Sense-making in theory and practice: a metatheoretical foundation and application for health information seeking

This thesis attempts to provide deeper historical and theoretical grounding for sense-making, thereby illustrating its applicability to practical information seeking research. In Chapter One I trace the philosophical origins of Brenda Dervin’s theory known as “sense making,” reaching beyond current scholarship that locates the origins of sense-making in twentieth-century Phenomenology and Communication theory and find its rich ontological, epistemological, and etymological heritage that dates back to the Pre-Socratics. After exploring sense-making’s Greek roots, I examine sense-making’s philosophical undercurrents found in Hegel’s Phenomenology of Spirit (1807), where he also returns to the simplicity of the Greeks for his concept of sense. With Chapter Two I explore sense-making methodology and find, in light of the Greek and Hegelian dialectic, a dialogical bridge connecting sense-making’s theory with pragmatic uses. This bridge between Dervin’s situation and use occupies a distinct position in sense-making theory. Moreover, building upon Brenda Dervin’s model of sense-making, I use her metaphors of gap and bridge analogy to discuss the dialectic and dialogic components of sense making. The purpose of Chapter Three is pragmatic – to gain insight into the online information-seeking needs, experiences, and motivation of first-degree relatives (FDRs) of breast cancer survivors through the lens of sense-making. This research analyses four questions: 1) information-seeking behavior among FDRs of cancer survivors compared to survivors and to undiagnosed, non-related online cancer information seekers in the general population, 2) types of and places where information is sought, 3) barriers or gaps and satisfaction rates FDRs face in their cancer information quest, and 4) types and degrees of cancer information and resources FDRs want and use in their information search for themselves and other family members. An online survey instrument designed to investigate these questions was developed and pilot tested. Via an email communication, the Susan Love Breast Cancer Research Foundation distributed 322,000 invitations to its membership to complete the survey, and from March 24th to April 5th 10,692 women agreed to take the survey with 8,804 volunteers actually completing survey responses. Of the 8,804 surveys, 95% of FDRs have searched for cancer information online, and 84% of FDRs use the Internet as a sense-making tool for additional information they have received from doctors or nurses. FDRs report needing much more information than either survivors or family/friends in ten out of fifteen categories related to breast and ovarian cancer. When searching for cancer information online, FDRs also rank highest in several of sense-making’s emotional levels: uncertainty, confusion, frustration, doubt, and disappointment than do either survivors or friends and family. The sense-making process has existed in theory and praxis since the early Greeks. In applying sense–making’s theory to a contemporary problem, the survey reveals unaddressed situations and gaps of FDRs’ information search process. FDRs are a highly motivated group of online information seekers whose needs are largely unaddressed as a result of gaps in available online information targeted to address their specific needs. Since FDRs represent a quarter of the population, further research addressing their specific online information needs and experiences is necessary.

Legalities of treating wildlife in UK veterinary practice.

Many different species of wildlife will be presented to veterinary practices. In addition to providing care for these patients, veterinary nurses need to be aware of the legal aspects that apply. Legislation relating to wildlife species is particularly relevant to taking animals from the wild, keeping wild animals and birds in care, releasing them back into the wild and notifiable diseases. Following devolution, there are some differences in legislation in different parts of the UK. Specific species, particularly endangered species, have more detailed legislation which also needs to be adhered to. While lay people may have the best of intentions, they need to be aware that all veterinary care needs to follow Schedule 3 of the Veterinary Surgeon's Act 1966, and the best interests of the animals must be central to all care that is given.

