Development and validation of the mirror image comfort and avoidance scale (MICAS).

PURPOSE: The purpose of this study was to develop an instrument to measure the experience of viewing one's reflection in the mirror for use in rehabilitation, nursing, psychology, and in research studies designed to improve the mirror-viewing experience for those who have suffered psychological or bodily trauma. A secondary purpose was to explore demographic differences in each subscale of the instrument. METHODS: The developed items went through content expert validation, exploratory and confirmatory factor analyses, and internal consistency reliability testing. RESULTS: Using an exploratory factor analysis (n = 137) and a confirmatory factor analysis (n = 142), we validated a 17-item instrument for two distinct populations: veterans (n = 108) and individuals with upper and lower limb loss (n = 210). The mirror viewing comfort subscale (9 items; α = 0.90) and the mirror avoidance subscale (8 items, α = 0.94) were deemed reliable. Strong, significant correlations between pre-and post-comfort scores (r = 0.81, p < 0.001), as well as pre-and post-avoidance scores (r = 0.94, p < 0.001) provide evidence of test-retest reliability. Demographic differences were noted in the subscales. CONCLUSIONS: This instrument contributes to a greater understanding of the experience of mirror-viewing in clinical practice. In interventional research studies to improve the mirror-viewing experience, this instrument can act as a manipulation check or outcome measure.Implications for rehabilitationIndividuals who suffer actual or perceived body disfigurement due to surgery or trauma may suffer mirror discomfort or mirror trauma when viewing their bodies in a mirror. This reaction is due to a pre-frontal cortex neurological disruption and autonomic nervous system fright/flight or faint. Psychological disorders (e.g., devastation, shame, self-revulsion, decreased body image) may ensue.Falls have occurred due to mirror trauma due to an autonomic nervous system disturbance (faint) and may result in ongoing mirror avoidance. When mirrors are needed for incision visualization, mirror avoidance has led to severe surgical site infections.Although there were many scales available in the literature to measure several aspects of the effects of actual or perceived body disfigurement, there were no scales that measured the mirror-viewing experience.Clinicians and researchers can use the Mirror Comfort and Avoidance Scale (MICAS) to assess mirror comfort and avoidance.

The experience of nursing leadership in a crisis: A hermeneutic phenomenological study.

AIM: This study aimed to understand nursing leaders' experience during the pandemic. BACKGROUND: COVID-19 is a public health crisis that affects every nation in the world. METHODS: Purposeful sampling was used to recruit 28 leaders in a large health care system. Data were collected via semi-structured audiotaped interviews. Results were analysed using hermeneutic phenomenology. RESULTS: The structure in which leaders worked was described as: from the day-to-day grind to derailment and from manning the hospital to manning the frontlines. Five phenomenological themes were as follows: embodied leadership, navigating differently, trusting and earning trust, being the calm voice and envisioning the future. CONCLUSION: Disaster policies and procedures are needed that will alleviate leadership angst, maximize nursing resources, heighten trust and enhance communications. IMPLICATIONS FOR NURSING MANAGEMENT: In 2020, we witnessed a previously inconceivable media and public focus on the value of nursing care. Leaders can use this pivotal moment in time as a catalyst towards securing the support needed in planning for the next pandemic.

Battle weary/battle ready: A phenomenological study of parents' lived experiences caring for children with autism and their safety concerns.

AIM: The first aim of this study was to explore the lived experiences of parents caring for their autistic children and their experiences with safety for these children. The second aim was to elicit safety recommendations from the parents of autistic children. DESIGN: Hermeneutic phenomenology. METHODS: Fifteen participants who self-reported they were parents of children with autism were recruited via snowball sampling. Data were collected from September 2017-December 2018 in audiotaped interviews using semi-structured questions. Interviews were held with four participants to determine if the findings represented their experiences and concerns accurately. RESULTS: Two underlying structures which demonstrated the trajectory of the experience caring for autistic children were lost/finding our way and battle ready/battle weary. The phenomenological themes within battle weary included living with fear, living with uncertainty and living with disappointment. Resilience was a fourth phenomenological theme which supported the experience of being battle ready. The participants provided recommendations for other parents and healthcare professionals to help keep autistic children safe. CONCLUSION: This study illustrates the unique perspective of parents of autistic children concerning autism and safety. IMPACT: Most parents in this sample reported they faced substantial issues with safety for their child. Study results demonstrated that parents received little to no information about safety from healthcare professionals. Parents of autistic children and healthcare professionals need to be educated about safety issues to prevent injuries and death.

