Effect of a regular family visiting program as an affective, auditory, and tactile stimulation on the consciousness level of comatose patients with a head injury

Aim:  The purpose of this study was to determine the effect of a regular family visiting program, as an auditory, affective, and tactile stimulation, on the consciousness level of comatose head injury patients.
Method:  A randomized controlled trial design was used. Fifty comatose head injury patients were randomly allocated into a control group or an intervention group. The consciousness level of the patients in both groups was evaluated and recorded by the Glasgow Coma Scale, before and 30 min after the visiting program.
Results:  The independent t -test results demonstrated that the means of the consciousness level at the first day before intervention had no significant difference in both groups. The repeated measured ANOVA results demonstrated that the consciousness level alterations were significant between the two groups over the 6 days of intervention.
Conclusion:  The results of the present study provided evidence to support that a regular family visiting program could induce the stimulation of comatose patients. Therefore, it can be considered as a potential nursing intervention.     

Clinician's use of the Statin Choice decision aid in patients with diabetes: a videographic study nested in a randomized trial

Objective  To describe how clinicians use decision aids.
Background  A 98-patient factorial-design randomized trial of the Statin Choice decision vs. standard educational pamphlet; each participant had a 1:4 chance of receiving the decision aid during the encounter with the clinician resulting in 22 eligible encounters.
Design  Two researchers working independently and in duplicate reviewed and coded the 22 encounter videos.
Setting and participants  Twenty-two patients with diabetes (57% of them on statins) and six endocrinologists working in a referral diabetes clinic randomly assigned to use the decision aid during the consultation.
Main outcome measures  Proportion and nature of unintended use of the Statin Choice decision aid.
Results  We found eight encounters involving six clinicians who did not use the decision aid as intended either by not using it at all ( n  = 5; one clinician did use the decision aid in three encounters), offering inaccurate quantitative and probabilistic information about the risks and benefits of statins ( n  = 2), or using the decision aid to advance the agenda that all patients with diabetes should take statin ( n  = 1). Clinicians used the decision aid as intended in all other encounters.
Conclusions  Unintended decision aid use in the context of videotaped encounters in a practical randomized trial was common. These instances offer insights to researchers seeking to design and implement effective decision aids for use during the clinical visit, particularly when clinicians may prefer to proceed in ways that the decision aid apparently contradicts.     

Feasibility of Using Communication Coaching to Teach Palliative Care Clinicians Motivational Interviewing

ContextPalliative care clinicians often have challenging conversations with patients or family caregivers who express ambivalence about goals or feel reluctant to discuss topics. Motivational Interviewing (MI) has tools to address ambivalence and reluctance.ObjectiveThe aim of this pilot study was to test the feasibility, acceptability, and preliminary efficacy of an MI communication coaching intervention.MethodsWe enrolled 22 palliative care clinicians and randomly assigned half to receive communication coaching versus wait-list control. The coaching entailed a lecture on MI, a 1:1 session to discuss applying MI, and audio recording and receiving feedback on four encounters (two separate times). Palliative care clinicians in the wait-list control arm audio-recorded four encounters. Coders blinded to study arm coded MI behaviors. We surveyed patients, caregivers, and clinicians after all audio-recorded encounters to assess perceptions of the encounter. The analyses were performed using a repeated-measures mixed model.ResultsWe found the intervention to be feasible and acceptable. Eighty-six percent of those enrolled completed all study activities including coaching sessions, audio-recording encounters, and completing surveys. Of those in the intervention arm, 88% rated the intervention as helpful and 100% would recommend it to a colleague. Compared to control clinicians, intervention clinicians had higher ratings of their MI skills after intervention, higher objectively rated communication skills, and slightly better burnout scores. We found no arm differences in patient, caregiver, or clinician ratings of satisfaction.ConclusionThis pilot study indicates that coaching palliative care clinicians is feasible and shows promise that coaching can improve palliative care clinician communication.     

