Using a mixed methods grounded theory methodology to explain neonatal nurses' professional quality of life.

BACKGROUND: Nurse researchers are constantly seeking novel methods of maintaining philosophical congruence while advancing their knowledge of the human condition using paradigmatically diverse means. AIM: To provide an overview of the research philosophies underpinning the mixed methods grounded theory (MM-GT) methodology, illustrate its optimal use and introduce a quality-appraisal tool being developed with reference to extant literature. DISCUSSION: The utility of MM-GT has been effectively demonstrated in the nursing and health literature. Yet, there are examples of how it has been under-used and sub-optimally applied. This article includes a two-phase MM-GT study protocol guided by a pragmatic research philosophy and best practice recommendations that aims to explain neonatal nurses' professional quality of life. CONCLUSION: Optimal use of MM-GT's five essential components - purposive sampling, constant comparative methods with iterative coding and analysis, theoretical saturation, memoing and theory development - combine to produce high-quality, defensible research outputs and new nursing theory. IMPLICATIONS FOR PRACTICE: Research outputs, such as publication and presentation, expounding the multifactorial influences affecting neonatal nurses' professional quality of life will not only benefit the neonatal nursing community but also contribute to the corpus of nursing and midwifery research and enhance the health, well-being and retention of nurses and midwives more broadly.

Bayesian analysis for nurse and midwifery research: statistical, practical and ethical benefits.

BACKGROUND: The statistical shortcomings of null hypothesis significance testing (NHST) are well documented, yet it continues to be the default paradigm in quantitative healthcare research. This is due partly to unfamiliarity with Bayesian statistics. AIM: To highlight some of the theoretical and practical benefits of using Bayesian analysis. DISCUSSION: A growing body of literature demonstrates that Bayesian analysis offers statistical and practical benefits that are unavailable to researchers who rely solely on NHST. Bayesian analysis uses prior information in the inference process. It tests a hypothesis and yields the probability of that hypothesis, conditional on the observed data; in contrast, NHST checks observed data - and more extreme unobserved data - against a hypothesis and yields the long-term probability of the data based on repeated hypothetical experiments. Bayesian analysis provides quantification of the evidence for the null and alternative hypothesis, whereas NHST does not provide evidence for the null hypothesis. Bayesian analysis allows for multiplicity of testing without corrections, whereas NHST multiplicity requires corrections. Finally, it allows sequential data collection with variable stopping, whereas NHST sequential designs require specialised statistical approaches. CONCLUSION: The Bayesian approach provides statistical, practical and ethical advantages over NHST. IMPLICATIONS FOR PRACTICE: The quantification of uncertainty provided by Bayesian analysis - particularly Bayesian parameter estimation - should better inform evidence-based clinical decision-making. Bayesian analysis provides researchers with the freedom to analyse data in real time with optimal stopping when the data is persuasive and continuing when data is weak, thereby ensuring better use of the researcher's time and resources.

Self-management of vocational skills for people with significant intellectual disabilities: A systematic review.

Access to employment opportunities is associated with increased quality of life for people with intellectual and developmental disabilities; however, many adults with intellectual and developmental disabilities struggle to find employment. One reason they may have difficulty achieving employment is an inability to work independently. Self-management interventions have been used to promote independence in the workplace for people with intellectual and developmental disabilities by involving them in changing their own behavior. In this literature review, we identified 47 peer-reviewed, single-case design studies in which researchers investigated the use of self-management interventions as an intervention component to improve the vocational skills for people with intellectual and developmental disabilities. Visual analysis of the data indicated that most participants were successful at improving skills related to on-task behavior, task completion, independent transitions, and self-initiations. Potential directions for future research and implications for practice are discussed.

Teaching academic skills to students with significant intellectual disabilities: A systematic review of the single-case design literature.

Students with significant intellectual and developmental disabilities deserve access to instruction on academic skills in addition to functional skills. Many teachers, however, report challenges with identifying appropriate evidence-based practices to teach academics to these students. The purpose of this systematic review was to summarize and analyze literature on academic instruction for students with significant disabilities. Two hundred twenty-two articles with 225 experiments utilizing a single-case design and published between 1976 and 2018 were included in the review. Visual analysis indicated that, in most cases, interventions enabled students to make progress on targeted academic skills. The majority of studies focused on basic reading skills and included participants with moderate disabilities. Most studies used a combination of three or four evidence-based practices, with modeling, prompting, visual supports, time delay, and reinforcement being the most frequently used combination across studies.

Complementing the P-value from null-hypothesis significance testing with a Bayes factor from null-hypothesis Bayesian testing.

BACKGROUND: Classical frequentist statistics, including null-hypothesis significance testing (NHST), dominates nursing and medical research analysis. However, there is increasing recognition that null-hypothesis Bayesian testing (NHBT) merits inclusion in healthcare research analysis. AIM: To recommend that researchers complement the P-value from NHST with a Bayes factor from NHBT in their research analysis. DISCUSSION: Reporting the P-value and a Bayes factor clarifies results that may be difficult to interpret using the P-value alone. CONCLUSION: NHBT offers statistical and practical advantages that complement NHST.

