Deborah Stiffler

Diabetes Barriers and Self-Care Management The Patient Perspective

For those individuals diagnosed with diabetes, the challenge is how to cope and manage the many aspects of their lives. The aim of this qualitative synthesis was to evaluate research studies for findings and then synthesize patients’ experiences within the context of diabetes self-care while facing daily barriers. A total of 95 findings from 21 studies were categorized via like themes. These themes were further analyzed and aggregated to represent an interpretive meta-synthesis via a rigorous methodological protocol as described by Pearson, Robertson-Malt, and Rittinmeyer and the Joanna Briggs Institute. Meta-synthesized findings suggest that patients “avoid and hinder self-management” as well as “desire self-care and living life.” Clinicians can improve interactions and potentiate understanding when the therapeutic approach is about the person living with diabetes as opposed to clinical control.

An integrative review of communication between parents and nurses of hospitalized technology-dependent children.

BACKGROUND With advances in health care, the population of children who are technology-dependent is increasing and, therefore, the need for nurses to understand how best to engage in communication with the parents of these children is critical. Shared communication between the parents of hospitalized technology-dependent children and their nurses is essential to provide optimal care for the child. The components and behaviors of the parent-nurse communication process that improve mutual understanding of optimal care for the child had not previously been examined. RESEARCH QUESTION Among parents of hospitalized technology-dependent children and their nurses, what communication behaviors, components, concepts, or processes improve mutual understanding of optimal care for the child? METHODS An integrative review of both qualitative and quantitative studies was conducted. Key words including communication, hospitalized, nurse, parent, pediatric, and technology-dependent were used to search databases such as Cumulative Index to Nursing and Allied Health and Medline for years 2000-2014. The data regarding the process of parent-nurse communication were extracted as they related to the mutual understanding of optimal care for the child. The data were grouped into themes and compared across studies, designs, populations, and settings. RESULTS Six articles were identified that provided information regarding the processes of shared communication among the parents of hospitalized technology-dependent children and their nurses. Providing clear information, involving parents in care decisions, trust and respect for each others expertise, caring attitudes, advocacy, and role negotiation were all found to be important factors in shared parent-nurse communication. LINKING EVIDENCE TO ACTION The results of this integrative review inform our understanding of the parent-nurse communication process. The findings provide nurses with an understanding of strategies to better engage in respectful, engaging, and intentional communication with parents of hospitalized technology-dependent children and improve patient outcomes.Background With advances in health care, the population of children who are technology-dependent is increasing and, therefore, the need for nurses to understand how best to engage in communication with the parents of these children is critical. Shared communication between the parents of hospitalized technology-dependent children and their nurses is essential to provide optimal care for the child. The components and behaviors of the parent-nurse communication process that improve mutual understanding of optimal care for the child had not previously been examined. Research Question Among parents of hospitalized technology-dependent children and their nurses, what communication behaviors, components, concepts, or processes improve mutual understanding of optimal care for the child? Methods An integrative review of both qualitative and quantitative studies was conducted. Key words including communication, hospitalized, nurse, parent, pediatric, and technology-dependent were used to search databases such as Cumulative Index to Nursing and Allied Health and Medline for years 2000–2014. The data regarding the process of parent-nurse communication were extracted as they related to the mutual understanding of optimal care for the child. The data were grouped into themes and compared across studies, designs, populations, and settings. Results Six articles were identified that provided information regarding the processes of shared communication among the parents of hospitalized technology-dependent children and their nurses. Providing clear information, involving parents in care decisions, trust and respect for each others expertise, caring attitudes, advocacy, and role negotiation were all found to be important factors in shared parent-nurse communication. Linking Evidence to Action The results of this integrative review inform our understanding of the parent-nurse communication process. The findings provide nurses with an understanding of strategies to better engage in respectful, engaging, and intentional communication with parents of hospitalized technology-dependent children and improve patient outcomes.

