Patients' and nurses' perspectives on oxygen therapy: a qualitative study

Title.  Patients' and nurses' perspectives on oxygen therapy: a qualitative study.
Aim.  This paper is a report of a study to describe patients' and nurses' perspectives on oxygen therapy.
Background.  Failure to correct significant hypoxaemia may result in cardiac arrest, need for mechanical ventilation or death. Nurses frequently make clinical decisions about the selection and management of low-flow oxygen therapy devices. Better understanding of patients' and nurses' experiences of oxygen therapy could inform clinical decisions about oxygen administration using low-flow devices.
Methods.  Face-to-face interviews with a convenience sample of 37 adult patients (17 cardio-thoracic: 20 medical surgical) and 25 intensive care unit nurses were conducted from February 2007 to September 2007. Interviews were audio-taped, transcribed verbatim and then analysed using a thematic analysis approach.
Findings.  The patients identified three key factors that underpinned their compliance with oxygen therapy: (i) device comfort; (ii) ability to maintain activities of daily living; and (iii) therapeutic effect. The nurses identified factors, such as: (i) therapeutic effect, (ii) issues associated with compliance, (iii) strategies to optimize compliance, (iv) familiarity with device, (v) triggers for changing oxygen therapy devices, as being key to the effective management of oxygen therapy.
Conclusion.  Differences between the patients' and nurses' perspective of oxygen therapy illustrate the variety of factors that impact on effective oxygen administration. Further research should seek to provide a further in-depth understanding of the current oxygen administration practices of nurses and the patient factors that enhance or hinder effectiveness of oxygen therapy. Detailed information about nurse and patient factors that influence oxygen therapy will inform a sound evidence base for nurses' oxygen administration decisions.     

Adolescents with asthma: predictors of quality of life

Title.  Adolescents with asthma: predictors of quality of life.
Aim.  This paper is a report of a study to determine the demographic, personal, interpersonal and illness factors associated with asthma quality of life (QOL), as self-reported by adolescents from the United States of America (USA) and Iceland.
Background.  Asthma affects 12% of children in the USA and an estimated 9% in Iceland. Limited research has addressed asthma QOL for adolescents.
Methods.  This cross-sectional exploratory study included adolescents with asthma ( n  =   15 from the USA; n  =   15 from Iceland), aged 13–17 years, primarily recruited from paediatric practices in central Kentucky, USA and Reykjavik, Iceland. Data were collected in 2006. Adolescents in the USA (47% male) had a mean age of 14·1 years ( sd   = 1·5); Icelandic adolescents (73% male) had a mean age of 15·1 years ( sd   = 1·4). Participants completed questionnaires measuring sociodemographic and asthma characteristics, degree of limitations due to asthma, self-rated health, depressive symptoms and asthma QOL. Multiple regression was used to determine predictors of asthma QOL.
Results.  Gender was statistically significantly associated with QOL. The difference in QOL between adolescents in the USA and Iceland was not statistically significant. Statistically significant predictors of higher asthma QOL were a better rating of overall health ( P  < 0·01), not having had a severe asthma attack in the last 6 months ( P  < 0·01), and lower depressive symptoms ( P  < 0·05).
Conclusion.  Interventions designed to decrease depression and prevent asthma exacerbations may improve QOL for adolescents with asthma.     

Managing Children's Cancer Pain in Morocco

Purpose: To identify issues in managing pain of children with cancer in the two pediatric oncology centers in Morocco.
Methods: Focus groups were conducted with pediatric oncology nurses and physicians.
Findings: Four themes were identified: (a) children's cancer pain is an overwhelming concern to the Moroccan nurses and physicians who participated in this study; (b) training and resources for children's cancer pain management are lacking in Morocco; (c) some impediments to pain relief were verbalized, such as a stoic approach to suffering and limited use of some drugs; and (d) a critical need exists for a comprehensive pain management approach for children with cancer in Morocco.
Conclusions: This study elucidated issues in managing children's cancer pain in Morocco and increased knowledge of current practice issues. A program of policy research has been initiated with the aim of establishing guidelines for practice policies for managing children's cancer pain in Morocco.     

