Improving practice and informing policy development: The impact of gerontological nursing research

Nurses have always approached the clinical care challenges they encounter with a combination of critical observation and a profound concern for human suffering. Beginning in earnest in the early 1980s, nurse researchers have pursued the answers to questions about the wellbeing of older adults, particularly those suffering from serious, chronic conditions. This paper offers three exemplars of nursing research domains that illustrate the creativity and commitment of nurse researchers seeking to understand and improve pervasive clinical problems experienced by older adults and to demonstrate the profound influence these activities have had on the evolution of the science and the quality of care for older adults. The impact of this work is reflected in practice protocols, institutional policies, government oversight, and improved outcomes for patients.     

Clinical nursing research priorities in Australian critical care: a pilot study

The aims of this research project were to identify areas for research in Australian critical care nursing with potential for improvement in patient care, and to advise nursing research policy and priorities with relevance to areas of patients'needs Research participants represented a national sample of clinical nurse specialists (CNSs) and clinical nurse consultants (CNCs) The Delphi method was used to obtain the most reliable consensus of the specialist nurses, and over 238 research priorities were identified initially In the final phase of the research nine high priorities were identified The findings of this study suggest directions for clinical nursing research in critical care     

Magnetic resonance imaging technology in transtibial socket research: a pilot study

Investigations into the shape and volume of transtibial prosthetic sockets are complicated because of the difficulty in establishing an accurate reference grid. Magnetic resonance imaging (MRI) presents a possible solution to this problem. However, the reliability of MRI in defining the residual-limb/cast interface depends on the scanned image not being distorted by the materials present. We investigated the potential of MRI technology to establish the desired reference grid. Distortion from the so-called "chemical shift" may influence the MRI when certain materials are used during the casting process. These materials include plaster of paris (POP) and silicone (in the form of an interface liner). POP is commonly used to capture the shape of the residual limb. However, if the casting technique requires the use of a silicone liner, the liner is placed over the residual limb first and then the POP is applied over the liner. Experimental results indicate that the materials used do not distort or interfere with the scanned image. The object segmentation process that extracts the bone and skin from an MRI scan and enables the establishment of the required reference grid was explored. Results show that extracting the bone structure and using it as the reference grid to quantify the differences in volume and shape of the soft tissues of the residual limb is feasible.     

Life support decisions for extremely premature infants: report of a pilot study

The purpose of this pilot study was to describe decision making and the decision support needs of parents, physicians, and nurses regarding life support decisions made over time prenatally and postnatally for extremely premature infants. Using the collective case study method, one prenatal, one postnatal, and one postdeath, if the infant had died, tape-recorded interviews were conducted with each parent. With parents' permission, prenatal interviews were done with the physicians and nurses who talked to them about life support decisions for their infants. Twenty-five tape-recorded interviews were conducted with six cases (six mothers, two fathers, six physicians, and two nurses). Hospital records were reviewed for documentation of life support decisions. Results of this pilot study demonstrated that most parents wanted a model of shared decision making and perceived that they were informed and involved in making decisions. Parents felt that to be involved in decision making they needed information and recommendations from physicians. Parents also stressed the importance of encouragement and hope. In contrast, physicians informed parents but most physicians felt that parents were the decision makers. Physicians used parameters to offer options or involve parents in decisions and became very directive at certain gestational ages. Nurses reported that they believed that parents needed information from the physician first, then they would reinforce information. The results of this study offer an initial understanding of the decision support needs of parents.     

Behavioral management of childhood headache: a pilot study and case history report

Many chronically recurrent disorders of children and adolescents are often unresponsive to standard medical therapy. The Stress and Headache Management Clinic was established as a prototype behavioral medicine clinic to provide integrated therapeutic modalities. Using biofeedback and relaxation/mental-imagery techniques, 119 patients with the chief complaint of recurrent headache were evaluated. This paper describes the use, application, and efficacy of behavioral techniques for the management of headache in children and adolescents. Relevant treatment factors in behavioral treatment of pediatric headache are also discussed.     

Glycosylated hemoglobin monitoring of diabetic patients: a pilot study and case report

Fasting and post-prandial blood glucose values have been found to be not totally representative of daily mean blood glucose concentration. Glycosylated hemoglobin (HbA1c) can be used as a supplemental monitoring device in the management and control of the diabetic patient. A pilot study on HbA1c was performed on a severe insulin dependent diabetic who had fasting glucose levels of 200-400 mg/dl over a six month period. The experimental data indicates that for every 10 mg/dl increase in glucose level, there is a corresponding increase in HbA1c of about .35%. Rate of formation of HbA1c depends on blood glucose concentration and is a slow continuous non-enzymatic process occurring during the normal 120 life span of the red blood cell. As such, it can be a useful monitoring tool.     