Pressure ulcer management in Oman: nurses’ knowledge and views

Background: Pressure ulcers (PrUs) have a significant impact on health system expenditure and patient’s quality of life. It is a global problem. Many studies were undertaken in regard to PrU prevention and management. In Oman, no studies have been conducted to investigate nurses’ knowledge on prevention and management of PrUs. The purpose of this descriptive sequential explanatory mixed-method study was to explore the nurses’ level of knowledge in relation to prevention and management of PrUs in Oman. Methods: A mixed method design was used and the study was conducted over two Phases. In Phase I, a questionnaire was developed to explore nurses’ knowledge on PrU, policy, and resources. The main section of the questionnaire was the Pieper-Zulkowski Pressure Ulcer knowledge test (PZ-PUKT) which tests the knowledge on PrU. Another two sections were developed including questions about wound policy and resources available for PrU prevention and management in Oman. The questionnaire was distributed to nurses who were working in surgical, medical, orthopaedic, CCU, and ICU wards/units in seven hospitals. In Phase II study, semi-structured qualitative interviews were conducted with 16 of the questionnaire respondents. Interviews took approximately 30 minutes, were recorded and transcribed verbatim. Qualitative data were analysed using the Knowledge, Attitudes and Practice (KAP) model as the a priori framework. Results: In Phase I, 478 questionnaires were analysed. The knowledge test results showed the overall mean percent score for correctly answered questions was 51% suggesting a low level of knowledge. There was a significant relationship between nurses’ knowledge and age (P=0.001) and between knowledge and years of experience (P=0.001) with knowledge increasing with age and years of experience. In Phase II, four themes were identified from the interviews: knowledge, attitude, and practice (framework themes) and perception of role. Findings indicated positive and negative attitudes towards the care of PrUs. Some nurses stated feeling rewarded when they see wounds improving while others said they could not work with patients independently because they lacked the knowledge and the skills needed. There was variation in the management of PrU between hospitals. Both studies indicated that the wound management policy did not include enough information to guide nurses. Conclusion: Overall the nurses’ level of knowledge on PrU was relatively low. Most nurses were not familiar with wound management policy or different PrU prevention and management strategies. Nurses are aware of the risk of PrUs and try their best to manage them with the available resources however more training is required.

Accidents at work by excessive efforts / inappropriate movements in nurses

Nurses continuously develop various activities that expose them to excessive force and inappropriate movements. Characterize the accidents reported by overexertion and inappropriate movements in Portuguese nurses during 2009 and 2010. Retrospective cross-sectional study, covering the period from January 1, 2009 to December 31, 2010. Were defined as inclusion criteria, be nurse and having notified by excessive straining and improper motion accident. The information was obtained by reference to the computer record of accidents at work General Administration of Health Services, relating to 672 nurses. There were 672 notifications of accidents by overexertion/ inappropriate moves in Portuguese nurses. The higher prevalence of these accidents was in nurses with over 10 years of service 277 (41.2%), 565 were female (42.6%) in the age group 25-29 (29.9%) and practice time for 555 shifts (82.6%). At admission there were 387 (57.3%) within 3 hours of work 330 (49.1%) and the third day after weekly rest 216 (32.1%). The Mobilization of patients was the most frequent cause of this accident 430 (64.0%). The main effects were the sprains and strains 321 (47.8%), mainly the trunk reached 367 (54.7%) and absenteeism caused 373 (55.5%). On average 17.7 days missed a total of 12.054 days. There was a high prevalence of accidents during the mobilization of prayer on patients so importante to invest in the implementation of mechanical equipment for the mobilization and transport of patients.