Accuracy of Children's Self-Reported Adherence to Treatment

Purpose: To examine the relationship between self-reported and electronically monitored adherence to a recommended asthma treatment and to assess the accuracy of the diary data reported by school-age children.
Design: A randomized, controlled clinical trial of the effectiveness of an asthma self-management program. The relationship between self-reported and electronically recorded daily peak expiratory flow rate (PEFR) adherence was assessed in a sample of 42 children, ages 7 through 11 years with moderate to severe asthma in one community in West Virginia, USA. Cognitive social learning theory served as the framework for the intervention.
Methods: At-home adherence to PEFR monitoring during the 5-week study was evaluated using the self-report Asthma Diary and an electronic PEFR meter. Recommended twice daily (morning and evening) PEFR monitoring was measured.
Results: Self-reported and electronically recorded PEFR adherence were modestly correlated. Self-reported adherence was significantly higher than electronically monitored adherence during Week 5. Accuracy of the self-reported PEFR declined over time, and over half of the children fabricated at least one PEFR value during the final week of the study.
Conclusions: Clinicians often evaluate the efficacy of prescribed treatment for children with chronic conditions based on the children's self-reported diary data. The findings indicate that these children's self-reported adherence behaviors contained errors. Parent education regarding supervision of children's adherence, including validating the accuracy of diary data, is critical for successful self-management in children with chronic conditions.     

Social Capital in an Impoverished Minority Neighborhood: Emergence and Effects on Children's Mental Health

PROBLEM:  This study aims to describe and analyze neighborhood effects on children's mental health, focusing on the emergence and effects of Social Capital or informal social control.
METHOD:  Focus groups of Hispanic and African American families raising children in a low-income, minority neighborhood.
FINDINGS:  Parents' alienation from and distrust of public sources of formal social control, such as policemen, prevented the emergence of positive informal social control.
CONCLUSION:  Psychiatric nurses and nurse practitioners must utilize public health and individual therapeutic approaches to prevent and treat children's mental health problems in disorganized, violent neighborhoods.     

Experiences and challenges of informal caregiving for Korean immigrants

Title.  Experiences and challenges of informal caregiving for Korean immigrants.
Aim.  This paper is a report of a study designed to explore the caregiving experiences of Korean Americans.
Background.  Increasing numbers of older people in the Asian population place important long-term care demands on Asian caregivers, yet minimal attention has been given to the issue of caregiving in this group. The current study attempts to fill the gap by describing Korean American caregivers' unique caregiving experiences from their perspectives.
Method.  A qualitative research design using a focus group approach was employed to discuss caregiving experiences in a cultural context. Data were collected over an 8-month period in 2005. Twenty-four informants, mostly women, at varying points surrounding caregiving participated in a focus group interview. Each focus group lasted about 1 ½–2 hours. Thematic analysis was conducted by two bilingual researchers.
Findings.  Three key themes were identified: the caregiver role – competing priorities and beliefs, the extent and impact of caregiving, and the need for education and culturally-tailored support systems. Ten subthemes were identified within the three major themes: (1) facing double challenges; (2) changing attitudes about filial piety ( Hyo ); (3) providing care; (4) feeling out of control; (5) going through changing family dynamics; (6) being connected vs. providing connection; (7) paying back; (8) learning by themselves; (9) recognizing differences and (10) reconsidering geriatric care systems.
Conclusion.  The caregiving experiences described by Korean American families point to the need to identify and develop more focused outreach programmes as well as more culturally appropriate support services for this rapidly increasing population.     

Antibiotics for nasopharyngitis are associated with a lower risk of office-based physician visit for acute otitis media within 14 days for 3- to 6-year-old children

Objectives  This study was designed to analyse factors potentially influencing children's return visits to physicians for symptoms of acute otitis media (AOM) within 14 days after being diagnosed with nasopharyngitis (NP), and the impact of recent antibiotic use.
Design  A controlled population-based pharmaco-epidemiological trial in 3- to 6-year-old children conducted from January to May 2000.
Setting  Three different geographical regions in France.
Participants  Among 2507 eligible children, 2456 could be analysed and 505 children had 634 office-based physician visits (OBPV) for NP symptoms.
Interventions  The statistical associations between antibiotics prescribed for NP and an OBPV for AOM within 14 days in a population-based study were analysed along with risk factors of AOM.
Main outcomes measure  Clinical events and antibiotic use.
Results  During the 2 weeks following physician-diagnosed NP, antibiotic use, especially a beta-lactam, significantly decreased the risk of OBPV for AOM in children (odds ratio = 0.2; 95% confidence interval = 0.09–0.7; P  = 0.002).
Conclusion  Antibiotics prescribed to children for NP seem to protect during the following 2 weeks against the risk of OBPV for AOM. It remains to be determined whether a subgroup at high risk of developing AOM after a viral infection exists and what might be the best strategy to adopt for NP in a national programme of optimal antibiotic use.     

