Smoking cessation strategies may increase quit rates among adults of low socioeconomic status

·         Interactive technology can be used to engage low socioeconomic smokers in effective tobacco treatment outside of the traditional clinical setting.

·         Nurses should encourage all smokers to use evidence-based cessation strategies, including telephone-based counselling and pharmacotherapy.

·         More research is needed to address social and contextual factors impacting tobacco use.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Nurses experience feelings of disempowerment when caring for patients in severe pain

·         Protocols are required to enhance nurses’ lines of power when caring for patients in pain. This includes triggering a critical incidence when nurses struggle to control a patient's pain, thus mobilising senior medical staff and pain specialists to the patient's bedside.

·         Whether triggering a critical incidence in this context results in better pain care needs further evaluation.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Parents are psychologically affected by their experiences when their child is in hospital because of uncertainty about prognosis and anxiety at the time of admission

Post-traumatic stress symptoms are experienced by parents after a child's hospitalisation, even where the child's medical condition is not life-threatening.

Screening parents during admission for risk factors, such as anxiety and single parent status, may facilitate more appropriate targeting of support.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Goals of care are important for older adults with severe illness and their families, and are infrequently addressed by health professionals

Patients and families identify goals of care discussions as being essential and include preferences for care at the end-of-life, eliciting patient's values, disclosing prognosis, allowing expression of fears or concerns and questions about goals of care.

Healthcare providers often do not address guideline recommended elements of goals of care discussion, but when undertaken, patient satisfaction can improve.

Future research should examine the benefits of automatic triggers, variations of timing along the disease trajectory and interventions …

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Ateplase for ischaemic stroke: increased risk of intracranial haemorrhage is balanced by improved stroke outcomes, particularly if treated within 3–4.5 h of onset

Thrombolysis given to appropriate patients within 4.5 h of the onset of stroke symptoms increases the chance of a good outcome. The earlier it is given, the more likely it is to be effective.

Thrombolysis increases the risk of early death, but by 3–6 months mortality is equivalent in treated and untreated patients.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Heel stick test for obtaining blood samples in neonates: both swaddling and heel warming may help, but heel warming appears to provide greater pain reduction

Heel warming and swaddling are found to effectively reduce infant pain during heel stick tests for obtaining blood samples and can be used as pain interventions in routine neonatal practice.

The efficacy of swaddling and heel warming on neonatal pain can be added to the health professionals’ armoury for pain management in infants, especially in the intensive care environment.

The underpinning mechanisms of pain reduction by heel warming and swaddling may be different and need to be investigated in future studies.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Behavioural counselling improves physiological outcomes in those with cardiovascular risk factors

Clinicians need to engage community-based public health and other partners to deliver the intensity of diet and physical activity needed to have a positive impact on cardiovascular disease (CVD) risk.

More research is needed to identify the most efficient (cost and time) means of intervention delivery to achieve positive short-term and long-term impacts.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Clinically significant pain is experienced by just over a third of all hospitalised patients, affecting around a half of surgical and a quarter of medical admissions

Greater attention should be placed on assessing pain independently of vital signs, when there is evidence of pain that needs to be relieved.

Future research needs to examine the development and implementation of minimum standards for clinicians assessing and responding to pain in hospitalised patients.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

A nurse-facilitated cognitive behavioural self-management programme for heart failure is no more cost effective than usual CBT care

Using nurses to facilitate a cognitive behavioural therapy (CBT) based self-management intervention for heart failure patients is no more cost-effective than a CBT manual alone.

CBT self-management for heart failure patients may be more effectively delivered as part of collaborative care but this needs to be confirmed in future trials.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

A psychological intervention for family carers of people with dementia is clinically and cost effective at reducing carer depression and anxiety levels over 2 years of follow-up

The START (STrAtegies for RelaTives) intervention is easy to administrate, cost-effective and likely to enhance psychological well-being of family carers of people with dementia.

Training and monitoring of START therapists will be important when implemented by local mental health services.

Future research should evaluate carers’ increased positive behaviours as well as a reduction of psychological symptoms.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

The role of nursing unit culture in shaping research utilization behaviors

A hierarchical structure of authority, routinized and technology-driven work at the bedside, a workplace ethos that discouraged innovation, and an emphasis on clinical experience acted together to teach nurses both that they were to do as they were told and that they were not expected to use research. Nurses perceived that the behaviors expected of them were arbitrarily determined by physicians and managers in charge. Consequently, they were reluctant to step outside of routine and physician-ordered nursing care. This left little opportunity for research utilization.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Using saliva to measure endogenous cortisol in nursing home residents with advanced dementia

Two research teams determined the feasibility of saliva collection for cortisol measurement in nursing home residents with advanced dementia. Study aims were to:

