Diana E. McMillan

Original Research: The Effects of Active Warming on Patient Temperature and Pain After Total Knee Arthroplasty

BackgroundTotal knee arthroplasty (TKA) is a procedure with associated risks of inadvertent perioperative hypothermia and significant postoperative pain. Hypothermia may affect patients’ experience of postoperative pain, although the link is not well understood. ObjectiveThe aim of this prospective, randomized controlled trial was to determine the efficacy of a patient-controlled active warming gown in optimizing patients’ perioperative body temperature and in diminishing postoperative pain after TKA. MethodsThirty patients who would be undergoing TKA received either a standard hospital gown and prewarmed standard cotton blanket (n = 15) or a patient-controlled, forced-air warming gown (n = 15). ResultsAlthough pain scores were not significantly different in the two groups (P = 0.08), patients who received warming gowns had higher temperatures (P < 0.001) in the postanesthesia care unit, used less opioid (P = 0.05) after surgery, and reported more satisfaction (P = 0.004) with their thermal comfort than did patients who received standard blankets. These findings indicate that patient-controlled, forced-air warming gowns can enhance perioperative body temperature and improve patient satisfaction. Patients who use warming gowns may also need less opioid to manage their postoperative pain. ConclusionsNurses should ensure that effective patient warming methods are employed in all patients, particularly in patients with compromised thermoregulatory systems (such as older adults), and in surgeries considered to be exceptionally painful (such as TKA).

Pilot Study of a Survey to Identify the Prevalence of and Risk Factors for Chronic Neuropathic Pain Following Breast Cancer Surgery

PURPOSE/OBJECTIVES To provide a preliminary determination of the prevalence rate of women who suffer from neuropathic pain post breast surgery (PPBS) and explore potential risk factors associated with its development. DESIGN Prospective, quantitative, longitudinal survey. SETTING Breast health clinic in western Canada. SAMPLE A convenience sample of 17 women undergoing breast cancer surgery. METHODS The Brief Pain Inventory was administered before surgery and 2 days, 10 days, and 3 months postsurgery. Demographic data also were collected preoperatively. Analysis included determining prevalence of PPBS; descriptive analyses on age, gender, and body mass index (BMI); presence of acute postoperative pain; type of surgery; and two-tailed t tests on age and BMI. MAIN RESEARCH VARIABLES The symptom experience of chronic PPBS. FINDINGS Twenty-three percent of the sample developed PPBS. Younger age (50 years or younger), more invasive surgery, acute postoperative pain, and less analgesic use during the acute postoperative period were factors associated with the development of PPBS. CONCLUSIONS Additional research is required to confirm the significance of these potential risk factors in the development of PPBS. IMPLICATIONS FOR NURSING Nurses are ideally situated to identify early signs of PPBS. In addition, nurses play a key role in the education of patients and healthcare professionals and can facilitate increased awareness about the possibility of developing PPBS, enabling earlier and more effective treatment of PPBS.

Psychosocial adaptation: an evolutionary concept analysis exploring a common multidisciplinary language

AIMS To provide the first known concept analysis of psychosocial adaptation, exploring its evolution from the concept adaptation. We also determine how psychosocial adaptation is conceptualized across nursing, health, sociobehavioural and education disciplines. BACKGROUND Psychosocial adaptation is an important conceptual term that is poorly defined in nursing and other health, sociobehavioural and education disciplines. A thorough understanding of the concepts application in nursing and across disciplines can help to clarify its meaning, facilitate a more effective common language between disciplines and inform future psychosocial adaptation research. DESIGN Rodgers evolutionary view guided this concept analysis. DATA SOURCES Peer-reviewed English and Spanish manuscripts published between 2011-2013 were retrieved from the following databases: CINAHL, Psych INFO, PubMed, Scopus and LILACS. REVIEW METHODS Eighty-nine articles related to psychosocial adaptation were included in the analysis. Findings identify key attributes, antecedents and consequences associated with the use of the concept. Findings were compared vis-a-vis reported characteristics of adaptation. RESULTS The attributes characterizing psychosocial adaptation are: change, process, continuity, interaction and influence. In psychosocial adaptation, new life conditions serve as antecedents, while consequences are good or bad outcomes. Important features of the evolution of this concept include its broad appropriation across the reviewed disciplines. The attributes of psychosocial adaptation, have some similarities to those of general adaptation. Both concepts include an aspect of change, but unlike adaptation, psychosocial adaptation has branched away from biological descriptors, such as homeostasis and tends to focus on relational characteristics, such as interaction and influences.

Writing self‐efficacy in nursing students: The influence of a discipline‐specific writing environment

To explore if writing self‐efficacy improved among first‐year nursing students in the context of discipline‐specific writing. The relationship between writing self‐efficacy, anxiety and student grades are also explored with respect to various learner characteristics such as postsecondary experience, writing history, English as a second language status and online versus classroom instruction.