Prevention of further weight gain in overweight school children, a pilot study

Background:  Involving school nurses in weight gain prevention activities in already overweight children may be a means to address childhood obesity prevention.
Objective:  To describe and evaluate a treatment method aimed for implementation in school care centres.
Methods:  Twenty families (20 overweight children aged 7 years) were interviewed at baseline with standardized questionnaires, received simple dietary and lifestyle advice. Weight was measured and advice/support by school nurses was available monthly during the 1-year period. A follow-up was made after 1 year. Changes in wellbeing, life style and body mass index (BMI) z -score were recorded and analysed. Experiences from parents and nurses were also examined.
Results:  A good (91%) or fair (54%) adherence to dietary advice was found in children who decreased or maintained their z -score respectively. Mean BMI z -score reduced [−0.16 (p = 0.03)] during the intervention period. Generally, parents and school nurses were satisfied with the programme, helping them to set limits and be more self-confident in their role as 'health adviser' respectively.
Conclusions:  Overweight progression in younger children is possible to modify by increased awareness of the problem, of their food habits and lifestyle practices. Providing school nurses with the knowledge to address the problem and working in collaboration with dieticians and a healthcare team can be an effective means to prevent further weight gain in overweight school-age children. Possibility of stigmatization was expressed thus efforts will need to be made to carry out such a programme to preserve the children's integrity and run activities in a discrete manner in the school environment.     

Care dependency of hospitalized children: testing the Care Dependency Scale for Paediatrics in a cross-cultural comparison

Title.  Care dependency of hospitalized children: testing the Care Dependency Scale for Paediatrics in a cross-cultural comparison.
Aim.  This paper is a report of a study to examine the psychometric properties of the Care Dependency Scale for Paediatrics in Germany and Egypt and to compare the care dependency of school-age children in both countries.
Background.  Cross-cultural differences in care dependency of older adults have been documented in the literature, but little is known about the differences and similarities with regard to children's care dependency in different cultures.
Method.  A convenience sample of 258 school-aged children from Germany and Egypt participated in the study in 2005. The reliability of the Care Dependency Scale for Paediatrics was assessed in terms of internal consistency and interrater reliability. Factor analysis (principal component analysis) was employed to verify the construct validity. A Visual Analogue Scale was used to investigate the criterion-related validity.
Findings.  Good internal consistency was detected both for the Arabic and German versions. Factor analysis revealed one factor for both versions. A Pearson's correlation between the Care Dependency Scale for Paediatrics and Visual Analogue Scale was statistically significant for both versions indicating criterion-related validity. Statistically significant differences between the participants were detected regarding the mean sum score on the Care Dependency Scale for Paediatrics.
Conclusion.  The Care Dependency Scale for Paediatrics is a reliable and valid tool for assessing the care dependency of children and is recommended for assessing the care dependency of children from different ethnic origins. Differences in care dependency between German and Egyptian children were detected, which might be due to cultural differences.     