Psychosocial Experiences of Parents of a Child With Imperforate Anus

PURPOSE.  This study aims to examine the psychosocial experiences of parents of children with imperforate anus (IA) and to describe their potential positive experiences.
DESIGN AND METHODS.  Parents of IA children and a comparison group answered a questionnaire, which was analyzed quantitatively and with manifest content analysis.
RESULTS.  Social relationships and respect for the child's will were more affected among IA mothers. Positive experiences were revealed in relation to the child, the parent, and the family.
PRACTICE IMPLICATIONS.  Support to parents in caring for a child with IA should be individualized and occasionally undertaken through collaboration with experts from child and adolescent psychiatry.     

Heteronormative communication with lesbian families in antenatal care, childbirth and postnatal care

Title.  Heteronormative communication with lesbian families in antenatal care, childbirth and postnatal care.
Aim.  This paper is a report of a study of lesbian parents' experience of antenatal care, childbirth and postnatal care.
Background.  In a strictly heteronormative-based care system, 'parents' naturally implies a man and a woman, and all communication and routines are based on heterosexual couples.
Method.  A qualitative interview study was carried out in 2008. Ten mothers, eight of whom were in a relationship with another woman, participated. The participants had experience from several care facilities from three different cities in central Sweden.
Findings.  Most participants had positive experiences but also complained that the focus was not always on the pregnancy and that no parenthood education had been offered. Heteronormativity was communicated by midwives and nursing staff throughout the process – from antenatal care to postnatal care, via forms, journals, verbal communication and orientation visits. This was experienced as embarrassing for the participant parents, and they also described encountering what they interpreted as embarrassment on the part of care providers. Participants called for increased knowledge about lesbian parenting, since they believed this would influence and facilitate communication, not least with midwives in antenatal care.
Conclusion.  Midwives educated in lesbian issues could ask questions and communicate in a more neutral way at the first meeting, and thereby make prospective parents feel less insecure. Special parenthood education groups for lesbians are recommended so that lesbian couple can meet others with similar experiences and so that the focus will be on prospective parenthood and not on their sexual orientation.     

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.     

Effects of a nurse practitioner on a multidisciplinary consultation team

Title.  Effects of a nurse practitioner on a multidisciplinary consultation team.
Aim.  This paper is a report of a study to evaluate the impact on office hours capacity, patient satisfaction, quality of life and costs of including a nurse practitioner in a multidisciplinary consultation team for patients with hand problems caused by rheumatoid arthritis.
Background.  Over 90% of patients with rheumatoid arthritis suffer symptoms in their hand joints and may be seriously disabled in performing daily, work or leisure activities. A recent promising development in the treatment of patients with a chronic disease is the co-ordinating and accompanying role of a nurse, such as a nurse practitioner, in a multidisciplinary treatment team.
Methods.  A two successive group time-series design was adopted. The intervention group ( n  = 78) visited a clinic with a nurse practitioner assigned to the team during 2003–2004. The control group ( n  = 69) was seen before inclusion of the nurse practitioner. Office hours capacity, patient satisfaction, quality of life and costs were assessed using questionnaires directly after consulting the team, and 3 and 6 months later.
Results.  Between-group comparisons of patient satisfaction and quality of life revealed no statistically significant differences. Changes within groups over time were not demonstrable. Mean office hour capacity increased by 17% ( t  = −1·906, d.f. = 32·879, P  = 0·065). The costs for professional home care or informal care were equal in the two groups.
Conclusion.  Evaluation of clinical practice using pre- and post-test design was impeded by changes in clinical practice, which made concrete conclusions difficult to draw. In future studies the satisfaction of participating clinicians should be evaluated, in addition to that of patients.     