Decision-tables for choosing commonly applied inferential statistical tests in comparative and correlation studies.

BACKGROUND: Nurse researchers are increasingly using a wide variety of inferential statistical tests. However, novice researchers might find choosing tests for their studies difficult, as a result of this variety. AIM: To present structured decision-tables to help choose which statistical tests to use in comparative and correlation studies. DISCUSSION: The wide spectrum of statistical techniques the authors identified in nursing research helped them to construct overview tables that researchers could use as a simple tool to help choose appropriate statistical tests for their studies. CONCLUSION: The decision-tables provided in this paper are unique in that they are composed of commonly applied statistical techniques identified in nursing studies and structured to simplify the pathway to statistical test decision-making for a broad spectrum of study designs. IMPLICATIONS FOR PRACTICE: Novice nurse researchers can use the decision-tables presented in this paper as a starting point to explore with research colleagues or supervisors the appropriate choice of statistical techniques.

Practitioner Implementation of Communication Intervention With Students With Complex Communication Needs.

This study evaluated the effects of a pyramidal training approach that used an expert trainer who taught teachers how to train their paraeducators. Three special education teachers were taught to train four paraeducators to provide students with intellectual and developmental disabilities opportunities to initiate (OTI). A multiple baseline design across participants was used to evaluate the rate and fidelity that paraeducators provided OTI and least to most prompting strategies with students. Rates increased from 0 to an average of .58 per minute. Fidelity of implementation increased from 0% to an average of 94.5%. Maintenance data were recorded for three paraeducators. Schools should consider using this cost- and time-effective training model with staff.

Interventions for promoting participation in shared decision-making for children and adolescents with cystic fibrosis.

BACKGROUND: Shared decision-making is important in child and adolescent healthcare because there is growing international recognition of children and young people's rights to be included in decisions that affect them. In order for young people to participate effectively in shared decision-making they need to develop the skills of engagement with healthcare professionals and confidence in interacting with them. They also need to learn how to manage their condition and treatments on their own when they move into adulthood. Children and young people who participate in shared decision-making in healthcare are likely to be more informed, feel more prepared, and experience less anxiety about the unknown. Significant improvements in cystic fibrosis (CF) survival over recent decades, due to improved therapies and better management of care, means that young people with CF are routinely transitioning to adult healthcare where increasing emphasis on self-management brings greater complexity in decision-making. We need to know what interventions are effective in promoting shared decision-making for young people with CF. OBJECTIVES: To assess the effectiveness of interventions that promote participation in shared decision-making for children and adolescents (aged between four and 18 years) with CF. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearches of journals and conference abstract books. We also searched the reference lists of articles and reviews addressing shared decision-making.Date of most recent search: 12 March 2019.We searched PubMed, CINAHL (EBSCO), Embase (Elsevier), PsycINFO (EBSCO), WHO ICTRP, ASSIA (ProQuest), ERIC (ProQuest), ProQuest Dissertations and Theses, and ClinicalTrials.gov. We contacted study authors with published relevant research in shared decision-making for adults to ask if they were aware of any published or ongoing studies on the promotion of the intervention for children or adolescents (or both) with CF.Date of most recent search: 19 March 2019. SELECTION CRITERIA: We planned to include randomised controlled trials (RCTs) (but not cross-over RCTs) of interventions promoting shared decision-making for children and adolescents with CF aged between four and 18 years, such as information provision, booklets, two-way interaction, checking understanding (by the participant), preparation to participate in a healthcare decision, decision-aids, and training interventions or educational programs. We planned to include interventions aimed at children or adolescents (or both), parents or healthcare professionals or any combination of these groups provided that the focus was aimed at promoting shared decision-making for children and adolescents with CF. DATA COLLECTION AND ANALYSIS: Two authors independently reviewed papers identified in the searches. MAIN RESULTS: No eligible RCTs were identified for inclusion in this systematic review. AUTHORS' CONCLUSIONS: We were unable to identify RCTs with evidence which would support healthcare policy-making and practice related to implementation of shared decision-making for children and adolescents (aged between four and 18 years) with CF). We hope that having identified this gap in research, awareness will increase amongst researchers of the need to design high-quality shared decision-making interventions for young people with CF, perhaps adapted from existing models for adults, and to test these interventions and children's preferences in RCTs. It is also important to target health professionals with evidence-based education programmes on shared decision-making and a need for international consensus on addressing the variability in education programmes.

Transition from paediatric to adult healthcare for young people with cystic fibrosis: Parents' information needs.

Parents of young people with cystic fibrosis (YPWCF) play an important role during the transition from paediatric to adult health services. There is limited evidence on parental information needs and the extent to which they are met. An online survey was conducted targeting a finite population of 190 parents of YPWCF in Ireland. Fifty-nine parents responded (31% response rate). Parents reported the need for more general preparation and timing of the transfer, more information regarding the differences between adult and child health services and how their child will self-manage his/her illness in the future. Most parents received information on the timing of transfer and new healthcare providers but reported being insufficiently informed about their legal status relating to medical confidentiality for their adult child and community resources available for their child after transition to adult health services. The findings highlight the importance of information and preparation for caregivers as well as young people to promote successful transition to adult healthcare. Providing parents with clear information and anticipatory guidance are simple changes in practice that may lead to improvements in transition experiences.

