The Effect of Acupressure and Cryotherapy on the Pain of Patients on Hemodialysis During Arteriovenous Fistula Cannulation: A Randomized Crossover Clinical Trial.

Various pharmacological and non-pharmacological measures are used to reduce pain of patients on hemodialysis during an arteriovenous fistula (AVF) cannulation. In this randomized, crossover clinical trial, 39 patients randomly received acupressure and cryotherapy. In cryotherapy, an ice cube was used to massage the Hegu point in the hand without the fistula for 10 minutes before AVF cannulation. In acupressure, a moderate pressure with the thumb was applied. The pain score was mild after cryotherapy and acupressure, with no significant difference between the two methods. In addition, acupressure significantly reduced pain compared with routine care, but cryotherapy did not significantly reduce pain compared with routine care. Pain intensity was mild after acupressure and cryotherapy, and neither of these two methods was preferred over the other to reduce the pain during AVF cannulation.

Improving Cultural Competence and Self-Efficacy Among Postgraduate Nursing Students: Results of an Online Cultural Care Training Program.

INTRODUCTION: Since nurses and nursing students interact with culturally diverse clients in health care settings, training programs are required to improve cultural competence and self-efficacy among them. This study aimed to investigate the effect of an online cultural care training program on cultural competence and self-efficacy among postgraduate nursing students. METHODS: The present interventional study used random sampling to allocate 80 postgraduate nursing students into the intervention and control groups. Cultural care training program was held for the intervention group. RESULTS: No significant difference in cultural competence and self-efficacy scores was found between the intervention and control groups in the pretest. However, the intervention group scored higher in terms of cultural competence and self-efficacy after the intervention. DISCUSSION: Given cultural diversity and prevalence of medical tourism, nursing instructors need to pay special attention to cultural care education at all academic levels.

Assessing virtual education on nurses' perception and knowledge of developmental care of preterm infants: a quasi-experimental study.

BACKGROUND: To implement developmental care accurately, neonatal intensive care unit nurses should have a proper understanding and sufficient knowledge in this field. Applying new approaches in education such as offline and online education help nurses improve their skills and knowledge. This study aimed to investigate the effect of virtual education on the perception and knowledge of neonatal developmental care in nurses working in neonatal intensive care units. METHODS: This quasi-experimental study was conducted using a pretest-posttest design with two groups. The participants were 60 nurses working in neonatal intensive care units who were selected using convenience sampling (30 persons in each group). The data were collected before and 1 month after the intervention. The participants in the intervention group received developmental care training using an electronic file uploaded to Navid Learning Management System, while the members of the control group received no intervention. The instruments used to collect the data were the Demographic Information Questionnaire, the Developmental Care Knowledge Scale, and the Developmental Care Perception Scale. The collected data were analyzed using SPSS V25 software. All statistical tests were performed at the significance level of 0.05. RESULTS: The Developmental Care perception scores before the intervention in the control and intervention groups were 83.40 ± 11.36 and 84.53 ± 9.48, respectively, showing no statistically significant difference (P = 0.67). Also, Developmental Care perception scores after the intervention in the control and intervention groups were 83.16 ± 13.73, and 94.70 ± 6.89, respectively, showing a statistically significant difference (P < 0.001). The results of paired t-test showed that the mean knowledge score in the control group before and after the intervention was not statistically significant (P < 0.903), while in the intervention group there was a statistically significant difference between the mean knowledge score before and after the intervention (P < 0.001). The Developmental Care Knowledge scores before the intervention in the control and intervention groups were 52.66 ± 18.08 and 77.16 ± 17.20, respectively, showing a statistically significant difference (P = 0.001). Also, Developmental Care Knowledge scores after the intervention in the control and intervention groups were 53.66 ± 26.55and 90.33 ± 13.82, respectively, showing a statistically significant difference (P < 0.001). The results of paired t-test showed that the mean knowledge score in the control group before and after the intervention was not statistically significant, while in the intervention group there was a statistically significant difference between the mean knowledge score before and after the intervention. CONCLUSION: The results of this study showed that virtual education for the developmental care of premature infants plays an effective role in the perception and knowledge of nurses working in the neonatal intensive care unit. Therefore, the development of e-learning packages for developmental care and their availability for nurses can be a step to improve the quality of nursing care for infants admitted to the NICU.

A Nurse Theorist's Life of Providence: A Dialogue With Sister Callista Roy.