An interactive education session and follow-up support as a strategy to improve clinicians' goal-writing skills: a randomized controlled trial

Background  Recent research indicates that allied health clinicians have difficulty articulating client needs and priorities into specific and measurable goals. As a result, a number of strategies to facilitate improvement in allied health clinicians' goal-setting skills have been recommended in the literature. In order to assist clinicians develop the skills required to set SMART goals, it is necessary that the strategies are rigorously tested.
Aim  To determine if a 50-minute education session and 3-month email and telephone support programme improves clinicians' SMART goal-writing skill and accurately predicts improved goal-writing behaviour.
Methods  Concealed random allocation of participants ( n  = 120) into two parallel groups: (1) intervention group received education on writing goals using the SMART Goal Evaluation Method as part of a workshop on outcome measurement and received 3 months of follow-up support ( n  = 60); and (2) control group attended a workshop on evidence-based practice ( n  = 60).
Results  Education and follow-up support improved clinicians' SMART goal-writing skills at both the 3- and 6-month review (Yates χ² = 4.324, d.f. = 1, P  = 0.0375). Structural equation modelling revealed education and follow-up support is an accurate predictor of SMART goal-setting behaviour change at both 3 months (standardized regression weights = 0.21; P  = 0.014) and 6 months (standardized regression weights = 0.19; P  = 0.02) post intervention. Changes were modest and developed over a 6-month period.
Conclusion  This study provides empirical evidence that a programme of educating clinicians in a standardized method of goal setting and providing follow-up support improves allied health clinicians' SMART goal-writing skills.     

Brief Motivational Intervention to Increase Self-reported Safety Belt Use among Emergency Department Patients

Objectives:  Brief motivational interventions have shown promise in reducing harmful behaviors. The authors tested an intervention to increase safety belt use (SBU) among emergency department (ED) patients.
Methods:  From February 2006 to May 2006, the authors conducted a randomized trial of adult ED patients at a teaching hospital in Boston. ED patients were systematically sampled for self-reported SBU. Those with SBU other than "always" were asked to participate. At baseline, participants answered a 9-item series of situational SBU questions, each scored on a 5-point Likert scale. SBU was defined as a continuous variable (9-item average) and as a dichotomous variable (response of "always" across all items). Participants were randomized to an intervention or a control group. The intervention group received a 5- to 7-minute intervention, adapted from classic motivational interviewing techniques, by a trained interventionist. Participants completed a 3-month follow-up phone survey to determine changes from baseline SBU. Continuous and dichotomous SBU were analyzed via analysis of covariance and chi-square testing.
Results:  Of 432 eligible patients, 292 enrolled (mean age 35 years, standard deviation [SD] ±11 years; 61% male). At baseline, the intervention and control groups had similar mean (±SD) SBU scores (2.8 [±1.1] vs. 2.6 [±1.1], p = 0.31) and SBU prevalence (each 0%). At 3 months, 81% completed follow-up. The intervention group had significantly greater improvement in mean (±SD) SBU scores than controls (0.76 [±0.91] vs. 0.34 [±0.88], p < 0.001). Also, SBU prevalence of "always" was higher for the intervention group than controls (14.4% vs. 5.9%, p = 0.03).
Conclusions:  Participants receiving a brief motivational intervention reported higher SBU at follow-up compared to controls. An ED-based intervention may be useful to increase SBU.     

Use of a Standardized Order Set for Achieving Target Temperature in the Implementation of Therapeutic Hypothermia after Cardiac Arrest: A Feasibility Study

Objectives:  Induced hypothermia (HT) after cardiac arrest improved outcomes in randomized trials. Current post–cardiac arrest treatment guidelines advocate HT; however, utilization in practice remains low. One reported barrier to adoption is clinician concern over potential technical difficulty of HT. We hypothesized that using a standardized order set, clinicians could achieve HT target temperature in routine practice with equal or better efficiency than that observed in randomized trials.
Methods:  After a multidisciplinary HT education program, we implemented a standardized order set for HT induction and maintenance including sedation and paralysis, intravenous cold saline infusion, and an external cooling apparatus, with a target temperature range of 33–34°C. We performed a retrospective analysis of a prospectively compiled and maintained registry of cardiac arrest patients with HT attempted (intent-to-treat) over the first year of implementation. The primary outcome measures were defined a priori by extrapolating treatment arm data from the largest and most efficacious randomized trial: 1) successful achievement of target temperature for ≥85% of patients in the cohort and 2) median time from return of spontaneous circulation (ROSC) to achieving target temperature <8 hours.
Results:  Clinicians attempted HT on 23 post–cardiac arrest patients (arrest location: 78% out-of-hospital, 22% in-hospital; initial rhythm: 26% ventricular fibrillation/tachycardia, 70% pulseless electrical activity or asystole) and achieved the target temperature in 22/23 (96%) cases. Median time from ROSC to target temperature was 4.4 (interquartile range 2.8–7.2) hours. Complication rates were low.
Conclusions:  Using a standardized order set, clinicians can achieve HT target temperature in routine practice.     

