Employment Experiences,Perspectives, and Wishes of Mothers of Children with Autism in the People’s Republic of China

Background The purpose of this study was to examine the experiences with and meaning of employment in the lives of mothers of children with autism in China. Materials and Methods This research used qualitative methods including open‐ended questionnaires and semi‐structured interviews with mothers of children with autism participating in an intervention program in Beijing. Results Mothers find employment outside the home appealing, but they also see their role of mother as requiring being responsible and often making sacrifices. Conclusions Mothers in this study make sacrifices in their own lives, including employment, in order to promote and provide intervention for their children with autism. These families had fewer services available to them than in many developed Western countries, and most services are at a cost to the parents. Considerations that Chinese mothers of children with autism make regarding their own employment situation are unique.     

Validation of cutaneous stimulation interventions for pain management

The purpose of this study was to identify and validate specific activities considered important in the implementation of selected cutaneous stimulation pain management interventions including heat and cold application, massage and Transcutaneous Electrical Nerve Stimulation (TENS). A two-round Delphi survey was completed by nurses selected for their expertise in pain management. Data were analyzed using a modification of Fehring's diagnostic content validity method. Consistently high scores were obtained by the raters for each intervention and activity, with most activities perceived as critical to the intervention. From this process, a list of activities for each cutaneous stimulation intervention evolved that are applicable to education, clinical practice and clinical nursing research.     

Recruitment of older women: lessons learned from the Baltimore Hip Studies

OBJECTIVES: This study used a qualitative approach in which participants were asked to write about their experiences in recruiting older women into either one of two exercise intervention studies that are part of the Baltimore Hip Studies. The sample included 8 researcher nurses all women, White, and 42-53 years of age. BACKGROUND: Older adults, particularly older women, are less likely to participate in research studies when compared to their younger counterparts. The purpose of this study was to explore the techniques successfully used by research nurses in the Baltimore Hip Studies to recruit older women after hip fracture into exercise intervention studies. METHOD: Data analysis was performed using basic content analysis (Crabtree & Miller, 1992; Miles & Huberman, 1984) "in vivo" coding (Dowd, 1991), or "grounded" coding (Glaser & Strauss, 1967), which involves using the informants' own words to capture a particular idea. RESULTS: A total of 16 codes were identified and reduced to nine themes. Seven themes focused on techniques that facilitated recruitment: (a) caring for individuals; (b) emphasizing benefits; (c) eliciting support from others; (d) being an expert; (e) using role models; (f) using good timing; and (g) giving good first impressions. The remaining two themes identified barriers to recruitment: (a) time commitment and (b) lack of support. DISCUSSION: Based on these themes, specific recruitment techniques are recommended. Ongoing research, however, is needed to establish the most effective recruitment procedures with older women.     

Using feedback to reduce students' judgment bias on test questions

Judgment bias represents a common tendency of people to inaccurately gauge the extent of their own knowledge. While research has shown that people tend to overestimate their knowledge on hard questions and underestimate their knowledge on easy questions, overconfidence poses a more pernicious problem from an educational perspective since it can undermine students' ability to monitor their own learning effectively and interfere with their test performance. The findings of the present study show that students who perform poorly on a test are more overconfident about their answers to hard test questions, especially those they answer wrongly, than are students who perform better. The results also show that judgment bias can be reduced by providing feedback to students about their prior performance and confidence on specific test questions. This intervention was found to be effective in decreasing both underconfidence on easy questions and overconfidence on hard questions regardless of students' performance level.     

Implementing the Food and Drug Administration's Final Rule for Waiver of Informed Consent in Certain Emergency Research Circumstances

In 1996, the Food and Drug Administration released its Final Rule for Waiver of Informed Consent in Certain Emergency Research Circumstances (the Final Rule). The Department of Health and Human Services (DHHS) also released an update of its regulations related to waiver of informed consent in emergency research. These new regulations allow resuscitation research to proceed with a waiver of informed consent under very narrow and specific clinical research circumstances. Waiving informed consent for research participation has profound ethical and scientific implications. However, in unpredictable life-threatening clinical situations for which current therapy is unproven or unsatisfactory, patients usually are unable to consent on their own behalf to participate in clinical trials of potentially beneficial but experimental interventions. Because of the time-dependent nature of most resuscitation interventions, it is usually not feasible to identify and contact the legally authorized representative who can speak on behalf of the patient within the presumed therapeutic window of the intervention under investigation. For such clinical trials to proceed, a waiver of informed consent is usually necessary. Patients who are critically ill or injured and unable to provide meaningful prospective informed consent because of their current life-threatening condition are vulnerable and require additional protections beyond those for research subjects who can speak on their own behalf. The Final Rule and the DHHS-updated regulations incorporate a number of additional patient safeguards that must occur if a clinical trial is to proceed with waiver of informed consent. Specific means of adequately meeting these requirements are not described in the regulations. Although this was intentional on the part of the federal regulators so that individual protocols and research environments would direct the development of these patient safeguards, the lack of specific guidance has led to confusion on the appropriate implementation of the new regulations. This article reviews some of the key concepts of the Final Rule, with suggestions on their purpose and meaning. It also reviews the studies that have been approved to date to proceed with waiver of informed consent, and offers suggestions for the process of implementing the requirements of the Final Rule for research involving patients who are unable to give prospective informed consent.     