The year 2022 is Nursing Science Quarterly's 35th year in publication, and we are dialoging with nurse theorists. We hope to uncover influences and origins of their theoretical thinking and hear about their current projects related to nursing science. In this scholarly dialogue column, we dialogue with Sister Callista Roy, nurse theorist, retired professor at Mount Saint Mary's University and Professor Emeritus at Boston College Connell School of Nursing. Her contribution to nursing science began in her master's program and her Roy adaptation model (RAM) has been the foundation for countless studies across at least five continents, nursing programs, and implementation practice projects.

Effectiveness of Spiritual Counseling on the Enhancement of Hope in Iranian Muslim Patients with Myocardial Infarction: A Two-Month Follow-Up.

Hope is the most important source of coping in patients who have experienced acute cardiac events, and despair is considered an important cause of discontinued treatment and a threat to patients' mental health. This study aimed to determine the effectiveness of spiritual counseling on hope in patients with myocardial infarction over a two-month period. Fifty-six Iranian Muslim patients with myocardial infarction participated; participants were randomly allocated to either the intervention group (n = 28) or the control group (n = 28). The experiment group received three sessions of group spiritual counseling. The patients' hope was measured before intervention and immediately, one month, and two months after the intervention. The results indicated that no significant difference in hope was present between the intervention and control groups at baseline (Z = - 2.56, effect size = 0.75, P = 0.1). Significance between-group differences favoring the intervention group, however, were noted immediately post-intervention (Z = - 2.72, effect size = 0.91, P = 0.007), one month afterward (Z = - 6.22, effect size = 3.14, P < 0.001), and two months afterward (Z = - 6.10, effect size = 2.65, P < 0.001). Hope significantly improved in the intervention group during the study. Utilizing spiritual counseling as an effective non-aggressive form of treatment can improve hope among patients with myocardial infarction.

The effects of lavender, rosemary and orange essential oils on memory problems and medication adherence among patients undergoing hemodialysis: A parallel randomized controlled trial.

BACKGROUND: hemodialysis patients' daily use of medications is essential for the disease management. One of the causes of medication non-adherence is that they forget to take medications, and non-adherence to treatment following memory loss is a common problem in patients on hemodialysis. OBJECTIVE: the current study aimed to compare the effects of Lavender, Rosemary, and Orange essential oils on memory problems (both retrospective and prospective aspects of memory) and medication adherence in hemodialysis patients. DESIGN: this study was a parallel randomized controlled trial. SETTING: the two main hemodialysis centers in Kerman, southeastern Iran. PARTICIPANTS: eighty-six patients under chronic hemodialysis were randomly allocated into four groups (Lavender, Rosemary, Orange, and control) by simple randomization method. INTERVENTIONS: The samples of the intervention group, in addition to routine care, received Lavender or Rosemary or Orange essential oils three times a week for a month. A gauze containing with five drops of the essential oil was placed at a distance of 10 cm from the patient's nose one hour after hemodialysis, and the patient was asked to inhale it for 30 min. MAIN OUTCOME MEASURES: retrospective and prospective memory, and medication adherence were assessed before, immediately and one month after the intervention. RESULTS: prospective memory problems in Lavender, Rosemary and Orange groups did not change significantly over time (P > 0.05). Prospective memory problems in the control group had a significant increase (P = 0.002). No significant difference was found in prospective memory problems between the four groups (P > 0.05). Retrospective memory problems in the Lavender and Rosemary groups decreased significantly over time (P <0.05). The decreasing retrospective memory problems in the Orange and control groups were not statistically significant over time (P > 0.05). There was no significant difference in retrospective memory problems between the four groups (P > 0.05). No significant difference was observed between the four groups in medication adherence score during the study (P > 0.05). CONCLUSION: aromatherapy with Lavender or Rosemary can reduce some memory problems in hemodialysis patients. However, the results of this study could not justify the effect of aromatherapy on the rate of medication adherence in patients on hemodialysis, so further studies are required. TRIAL REGISTRATION: IRCT20190428043410N1.