The health of children with cerebral palsy and stress in their parents

Title.  The health of children with cerebral palsy and stress in their parents.
Aim.  This paper is a report of a study conducted to describe the health of children with cerebral palsy and investigate predictors of stress in their parents.
Background.  Children with severe cerebral palsy tend to have poorer health than their able-bodied peers, and their parents are more likely to be stressed and have poorer health.
Method.  A cross-sectional survey with home visits using standard questionnaires was administered to parents in 2004–05. A total of 102/199 (51%) children and parents participated. The children were compared with a normative sample.
Results.  Children with cerebral palsy had poorer physical health, and 79% of parents reported that their child had moderate to severe pain. Their poorer health, in comparison with the normal sample and measured by the Child Health Questionnaire, was related to feeding problems and seizures, general health perceptions to intellectual and feeding impairment, and family activities with severe motor, intellectual and feeding impairment. Poorer psychological well-being on the hyperactivity domain of the Strengths & Difficulties Questionnaire was related to feeding difficulties, on the prosocial domain to more severe forms of all child impairments, and on the social impairment scale to intellectual impairment. Children with psychological problems had statistically significantly increased odds (OR = 7·2, 95% CIs 2·6–20·3) of having parents with high stress.
Conclusion.  Children with cerebral palsy and associated impairments are at higher risk of poorer health and family well-being. A family-centred approach to the care of children with cerebral palsy and their families is essential to ensure both receive adequate care and support.     

Parenting with a diagnosis bipolar disorder

Title.  Parenting with a diagnosis bipolar disorder.
Aim.  This paper is a report of a study of the ways in which bipolar disorder is constructed in the DSM-IV and popular texts, and how parents who have been diagnosed as having a bipolar disorder construct their role as parent.
Background.  Research into parenting and mental illness has typically taken a deficit-based approach that focuses on the risks to children when a parent has a mental illness. Literature that considers parenting specifically in the context of bipolar disorder retains a focus on the increased risk to their children of psychopathology or psychosocial difficulties.
Method.  A critical discourse analysis was conducted using interviews with five parents who had received a diagnosis of bipolar disorder. These interviews were examined in relation to the text that constructs the diagnosis of bipolar disorder (DSM-IV) and the popular texts from which the parents drew their understandings of parenting.
Findings.  The need to monitor and moderate emotions was a dominant theme that emerged from the analysis. For these parents this also involved teaching moderation to their children and monitoring it in their children's development. The consequence of this for these parents was a heightened sense of the need for self-surveillance.
Conclusion.  The challenge for people working with parents who have been diagnosed with a bipolar disorder is to support them to feel confident in the management of their bipolar disorder and their ability to parent effectively.     

Asthma treatment needs: a comparison of patients' and health care professionals' perceptions