(a) determine if sufficient saliva could be obtained for assay and

(b) examine whether cortisol values exhibited range and variability for meaningful interpretation. Useable samples were consistent across sites, suggesting that saliva collection for cortisol assay is a viable method in this setting. Cortisol values showed range and variability. More than half of the residents showed the normal adult pattern of high morning levels decreasing throughout the day. A third of the participants demonstrated an increase in the evening cortisol levels, while the remaining profiles were flat, suggesting hypothalamic-pituitary-adrenal (HPA) dysregulation in this population.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Home healthcare practice environment: predictors of RN satisfaction

Home healthcare nurses reported slightly lower satisfaction than hospital nurses and were approximately 50% less satisfied than they were in 2000. Satisfaction had a negative relationship with years worked as a home healthcare nurse (r= -.25, p< .01). Controlling for years of home healthcare experience, control over practice decisions and practice setting decisions were significant predictors of satisfaction. With the demand for home healthcare nurses expected to increase 109% by 2020, development of a National Database of Nursing Quality Indicators for home healthcare that includes satisfaction as a nurse-sensitive outcome might be helpful.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

The relationship of nursing staff to the hospitalization of nursing home residents

Although most nursing home admissions are from hospitals, their studies involved residents who probably were not admitted from hospitals. In this study I examined data on 6,623 discharges of nursing home residents admitted or not admitted from a hospital. For patients with longer stays (>30 days), higher RN staffing levels in nursing homes reduced hospitalizations only for residents admitted from hospitals. Higher RN levels reduced hospitalizations more than higher licensed nurse levels or skill mix. Only among longer-stay residents not admitted from hospitals was RN staffing unrelated to hospitalizations.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Metaphors in qualitative research: Shedding light or casting shadows?

Metaphors can be used to provide structure to the data; to understand a familiar process in a new light; to identify situation-specific interventions; and to evoke emotion. Misuse of metaphors may detract from the intended research message. Mixing metaphors, failing to follow through with metaphors, and using metaphors that do not fit the data can misrepresent the data. The choice to use metaphors should not become a self-serving attempt at creativity that supersedes subject and substance. At their best, metaphors illuminate the meanings of experiences; at their worst, metaphors distort or obscure the essences of them.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

The relationship of military imposed marital separations on maternal acceptance of pregnancy

The sample was 503 primigravida or multigravida women eligible for care in the military medical system. Military deployment and community support had a statistically significant effect on pregnancy acceptance. Gravidas with deployed husbands had higher conflict for accepting pregnancy than gravidas without deployed spouses. Community support had a significant positive effect on pregnancy acceptance. Women perceiving support predominantly from off-base versus on-base communities had significantly higher conflict with acceptance of pregnancy. Findings point to improved maternal acceptance of pregnancy with paternal presence and community support in the event of military deployment.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Effectiveness of teaching an early parenting approach within a community-based support service for adolescent mothers

Participants were sequentially allocated to groups in order of referral. The outcome was the enhancement of maternal and infant behaviors that exhibited mutual responsiveness as measured by the Nursing Child Assessment Teaching Scale. Issues with recruitment and collaboration with the community agencies made achieving a desirable sample size difficult. Pre-tests and post-tests were completed for 13 participants. While the sample size was insufficient to confidently establish whether or not the Keys to Caregiving produced a between groups treatment effect, mothers within the treatment group evidenced significantly greater contingent responsiveness over time than those within the control group.

Website:  http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Focus groups as an intervention for low-income African American smokers to promote participation in subsequent intervention studies

Americans are often underrepresented in smoking cessation research. Focus groups were examined as an intervention to increase readiness to quit smoking, the processes of change, and the odds of randomized clinical trial (RCT) participation of non-treatment-seeking, low-income African American smokers. Ten focus groups were conducted. Smokers completed baseline and/or post-group assessments of readiness to quit, the processes of change, and focus group quality. Significant increases were discerned in readiness to quit smoking and the processes of change. Seventy-six percent of participants enrolled in a self-help RCT, which was associated with readiness to quit smoking and plans to set a quit date. One-session focus groups among low-income African American smokers appear to facilitate cognitive changes and participation in RCTs.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

The long-term impact of adolescent gestational weight gain.

The purpose of the study was to examine predictors of body mass index (BMI) change in Black adolescents 6 and 9 years after they gave birth. Predictors were gestational weight gain, pre-pregnant BMI, and age (p < .001). For older adolescents (ages 18-19), gestational weight gain was the only predictor of BMI change (p = .008). Regardless of pre-pregnant BMI category, adolescents whose gestational weight gain exceeded Institute of Medicine (IOM) recommendations were 4.6 times more likely to be obese than those whose weight gain was within recommendations. Excessive gestational weight gain and pre-pregnant overweight contribute to adolescent obesity. These findings have implications from both a clinical and public health perspective.