The self-management of psychiatric medications: a pilot study

The self-management of psychiatric medications: a pilot study This paper reports on a pilot study where a scheme for the self-management of medication has been devised as an intervention strategy, where the mental health nurse and the mentally ill client work together to improve the client's knowledge of prescribed medication and medication-related issues. Aspects of non-compliance and the various factors involved in the non-compliance of psychiatric medications by the person who is severely mentally ill are discussed. When noncompliance to psychiatric medication is briefly examined, the complexity of the phenomena becomes increasingly apparent, confounding single intervention strategies, therefore as the phenomena is multidimensional, so must be any response. A review of the literature, and from the past clinical experience of the authors, suggests that when there is an involved therapeutic alliance, and the active participation of both the client and the mental health nurse in a rehabilitation orientated self-medication management scheme, a difference can occur for the client where their understanding of, and compliance with, psychiatric medication can improve. This could possibly improve the overall quality of life for the mentally ill person. Within a psychosocial rehabilitation setting, a self-medication management scheme has been developed that gradually facilitates the client's responsibility for managing their own prescribed medication, and in conjunction with this increased awareness of their medication and related issues, the focus eventually leads to the client having complete responsibility for managing their own medication. This self-medication management scheme consists of several graded stages that are contractual in nature, in which the clients and nurses are active participants. A rating and self-reporting scale has been developed within the scheme and is used by both the nurse and the client to assist in gauging the client's understanding and knowledge of issues related to their medication use. This self-medication management scheme has demonstrated that when severely mentally ill persons are given the opportunity to practice and manage their own medication as a component of the rehabilitative process, a self-medication management scheme does make a difference.     

Reconceptualising the objectives of a pilot study for clinical research

This is a methodological study in which a case report is used to retrospectively analyse the link between a successful pilot study and stalled main study to identify potential methodological weaknesses in the planning process. The analysis identified unanticipated influences related to hospital processes and discipline boundaries that adversely influenced participant recruitment and retention for a clinical trial. The findings of the study demonstrate that, whilst the pilot is an important step in research planning to confirm the design and operational processes for a study, a thorough analysis of the relevant health service environment is an important additional objective for the pilot study.     

Management and outcome of a preferred place of care pilot

This paper reports on the management and outcome of a pilot of The Preferred Place of Care document in south Essex. This is a summary of the paper, the full version can be accessed at nursingtimes.net.     

Speculum 'self-insertion': a pilot study

Aim. This paper reports phase II of a pilot study that aimed to determine whether self‐insertion of a speculum by women undergoing a pap smear would be more comfortable and lead to an improvement in satisfaction and a decrease in anxiety associated with this procedure. Background. Research demonstrates that pelvic examinations are considered by most women to be unpleasant and are routinely associated with embarrassment, apprehension, fear and often some level of discomfort and/or pain. Design. The study used quantitative and qualitative data collection techniques. Phase I (described elsewhere) tested the newly developed Speculum Self‐Insertion Satisfaction Questionnaire for content validity, internal consistency and clarity. Phase II pilot study tested the technique of speculum self‐insertion. Women's general level of anxiety was measured using the State Trait Anxiety Inventory, both before and after they performed the self‐insertion procedure. Women's satisfaction and acceptance of the procedure was measured using the Speculum Self‐Insertion Satisfaction Questionnaire and explored through the use of qualitative research techniques. Participants. A total of 198 women attending family planning clinics in Perth, Western Australia, between September and December 2003 were invited to participate in the study. One hundred and thirty‐three women agreed to self‐insert their own speculum. Results. The study demonstrated that speculum self‐insertion was acceptable to most women, especially younger women. Nearly 91% of women either agreed or strongly agreed that they were satisfied with the experience of self‐insertion and would choose to self‐insert the speculum again. This included the women who had not previously had a speculum examination. The quality of specimen collected was not detrimentally affected by speculum self‐insertion. Conclusions. The results of this pilot research, while needing to be replicated in a larger study, demonstrate that offering women the opportunity to self‐insert a speculum during a routine pelvic examination is an acceptable, innovative, simple and cost‐neutral change in clinical practice that increases women's comfort and satisfaction and potentially makes sexual health screening less threatening to women of all ages. Relevance to clinical practice. Speculum self‐insertion may encourage women's attendance at clinics for regular screening. Early diagnosis and treatment will result in better health outcomes for women, families and the community at large.