Implementation and effects of an individual stress management intervention for family caregivers of an elderly relative living at home: a mixed research design

The purpose of this project was to evaluate the implementation and effects of a stress management intervention for family caregivers of elderly persons. The intervention was implemented through an action research design with the collaboration of case managers working in community health centers. A total of 81 caregivers participated in the study. The quasi-experimental design used to test the effects of the intervention showed significant effects on perceived challenge associated with caregiver role, control by self, use of social support, and use of problem solving. Qualitative data demonstrate caregiver empowerment with respect to the caregiving role. This study illustrates the relevance of using a mixed research design in order to provide evidence for changes in practice.     

Action research from the inside: issues and challenges in doing action research in your own hospital

BACKGROUND AND RATIONALE: Nurses are increasingly engaging in action research projects to improve aspects of nursing practice, education and management and contribute to the development of the profession. Action research involves opportunistic planned interventions in real time situations and a study of those interventions as they occur, which in turn informs further interventions. Insider action research has its own dynamics which distinguish it from an external action researcher approach. The nurse-researchers are normally already immersed in the organization and have a pre-understanding from being an actor in the processes being studied. There is a paucity of literature on the challenges that face nurse action researchers on doing action research in their own hospital. AIM: The aim of this article is to address this paucity by exploring the nature of the challenges which face nurse action researchers. Challenges facing such nurse-researchers are that they frequently need to combine their action research role with their regular organizational roles and this role duality can create the potential for role ambiguity and conflict. They need to manage the political dynamics which involve balancing the hospital's formal justification of what it wants in the project with their own tactical personal justification for the project. MAIN ISSUES: Nurse-researchers' pre-understanding, organizational role and ability to manage hospital politics play an important role in the political process of framing and selecting their action research project. In order that the action research project contribute to the organization's learning, nurse action researchers engages in interlevel processes engaging individuals, teams, the interdepartmental group and the organization in processes of learning and change. CONCLUSIONS: Consideration of these challenges enables nurse-action researchers to grasp the opportunities such research projects afford for personal learning, organizational learning and contribution to knowledge.     

Effect of purposeful action observation on upper extremity function in stroke patients

[Purpose] The purpose of this study was to identify the effect of purposeful action observation on upper extremity function in patients with stroke. [Subjects and Methods] Twelve subjects were randomly to either the experimental group or control group. The experimental group underwent occupational therapy and a purposeful action observation program. The control group underwent occupational therapy and placebo treatment in which the subjects performed a purposeful action observation program without actually observing the purposeful actions. The Wolf Motor Function Test was used to measure upper extremity function before and after the intervention in both groups. [Results] Both the experimental and control groups demonstrated improved upper extremity function after the intervention, but there was no significant difference between groups. Compared with before the intervention, the experimental group showed significantly improved upper extremity function after the intervention. [Conclusion] Based on these results, a purposeful action observation program can improve upper extremity function in patients with stroke. In future research, more subjects should be included for evaluation of different treatments.Key words: Purposeful action observation, Stroke, Upper extremity function     

Life situation of aged home-nursing clients

We describe the life situation of elderly Finnish home-nursing clients (N = 50) on the basis of their own experiences and opinions of need-satisfaction. The purpose of the study, which was carried out as part of a nursing development project in the form of action research, was to gain a deeper understanding of the satisfaction of human needs and problems of need-satisfaction in aged people and on this basis to develop forms of nursing that support self-care. The data were collected using a semistructured questionnaire, which was designed primarily on the basis of the need theories of Yura and Walsh and Orem. The specific areas of inquiry included the clients' experiences of need-satisfaction in the promotion of physical health, emotional life, relations of communality, personal growth and development, and spiritual life. Overall the aged clients were relatively satisfied. However, in certain areas there were also unmet needs, notably in getting adequate nutrition, rest, and sleep, as well as in secretory activity. In addition, it seemed that loneliness caused considerable anxiety to the elderly home-nursing clients.     