Body Image Perceptions of Women Veterans With Military Sexual Trauma.

The researchers were invited to a transitional home for homeless women veterans to help veterans with body image issues. Convenience sampling was used to recruit 12 veterans who perceived they had a physical difference due to military service. Data were obtained in focus groups where the veterans were invited to share stories. Ricoeur's hermeneutic phenomenology guided the study. The research team learned early in the data collection stage that 11 of the 12 participants suffered military sexual trauma (MST). Three structures emerged in the data: (a) to speak up or not to speak, (b) from military pride to shameful anguish, and (c) invisible scars versus visible scars. A phenomenological interpretation of these invisible scars uncovered that viewing self in a mirror was depicted as viewing a stranger. Being with others, including family, was described as wearing a fake face. The phrase I am broken defined intimate relationships which were non-existent or strained. Shame permeated all body image structures. As the veterans listened to each other, they began to see themes in their stories. There was a shared sense of identity and a movement toward greater self-understanding and resolving. In addition to the recommendations the participants had regarding prevention of MST and recovery care of those with MST, implications for research and practice are provided.

A Study of the Amputee Experience of Viewing Self in the Mirror.

PURPOSE: To describe the trajectory of viewing self in a mirror after an ampu-tation and participants' perceptions of what health care professionals should know about mirrors. DESIGN: Hermeneutic phenomenologyMETHODS: Focus groups were conducted to collect the research data. FINDINGS: The mirror experience had three key moments: decision, seeing, and consent. The trajectory of viewing self in a mirror had four key themes: mirror shock, mirror anguish, recognizing self, and acceptance: a new normal. Participants' recommendations for introducing the mirror after an amputation and using a mirror to avoid skin breakdown and infection, and correct gait and balance are described. CONCLUSIONS: This study provides a unique viewpoint into the world of those who have suffered amputation of a limb. CLINICAL RELEVANCE: Rehabilitation nurses and other health care professionals are encouraged through these participants to consider the effect and value of mirrors when caring for those who have had an amputation.

Concurrent Medical Conditions in Autism Spectrum Disorders.

Long thought to be purely psychological in origin, current research lends credenceto the idea that autism has a medical basis. Patients with autism can be among themost challenging patients that a healthcare provider may care for. Often the presentingsymptoms of autism make these patients difficult to examine and may alsomask underlying concurrent conditions. This article reviews some of the more commonconditions found concurrently in the autistic population.

Reliability of a rapid hematology stain for sputum cytology.

OBJECTIVE: To determine the reliability of a rapid hematology stain for the cytological analysis of induced sputum samples. METHODS: This was a cross-sectional study comparing the standard technique (May-Grünwald-Giemsa stain) with a rapid hematology stain (Diff-Quik). Of the 50 subjects included in the study, 21 had asthma, 19 had COPD, and 10 were healthy (controls). From the induced sputum samples collected, we prepared four slides: two were stained with May-Grünwald-Giemsa, and two were stained with Diff-Quik. The slides were read independently by two trained researchers blinded to the identification of the slides. The reliability for cell counting using the two techniques was evaluated by determining the intraclass correlation coefficients (ICCs) for intraobserver and interobserver agreement. Agreement in the identification of neutrophilic and eosinophilic sputum between the observers and between the stains was evaluated with kappa statistics. RESULTS: In our comparison of the two staining techniques, the ICCs indicated almost perfect interobserver agreement for neutrophil, eosinophil, and macrophage counts (ICC: 0.98-1.00), as well as substantial agreement for lymphocyte counts (ICC: 0.76-0.83). Intraobserver agreement was almost perfect for neutrophil, eosinophil, and macrophage counts (ICC: 0.96-0.99), whereas it was moderate to substantial for lymphocyte counts (ICC = 0.65 and 0.75 for the two observers, respectively). Interobserver agreement for the identification of eosinophilic and neutrophilic sputum using the two techniques ranged from substantial to almost perfect (kappa range: 0.91-1.00). CONCLUSIONS: The use of Diff-Quik can be considered a reliable alternative for the processing of sputum samples.