A Review of the Pyramidal Training Approach for Practitioners Working With Individuals With Disabilities.

Pyramidal training has been used for many years to expedite training for those who work with individuals with disabilities and utilizes an expert who provides training to a practitioner who then trains another practitioner to implement practices with clients. Fourteen articles were analyzed to investigate the viability of this training approach for practitioners of all types who support individuals with disabilities. Research does support the effectiveness of pyramidal training within the parameters with which it has been evaluated in this review. All Tier 1 participants made improvement; 83% of Tier 2 participants and 43% of individuals with disabilities showed improvement. Future researchers are encouraged to analyze not only the fidelity of the implementation of these practices but also the changes among the individuals with disabilities. To that end, progress monitoring is necessary to determine whether the implementation was the cause for the meaningful gains for the population being served.

Fundamentals of estimating sample size.

BACKGROUND: Estimating sample size is an integral requirement in the planning stages of quantitative studies. However, although abundant literature is available that describes techniques for calculating sample size, many are in-depth and have varying degrees of complexity. AIM: To provide an overview of four basic parameters that underpin the determination of sample size and to explain sample-size estimation for three study designs common in nursing research. DISCUSSION: Researchers can estimate basic sample size if they have a comprehension of four parameters, such as significance level, power, effect size, and standard deviation (for continuous data) or event rate (for dichotomous data). In this paper, these parameters are applied to determine sample size for the following well-established study designs: a comparison of two independent means, the paired mean study design and a comparison of two proportions. CONCLUSION: An informed choice of parameter values to input into estimates of sample size enables the researcher to derive the minimum sample size required with sufficient power to detect a meaningful effect. An understanding of the parameters provides the foundation from which to generalise to more complex size estimates. It also enables more informed entry of required parameters into sample size software. IMPLICATIONS FOR PRACTICE: Underpinning the concept of evidence-based practice in nursing and midwifery is the application of findings that are statistically sound. Researchers with a good understanding of parameters, such as significance level, power, effect size, standard deviation and event rate, are enabled to calculate an informed sample size estimation and to report more clearly the rationale for applying any particular parameter value in sample size determination.

Using eye gaze to identify reinforcers for individuals with severe multiple disabilities.

The purpose of this study was to replicate Fleming et al. (2010) by examining the use of eye gaze in identifying reinforcers for 3 individuals with severe multiple disabilities. Preference was measured in a paired-choice stimulus preference assessment using duration of eye gaze to determine stimulus selection. A subsequent reinforcer assessment used a reversal design to test the reinforcing effects of the high- and low-preference stimuli. The results replicated Fleming et al., indicating that using eye gaze as a selection method successfully identified reinforcing stimuli.

Awareness and minimisation of systematic bias in research.

A major goal of nursing and midwifery is the delivery of evidence-based practice. Consequently, it is essential for the quality and safety of patient/client care that policy makers, educators and practitioners are aware of the presence of potential systematic bias in research practice and research publications so that only sound evidence translates into practice. The main aim of this paper is to highlight the need for ongoing awareness of the potential presence of systematic bias in research practice, to explore commonly reported types of systematic bias and to report some methods that can be applied to minimise systematic bias in research.

Developing an information leaflet on 22q11.2 deletion syndrome for parents to use with professionals during healthcare encounters.

PURPOSE: The purpose of this project was to gather parents' expertise to inform an educational leaflet for parents to share with professionals caring for children with 22q11.2 deletion syndrome (22q11.2 DS). DESIGN AND METHODS: A mixed-method design was adopted. Data were collected by one focus group interview (n = 8) and questionnaires with 92 other parents of children with 22q11.2 DS. RESULTS: Quantitative and qualitative responses informed the development of an information leaflet. PRACTICE IMPLICATIONS: Parents are well positioned to assist in development of information leaflets that can minimize "repeated storytelling" during professional encounters.

Teaching physical activities to students with significant disabilities using video modeling.

OBJECTIVE: The objective of this study was to examine the effectiveness of video modeling on teaching physical activities to three adolescents with significant disabilities. METHODS: The study implemented a multiple baseline across six physical activities (three per student): jumping rope, scooter board with cones, ladder drill (i.e., feet going in and out), ladder design (i.e., multiple steps), shuttle run, and disc ride. Additional prompt procedures (i.e., verbal, gestural, visual cues, and modeling) were implemented within the study. After the students mastered the physical activities, we tested to see if they would link the skills together (i.e., complete an obstacle course). RESULTS: All three students made progress learning the physical activities, but only one learned them with video modeling alone (i.e., without error correction). CONCLUSION: Video modeling can be an effective tool for teaching students with significant disabilities various physical activities, though additional prompting procedures may be needed.

Building an expanded learning time and opportunities school: principals' perspectives.

Four principals from New York City, Los Angeles, and Houston share their schools' journeys of how they expanded learning time and opportunities to best meet their students' academic and developmental needs.