BACKGROUND: Patients' perceptions of asthma tend to differ from those of clinicians, who primarily focus on asthma control. Patients' treatment needs and preferences may not be adequately addressed. OBJECTIVE: The aims of this study were as follows: to provide data on unmet treatment needs and to investigate the main finding of a qualitative study using a questionnaire study. METHODS: To assess treatment needs in patients with asthma, focus groups were conducted with patients/parents and clinicians. Based on these results, quantitative surveys of adult patients and parents were performed in the United Kingdom, Germany, and Spain. RESULTS: The UK focus group comprised 11 patients and 8 parents; in Germany, there were 10 patients and 11 parents; in Spain, there were 5 patients and 8 parents. The focus groups showed some differences between clinicians' and patients'/parents' perceptions of treatment. For patients, side effects meant long-term effects (ie, 10-20 years); for clinicians, it meant occasional local problems. The quantitative study comprised 454 participants: 310 adult patients (mean [SD] age, 37.13 [13.12] years) and 142 parents (children's mean [SD] age, 13.98 [1.37] years), plus 2 nonspecified. Some patients reported good asthma control and simultaneously reported frequent exacerbations. Most patients and parents expressed a preference for a simpler regimen using fewer drugs, and most had concerns about their treatment. Although some patients concurred with treatment guidelines, 62.2% tended to rely on reliever medication (ie, bronchodilators). Additionally, 6.9% described their asthma as very well-controlled but reported experiencing asthma symptoms > or =3 days per week. Finally, 1.9% of patients and 2.1% of parents reporting very well-controlled asthma also reported visiting the emergency department or calling a physician for a home visit in the previous 3 months. CONCLUSIONS: Asthma patients and parents of asthmatic children had unmet treatment needs and may interpret medical terminology differently than clinicians.     

Integrated health programme: a workplace randomized controlled trial

Title.  Integrated health programme: a workplace randomized controlled trial.
Aim.  This paper is the report of a pilot study to assess if an Integrated Health Programme would reduce sick leave and subjective health complaints, and increase coping in a population of nursing personnel.
Background.  The work group in Norway with most sick leave is healthcare workers. More than 50% of the sick leave is because of subjective health complaints. Work place physical exercise interventions have a documented positive effect on sick leave.
Method.  After baseline screening, employees who had agreed to participate ( n  = 40) were randomized to an intervention or control group. The intervention group participated in an Integrated Health Programme twice weekly during working hours. The programme consisted of physical exercise, stress management training, health information and an examination of the participants' workplace. The control group was offered the same intervention after the project was finished. This study was carried out from 2001 to 2002.
Findings.  There were no statistically significant effects on sick leave or health-related quality of life. The intervention group reported fewer neck complaints compared to the control group, but otherwise there were no effects on subjective health complaints. However, the subjective effects were large and highly statistically significant, the intervention group reporting improvement in health, physical fitness, muscle pain, stress management, maintenance of health and work situation.
Conclusion.  The Integrated Health Programme was not effective in reducing sick leave and subjective health complaints, but may be of use to employers wanting to increase employee job satisfaction and well-being.     

Health-related self-assessed quality of life in young people at a Youth Centre in Sweden

Objective:  To study the self-reported health of young people visiting a Youth Centre (YC) at a University hospital, describe possible gender differences and to compare the results with those in previous Swedish reports on similar age groups using the same instrument.
Design:  All young people who visited a YC at a particular, randomly chosen time, were verbally asked to fill out a questionnaire, Short Form 36. The interviews were conducted during a 12-month period to lessen the impact of seasonal variations.
Setting:  A YC at the department for obstetrics and gynaecology, Uppsala University hospital.
Participants:  A total of 1495 young people aged 14–25 years who visited the YC.
Results:  The study population (n = 1495). Response rate was 96%. This population reported lower overall scores compared with the normative Swedish population from 1992. Further, females scored significantly lower than males on all subscales (p < 0.001), except for 'Physical Functioning'. The lowest scores were reported for the subscales Vitality, Role Emotional and Mental Health.
Conclusion:  This study describes physical functioning and mental health among young people visiting a YC. The results indicate a worsening of the perceived physical and MH in young individuals, especially in young women. Further studies are needed to monitor changes in MH and quality of life over time in this group and assess the effects of interventions. This study enhances the importance of a holistic approach towards health and health promotion comprising both physical and mental health issues.     

Attitudes of nurse professionals and nursing students towards children with disabilities. Do nurses really overcome children's physical and mental handicaps?