Reliability of a rapid hematology stain for sputum cytology / Confiabilidade da coloração hematológica rápida para citologia de escarro

Objective: To determine the reliability of a rapid hematology stain for the cytological analysis of induced sputum samples. Methods: This was a cross-sectional study comparing the standard technique (May-Grünwald-Giemsa stain) with a rapid hematology stain (Diff-Quik). Of the 50 subjects included in the study, 21 had asthma, 19 had COPD, and 10 were healthy (controls). From the induced sputum samples collected, we prepared four slides: two were stained with May-Grünwald-Giemsa, and two were stained with Diff-Quik. The slides were read independently by two trained researchers blinded to the identification of the slides. The reliability for cell counting using the two techniques was evaluated by determining the intraclass correlation coefficients (ICCs) for intraobserver and interobserver agreement. Agreement in the identification of neutrophilic and eosinophilic sputum between the observers and between the stains was evaluated with kappa statistics. Results: In our comparison of the two staining techniques, the ICCs indicated almost perfect interobserver agreement for neutrophil, eosinophil, and macrophage counts (ICC: 0.98-1.00), as well as substantial agreement for lymphocyte counts (ICC: 0.76-0.83). Intraobserver agreement was almost perfect for neutrophil, eosinophil, and macrophage counts (ICC: 0.96-0.99), whereas it was moderate to substantial for lymphocyte counts (ICC = 0.65 and 0.75 for the two observers, respectively). Interobserver agreement for the identification of eosinophilic and neutrophilic sputum using the two techniques ranged from substantial to almost perfect (kappa range: 0.91-1.00). Conclusions: The use of Diff-Quik can be considered a reliable alternative for the processing of sputum samples. .

Objetivo: Determinar a confiabilidade da coloração hematológica rápida para a análise do escarro induzido. Métodos: Estudo transversal comparando a técnica padrão (coloração May-Grünwald-Giemsa) com a coloração hematológica rápida (panótico rápido). Participaram do estudo 50 indivíduos (21 asmáticos, 19 portadores de DPOC e 10 controles). Após a coleta do escarro induzido, foram preparadas 4 lâminas, sendo 2 coradas por May-Grünwald-Giemsa e 2 por panótico rápido. As lâminas foram lidas de forma independente por dois pesquisadores capacitados para o exame de escarro induzido e cegados para a identificação das lâminas. A confiabilidade para as contagens celulares dos dois métodos foi avaliada pela determinação dos coeficientes de correlação intraclasse (CCI) para as concordâncias intraobservador e interobservador. As concordâncias na identificação de escarro neutrofílico e eosinofílico entre observadores e entre as duas colorações foram calculadas por estatística kappa. Resultados: Nas duas colorações, os CCI apontaram concordância interobservador quase perfeita para as contagens de neutrófilos, eosinófilos e macrófagos (variação do CCI: 0,98-1,00) e substancial para as contagens de linfócitos (variação do CCI: 0,76-0,83). Na análise intraobservador, a concordância foi quase perfeita para as contagens de neutrófilos, eosinófilos e macrófagos (variação do CCI: 0,96-0,99) e de moderada a substancial para as contagens de linfócitos (CCI = 0,65 e 0,75 para observadores 1 e 2, respectivamente). A concordância interobservador na identificação de escarro eosinofílico e neutrofílico para os dois métodos de ...