Designing nursing interventions

The development of nursing interventions that demonstrate the link between nursing actions and patient outcomes is a high priority for nursing research. The development of intervention research frequently focuses on the methods used to test the intervention while less attention is placed on rigor in intervention development and design. The purpose of this paper is to provide thinking points for researchers considering the development of nursing interventions. The thinking points were developed from the limited literature on this topic in synthesis with the authors own experiences of designing nursing interventions. Adoption of a systematic approach to intervention testing is advocated along with a step-wise intervention development process. This process calls for attention to problem definition, conceptual underpinnings, desired outcomes and measures and evidence-based content along with careful consideration of delivery methods, dose and attention to protecting the integrity of the intervention during testing. The approach advocated will help to ensure that nursing intervention research makes a useful contribution to the development of nursing practice.     

Ethical implications of pain management in a nursing home: a discussion

Pain is the most frequently communicated complaint among elderly people. Discussion of the ethics of pain management in nursing home residents has not appeared in the literature. The purpose of this article is to present an ethically-based pain management action plan for elderly nursing home residents. Nurses empowered with the latest information and cognizant and comfortable with their own views about pain are likely to effectuate a positive patient outcome. Further research will add to the current knowledge base while laying the groundwork for new interventions.     

Nurses' reflections on pain management in a nursing home setting.

Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.     

Effects of peer review on communication skills and learning motivation among nursing students

The purpose of this study was to investigate the effects of video-based peer review on communication skills and learning motivation among nursing students. A non-equivalent control with pretest-posttest design was used. The participants were 47 sophomore nursing students taking a fundamentals of nursing course at a nursing college in Korea. Communication with a standardized patient was videotaped for evaluation. The intervention group used peer reviews to evaluate the videotaped performance; a small group of four students watched the videotape of each student and then provided feedback. The control group assessed themselves alone after watching their own videos. Communication skills and learning motivation were measured. The intervention group showed significantly higher communication skills and learning motivation after the intervention than did the control group. The findings suggest that peer review is an effective learning method for nursing students to improve their communication skills and increase their motivation to learn.     

Qualitative evaluation of a stress management intervention for elderly caregivers at home: a constructivist approach

The purpose of this project was to evaluate, using a constructivist qualitative design, an individual stress management intervention based on a stress-coping model and intended for family caregivers of elderly persons within the current context of the shift to ambulatory care. This nursing intervention comprised seven weekly encounters with caregivers following their elderly family member's discharge from hospital and a follow-up visit one month after. The aim of the qualitative evaluation was to document the feasibility and acceptability of the content of the intervention, its relevance in terms of process and structure, and the benefits to the principal stakeholders. This action research project was a case study of four participants. The assessment instruments included an intervention analysis grid, a diary, and a semistructured interview guide with the participants. Data analysis drew on Guba and Lincoln's (1989) method which made it possible to refine the intervention. Results underscored that certain implementation conditions must be respected in order to ensure the intervention's acceptability and feasibility. Above all, it must remain flexible and the nurse must possess the requisite clinical skills and theoretical knowledge. It is important also to screen judiciously for caregivers likely to benefit from the intervention. The pertinence of using a circular intervention model rather than a linear approach to stress management was highlighted as well.     

An educational intervention as decision support for menopausal women

The purpose of this study was to develop and test a decision support intervention (DSI) to assist women to make and act on informed decisions that are consistent with their values in the area of menopause and hormone replacement therapy (HRT). Mode and intensity of intervention were tested in midlife women (N 5 248), randomly assigned to one of three intervention formats: written information only, guided discussion, or personalized decision exercise. Data were collected over 12 months. Knowledge, decisional conflict, satisfaction with health care provider, and self-efficacy improved following intervention and were maintained for 12 months for all groups. Women's adherence to their own plans over 12 months was 59% (exercise), 76% (calcium intake), and 89% (HRT). Carefully written information is effective in promoting knowledge, adherence, and satisfaction among well-educated, interested women. It was concluded that women can understand complex information, including tradeoffs regarding treatment options. Women will adhere to their own plans, suggesting that consumer rather than provider plans may be the more appropriate gold standard for measuring adherence. © 1997 John Wiley & Sons, Inc. Res Nurs Health 20: 377–387, 1997     

Cognitive-behavioral techniques to reduce pain: a validation study

The purpose of this study was to identify and validate specific activities considered important in the implementation of three non-pharmacologic pain management interventions—relaxation, distraction and guided imagery. Using a two-round Delphi survey, nurses selected for their expertise in pain management were asked to validate definitions and activities considered important in the implementation of each of these strategies. Data were analyzed using a modification of Fehring's diagnostic content validity method. From this process, a list of activities for each intervention evolved that has implications for nursing research, practice and education.     

