Advocating for a Loved One in the Setting of Uncertainty: A Mixed-Methods Study Among Caregivers of Sepsis Survivors at the Point of a Sepsis Readmission.

BACKGROUND: The trajectory of recovery after sepsis varies. Survivors may have considerable ongoing limitations, requiring a caregiver for a prolonged period. OBJECTIVES: To learn about experiences, quality of life, coping, resilience, and social support of caregiver caring for survivors of sepsis. METHODS: We conducted a convergent mixed-methods study, recruiting informal caregivers of patients who had survived sepsis in the past year and were readmitted to the intensive care unit with sepsis. Individual face-to-face, semistructured interviews and validated surveys on quality of life, coping, caregiver burden, resilience, and social support were administered to caregivers. Interview transcripts were analyzed using content analysis. Surveys were scored and summarized using descriptive statistics. RESULTS: Caregivers were primarily middle-aged, White, and female. Half were spouses of their care recipient. Caregivers reported some deficits in mobility, pain, and anxiety/depression. Coping styles varied, with engaged coping being more prevalent. Most caregivers reported mild to moderate burden, all reported either normal or high resilience levels, and types of social support were similar. However, interviews and survey findings were not always consistent. Major themes that emerged from the analysis included (1) advocating for and protecting their loved one, (2) coping with caregiving, (3) uncertain future, (4) rewards of caregiving, and (5) need to optimize communication with family. DISCUSSION: Caregivers of sepsis survivors are protective of their care recipient and use a variety of strategies to advocate for their loved one and to cope with the uncertainty involved in a new intensive care unit admission. More advocacy and support are needed for this population.

An outcome of evidence-based practice education: sustained clinical decision-making among bedside nurses.

This research described factors related to incorporating evidence-based practice for clinical decision-making by staff nurses who completed an evidence-based practice (EBP) scholars program. A phenomenological approach was used with focus groups to collect data. A semi-structured questionnaire and field notes comprised study instruments. Audio tapes were transcribed and semantic content analysis was used to code data. Programs to teach bedside nurses how to incorporate EBP into care delivery not only result in better outcomes for patients but also greatly contribute to the sustained enculturation of EBP as a foundation for nursing practice.

Teaching research and evidence-based practice using a service-learning approach.

Because nurses are expected to engage in evidence-based practice (EBP), nursing students must learn to critically evaluate and apply research findings to prepare for professional practice. To connect research and EBP, the focus of a baccalaureate research course was changed from a traditional format to one of evidence appraisal and synthesis. Using an approach that incorporated service-learning and collaborative learning resulted in a new hybrid course that provided students with an opportunity to apply concepts in the real world. Working with a community partner, students were able to develop PICO (Population, Intervention, Comparison, and Outcome) questions and critically appraise the literature to establish the evidence base for three pediatric programs. Students reported that working with a community partner was a meaningful experience because course assignments had a direct impact on current practice. Research courses taught from an EBP perspective can provide motivation for students to incorporate research into their practice as professional nurses.

Parental holding and positioning to decrease IV distress in young children: a randomized controlled trial.

Young children are generally restrained in supine position for IV starts, a position that creates fear but is presumed necessary. This study randomly assigned children of ages 9 months to 4 years (N = 118) to being held upright by a parent or lying flat on an exam table for their IV procedure. Distress scores as rated by the Procedure Behavior Rating Scale were significantly lower in the upright positioning group (p = .000); parents were more satisfied with the upright position, and the upright position did not significantly alter the number of IV attempts needed. The upright position appears to be an effective way to decrease IV distress in young children.