Relatório de estágio de intervenção comunitária

O Mestrado em Enfermagem, com Especialização em Enfermagem Comunitária, visa a aquisição e desenvolvimento de competências para o exercício autónomo, auto refletido e com poder de avaliação critica sobre os cuidados prestados e a sua qualidade no que diz respeito aos vários níveis de prevenção do cliente comunidade. O presente relatório, realizado no âmbito da unidade curricular de Estágio, pretende descrever, analisar e refletir sobre o percurso da construção de competências específicas para a intervenção especializada em Enfermagem Comunitária e de Saúde Pública. Ele propõe-se sintetizar as etapas de crescimento pessoal e profissional que permitem uma melhoria da qualidade dos cuidados prestados, um maior desenvolvimento profissional e a melhoria da satisfação dos grupos e comunidades onde decorreram as intervenções. Nele se demonstram as competências desenvolvidas e que convergem nos objetivos académicos definidos por este Mestrado, bem como no perfil de competências preconizado pela Ordem dos Enfermeiros para o desempenho autónomo de cuidados especializados de Enfermagem a grupos e comunidades. O módulo de estágio consistiu no desenvolvimento de um Projeto de Intervenção Comunitária, baseado na metodologia do Planeamento em Saúde, com o objetivo geral de Promover a capacitação e o empoderamento dos adolescentes da E.S.S.L. no âmbito de uma sexualidade saudável e responsável. Na intervenção em enfermagem avançada na comunidade e dando resposta aos problemas/necessidades identificados, foram realizadas sessões de Educação para a Saúde como estratégia de promoção e proteção da saúde e de prevenção da doença, com a finalidade de se atingir o grau de excelência na qualidade de vida e obter ganhos em saúde. A Educação para a Saúde numa ação essencialmente voltada para a Promoção da Saúde desempenha um papel fundamental na capacitação dos indivíduos para a aquisição de hábitos de vida saudáveis e consequentemente na obtenção de ganhos em saúde. A possibilidade de ocorrerem transformações sobre as condições de vida e de saúde nas comunidades depende do acesso a determinadas formas de conhecimento, e a Educação para a Saúde tem um papel significativo face à melhoria das condições de vida e de saúde das populações. Após a intervenção, e ainda que não seja possível avaliar o impacto deste projeto, podemos constatar que as metas estabelecidas foram todas superadas e até ultrapassadas, assim como os objetivos que tinham sido delineados. Observa-se um grau de satisfação em geral com as sessões de Educação para a Saúde desenvolvidas de 98,1%. Esperamos que com a nossa intervenção, as competências pessoais e sociais adquiridas possam ser desenvolvidas e utilizadas para melhorar a vivência da Sexualidade na Adolescência. No entanto, temos consciência de que a intervenção na área da promoção e prevenção, deve ser um trabalho contínuo e dinâmico para se conseguir ganhos em saúde, com resultados a médio/longo prazo

Interventions for nurses caring for a child who has an unexpected acute life threatening event (ALTE) in hospital

Introduction: Caring for a child who has an unexpected ALTE in hospital can be stressful. An ALTE may include a cardiac arrest, respiratory arrest or call for immediate assistance. An international survey of practice was conducted to identify any existing interventions to inform a PhD program of work aimed at reducing the stress from these events through preparation and support. Purpose: The purpose of the survey was threefold: (1) Describe ‘normal’ practice when it comes to preparing staff or providing psychological support after caring for a child who has had an ALTE. (2) Determine if there are any interventions to prepare clinical staff for potential psychological effects of caring for a child who has an ALTE. (3) Determine if there are any interventions to provide support for clinical staff after caring for a child who has an ALTE. Material - Methods: An 18 item semi structured questionnaire was designed for the study to allow respondent to describe practices within their institution and outline their opinions and professional experiences. Clinicians from selected children’s and adult hospitals in Australia, Canada, New Zealand, United Kingdom and the United States of America were contacted by telephone. Following consent they were given the option to complete the survey via the telephone, by post or online. Results: Of the 61 hospitals approached 44 (72%) clinicians responded. Eighteen (41%) respondents identified interventions in place to prepare nurses for an ALTE ranging from (but not limited to) ad hoc discussions during life support training through to structured simulation training. Thirty-six (82%) respondents identified that they had interventions in place to support nurses after an ALTE ranging from (but not limited to) debriefing through to structured case reviews. Conclusions: Interventions varied across institutions, with no outcome or evaluation data for the interventions published to date.

Raising concerns and reporting poor care in practice

This article considers the issue of poor care and how nurses should respond when they encounter it. Several reports and inquiries into failings in care have called into question the standards of care provided by nurses. Of equal concern is the observation that in some instances, poor care is unreported. While there may be underlying structural and organisational reasons for this, it is contended that nurses have a legal, moral and professional obligation to report poor care when they become aware of it.