Self-reported health-promoting behaviors of black and white caregivers

The purpose of this study was to describe the behaviors that caregivers report carrying out to maintain their own health, and to compare the health-promoting behaviors of Black and White caregivers. Although many studies have examined health-promoting behaviors, few have examined health promotion among caregivers. Reported studies of caregivers' health-promoting behaviors have not compared cultural groups. The sample for this study was selected by random digit dialing, and included 136 Black and 257 White caregivers of frail elders. Content analysis of respondents' answers to the open-ended question, "In general, what do you do to stay healthy?" was used to address the research questions. Most caregivers reported specific behaviors they engaged in for the purpose of staying healthy. Although most of their behaviors addressed physical health, caregivers also mentioned behaviors that contribute to mental and spiritual health. Both differences and similarities were found in Black and White caregivers' self-reported health behaviors, which have important implications for nursing practice and research in the future.     

A Creative Writing Program to Enhance Self-Esteem and Self-Efficacy in Adolescents

PURPOSE: To describe the rationale, content, and results of a group creative writing program to increase adolescent self-esteem and self-efficacy. METHODS: Subjects were low-income, at-risk minority youth (N = 11). Free writing in response to specific exercises, sharing their own stories in their own language, and responding to their peers were used daily for 2 weeks as part of the high school English class. The program was oriented toward health rather than problems, with the content created by the adolescents. FINDINGS: The opportunity to tell their own story, in their own language in a safe, structured setting with positive feedback led to higher self-efficacy and self-esteem. CONCLUSIONS: This study suggests that a writing intervention focused on building self-in-relation self-esteem and the four aspects of self-efficacy resulted in increased sense of well-being.     

Chronic illness: reflections on a community-based action research programme

AIM: The purpose of this paper is to describe the birth of a research culture in a community nursing service, and the development and implementation of an action research programme that focuses on understanding the experiences of living with chronic illness. BACKGROUND: Approximately 70% of the clients of our community nursing practice in South Australia live with chronic illness. Our research interest has focused on how community nurses can assist people living with chronic conditions to live 'well'. In this paper we describe the way in which we have applied the principles of participatory action research (PAR) when working with women who live with multiple sclerosis (MS) and urinary incontinence. We then draw on elements of PAR research with men who live with MS and men and women who live with type 2 diabetes. In total, we have convened eight PAR groups researching with people who live in the community with chronic illness and this work constitutes our chronic illness research programme. DESIGN: The PAR philosophy is based on the principles of democratic, equitable, liberating and life enhancing relations within a research process, and is operationalized in cycles of: look, think and act. In these collaborative inquiries the researchers have facilitated participants to reflect on how illness affects their lives, to tell their own story, make connections, plan action and help them negotiate the rites of passage. We select two areas for discussion: methodological issues in the application of PAR principles and our tentative findings from the chronic illness research programme. FINDINGS: We assert that the facilitator's skill in managing group dynamics is crucial to the life and outcome of the project. Change can occur as a result of action at an individual level, with improved self-management of chronic illness, or at a collective level where the PAR group instigates larger reform strategies. In terms of tentative findings, men and women living with a chronic illness appear to be involved in an ongoing process of transition toward incorporating the illness into their lives. Although we have not yet identified specific events, we have noted that there are critical turning points in the illness transition experience. Participants feel validated in telling their story of living with a chronic illness. Story telling may be the turning point that enhances the lives of all those who participate. CONCLUSION: If health care professionals can understand the process that facilitates people to move toward incorporating chronic illness into their lives, we can make a substantial contribution to enhance their chronic disease self care management.     

A home rehabilitation program for stroke patients

The purpose of this study was to develop a rehabilitation program wherein the stroke team, patient and family act as partners in the rehabilitation process initially at hospital and subsequently on discharge for 4 weeks in the stroke patient's home. The study attempted to address the stroke patient's functional ability and life satisfaction from a holistic viewpoint. A quasi-experimental design was used. Thirty-two stroke patients participated in the intervention group and nine in the control group. The intervention group improved in functional ability after 4 weeks at home. They also participated in activities and were generally more active than the control group. Ninety percent of the families in the intervention group experienced high life satisfaction levels after the training period. However this satisfaction decreased after 6 months, and one year post-stroke, the patient and family's life satisfaction levels increased once more. It is likely that being given the opportunity to make one's own decisions, to be more active and motivated led to improvements in patients' daily life functions as they were able to carry out their preferred activities in the comfort of their own home. The program shortened the admission time for the intervention group by one-third.