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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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