Research and Theory for Nursing Practice最新文献

Objective: Examination of community resilience after Hurricane Harvey and -applicability of Neuman's systems model to the role of public health nurses in applying primary, secondary, and tertiary prevention strategies to communities susceptible to natural disasters. Design: Descriptive, exploratory study. Sample: A convenience sample (N = 1,470). Measurements: Hurricane Harvey Survey. Results: Respondents from seven counties in southeast Texas report previously experiencing a hurricane (80%) with no weather-related flooding (79%), adequate preparation (54%), failure to comprehend the potential severity of Hurricane Harvey (62%), damage to their homes (45%), and a 68% loss of personal belongings. Anxiety, frustration, disbelief, determination, and hopefulness were rated highest after the storm. Residents received updates from family and friends, social media, and online news reports regarding rising water, even though, in many cases, a mandatory evacuation was not officially announced. Only 35% of respondents reported being aware of resources available, possibly due to flooding or inaccessibility of typical resources (e.g., hospitals, shelters). Communicating through social networks (social media, family, and friends) provided avenues for arranging evacuations and assistance. Respondents report giving assistance to others and receiving assistance from family, friends, and their faith community. The majority of respondents reported that the community provided adequate services during the hurricane (59%), and they plan to stay in southeast Texas (70%). Conclusions: Southeast Texas residents demonstrated individual and community resilience which may be further supported with primary, secondary, and tertiary nursing interventions as illustrated by Neuman's systems model. The rise in positive emotional response traits demonstrates positive coping, which is consistent with resilience. Effective and timely communication through social networks provides an additional line of resistance to protect and promote the resilience of the community. The lack of medical resources indicates a break in the normal line of defense and an area for potential improvement with the utilization of mobile medical units to provide healthcare for areas not easily accessible during a disaster. Public health nurses are strategically positioned in the international community to lead prevention and recovery efforts by applying theory-based community interventions.

Background and Purpose: HIV infection is a health disparity among transgender women. Despite availability of HIV-prevention interventions and services, many transgender women do not access these interventions and services. The purpose of this study was to identify the process by which barriers may prevent transgender women from receiving HIV-prevention interventions and services and to have participants propose ideas on how to overcome these barriers. Methods: Utilizing a grounded theory approach, 25 in-depth, semistructured interviews were conducted with transgender women aged 20-69 years. After providing written informed consent, participants completed an in-depth individual interview. Interviews were audio-recorded and transcribed verbatim. Categories and subcategories were identified from the data using open, axial, and selective coding. Results: A theory grounded in the data named Living in Stealth emerged that described this central phenomenon that underpinned the other main categories of Encountering Social Barriers and Encountering Structural Barriers. Generating Ideas for Restructuring HIV-Prevention for Transgender Women was the final category in which participants provided ideas to overcome HIV-prevention barriers. Implications: Clinicians and researchers providing HIV-prevention services and interventions for transgender women need awareness of the complex nature of HIV prevention for this subpopulation of women. More research is needed to incorporate findings from this study into HIV-prevention interventions for transgender women.

Background and Purpose: Although patients have had reduced access to healthcare institutions due to the COVID-19 pandemic and the related preventive measures, there is no current data on how the pandemic has affected patients who underwent transcatheter aortic valve implantation (TAVI), despite their need for close follow-up.This study investigated TAVI patients' experiences with self-care management during the pandemic. Methods: This study adopted a descriptive qualitative design. The sample consisted of 24 patients recruited using purposive sampling. Data were collected by telephone and analyzed using inductive content analysis. Results: The data were grouped under three themes: "vulnerability," "worsening of psychological condition," and "expectations." The most challenging self-care behaviors reported by TAVI patients were determined to be doing regular physical activity, managing their symptoms, complying with treatment, and attending regular check-ups. They also reported experiencing psychological problems such as fear, concern, and abandonment and stated a need for better communication and follow-up at home during the pandemic. Implications for Practice: The pandemic has more than ever demonstrated the importance of effective self-care for cardiovascular patients. Nurses should plan individualized interventions regarding the problems in self-care management that we identified in this study. In this regard, the use of secure digital applications such as telerehabilitation can be effective. Also, nurses should develop community-based and political initiatives to allow sustainable self-care management to be effectively implemented in special patient groups in extraordinary circumstances such as pandemics.