Medición de la cultura de seguridad del paciente en un hospital público de primer nivel en el municipio de Villeta

Esta investigación midió la percepción del personal asistencial sobre la cultura de seguridad de los pacientes en un hospital de primer nivel de complejidad por medio de un estudio descriptivo de corte transversal. Se utilizó como herramienta de medición la encuesta ‘Hospital Survey on Patient Safety Cultura’ (HSOPSC) de la Agency of Healthcare Research and Quality (AHRQ) versión en español, la cual evalúa doce dimensiones. Los resultados mostraron fortalezas como el aprendizaje organizacional, las mejoras continuas y el apoyo de los administradores para la seguridad del paciente. Las dimensiones clasificadas como oportunidades de mejora fueron la cultura no punitiva, el personal, las transferencias y transiciones y el grado en que la comunicación es abierta. Se concluyó que aunque el personal percibía como positivo el proceso de mejoramiento y apoyo de la administración también sentía que era juzgado si reportaba algún evento adverso.

The use of motivational interviews by nurses to promote health behaviors in adolescents: a scoping review protoco

The objective of this scoping review is to examine and map the use of motivational interviews (MI) by nurses in their clinical practice with adolescents to promote health behaviors.More specifically, the review will focus on the following questions:What is the current nature and extent of use of nurse-led MI in the promotion of health behaviors in adolescents?Which adolescent populations (in terms of health status and adoption or not of health risk behaviors have been included in nurse-led MI with the aim of promoting health behaviors?What are the contexts in which nurses have used MI to promote health behaviors in adolescents?Which specific MI techniques and/or strategies have been used by nurses to promote health behaviors in adolescents?What outcomes on the promotion of health behaviors have been reported from nurse-led MI with adolescents?

The use of motivational interviews by nurses to promote health behaviors in adolescents: developing a search strategy for this review

Introduction: The developmental changes during adolescence may affect subsequent risk for diseases and health-related behaviors. Motivational Interview (MI) may be taken as an essential tool in the provision of nursing care to adolescents, being itself a workspace with possible therapeutic effects. At this context, it is important to examine and map the use of MI by nurses in their clinical practice with adolescents to promote health behaviors. Objectives: A scoping review has been undertaking to find out what is the current extent of the use of nurse-led MI; which adolescents were included; in which contexts nurses use MI; which MI techniques/strategies are used and what outcomes have been reported. The first task was to develop a search strategy to identify relevant studies for this review. It is described here the experience in constructing the search strategy review. Methodology: This scoping review will be informed by JBI methodology. An initial search of MEDLINE and CINAHL was undertaken. An analysis of the text words contained in the title and abstract, and of the index terms used to describe the searched articles were retrieved and these were then used to construct a search strategy for use in Medline and Cinahl. Results: Analysis of the text words and the index terms generated 19 keywords: It was identified 5 synonyms for "Adolescents", 12 for "MI" and 2 for "nurse". A new research formula was designed using the text words identified. Adolescen*[Title/Abstract]) OR Younger*[Title/Abstract]) OR Youth*[Title/Abstract]) OR Teen*[Title/Abstract]) OR Adolescent[MeSH Terms])) AND (((((((((((("Motivational interview"[Title/Abstract]) OR "Motivational intervention"[Title/Abstract]) OR "Motivational interviews"[Title/Abstract]) OR "Motivational interventions"[Title/Abstract]) OR "motivational interviewing"[Title/Abstract]) OR "motivational counseling"[Title/Abstract]) OR "motivational support"[Title/Abstract]) OR "Motivational enhancement"[Title/Abstract]) OR "Brief intervention"[Title/Abstract]) OR "Brief interventions"[Title/Abstract]) OR Motivational Interviewing[MeSH Terms]) OR Directive Counseling[MeSH Terms])) AND ((nurs*[Text Word]) OR Nurses[MeSH Terms]). Limiters - Language: English, Portuguese, Spanish. In MEDLINE this research formula generated 125 results. Other 16 databases referenced at the protocol will be searched to identify additional studies. Articles identified from the final search will be assessed for relevance to the review, based on information provided in the title and abstract. The full article will be retrieved for all studies that meet the inclusion criteria of the review. Conclusions: It was presented here the initial results of this search. Next steps of this study will be to develop and refine the search strategy for use in other databases. It is expected that findings from this Scoping Review provide needed information to nurses related to the use of MI to promote health behaviors in adolescents and inform opportunities for future development in nursing practice.