Background:  Many health professionals and nurses, who are involved in the care of disabled children, do not exhibit the essential sensitivity and appropriate attitudes towards them, resulting in a poor quality of nursing care.
Aim:  The objective of this study was to investigate the attitudes of nurse professionals (paediatric nurses) and nursing students towards disabled children.
Patients and methods:  The present study is a comparative study. The sample consisted of 228 first-year nursing students, 90 post-diploma nurses attending MSc degree course and 123 nurse professionals who are employed in paediatric hospitals. After obtaining permission from the hospitals and the educational settings and informing about the subjects of the study, data were collected using the paediatric Attitude Towards Disabled Person Scale (ATDP).
Results:  Overall nurses' attitudes appeared to be poor (mean ATDP score 61.7 ± 14.2). However, the post-diploma nurses had significantly higher ATDP scores than first-year students and paediatric nurses ( P  < 0.001). In addition, first-year students had significantly higher scores than paediatric nurses ( P  = 0.047). Across the sample, females hold significantly more positive attitudes than males ( F  = 9.5, P  = 0.002), while age did not have any significant effect.
Conclusions:  Carefully designed curricula can influence the attitudes of nursing students towards children with disabilities. Special courses for treating disabled children should be integrated to the basic nursing studies. Moreover, continuing hospital education can change paediatric nurses' attitudes towards children with disabilities.     

Barriers to nurse/nursing aide communication: the search for collegiality in a southeast Ohio nursing home

Aim  The aims of this study were: (1) to identify barriers to nurse/nursing aide communication and to discuss and provide solutions to some of these problems through a focus group; and (2) to determine the effectiveness of this focus group on job satisfaction-related outcomes.
Background  Numerous studies have attributed problems with nurse staffing and turnover to faulty communication between nursing supervisors and nursing aides.
Methods  Registered nurses (RNs) ( n  = 2), licensed practical nurses (LPNs) ( n  = 10) and nursing aides ( n  = 19) were interviewed; narrative themes from the interviews were then used to guide focus group discussions. A job satisfaction survey in a pre-test/post-test fashion was used to test the efficacy of the focus group.
Results  Qualitative data from the interviews highlighted: (1) anger and condescension in communication; and (2) lack of mentoring, empathy and respect. The job satisfaction survey data showed that the attitudes decreased significantly among participants in the focus group but not in the control group ( P  < 0.05).
Conclusion  Nurse supervisors, both RN and LPN, are key to educational reform and must be taught collegial methods when delegating authority.
Implications for nursing management  Findings from this study can be used to develop a multidisciplinary educational tool to foster communication and collegiality, thereby reducing job turnover in nursing homes.     

Efficacy of a self-management education program for people with type 2 diabetes: Results of a 12 month trial

Aim:  Patient education that enhances one's self-management ability is of utmost importance for improving patient outcomes in chronic diseases. We developed a 12 month self-management education program for type 2 diabetes, based on a previous 6 month program, and examined its efficacy.
Methods:  A randomized controlled trial was carried out on outpatients with type 2 diabetes from two hospitals who met the criteria and gave consent to participate. They were randomly divided into an intervention group that followed the program and a control group that followed usual clinical practise. The intervention group received <30 min of monthly interviews based on the program's textbook and biweekly telephone calls from a nurse educator throughout the 12 months.
Results:  Of the 50 participants in the intervention group and the 25 participants in the control group, 42 and 23, respectively, completed the program (a completion rate of 84.0%). The body weight, HbA1c, self-efficacy, dietary and exercise stages, quality of life, diastolic blood pressure, and total cholesterol level were significant by two-way repeated-measures anova . As for changes over time within the groups, only the intervention group showed significant differences by Friedman's test. The complication prevention behaviors showed a high implementation rate in the intervention group. The overall evaluation of this program by the participants was very high and, therefore, they highly recognized the need for this type of program.
Conclusions:  Self-management education works successfully in relation to patients' behavior modification skills, degree of goal attainment, and self-efficacy, consequently improving their health outcomes.