Cystic fibrosis research in allied health and nursing professions

This report is the result of the "Allied Health and Nursing Professions Working Group" meeting which took place in Verona, Italy, November 2009, which was organised by the European Cystic Fibrosis Society, and involved 32 experts. The meeting was designed to provide a "roadmap" of high priority research questions that can be addressed by Allied Health Professionals (AHP) and nursing. The other goal was to identify research skills that would be beneficial to AHP and nursing researchers and would ultimately improve the research capacity and capability of these professions. The following tasks were accomplished: 1) a Delphi survey was used to identify high priority research areas and themes, 2) common research designs used in AHP and nursing research were evaluated in terms of their strengths and weaknesses, 3) methods for assessing the clinimetric and psychometric properties, as well as feasibility, of relevant outcome measures were reviewed, and 4) a common skill set for AHPs and nurses undertaking clinical research was agreed on and will guide the planning of future research opportunities. This report has identified important areas and themes for future research which include: adherence; physical activity/exercise; nutritional interventions; interventions for the newborn with CF and evaluation of outcome measures for use in AHP and nursing research. It has highlighted the significant challenges AHPs and nurses experience in conducting clinical research, and proposes strategies to overcome these challenges. It is hoped that this report will encourage research initiatives that assess the efficacy/effectiveness of AHP and nursing interventions in order to improve the evidence base. This should increase the quality of research conducted by these professions, justify services they currently provide, and expand their skills in new areas, with the ultimate goal of improving care for patients with CF.

The impact of nurse-directed protocolised-weaning from mechanical ventilation on nursing practice: A quasi-experimental study

Background:
Internationally, nurse-directed protocolised-weaning has been evaluated by measuring its impact on patient outcomes. The impact on nurses’ views and perceptions has been largely ignored.

Aim:
To determine the change in intensive care nurses’ perceptions, satisfaction, knowledge and attitudes following the introduction of nurse-directed weaning. Additionally, views were obtained on how useful protocolised-weaning was to practice.

Methods:
The sample comprised nurses working in general intensive care units in three university-affiliated hospitals. Nurse-directed protocolised-weaning was implemented in one unit (intervention group); two ICUs continued with usual doctor-led practice (control group). Nurses’ perceptions, satisfaction, knowledge and attitudes were measured by self-completed questionnaires before (Phase I) and after the implementation of nurse-directed weaning (Phase II) in all units.

Results:
Response rates were 79% (n=140n=140) for Phase 1 and 62% (n=132n=132) for Phase II. Regression-based analyses showed that changes from Phase I to Phase II were not significantly different between the intervention and control groups. Sixty-nine nurses responded to both Phase I and II questionnaires. In the intervention group, these nurses scored their mean perceived level of knowledge higher in Phase II (6.39 vs 7.17, p=0.01p=0.01). In the control group, role perception (4.41 vs 4.22, p=0.01p=0.01) was lower and, perceived knowledge (6.03 vs 6.63, p=0.04p=0.04), awareness of weaning plans (6.09 vs 7.06, p=0.01p=0.01) and satisfaction with communication (5.28 vs 6.19, p=0.01p=0.01) were higher in Phase II. The intervention group found protocolised weaning useful in their practice (75%): this was scored significantly higher by junior and senior nurses than middle grade nurses (p=0.02p=0.02).

Conclusion

We conclude that nurse-directed protocolised-weaning had no effect on nurses’ views and perceptions due to the high level of satisfaction which encouraged nurses’ participation in weaning throughout. Control group changes are attributed to a ‘reactive effect’ from being study participants. Weaning protocols provide a uniform method of weaning practice and are particularly beneficial in providing safe guidance for junior staff.

Research priorities of adult intensive care nurses in 20 European countries: a Delphi study.

Aims: This paper is a report of a three round Delphi study of intensive care nursing research priorities in Europe (October 2006–April 2009).

Background: Internationally, priorities for research in intensive care nursing have received some attention focusing on healthcare interventions and patient needs. Studies as early as the 1980s identified priorities in the United States, United Kingdom, Hong Kong and Australia. Research priorities of intensive care nurses across the European Union are unknown.