Patient safety culture in nursing: a dimensional concept analysis

Title.  Patient safety culture in nursing: a dimensional concept analysis.
Aim.  This paper is a report of a dimensional concept analysis of patient safety culture in nursing.
Background.  Patient safety is an important issue in healthcare organizations. As the release of Institute of Medicine reports in the United States of America, substantial interest has arisen in studying patient safety culture; however, the concept remains poorly defined.
Data sources.  Multiple databases, including CINAHL, MEDLINE, PsycINFO and Anthropological Index Online, were searched from 1970 to 2006. A keyword search method was employed followed by a combined key word search.
Review methods.  A concept analysis based on Caron and Bowers' method was carried out using 45 papers, three books and three theses after examination of the abstracts to identify definitions, dimensions, perspectives and consequences needed for content and dimensional analyses.
Findings.  Nurses' shared values, beliefs and behavioural norms towards patient safety were identified as the overarching dimensions of the patient safety culture. The four sub-dimensions of patient safety culture were synthesized as system, personal, task-associated and interaction. Two main philosophical perspectives, functional and interpretative, were added to the analysis and further clarification was provided.
Conclusion.  It is expected that understanding the nature, as well as the key elements of the concept, would assist with analysing the existing safety culture and help to determine the strategies to build or shape the safety culture.     

Children's Exposure to Community Violence

Purpose: To analyze the effects of exposure to chronic community violence on children and adolescents.
Design: An integrative review of the literature was conducted on reports of studies about children's exposure to community violence.
Sources: Studies for analysis were identified through a literature search of relevant topics in Medline, CINAHL, and PsycINFO.
Conclusions: Exposure to community violence is related to significant stress and depression in children. Evidence on how exposure to violence affects children's growth patterns, intellectual growth, school performance, decision-making ability, or their hope for a future is needed.     

Children's Rights in Clinical Research

Purpose: To address the use of children and children's genetic information in research, analyze Icelandic laws as an example, review existing literature on children in clinical research, and describe nurses' actions as children's advocates.
Method: An integrated literature review was conducted using theoretical and empirical literature on children as human subjects in clinical research. Five Icelandic laws were analyzed.
Findings: Legal protection of children as human subjects is an international issue and is lacking in Icelandic legislation. In spite of an identified need to protect children as human subjects, research on children's rights in clinical research is scarce. Nurses have not taken an active stance in protecting children as human subjects.
Conclusions: The recently passed Bill on Health Sector Database in Iceland raises questions about protection of human subjects regardless of age and stature. The effects of this Icelandic case could have international implications regarding centralized health care databases, ownership of data, and related ethical and legal decisions.     

Furthering the Understanding of Parent–Child Relationships: A Nursing Scholarship Review Series. Part 2: Grasping the Early Parenting Experience—The Insider View

PURPOSE.  The purpose of this integrative review is to systematically and critically synthesize nursing scholarship on parents' perspectives of the parent–child relationship during infancy.
CONCLUSION.  Research has shown that the process of establishing the parent–child relationship is highly individualized and complex. Numerous barriers and facilitators influencing this relationship have been identified that are relevant to nursing.
PRACTICE IMPLICATIONS.  Nurses have an important opportunity to positively affect the developing parent–infant relationship. Screening parents for depression and providing parents with resources and support are key nursing interventions supporting the parent–infant relationship.     

The relationship of clinical laboratory parameters and patient attributes to the quality of life of patients on hemodialysis

Aim:  With advances in medicine, the subjective assessment of patients on hemodialysis regarding their quality of life (QOL) is gaining importance. Clinicians cannot rely solely on objective markers, such as the rates of complications and mortality, when evaluating responses to dialysis. In clinical settings, laboratory values are used as measures of patients' health. However, the relationship between clinical laboratory values and QOL has not been elucidated yet. Therefore, the present study aimed to define the relationship of laboratory values and patient attributes to the QOL of outpatients on hemodialysis in order to obtain basic data for reevaluating nursing support for patients on hemodialysis in the future.
Methods:  The participants were 44 outpatients receiving hemodialysis at Hospital B. The QOL was surveyed using a self-administered questionnaire, the Kidney Disease Quality of Life Short Form. The following patient attributes and laboratory values were taken from the medical records: age; sex; primary disease; number of years on hemodialysis; complications; number of hours of hemodialysis per session; percentage weight gain; cardiothoracic ratio; blood pressure; hematocrit; and the serum levels of albumin, potassium, phosphorus, and calcium.
Results:  The serum potassium level significantly affected mental health, social functioning, symptoms, and the effect of kidney disease, with the 3.5–5.0 mEq/L target range group scoring higher than the ≥5.1 mEq/L group.
Conclusions:  The serum potassium level significantly affected not only physical health, but also QOL, a measure of psychosocial health. This suggests that providing nursing support to patients, guided by the serum potassium target range of 3.5–5.0 mEq/L, might improve and maintain QOL.     