Nursing Theory Makes a Practice Turn in the 21st Century / La teoría de la enfermería da un giro hacia la práctica en el siglo XXI / Teoria de enfermagem: virada à prática no século XXI

The author assumes that practice became prominent in nursing theory in the first two decades of the 21st century. The end of the last century saw a burgeoning of literature on what is known as grand theories, their implementation, and evaluation. The era of healthcare quality research began when the Institute of Medicine issued a report on building a safer health system. At this time, the 21st-century literature in nursing took a distinct turn toward practice, influencing nursing theory. The movement to individualize care acted to further this influence. The nurse and patient relationship is the source of data for knowledge development. Established research approaches such as grounded theory and new approaches such as story theory were being used to create nursing theory from practice. Grand theory work moved to the development of instruments to measure the effects of theory in practice, such as that of Watson and Roy. The middle-range theories were developed and seen as closer to and easier to use in practice. The evidence-based practice movement also contributed to the role of theory in practice. These knowledge developments led to nurses having expanded roles in nursing.

La autora asume que la práctica se volvió prominente en la teoría de la enfermería en las dos primeras décadas del siglo XXI. Al final del siglo pasado, se vio un florecimiento de la literatura sobre lo que se conoce como grandes teorías, su implementación y evaluación. Además, la era de la investigación sobre la calidad de la atención médica comenzó cuando el Instituto de Medicina publicó un informe sobre la construcción de un sistema de salud más seguro. En ese momento, la literatura de enfermería del siglo XXI dio un giro distinto hacia la práctica, que influyó en la teoría de la enfermería y el movimiento para individualizar el cuidado actuó para promover esta influencia. La relación enfermera-paciente se convierte en la fuente de datos para el desarrollo del conocimiento. Se estaban utilizando enfoques de investigación establecidos, como la teoría fundamentada, y nuevos enfoques, como la teoría de historias, para crear la teoría de la enfermería a partir de la práctica. El trabajo de la gran teoría se trasladó al desarrollo de instrumentos para medir los efectos de la teoría en la práctica, como el de Watson y Roy. Por otra parte, las teorías de rango medio se desarrollaron y se consideraron más cercanas y más fáciles de usar en la práctica. El movimiento de la práctica basada en la evidencia también contribuyó al papel de la teoría en la práctica. Estos desarrollos de conocimiento llevaron a las enfermeras a ampliar sus funciones en la enfermería.

Neste texto, assume-se que a prática se tornou predominante na teoria de enfermagem nas duas primeiras décadas do século XXI. No final do século passado, viu-se o florescimento da literatura sobre o que se conhece como "grandes teorias", sua implementação e evolução. Além disso, a era da pesquisa sobre a qualidade da atenção médica começou quando o Instituto de Medicina publicou um relatório acerca da construção de um sistema de saúde mais seguro. Nesse contexto, a literatura de enfermagem do século XXI deu uma reviravolta diferente no sentido da prática, o que influenciou a teoria de enfermagem, e o movimento para individualizar o cuidado agiu para promover essa influência. A relação enfermeiro-paciente se converteu na fonte de dados para o desenvolvimento do conhecimento. Eram utilizadas abordagens de pesquisa estabelecidas, como a teoria fundamentada, e novas abordagens, como a teoria de histórias, para criar a teoria de enfermagem a partir da prática. O trabalho da grande teoria passou ao desenvolvimento de instrumentos para medir os efeitos da teoria na prática, como o de Watson e Roy. Por sua vez, as teorias de médio alcance foram desenvolvidas e consideradas mais próximas e mais fáceis de usar na prática. O movimento da prática baseada em evidências também contribuiu para o papel da teoria na prática. Esse desenvolvimento de conhecimento levou os profissionais de enfermagem a ampliar suas funções na área.

Effectiveness of a nurse-led, face-to-face health coaching intervention in enhancing activation and secondary outcomes of primary care users with chronic conditions.

Prevalence of chronic diseases and multimorbidity is rising, and it remains unclear what the best strategy is for activating people with chronic conditions in their self-care. We designed a two-group quasi-experimental time series trial to examine the effectiveness of a nurse-led, face-to-face, individually-tailored health coaching (HC) intervention in improving patient activation and secondary outcomes (self-efficacy, quality of life, anxiety and depression symptoms, medication adherence, hospitalization and emergency visits) among primary care users with chronic conditions. A total of 118 people with chronic conditions were recruited through a primary care center and allocated to either the intervention group (IG) (n = 58) or control group (CG) (n = 60). The IG received a nurse-led individually-tailored HC intervention involving 4-6 face-to-face multicomponent sessions covering six core activation topics. The CG received usual primary care. Data were collected at baseline, after the intervention (6 weeks after baseline for controls) and at 6 and 12 months from baseline. Compared with controls, the IG had significantly higher patient activation scores after the intervention (73.29 vs. 66.51, p = .006). However, this improvement was not maintained at follow-up and there were no significant differences in secondary outcomes across the study period. HC may be an effective strategy for achieving short-term improvements in the activation of primary care users with chronic conditions. Further studies with different methodological approaches are needed to elucidate how HC may improve and sustain changes in patient activation.