Background and Purpose: Within nursing discourses, the concept of desire among gay, bisexual, and other men who have sex with men (gbMSM) is not well understood. Among nurses, this concept is often constructed as being synonymous with sexual and other risk-taking behaviors, which can influence the type of care nurses provide to gbMSM and affect how this group engages with nurses - and their health. This misinterpretation of what desire represents has resulted in gbMSM becoming the target of public health campaigns and nursing interventions aimed at curbing their deviant behaviors. Such an approach by nurses, however, overlooks the meaning of desire among gbMSM. Methods: To enhance nursing knowledge about, and improve nursing practice for, gbMSM, a concept analysis of desire specific to this group was undertaken using Rodger's evolutionary model. For this analysis, 90 articles reviewed from the disciplines of nursing and allied health, medicine, and psychology. Results: Findings from this analysis revealed a complexity to desire among gbMSM that extended well beyond engagement in radical sexual practices and into dimensions of desire for connection, freedom, and acceptance. These revelations were applied to demonstrate how nurses' beliefs about desire and subsequent regulations for "good health" can inhibit the ways in which desire is produced among gbMSM. Implications for Practice: Such findings demonstrate a need to develop future approaches for nursing practice that recognize the innate value and individual perspectives about desire held by this group, which can be uniquely tailored to meet their health needs.

Background/Purpose: To conduct a synthesis based on a realist perspective, -investigating how professional breastfeeding support can sometimes be ineffective and/or unsatisfactory from the viewpoint of the mother and fail to address the needs of the breastfeeding dyad. Methods: An innovative, targeted "quasi-realist" -synthesis technique was used to explore the context of the interpersonal relationships through which professional breastfeeding intervention is delivered and identify any unintended mechanisms and/or consequences. Results: Multiple expressions of failed breastfeeding support were revealed which had a negative impact on maternal empowerment, informed decision-making, and breastfeeding self-efficacy. The overarching theme, inadequate breastfeeding information/ support, was elucidated by several subthemes: giving inconsistent/contradictory advice, use of the hands-on approach, provision of insensitive care, and making parents feel scrutinized/judged Mothers who experienced inadequate breastfeeding information/support often resorted to the mechanism of duplicity/evasion and withdrew from seeking or following further professional advice. Finally, unintended consequences of not breastfeeding as recommended included feelings of guilt and a sense of failure This was particularly true for mothers who intended to exclusively breastfeed. Implications for Practice: The findings of this unique synthesis suggest that to sustain breastfeeding support relationships and prevent unintentional consequences of inadequate support, professionals must pay more attention to the manner in which breastfeeding intervention is provided. The findings also suggest that they must strive to provide more consistent, engaging, -sensitive, and nonjudgmental care that better meets the needs of breastfeeding dyads.

Background and Purpose: Demands on long-term services and supports for older adults are growing, although geriatric workforce shortages have persisted for decades. Methods to define and quantify practice of licensed nurses in nursing homes are needed for work optimization within limited nurse resources available in nursing homes. This study aimed to refine and validate observable nursing interventions for nursing homes, using the Omaha System. Methods: Based on the existing corpus of Omaha System interventions for acute care nursing, this multi-phase, multi-method study included a mapping procedure of interviews from licensed nurses in nursing homes, the evaluation of content validity and coding of the interventions using a survey, and inter-observer reliability assessment using TimeCaT. Results: This study validated 57 observable interventions for nursing homes. Of the previously identified acute care nursing interventions, eight interventions were deemed out of scope. One additional intervention was identified. Refined intervention definitions were related to procedures common in acute care settings such as tracheal intubations/extubations and nasogastric tube insertion that were not performed in nursing homes. Expert agreement for content validity and coding of the interventions was high (S-CVI = 0.97), and inter-observer reliability levels (Cohen's κ value >0.4; proportion agreement >60%) were acceptable for all case studies. Implications for Practice: The validated observable Omaha System nursing interventions for nursing home practice have potential for use in future studies of nursing home practice to understand evidence-based practice, and gaps in care provided. The methodology may be extended to define observable interventions for other roles and settings.

