Existing population-based health databases: useful resources for nursing research

Important research questions, such as the prevalence of health conditions in specific groups and health disparities, can be addressed through population-based health databases. Government-funded, federal databases can provide nurse researchers with a representative sample for various levels of analyses. Population-based health databases easily accessed from federal government Web sites for analysis are identified and discussed. These databases, such as the National Health Interview Survey and the National Sample Survey of Registered Nurses, were collected through rigorous probability sampling and data collection methods and can be generalized to the population of the study. The benefits and limitations of analyzing the databases as a research approach are summarized, using examples from the recently released National Survey of Children's Health. Findings from population-based studies provide significant information on health-related indicators and contribute to the development of sound recommendations for health care practice and policy, thereby supporting evidence-based practice. Analyses of population-based databases provide additional opportunities for nurse researchers to contribute to health policy and evidence-based practice within a framework of nursing-health services research.     

Predicting discharge of trauma survivors to rehabilitation: a sampling frame solution for a population-based trauma-rehabilitation survey

OBJECTIVES: To conduct a population-based survey among trauma survivors on accessibility to rehabilitation services in metropolitan, urban, and rural areas in Quebec (Canada), we attempted to use trauma registries as a sampling frame of subjects discharged to rehabilitation. Discharge destinations were inaccurate in many registries, preventing straightforward identification of the survey subjects. Using the best registry data, we aimed to identify predictors of rehabilitation discharge and to use them to specify a reliable sampling frame for the survey. DESIGN: A logistic predictive model of rehabilitation discharge was developed. This model was applied to data from metropolitan, urban, and rural trauma centers to identify all subjects predicted to be discharged to a rehabilitation facility. RESULTS: Age, acute-care length of stay, injury-severity score, lower-limb injuries, and seven other predictors were included in the model that generated an area under the ROC curve (AUC) of 0.83 and a classification accuracy of 76.6%. The metropolitan, urban, and rural frames were slightly different. They included, respectively, 808, 798, and 929 subjects. CONCLUSIONS: The procedure helped us bypass largely inaccurate data from trauma registries. The sampling frames reflected severely injured trauma survivors who were likely to have been referred to postacute rehabilitation.     

Creating a language for 'spiritual pain' through research: a beginning

The findings presented in this discussion seek to make a contribution to fostering an appreciation of the importance of research on spirituality, a previously neglected dimension of health care. Qualitative research methodology based on open-ended interviews with 12 survivors of haematological malignancies was used. The interviews were transcribed verbatim and thematically analysed using the NUD*IST computer package. The preliminary findings from the study indicate a need for the development of a new language for articulating spirituality. The present discussion is an introductory attempt to begin to explore the notion of, and language for, the idea of 'spiritual pain'. The findings indicate that individuals need a strong sense of meaning-making and connection with life to be able to deal with the demands of aggressive, invasive treatments. Such a connection can be threatened by a break with the normal or expected relationships and satisfaction with life through physical, identity, relational and existential challenges and losses. When the disconnection is acutely painful (a subjective phenomenon depending on the individual) it then is experienced as spiritual pain, creating a void that challenges the individual's ability to derive any meaning from their existence. This study is seen as preliminary work, the first step in a series of articles aimed at beginning to develop, through research, a language of spiritual care.     

Creating staff confidence in distinguishing between performance improvement and research studies: a user-friendly worksheet

In an era when emphasis is placed on implementing quality improvement and research initiatives promoting quality patient care, confusion often exists about the differences between research and performance improvement. The authors discuss the construction of a performance improvement/research differentiation form, a decision-making tool designed to assist nurses distinguish between these processes and inform them about the regulatory requirements to protect the rights and interests of patients.     

Creating a novel structure for nursing research in a cooperative clinical trials group: the Children's Oncology Group experience

OBJECTIVE: To describe a novel structure designed to integrate nursing research into the Children's Oncology Group (COG). DATA SOURCES: Review articles, reports, and newsleters. CONCLUSION: A new structure using nurse researcher-advanced practice nurse dyads has succesfully integrated nurse researchers into COG scientific activity, as evidenced by the development of concept proposals, companion protocols, nursing objectives in therapeutic trials, and nurse-led publications. IMPLICATIONS FOR NURSING PRACTICE: This provides a promising method for integrating nurse researchers and increasing multidisciplinary research collaboration in cooperative oncology group.     

