital-based comparative study including Swedish couples (n = 70) and American couples (n = 70). The couples were matched by the women's age, week of miscarriage and number of children. All participants answered socio-demographic, fertility and depression-scale questions in addition to RIMS. RESULTS: Cronbach's alpha analysis was above 0.650, the mean value was 0.824. There was no significant difference between the Swedish and American participants on the factors 'Isolation/Guilt' and 'Devastating event', but the Swedish women and men scored significantly lower on the factor 'Loss of baby' than the American women and men. The men, Swedish and American combined, scored lower than the women in all factors but the correlation within the couples was similar for both Swedish and American couples. CONCLUSIONS: The high consistency between the countries suggests that the RIMS questionnaire is reliable for both women and men to be used in both countries and two of three factors were similar between the two countries.

The RunSmart training program: effect on oxygen consumption and lower extremity biomechanics during running.

As recreational running continues to gain popularity, more individuals are seeking ways to improve running performance. RunSmart is a running intervention program designed to enhance a runner's form. In addition to correcting flaws in a runner's form, RunSmart offers the opportunity for runners to continue a regular regimen while slowly integrating changes in form. The purpose of this case series was twofold: to determine if the RunSmart program coincides with improvements in oxygen consumption (VO2), a variable often associated with better running performance times, and to evaluate the RunSmart program in regard to enhancing gait biomechanics. Five recreational runners volunteered to participate in this program. Subjects initially reported to the clinic for an initial submaximal VO2 treadmill test and lower extremity biomechanical analysis. After the initial testing session, each subject attended one session of one-on-one individualized RunSmart instruction per week for 6 weeks. At the first RunSmart session, subjects received a biomechanical analysis to determine their foot strike pattern and areas of muscular weakness and range of motion limitations. Throughout the 6-week run-ning program, participants ran 5 days every week for predetermined times each day; 2 runs every week were designated as interval training runs. Subjects then underwent a follow-up submaximal VO2 treadmill test and lower extremity biomechanical analysis at the end of 6 weeks. Descriptive statistics were used to assess data pertaining to VO2 and biomechanical analysis and compare initial and follow-up testing sessions. Following completion of the RunSmart program, subjects demonstrated improvements in VO2 and also improved several biomechanical factors related to the lower extremity running gait. Based on the results from this case series, the RunSmart training program may have the potential to change a runner's form and improve VO2, thus resulting in improved distance running times. However, this is speculation given the nonexperimental nature of this case series. Future research on this topic should include a greater number of participants in randomized controlled trials on injury prevention and running efficiency.

Parents' Verbal and Nonverbal Caring Behaviors and Child Distress During Cancer-Related Port Access Procedures: A Time-Window Sequential Analysis.

PURPOSE/OBJECTIVES: To study the relationship between parental verbal and nonverbal caring behaviors and child distress during cancer-related port access placement using correlational and time-window sequential analyses.
. DESIGN: Longitudinal, observational design.
. SETTING: Children's Hospital of Michigan and St. Jude Children's Research Hospital.
. SAMPLE: 43 child-parent dyads, each with two or three video recordings of the child undergoing cancer-related port placement.
. METHODS: Two trained raters coded parent interaction behaviors and child distress using the Parent Caring Response Scoring System and Karmanos Child Coping and Distress Scale, respectively. Mixed modeling with generalized estimating equations examined the associations between parent interaction behaviors and parent distress, child distress, and child cooperation reported by multiple raters. Time-window sequential analyses were performed to investigate the temporal relationships in parent-child interactions within a five-second window.
. MAIN RESEARCH VARIABLES: Parent caring behaviors, child distress, and child cooperation.
. FINDINGS: Parent caring interaction behaviors were significantly correlated with parent distress, child distress, and child cooperation during repeated cancer port accessing. Sequential analyses showed that children were significantly less likely to display behavioral and verbal distress following parent caring behaviors than at any other time. If a child is already distressed, parent verbal and nonverbal caring behaviors can significantly reduce child behavioral and verbal distress.
. CONCLUSIONS: Parent caring behaviors, particularly the rarely studied nonverbal behaviors (e.g., eye contact, distance close to touch, supporting/allowing), can reduce the child's distress during cancer port accessing procedures.
. IMPLICATIONS FOR NURSING: Studying parent-child interactions during painful cancer-related procedures can provide evidence to develop nursing interventions to support parents in caring for their child during painful procedures.

Mentors' perspectives on supporting nurse faculty scholars.

PURPOSE: Describe mentors' perceptions of the purpose, processes, outcomes, and challenges of mentoring; self-ratings of effectiveness in performing aspects of the mentoring role; and overall ratings of the quality of their mentoring relationship and the likely contributions of their junior faculty fellow to academia and the profession, the body of knowledge related to health and healthcare, and mitigation of the nursing faculty shortage. PARTICIPANTS: Fifty-one (of 86 possible) mentors of junior faculty who participated in a competitive methods: qualitative and quantitative data were gathered via an online investigator-developed survey. Narrative texts were content analyzed. Quantitative data were analyzed using measures of central tendency and association. OUTCOMES: For the most part mentors rated themselves as effective in their roles and indicated program and mentor-mentee goals were met. The overall purpose, processes, outcomes, and challenges of mentoring are described.