Website:  http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Focus groups as an intervention for low-income African American smokers to promote participation in subsequent intervention studies

Americans are often underrepresented in smoking cessation research. Focus groups were examined as an intervention to increase readiness to quit smoking, the processes of change, and the odds of randomized clinical trial (RCT) participation of non-treatment-seeking, low-income African American smokers. Ten focus groups were conducted. Smokers completed baseline and/or post-group assessments of readiness to quit, the processes of change, and focus group quality. Significant increases were discerned in readiness to quit smoking and the processes of change. Seventy-six percent of participants enrolled in a self-help RCT, which was associated with readiness to quit smoking and plans to set a quit date. One-session focus groups among low-income African American smokers appear to facilitate cognitive changes and participation in RCTs.

Website:  http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Effectiveness of teaching an early parenting approach within a community-based support service for adolescent mothers

Participants were sequentially allocated to groups in order of referral. The outcome was the enhancement of maternal and infant behaviors that exhibited mutual responsiveness as measured by the Nursing Child Assessment Teaching Scale. Issues with recruitment and collaboration with the community agencies made achieving a desirable sample size difficult. Pre-tests and post-tests were completed for 13 participants. While the sample size was insufficient to confidently establish whether or not the Keys to Caregiving produced a between groups treatment effect, mothers within the treatment group evidenced significantly greater contingent responsiveness over time than those within the control group.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Diagnostic frameworks and nursing diagnoses: a normative stance.

Diagnostic frameworks are essential to many scientific and technological activities and clinical practice. This study examines the main fundamental aspects of such frameworks. The three components required for all diagnoses are identified and examined, i.e. their normative dimension, temporal nature and structure, and teleological perspective. The normative dimension of a diagnosis is based on (1) epistemic values when associated with Hempel's inductive risk concerning the balance between false-positive and false-negative outcomes, leading to probabilistic judgements; and (2) non-epistemic values when related to ideas such as well-being, normality, illness, etc, as idealized norms or ideal points of reference. It should be noted that medical diagnoses match the three necessary components, while some essential diagnostic frameworks - the taxonomies of Gordon and NANDA - in nursing lack some components. The main lack is normative as the most popular frameworks in nursing diagnosis seem to be descriptions of observed reality rather than normative and value-based judgements in which both epistemic and non-epistemic values may coexist.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Foundations for a human science of nursing: Gadamer, Laing, and the hermeneutics of caring.

In the UK, where the Francis Report and other recent reviews have highlighted a number of cases of nurses who no longer appear willing or able to 'care'. The popular press, along with some elements of the nursing profession, has placed the blame for these failures firmly on the academy and particularly on the relatively recent move to all-graduate status in England for pre-registration student nurses.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

On to the 'rough ground': introducing doctoral students to philosophical perspectives on knowledge.

Doctoral programmes in nursing are charged with developing the next generation of nurse scholars, scientists, and healthcare leaders. The American Association of Colleges of Nursing (AACN) endorses the inclusion of philosophy of science content in research-focused doctoral programmes. Because a philosophy course circumscribed to the natural or social sciences does not address the broad forms of knowledge that are relevant to nursing practice, we have developed and co-taught a course on the philosophy of knowledge that introduces students to competing claims regarding the nature of knowledge, truth, and rationality. In addressing broad themes related to science and knowledge of the body, health and illness, and ethics, the course equips students to tread the rough and shifting ground of nursing scholarship and practice. Providing doctoral students with this philosophical footing is intended to give future scholars, researchers, and healthcare leaders the intellectual skills to critically reflect on knowledge claims, to challenge the hegemony of science, and to recognize the disciplinary forms of knowledge that are left out or trivialized. Our pedagogical approach to knowledge development does not denigrate scientific knowledge, but elevates forms of inquiry and notions of clinical knowledge that are too often marginalized in doctoral education and the academy in general.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Habermasian knowledge interests: epistemological implications for health sciences.

The Habermasian concept of 'interest' has had a profound effect on the characterization of scientific disciplines. Going beyond issues unrelated to the theory itself, intra-theoretical interest characterizes the specific ways of approaching any science-related discipline, defining research topics and methodologies. This approach was developed by Jürgen Habermas in relation to empirical-analytical sciences, historical-hermeneutics sciences, and critical sciences; however, he did not make any specific references to health sciences. This article aims to contribute to shaping a general epistemological framework for health sciences, as well as its specific implications for the medical and nursing areas, via an analysis of the basic knowledge interests developed by Habermas.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Doing Foucault: inquiring into nursing knowledge with Foucauldian discourse analysis.