Background and Purpose: Parents' competencies in coparenting are critical to adaptive and competent caregiving of an infant with complex congenital heart disease. To date, feasible interventions to support parents in working together-coparenting-for caregiving of these infants have not been developed and systematically examined. The purpose of this feasibility study was to examine the efficacy of the participatory teaching/learning intervention, Guided Participation (GP) on parent dyads' competencies in interactive problem-solving tasks in preparation for a randomized controlled trial. Methods: Nurse guides used GP to support mother and father couples in developing coparenting competencies through the first 6 months after birth. Couples, enrolled from two regional heart centers, were randomly assigned either to the usual care group (n = 10) or the GP group (n = 24). Intervention involved nurse guided GP in hospital and, following the infant's discharge, monthly telephone GP sessions between 2-months and 6-months infant age. In-home data collection visits at 2 and 6 months included video-recorded parent interaction problem-solving tasks with two goals, infant caregiving and the parent couple's relationship. The Iowa Family Interaction Rating Scales were used to score observed interactive competencies. Results: Retention was 82%, and results revealed small to moderate effect sizes for GP on problem-solving constructs for mothers and for the parent couple dyad. Implications for Practice: Our findings support further study in a fully powered randomized trial with a more diverse sample, handbook-enhanced GP, and examination of the effect on a broader spectrum of outcomes, including infant growth and development.

Background and purpose: Adolescents in contexts of social vulnerability experience obstacles in the development of their resilience, which compromises the development of coping/response strategies to daily adversities. This study aimed to understand the resilience process of school adolescents in situations of social vulnerability in the light of Barker's and Buchanan-Barker's Tidal Model.

Methods: This qualitative and exploratory study was carried out at a public school in the city of Recife, Pernambuco State, Brazil. The sample was composed of 17 adolescents. Data collection was carried out through in-depth narrative interviews. The material was analyzed with the aid of the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires, interpreted through the assumptions of Tidal Model.

Results: The dendrogram demonstrated the corpus delimited in five classes named as "Navigation Plan," "Storms," "Ocean of Experiences," "Rescue," and "Safe Harbor."

Conclusions and implications for practice: Through learning from narratives, nurses understand the important resources of a recovery journey and take care "with" adolescents, supporting the development of resilience to face storms by taking the helm of the vessel and resuming their travel.

Background and purpose: In the initial COVID-19 outbreak, nursing staff reportedly experienced high levels of psychological stress. The purpose of this study was to explore the real experience of the first cohort of pediatric fever clinic nurses during the COVID-19 epidemic.

Methods: Semi-structured interviews were conducted with eight nurses who worked in a fever clinic at a children's hospital in China. The interviews were conducted by an experienced and trained interviewer. Qualitative content analysis was used to describe the experiences of the nurses.

Results: Three themes were distilled from the interviews: 1) complex psychological experiences including positive experiences (increased sense of responsibility and honor, gaining the respect and recognition of parents, having a sense of achievement in personal growth) and negative experiences (panic and compulsion, guilt towards their family, antipathy, and dissatisfaction); 2) extreme physical discomfort; and 3) a lack of relevant knowledge.

Implications for practice: The nurses in the pediatric fever clinic experienced various psychological impacts and physiological discomfort. Nursing managers should improve the management of hospital emergency nursing, strengthen the psychological guidance and logistics support of frontline nurses, and provide nurses with the relevant knowledge and skills training. These improvements would support frontline nurses in their work to provide effective patient treatment during the COVID-19 epidemic.

Background and purpose: Chemotherapy-induced peripheral neuropathy (CIPN) is a multidimensional symptom cluster induced by neurotoxic chemotherapy agents among patients with cancer. A well-developed tool for assessing CIPN can help with the early detection and timely management of patients. This study assessed the reliability and validity of the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT) in Korean women with breast cancer who were treated with chemotherapy.

Methods: A psychometric analysis of the Korean version of CIPNAT was conducted with 207 patients with breast cancer who were treated with chemotherapy. Patients were assessed using the CIPNAT and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy-20 (CIPN-20). Analyses of internal consistency reliability, concurrent validity, and construct validity (based on structural and discriminant validity testing) were performed to evaluate the psychometric properties.

Results: The Korean version of the CIPNAT had good internal consistency (Cronbach's alpha = 0.95; the item-total correlation coefficients ranged 0.34-0.76). The CIPNAT and CIPN-20 were moderately correlated (r = .67). Confirmatory factor analyses showed a four-factor structural model with acceptable model fit indices. Discriminant validity was supported by differences between individuals treated with and without taxane-based chemotherapy (p < .001).

Implications for practice: The Korean version of the CIPNAT was a valid and reliable screening tool for identification of CIPN symptoms and functional interference in Korean women who received chemotherapy for breast cancer. The instrument can be useful for the timely and routine assessment of CIPN symptoms and functional limitations of patients with cancer by oncology nurses.