Healthcare providers' caring: Nothing is too small for parents and children hospitalized for heart surgery.

BACKGROUND: Parents of children with congenial heart disease (CHD) face frequent healthcare encounters due to their child's care trajectory. With an emphasis on assuring caring in healthcare, it is necessary to understand parents' perceptions of healthcare providers' actions when their child undergoes heart surgery. OBJECTIVES: To describe parents' perceptions of healthcare providers' actions when their child is diagnosed with CHD and undergoes heart surgery. METHODS: This is a qualitative study with in-depth interviews. Parents of children with CHD were interviewed twice after surgery. We analyzed data using directed content analysis guided by Swanson Caring Theory. RESULTS: Findings of the study indicate that parents perceive caring when providers seek to understand them (knowing); accompany them physically and emotionally (being with); help them (doing for); support them to be the best parents they can be (enabling); and trust them to care for their child (maintaining belief). CONCLUSIONS: Healthcare providers play an irreplaceable role in alleviating parents' emotional toll when their child undergoes cardiac surgery. Providers' caring is an integral component in healthcare.

Parents' experiences of having a child undergoing congenital heart surgery: An emotional rollercoaster from shocking to blessing.

OBJECTIVES: To describe parents' experiences when their child with congenital heart disease (CHD) underwent heart surgery. BACKGROUND: About 40,000 children are born with CHD in the United States each year. Very few studies have explored parents' experiences when their child was diagnosed with CHD and underwent heart surgery. METHODS: Descriptive phenomenology informed this study that consisted of two interviews with 13 parents. RESULTS: Parents experienced a "rollercoaster" of emotions. Critical times were when parents received their child's diagnosis, handed their child over to the surgical team, and visited their child in the pediatric intensive care unit after surgery. Related stressors were the uncertainty of outcomes after surgery, the loss of parental control, the physical appearance of their child, and the fear of the technological atmosphere in the intensive care unit. CONCLUSIONS: The ups and downs of parents' emotions reflected their child's changing condition and parents' adjustment to the condition.

Families of children with congenital heart disease: A literature review.

In 2000 and 2002, the National Heart, Lung, and Blood Institute launched two initiatives to encourage treatment innovations and research on children with heart disease and their families. Since then, no systematic reviews have examined the evidence regarding the impacts of having a child with congenital heart disease (CHD) on families. This review synthesized key findings regarding families of children with CHD, critiqued research methods, described what has been done, and provided recommendations for future inquiry. Databases searched included PubMed, CINAHL, Family & Society Studies Worldwide, Women's Studies International, and PsycINFO. The literature search followed the PRISMA guidelines. As a result, ninety-four articles were reviewed. Four major themes were derived: parents' psychological health, family life, parenting challenges, and family-focused interventions. In conclusion, while they found parents having psychological symptoms, researchers did not explore parents' appraisals of what led to their symptoms. Research is needed to explore parents' experiences and expectations.

Couples and Miscarriage: The Influence of Gender and Reproductive Factors on the Impact of Miscarriage.

OBJECTIVE: We sought to understand the effect of gender, age, mental health history, and reproductive factors on the appraisal of miscarriage in couples. DESIGN: We conducted a secondary analysis of data from the Couples Miscarriage Healing Project. SAMPLE: We analyzed data from 341 couples who had miscarried within 3 months of the original study recruitment. METHOD: Multifactorial analysis of variance was used to analyze baseline effects of gender, age, mental health history, infertility, number of miscarriages, living children, and gestational age on the impact of miscarriage as measured by the three subscales of the Revised Impact of Miscarriage Scale: Isolation/Guilt, Devastating Event, and Loss of Baby. RESULTS: Women scored significantly higher than men on all measures. Younger couples in whom either member had been previously treated for anxiety, depression, or grief were more likely to feel guilt and isolation over their miscarriage than those with no such history (13.30 vs. 11.64; p < .0001) and older couples with and without a mental health treatment history. Younger couples were also more likely to identify miscarriage as the "loss of a baby" and feel more devastated than older couples. Couples with infertility were more devastated (14.30 vs. 11.20; p < .01) and felt more isolation/guilt related to miscarriage (13.59 vs. 12.72; p < .05). CONCLUSIONS: In general, couples experiencing miscarriage after 8 weeks gestation were more impacted than when the miscarriage occurred before 8 weeks. Recommendations for future practice and research are discussed.

Pachymic acid inhibits growth and induces apoptosis of pancreatic cancer in vitro and in vivo by targeting ER stress.