A comparative study of nursing staff, care recipients' and their relatives' perceptions of quality of older people care

hasson h. & arnetz j.e. (2009)   A comparative study of nursing staff, care recipients' and their relatives' perceptions of quality of older people care. International Journal of Older People Nursing   5 , 5–15
doi: 10.1111/j.1748-3743.2009.00186.x
Background.  Comparisons of different stakeholders' ratings of the quality of older people care can help to drive quality improvement.
Aim.  The aim was to compare staff, older care recipients' and their relatives' quality of care ratings.
Design.  Cross-sectional questionnaire surveys in 2003 and 2004, using a repeated measures design on an organizational level.
Methods.  Nursing staff, care recipients and relatives in two older people care organizations were included. The ratings of an overall quality grade, information, activities, general care and staff skills were compared between the respondent groups.
Results.  Care recipients in both organizations rated the overall quality grade significantly higher than nursing staff and relatives. Staff ratings of the information given to care recipients were significantly more positive than care recipients' and relatives' ratings. All three groups gave lowest ratings to the quality of activities offered to care recipients, with lowest ratings from nursing staff.
Conclusions.  Concurrent measurements of staff, care recipients and relatives' care quality perceptions can provide a broad evaluation of an organization's strength and limitations.
Relevance to clinical practice.  Staff, care recipients' and relatives' perceptions can be useful for older people care organizations and decision makers in developing care processes and outcomes of care.     

Resident perspectives of the determinants of quality of life in residential care in Ireland

Title.  Resident perspectives of the determinants of quality of life in residential care in Ireland.
Aim.  This paper is a report of a study conducted to identify the determinants of quality of life for older people living in residential care, including exploration of mediating factors at personal and institutional levels and to construct a model of these.
Background.  The quality of life of older people living in residential care is an under-researched area. The focus in the gerontology literature has been on quality of care rather than quality of life for these people. There is emerging consensus, however, that quality of life for older people is a complex, multidimensional concept, incorporating both subjective and objective elements, whether people live at home or in residential care.
Method.  A grounded theory study was conducted in 2005–2006. A total of 101 interviews were undertaken with older people across 12 sites, representing different types of residential care in Northern Ireland. The constant comparative technique was used to analyse data.
Findings.  Four themes having an impact on the quality of life of residents were identified: ethos of care; sense of self and identity; connectedness; and activities and therapies. Mediating and facilitating and/or constraining factors for quality of life were also identified. The core category was conceptualized as 'maximizing potential'.
Conclusion.  Achieving optimal quality of life for older people in residential care will remain elusive unless all the factors which affect on it are taken into account by practitioners and policy-makers. Improving the quality of life of older people in residential care will require action in respect of all of the domains identified in this paper.     

Improvement in health-related quality of life, independent of fasting glucose concentration, via insulin pen device in diabetic patients

Rationale and aims  Using an insulin pen may improve the quality of life (QOL) for diabetic individuals. However, glycemic control and its relationship to better QOL are controversial. The aim of this study was to determine the relationship between health-related QOL and glycemic control in diabetic patients using insulin pen.
Methods  All of the participants were diabetic patients receiving insulin therapy by syringe injection for longer than 1 month. One group of enrolled subjects changed over to use of insulin pen for 12 weeks, while the other group (age-matched control subjects) continued to use syringe for insulin-injection during the same period. Fasting plasma glucose, HbA1c and a 36-Item Short-Form Health Survey (SF-36) were assessed in both groups before and after the 12-week study.
Results  A total of 32 subjects in the insulin pen group and 33 subjects in the syringe group completed the assessment. In comparison with baseline, fasting glucose significantly decreased in the insulin pen group (−57 ± 14 mg dL⁻¹, P  < 0.001), and the reduction was significantly greater than that in the syringe group ( P  = 0.003). The summary scale of physical components but not mental components in the SF-36 was significantly higher in the insulin pen group than in the syringe group ( P  = 0.037). This improvement was independent of the change in fasting glucose.
Conclusions  Using insulin pen for insulin-injection improved glycemic control and health-related QOL in diabetic patients. The better functional health status as a result of physical improvement was independent of the glycemic control.