Management of Chronic Multisymptom Illness: Synopsis of the 2021 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline

In 2019, senior leaders within the US Department of Veterans Affairs and the US Department of Defense commissioned the update of a clinical practice guideline for managing chronic multisymptom illness. Clinical experts were assembled across both agencies to systematically review evidence and to develop treatment recommendations based on that evidence. This effort resulted in the development of 29 evidence-based recommendations for providing care for individuals with chronic multisymptom illness.     

Using VA data for research in persons with spinal cord injuries and disorders: lessons from SCI QUERI

The Department of Veterans Affairs (VA) provides integrated services to more than 25,000 veterans with spinal cord injuries and disorders (SCI/D). VA data offer great potential for providing insights into healthcare utilization and morbidity, and these capabilities are central to efforts to improve healthcare for veterans with SCI/D. The objective of this article is to introduce researchers to the use of VA data to examine questions related to SCI/D using examples from Spinal Cord Injury (SCI) Quality Enhancement Research Initiative studies. Sources of VA data available to investigators interested in SCI/D-related research include national-level VA administrative and clinical databases and primary data (medical record review, patient surveys). Methods used to identify veterans with SCI/D include the Allocation Resource Center cohort, the Spinal Cord Dysfunction (SCD) Registry, and the VA inpatient SCI flag; only 33% of veterans were included in all three groups (n = 12,306). While neurological level of SCI was unknown for approximately a third of veterans (from SCD Registry data alone), the percent decreased to 13% when augmented with diagnostic codes. Primary data can be used to augment other missing SCI data and to provide more detailed information about complications commonly associated with SCI/D.     

Issues in defining and measuring veteran community reintegration: proceedings of the Working Group on Community Reintegration, VA Rehabilitation Outcomes Conference, Miami, Florida

In January 2010, the Department of Veterans Affairs (VA) Rehabilitation Research and Development Service convened a State of the Art (SOTA) conference to advance the field of outcome measurement for rehabilitation-related studies. This article reports on the proceedings of the SOTA Working Group on Community Reintegration. We explored the use of the International Classification of Health, Disability, and Functioning as a theoretical framework for measuring community reintegration; identified key dimensions of community reintegration that could and/or should be measured; discussed challenges in measuring community reintegration; suggested steps to enhance community reintegration measurement; proposed future research that focuses on outcomes measures for community reintegration and the study of community reintegration outcomes; and made policy recommendations that would facilitate community reintegration research within the VA.     

Los Alamos hepatitis C virus sequence and human immunology databases: an expanding resource for antiviral research

The hepatitis C virus (HCV) resource at Los Alamos (hcv.lanl.gov) provides access to multiple databases: one containing annotated sequences and the other a repository of immunogenic epitopes. They are derived from databases originally developed for HIV research (hiv.lanl.gov). HCV and HIV are RNA viruses with relatively compact genomes (around 10 kb) that are extraordinarily variable, both within and between hosts. This diversity requires methods to track and exclude variants from an individual infection or from epidemiologically related infections, and tools to analyse the variation. The HCV immunology database contains a curated inventory of immunogenic epitopes and information about their interaction with the host immune system, with associated retrieval and analysis tools. This interactive resource provides flexible retrieval tools for sequences, epitopes, clinical information, and meta-data, as well as utilities for scientific data analysis, to investigators with internet access and a web browser. This paper describes the types of data and the services that these databases offer, the tools they provide, and their configuration and use. Examples of applications to clonal analysis for drug-resistance mutations are shown.     

Issues to consider when choosing and using large national databases for research of families

Secondary analysis of large national databases offers promise for research of families. In this article, issues that the secondary analyst must consider when choosing a database for research of families are described. Potential advantages and limitations of databases are discussed. Strategies to minimize potential limitations are highlighted.     

The Department of Veterans Affairs pre- and post-doctoral nurse fellowships: diverse opportunities for research

The purpose of this article is to explicate research funding and training opportunities available through the Department of Veterans Affairs to nurses seeking advanced preparation at the pre- and post-doctoral levels. A brief discussion of the available resources including student stipend and health insurance, workspace, and research support is presented. Additionally, articulation of the benefits and challenges associated with these types of fellowships is delineated from the perspective of a fellow, Department of Veterans Affairs (VA) site preceptor, and dissertation faculty. Discussion of the post-doctoral fellowship and the extensive resources of the VA related to overall research career development are also addressed.