Pachymic acid (PA) is a purified triterpene extracted from medicinal fungus Poria cocos. In this paper, we investigated the anticancer effect of PA on human chemotherapy resistant pancreatic cancer. PA triggered apoptosis in gemcitabine-resistant pancreatic cancer cells PANC-1 and MIA PaCa-2. Comparative gene expression array analysis demonstrated that endoplasmic reticulum (ER) stress was induced by PA through activation of heat shock response and unfolded protein response related genes. Induced ER stress was confirmed by increasing expression of XBP-1s, ATF4, Hsp70, CHOP and phospho-eIF2α. Moreover, ER stress inhibitor tauroursodeoxycholic acid (TUDCA) blocked PA induced apoptosis. In addition, 25 mg kg-1 of PA significantly suppressed MIA PaCa-2 tumor growth in vivo without toxicity, which correlated with induction of apoptosis and expression of ER stress related proteins in tumor tissues. Taken together, growth inhibition and induction of apoptosis by PA in gemcitabine-resistant pancreatic cancer cells were associated with ER stress activation both in vitro and in vivo. PA may be potentially exploited for the use in treatment of chemotherapy resistant pancreatic cancer.

Perinatal palliative care: Parent perceptions of caring in interactions surrounding counseling for risk of delivering an extremely premature infant.

OBJECTIVE: When infants are at risk of being born at a very premature gestation (22-25 weeks), parents face important life-support decisions because of the high mortality for such infants. Concurrently, providers are challenged with providing parents a supportive environment within which to make these decisions. Practice guidelines for medical care of these infants and the principles of perinatal palliative care for families can be resources for providers, but there is limited research to bridge these medical and humanistic approaches to infant and family care. The purpose of this article is to describe how parents at risk of delivering their infant prior to 26 weeks gestation interpreted the quality of their interpersonal interactions with healthcare providers. METHODS: Directed content analysis was employed to perform secondary analysis of data from 54 parents (40 mothers and 14 fathers) from the previously coded theme "Quality of Interactions." These categorized data described parents' encounters, expectations, and experiences of interactions that occurred prenatally with care providers. For this analysis, Swanson's theory of caring was selected to guide analysis and to delineate parents' descriptions of caring and uncaring interactions. RESULTS: Parents' expectations for caring included: (a) respecting parents and believing in their capacity to make the best decisions for their family (maintaining belief); (b) understanding parents' experiences and their continued need to protect their infant (knowing); (c) physically and emotionally engaging with the parents (being with); (d) providing unbiased information describing all possibilities (enabling); and (e) helping parents navigate the system and creating a therapeutic environment for them in which to make decisions (doing for). SIGNIFICANCE OF RESULTS: Understanding parents' prenatal caring expectations through Swanson's theory gives deeper insights, aligning their expectations with the palliative care movement.

Measuring the meaning of miscarriage: revision of the Impact of Miscarriage Scale.

BACKGROUND AND PURPOSE: The purpose of this study was to determine a factor structure for the Impact of Miscarriage Scale (IMS). The 24 items comprising the IMS were originally derived from a phenomenological study of miscarriage in women. Initial psychometric properties were established based on a sample of 188 women (Swanson, 1999a). METHOD: Data from 341 couples were subjected to confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). RESULTS: CFA did not confirm the original structure. EFA explained 57% of the variance through an 18-item, 4-factor structure: isolation and guilt, loss of baby, devastating event, and adjustment. Except for the Adjustment subscale, Cronbach's alpha coefficients were > or = .78. CONCLUSION: Although a 3-factor solution is most defensible, with further refinement and additional items, the 4th factor (adjustment) may warrant retention.

Children's longing for everydayness: life following traumatic brain injury in the USA.

PRIMARY OBJECTIVE: Little is known about life after traumatic brain injury (TBI) from the child's perspective. RESEARCH DESIGN: This descriptive phenomenological investigation explored themes of children's experiences following moderate-to-severe TBI. INCLUSION CRITERIA: (1) 6-18 years of age at injury; (2) moderate-to-severe TBI; (3) ≤3 years since injury; and (4) English speaking and could participate in an interview. Children participated (n = 39) in two interviews at least 1 year apart. A preliminary model was developed and shared for participants' input. MAIN OUTCOMES AND RESULTS: Six themes emerged: (1) it is like waking up in a bad dream; (2) I thought going home would get me back to my old life, but it did not; (3) everything is such hard work; (4) you feel like you will never be like the person you were before; (5) it is not all bad; and (6) some people get it, but many people do not. CONCLUSIONS: Social support was important to how children adjusted to changes or losses. Most children did adjust to functional changes by second interviews. Children had a more difficult time adjusting to how others defined them and limited their possibilities for a meaningful life.

Parents' experiences following children's moderate to severe traumatic brain injury: a clash of cultures.

Little is understood about parents' experiences following children's moderate to severe traumatic brain injury (TBI). Using descriptive phenomenology, we explored common experiences of parents whose children were diagnosed with moderate to severe TBI. Parents from across the United States (N = 42, from 37 families) participated in two semistructured interviews (~ 90 minutes in length and 12 to 15 months apart) in the first 5 years following children's TBI. First interviews were in person. Second interviews, done in person or by phone, facilitated updating parents' experiences and garnering their critique of the descriptive model. Parent themes were (a) grateful to still have my child, (b) grieving for the child I knew, (c) running on nerves, and (d) grappling to get what my child and family need. Parents reported cultural barriers because of others' misunderstandings. More qualitative inquiry is needed to understand how the knowledge, attitudes, beliefs, and culture-based expectations of others influence parents' interactions and the family's adjustment and well-being.