Foucauldian discourse analysis (FDA) is a methodology that is well suited to inquiring into nursing knowledge and its organization. It is a critical analytic approach derived from Foucault's histories of science, madness, medicine, incarceration and sexuality, all of which serve to exteriorize or make visible the 'positive unconscious of knowledge' penetrating bodies and minds. Foucauldian discourse analysis (FDA) holds the potential to reveal who we are today as nurses and as a profession of nursing by facilitating our ability to identify and trace the effects of the discourses that determine the conditions of possibility for nursing practice that are continuously shaping and (re)shaping the knowledge of nursing and the profession of nursing as we know it. In making visible the chain of knowledge that orders the spaces nurses occupy, no less than their subjectivities, FDA is a powerful methodology for inquiring into nursing knowledge based on its provocation of deep critical reflection on the normalizing power of discourse.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Staying alive: rethinking deterritorialization in a post-feminist era.

In recent years, the concept 'post-feminism' and its links to neoliberal economic structures and to the extreme reinforcement of individualization as raison d'etre of Western civilization have been discussed at length by numerous distinguished scholars in feminist cultural studies and feminist philosophy. This article takes its point of departure in this discussion. Drawing on Wendy Brown, Elizabeth Grosz, Angela McRobbie, Wendy Larner, and others, the text is examining the discourse of post-feminism and neoliberalism, and its effects on overarching political scenarios, as well as on everyday life: What happens to feminist politics when the collective, both as figuration and as virtual political platform, is deemed to be something situated in the discursive outskirts? By drawing on examples form the contemporary cultural imaginaries, from popular culture, economic structures, and public debate, and by pointing out the links between the micro-perspective of our everyday living and overarching political structures, this article aims at bringing to the fore and critically discuss these issues, and the ways in which they intersect with contemporary Western feminism. The article ends with a discussion of possible points of exit or paths to follow in order to find alternatives.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Power and practices: questions concerning the legislation of health professions in Ameerica

Developments in professional practice can be related to ongoing changes in relations of power among professionals, which often lead to changes in the boundaries of practices. The differing contexts of practices also influence these changing relations among health professionals. Legislation governing professional practice also differs from country to country. In Brazil, over the past 12 years, in a climate of deep disagreement, a new law to regulate medical practice has been discussed. It was sanctioned, or made into law, but with some notable changes, in July 2013. Of interest to us in this paper are the ways the proposed legislation, by setting out the boundaries and scope of medical practice, 'interfered' in the practices of other health professions, undermining many 'independent' practices that have developed over time. However, even taking into account the multiple routes through which practices are established and developed, the role of legislation that seems able to contradict and deny the historical realities of multiple, intersecting practices should be critically interrogated.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Cyborgs, biotechnologies, and informatics in health care - new paradigms in nursing sciences.

Nursing Sciences are at a moment of paradigmatic transition. The aim of this paper is to reflect on the new epistemological paradigms of nursing science from a critical approach. In this paper, we identified and analysed some new research lines and trends which anticipate the reorganization of nursing sciences and the paradigms emerging from nursing care: biotechnology-centred knowledge; the interface between nursing knowledge and new information technologies; body care centred knowledge; the human body as a cyborg body; and the rediscovery of an aesthetic knowledge in nursing care.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Troubling practices of control: re-visiting Hannah Arendt's ideas of human action as praxis of the unpredictable.

In this article, Hannah Arendt's concept of action will be used to problematize current transformations of the health care sector and examine some responses by ethicists in light of those transformations. The sphere of human interaction that should typify health care work is identified as an action of unpredictable praxis in contrast to controllable procedures and techniques which increasingly take place in the health care sector.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Patients' participation in decision-making in the medical field - 'projectification' of patients in a neoliberal framed healthcare system.

This article focuses on patients' participation in decision-making in meetings with healthcare professionals in a healthcare system, based on neoliberal regulations and ideas. Drawing on two constructed empirical cases, primarily from the perspective of patients, this article analyses and discusses the clinical practice around decision-making meetings within a Foucauldian perspective. Patients' participation in decision-making can be seen as an offshoot of respect for patient autonomy. A treatment must be chosen, when patients consult physicians. From the perspective of patients, there is a tendency for healthcare professionals to supply the patients with the information that they think are necessary for them to make their own decision. But patients do not always want to be a 'customer' in the healthcare system; they want to be a patient, consulting an expert for help and advice, which creates resistance to some parts of the decision-making process. Both professionals and patients are subject to the structural frame of the medical field, formed of both neoliberal framework and medical logic. The decision-making competence in relation to the choice of treatment is placed away from the professionals and seen as belonging to the patient.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/