Evidence-based Practice for Nurse Practitioner Students: A Competency-based Teaching Framework

Evidence-based practice (EBP) has become increasingly important in nursing. It has become a dominant philosophy in teaching research courses and it brings a new definition to the translation of science. As more has become known about EBP, it has continued to grow in its importance and significance. EBP is the foundation to many doctor of nursing practice (DNP) programs in both the advanced practice nursing and organizational foci. The purpose of this article is to define evidence-based practice competencies for advanced practice nurses, especially nurse practitioners. A corresponding teaching framework is presented. Additionally, competencies related to the DNP with aggregate systems and organizational foci are suggested. Practical experiences emanating from working within the NP competency development and framework are highlighted and described.

Infant Co-Bedding: Practices and Teaching Strategies.

PURPOSE Studies show that co-bedding is a common cause of death in babies. The purpose of this study is to identify teaching strategies that can be used to increase safe sleep practices. DESIGN AND METHODS A rigorous systematic literature search identified articles that expressed ways in which to provide co-bedding teaching or provided recommended approaches to educating mothers and families about co-bedding risks. NOTARI software, from OVID Tools, was used to appraise articles, extract data, and thematically organize the findings, resulting in meta-aggregation. RESULTS Two major findings were synthesized from four categories. First, co-bedding occurred despite knowing risks and having received teaching. Second, families should receive co-bedding messages tailored to their specific circumstances and risks. PRACTICE IMPLICATIONS Findings showed that the lack of dialogue in co-bedding teaching often deters caregivers and families from seeking further education or consultation. Nurses need to ensure that safe sleep practices are taught and that the material provided pertains to the caregivers specific cultural and familial situation.

When Baby Stops Breathing Analysis of Mothers’ Interviews

Sudden unexplained infant death is responsible for 14% of Indiana’s infant mortality. The purpose of this qualitative research study was to describe mothers’ experiences when death of an infant occurred suddenly and unexpectedly. Field deputies or social workers interviewed mothers from central Indiana during the child-death team investigations. The Thematic Analysis Program from the Joanna Briggs Institute was used to analyze interview data. Sixteen de-identified interview cases were extracted, and a meta-aggregate method was conducted. The three synthesized themes were Extreme Emotional Shock, We Feel Like We’re to Blame, and Working Toward Moving On. Understanding these phenomena from mothers’ experience may assist in eliminating risks associated with infant deaths and inform nursing practice and policy.

A Guide for Preceptors of Advance Practice Nursing Students Caring for Women and Infants

Womens health care in the United States has been described as unsatisfactory and falling behind the Healthy People 2010 objectives. Inadequate health care due to a shortage of providers is especially problematic for women who are poor with lower socioeconomic status. Advanced practice nurses are well suited to address this need. In this article, preceptor and academic partnerships are discussed as strategies to make more qualified womens health and infant providers available.

Changing Women: Mothers and Their Adolescent Daughters

Budding fecundity in the female child is a matter of family concern. The authors used the grounded theory method to explore the process of communication between mothers and their adolescent daughters concerning sexuality issues within the context of the age changes of both. A core category of changing women was identified along with three maternal and three daughter processes. Changes that occur during this time period can lead to lasting separation between the pair if they fail to develop insight as a way of protecting themselves and one another. The findings may assist health professionals to understand these changes and facilitate the process of communication in these dyads.

A Synthesis of Coping Experiences After Infant Death.

The purpose of this article was to synthesize qualitative research data that examine parental coping strategies following infant death. This qualitative synthesis found that parents who effectively cope with the death of their infant would continue the bond with the deceased child, have differences in the way they manage their emotions about the loss, and have intergenerational support in the form of family being present, acknowledging the death, performing immediate tasks, and providing helpful information. Nurses should be vigilant to ensure parents receive “memories” of their infant after an in-hospital death. Knowledge of the coping process can assist nurses and clinicians to better care and support parents following an infant death and, in turn, facilitate the healing process.

Illustrations of unexpected infant sleep deaths

Case illustrations from central Indiana provide the narrative for infant suffocations because of unsafe sleep environments. Accidental strangulation or suffocation in bed is caused by co-bedding, blankets and pillows in cribs, or wedging and entrapment. Knowledge of the evidence-based risks associated with case data may assist further in the prevention of unexpected infant sleep deaths and may better inform best practice for death scene investigation including forensic nurses.