Effects of lavender and Citrus aurantium on pain of conscious intensive care unit patients: A parallel randomized placebo-controlled trial.

BACKGROUND: Conscious patients admitted to intensive care units (ICUs) suffer from pain for various reasons, which can affect their recovery process. OBJECTIVE: The present study compared the effects of aromatherapy with Citrus aurantium and lavender essential oils against placebo for reducing pain in conscious intensive care patients. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This study was a parallel randomized placebo-controlled trial. The ICUs of two educational hospitals in Kerman in Southeastern Iran were the study setting. One hundred and fifty conscious intensive care patients were randomly divided into three groups using a stratified block randomization method. Two groups received aromatherapy with essential oils: one with lavender and the other with C. aurantium; these patients received a 30-minute therapy session using their assigned essential oil on the second day of their intensive care stay. The placebo group used 5 drops of normal saline instead of essential oil during their session. MAIN OUTCOME MEASURES: Patient's pain was assessed using a visual analog scale before the aromatherapy intervention, as well as immediately after and one and three hours after intervention. RESULTS: The mean pain score of the lavender group was 40.01 before the aromatherapy intervention and fell to 39.40, 30.60 and 23.68 immediately after the intervention, and at hour one and three post-intervention, respectively. The mean pain score of the C. aurantium group was 45.48 before the intervention and was reduced to 32.34 at three hours after the intervention. The mean pain of the placebo group decreased from 42.80 before the intervention to 35.20 at three hours after the intervention. Pain scores of all groups decreased during the study (P < 0.001). The mean pain of the lavender group was significantly lower than that of the placebo group at three hours after the intervention. CONCLUSION: The results of this study showed that aromatherapy with lavender essential oil reduced pain in conscious ICU patients. Our data could not justify the use of C. aurantium for reducing pain in this population. TRIAL REGISTRATION: No. IRCT20170116031972N9 (https://en.irct.ir/trial/40827).

A Comparison of Two Case Studies Using the Roy Adaptation Model: Parents of Opioid-Dependent Adults and Bariatric Surgery.

The authors in this paper demonstrate the utility and versatility of the Roy Adaptation Model (RAM) as applied to two contemporary case studies. The first case uses the RAM model to gain understanding and guide nursing practice to assist the parents of a young adult with an opioid use disorder and depression, and the second case involves using the RAM model to help a woman who recently had bariatric surgery cope and adapt postoperatively in a way that helps her maximize the benefits of having had that procedure. The authors discuss how the RAM provides a holistic approach that can be used to provide high-quality, comprehensive nursing.

Realizing the Focus of the Discipline: Facilitating Humanization in PhD Education: A Student Exemplar Integrating Nature and Health.

Doctorally prepared nurses must be able to represent the unique nursing perspective within interdisciplinary teams to address contemporary health challenges. This article provides a student exemplar applying the unifying focus of facilitating humanization as described by Willis, Grace, and Roy to science on nature and health. As scientific knowledge becomes more complex, nurses must be skilled in translating information through the nursing lens to support individuals in realizing meaning, choice, quality of life, and healing in living and dying. In order for doctoral students to shepherd the discipline, they must first integrate nursing's philosophical underpinnings into their practice.

Nursing Knowledge in the 21st Century: Domain-Derived and Basic Science Practice-Shaped.

Some have described that nursing is at a crossroads that necessitates finding ways to balance knowledge development that is philosophical and conceptual/theoretical with the empirical inquiry, particularly of the developing related biologic sciences. This article sets a direction for nursing knowledge development that is domain-driven. The central role of nursing theory in attaining the common goals of nursing is envisioned. Recommendations include that grand theories, middle-range theories, and practice theories in tree-like fashion feed into the common goal of humanization; that all teaching tools in nursing begin with common goals and describe nursing theories as contributing to these goals; that theory-practice alliances are central in filling out the envisioned domain-driven knowledge and integrating this with practice-shaped basic sciences.