Methods: The participants, invited in 2006, included 110 intensive care nurses, managers, educators and researchers from 20 European Critical Care Nursing Associations. Delphi round one was an emailed questionnaire inviting participants to list important areas for research. The list was content analysed and developed into an online questionnaire for rounds two and three. In round two, participants ranked the topics on a scale of 1–6 (not important to extremely important). Mean scores of round two were added to the questionnaire of round three and participants ranked the topics again.

Results: There were 52 research topics in 12 domains. There was a dominance of priorities in five main areas: patient safety; impact of evidence based practice on outcomes; impact of workforce on outcomes; well being of patients and relatives; and impact of end-of-life care on staff and practice.

Conclusions: The results reflect worldwide healthcare concerns and objectives and highlight topics that nurses view as fundamental to the care of critically ill patients. These topics provide a platform for future research efforts to improve clinical practice and care of patients in intensive care.

The causal attributions of nursing students towards adolescent survivors of brain injury

Background: The hidden nature of brain injury means that it is often difficult for people to understand the sometimes challenging behaviors that individuals exhibit. The misattribution of these behaviors may lead to a lack of consideration and public censure if the individual is seen as simply misbehaving.

Objective: The aim of this study was to explore the impact of visual cues indicating the presence or absence of brain injury on prejudice, desire for social interaction, and causal attributions of nursing and computing science students.

Method: An independent-groups design was employed in this research, which recruited 190 first-year nursing students and 194 first-year computing science students from a major university in Belfast, UK. A short passage describing an adolescent’s behavior after a brain injury, together with one of three images portraying a young adolescent with a scar, a head dressing, or neither of these, was given to participants. They were then asked to answer questions relating to prejudice, social interaction, locus of control, and causal attributions. The attributional statements suggested that the character’s behavior could be the result of brain injury or adolescence.

Results: Analysis of variance demonstrated a statistically significant difference between the student groups, where nursing students (M = 45.17, SD = 4.69) desired more social interaction with the fictional adolescent than their computer science peers (M = 38.64, SD = 7.69). Further, analysis of variance showed a main effect of image on the attributional statement that described adolescence as a suitable explanation for the character’s lack of self-confidence.

Discussion: Attributions of brain injury were influenced by the presence of a visible but potentially specious indicator of injury. This suggests that survivors of brain injury who do not display any outward indicator may receive less care and face expectations to behave in a manner consistent with the norms of society. If their injury does not allow them to meet with these expectations, they may face public censure and discrimination.

Bracketing: practical considerations in Husserlian phenomenological research

Nursing research leans heavily towards naturalism, with phenomenology commonly adopted. The three main schools of phenomenology used are Husserl's descriptive approach, Heidegger's interpretive hermeneutic approach and the Dutch Utrecht School of phenomenology which combines characteristics of both. Husserl's approach--the description of ordinary human experiences as perceived by each individual--involves four main steps: bracketing, intuiting, analysing and describing. Many phenomenological nurse researchers consciously decide to adopt a Heideggerian approach because of the perceived difficulties in achieving bracketing. This paper examines the concept of bracketing (epoché) and outlines some of the practical considerations when attempting to achieve it.

Testing a model for developing, implementing and evaluating a strategy to improve the quality of nursing and midwifery care in an acute hospital trust.

Abstract:
Background: Health care organisations
worldwide are faced with the need to develop
and implement strategic organisational plans
to meet the challenges of modern health care.
There is a need for models for developing, implementing and evaluating strategic plans that engage practitioners, and make a measurable difference to the patients that they serve. These presentations describe the development, implementation and evaluation of such a model by a team of senior nurses and practice developers, to underpin a strategy for nursing and midwifery in an acute hospital trust. Developing a Strategy The PARIHS (Promoting Action on Research Implementation in Health Services) conceptual framework (Kitson et al, 1998) proposes that successful implementation of change in practice is a function of the interplay of three core elements: the level of evidence supporting the proposed change; the context or environment in which the change takes place, and the way in which change is facilitated. We chose to draw on this framework to develop our strategy and implementation plan (O’Halloran, Martin and Connolly, 2005). At the centre of the plan are ward managers. These professionals provide leadership for the majority of staff in the trust and so were seen to be a key group in the implementation process.