Key Issues in Nursing Theory: Developments, Challenges, and Future Directions.

BACKGROUND: Today, we face a situation some call the "profession at the crossroads." The problem is the development of the profession being threatened by an imbalance among philosophical, conceptual/theoretical, and empirical inquiry. OBJECTIVES: The aims of this project are to (a) examine the development and contributions of theory, (b) outline the challenges we face in knowledge development, and (c) provide a structure for disciplinary knowledge that provides a unifying focus and renovates theories' place in nursing science that can direct the future of developing knowledge for practice. METHODS: A personal narrative along with literature reviews. Narrative strategies included my own publications on theory, some relevant unpublished speeches, memories of meetings checked with concurrent attendees, and similar or dissimilar points of view in nursing theory textbooks. RESULTS: Contributions of theoretical work in the 20th century included maturing of the discipline, clarifying the theoretical focus of nursing as holistic persons with processes and patterns for environmental integration to attain health, a plurality of grand theories for articulating and testing of theories in practice and research, identification of the mutual impact of theory and education and major conferences, and contributions globally. Twenty-first century developments used all levels of theories particularly for research. Questions are raised about the evaluation of theory. Detours and dead ends for theory development involved metatheory debates and specific events. Challenges identified relate to rapid changes in society, healthcare, and science. A pathway for the future is presented in a figure with its description of the structure of nursing knowledge. DISCUSSION: The potential of this structure for developing future theory-based nursing knowledge for practice is envisioned, and strategies for creating this future are suggested.

Coping measurement: Creating short form of Coping and Adaptation Processing Scale using item response theory and patients dealing with chronic and acute health conditions.

PURPOSE: The purpose of this study was to enhance the CAPS tool by clarifying the concept of coping, using item response theory (IRT) to shorten and assess the metric equivalence of the scale, and testing the preliminary validity of the resulting shortened scale. METHODS: A descriptive design of participants from different ethnic backgrounds was employed (USA n = 347 and Panama n = 327). To select items for the shortened CAPS, a well-established multi-step process grounded in IRT was used. Further, a coping ladder was created to approximate the a priori perceived location/difficulty of each item along the coping trait scale. Items for the shortened scale were selected based on considerations central to the middle range theory of coping and adaptation processing and the results of the item calibration and model testing. RESULTS: A total of 15 items were selected. The selected items were well distributed on the coping ladder and all basic subconcepts of the middle range theory were included. Further the sum of the DIF size for the selected short form items is − 0.01, so the overall bias of the total score is minimal. Finally, concurrent and divergent validity of the new scale was demonstrated in two separate correlational studies. CONCLUSION: The 15-item Coping and Adaptation Processing Scale (CAPS)--Short-Form can be a practical tool to effectively and efficiently measure coping and adaptation in both practice and research for people dealing with both chronic and acute health conditions.

Profession at the crossroads: A dialog concerning the preparation of nursing scholars and leaders.

The purpose of a practice discipline's terminal degree is to develop wise scholars to guide the profession in anticipating and meeting the health-related needs of those served via philosophical, conceptual/theoretical, and empirical inquiry on behalf of professional practice. Each of these dimensions is important for the discipline's ability to meet its obligations to society. However, contemporary circumstances have created a context within which the maturation of the profession may be threatened by an imbalance among the three dimensions of PhD education. Specifically, we discuss the possibility of a tilt toward the empirical at the expense of the other two. Yet, the philosophical and conceptual/theoretical dimensions are those that have permitted core disciplinary knowledge to be developed. We aim to create a dialog about current challenges and the responsibilities of the discipline's scholars for stewardship of the discipline and offer some strategies to ensure balance among the three equally important dimensions.

Commonalities of nurse-designed models of health care.

The American Academy of Nursing has identified examples of care redesign developed by nurses who address the health needs of diverse populations. These models show important clinical and financial outcomes as summarized in the Select Edge Runner Models of Care table included in this article. A study team appointed by the Academy explored the commonalities across these models. Four commonalities emerged: health holistically defined; individual-, family-, and community-centric approaches to care; relationship-based care that enables partnerships and builds patient engagement and activation; and a shift from episodic individual care to continuous group and public health approaches. The policy implications include examining measures of an expanded definition of health, paying for visionary care, and transparency and rewards for community-level engagement.