A Template Analysis of Writing Self-Efficacy Measures

Background and Purpose: This investigation reviews the item content of writing self-efficacy (WSE) measures developed for undergraduate students. Bandura’s self-efficacy theory and a writing theory by Flower and Hayes informed the a priori themes used to develop a template of WSE categories critical to the concept. Method: Articles describing WSE measures were identified through Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Education Resources Information Center (ERIC), PubMed, Scopus, and Google Scholar (1984–2015). A template analysis method was used to analyze 182 individual items present on 11 WSE instruments. A nursing perspective was applied. Results: The analysis identified 16 categories influencing WSE as well as gaps in current measurement items. Conclusion: The theoretical examination of WSE is the first step toward the development of a WSE measure specific to the nursing context and contributes to nursing education by advancing the measurement of WSE.

A very low calorie diet plus lifestyle counselling improved mild obstructive sleep apnoea in overweight patients.

Does a very low calorie diet (VLCD) plus intensive lifestyle counselling improve mild obstructive sleep apnoea (OSA) in overweight patients? ### Design: randomised controlled trial (RCT). ### Allocation: unclear allocation concealment. ### Blinding: blinded (outcome assessors). ### Follow-up period: 1 year. ### Setting: Kuopio University Hospital, Kuopio, Finland. ### Patients: 81 patients 18–65 years of age (mean age 51 y, 65% men) who had a body mass index of 28–40 kg/m2 and an apnoea-hypopnoea index (AHI) of 5–15 events/hour. Exclusion criteria were active treatment for OSA, pregnancy, and chronic kidney, thyroid, or liver disease. ### Intervention: a VLCD (600–800 kcal/d) for 12 weeks plus intensive lifestyle counselling for 1 year (n = 40) or general oral and written …

Understanding access to healthcare among Indigenous peoples: A comparative analysis of biomedical and postcolonial perspectives

As nursing professionals, we believe access to healthcare is fundamental to health and that it is a determinant of health. Therefore, evidence suggesting access to healthcare is problematic for many Indigenous peoples is concerning. While biomedical perspectives underlie our current understanding of access, considering alternate perspectives could expand our awareness of and ability to address this issue. In this paper, we critique how access to healthcare is understood through a biomedical lens, how a postcolonial theoretical lens can extend that understanding, and the subsequent implications this alternative view raises for the nursing profession. Drawing on peer‐reviewed published and gray literature concerning healthcare access and Indigenous peoples to inform this critique, we focus on the underlying theoretical lens shaping our current understanding of access. A postcolonial analysis provides a way of understanding healthcare as a social space and social relationship, presenting a unique perspective on access to healthcare. The novelty of this finding is of particular importance for the profession of nursing, as we are well situated to influence these social aspects, improving access to healthcare services broadly, and among Indigenous peoples specifically.

A curriculum-wide assessment of writing self-efficacy in a baccalaureate nursing program

OBJECTIVES This study explores patterns of writing self-efficacy fluctuation across three academic years in a baccalaureate nursing program. The goal was to assess if writing self-efficacy predicted program grades. DESIGN Longitudinal exploratory design. SETTING Three-year accelerated nursing program in a college setting in Canada. PARTICIPANTS Follow-up cohort included 49 students; 32 (65.3%) synchronous in program progression and 17 (34.7%) had become asynchronous between first and third year. METHODS Data was collected five times between August 2013 and May 2016 at program admission, the start of their discipline-specific first-year writing course, the end of the writing course, start of third-year, and the end of third-year. Variables assessed included writing self-efficacy (two measures), writing anxiety, entrance degrees of reading power (DRP) scores, final college cumulative grade point average (GPA), and grades earned on first, second, and third-year papers. RESULTS Writing self-efficacy statistically significantly improved from the start of the nursing program to the finish (p < .001). Writing self-efficacy fluctuated decreasing from post first-year writing course to the start of the third-year, returning to or exceeding end of writing course levels by the end of the third year. Students who progressed normally through the program (synchronous) were academically stronger (paper grades, DRP, GPA scores) and had higher writing self-efficacy scores than asynchronous students. Using hierarchical regression, DRP scores and synchronous/asynchronous status in the program made a larger contribution to the prediction of final program GPA and paper grades, while the inclusion of writing self-efficacy in the models made a minor contribution to overall variance. CONCLUSIONS Writing self-efficacy will fluctuate based on context and complexity of writing demanded in academic programs. Second and third-year students require continued support with writing beyond an introductory course. Programs should attend to developing reading comprehension in students as part of their across-the-curriculum writing plans.

Linking clinical significance to a sleep intervention model

patients with advanced lung cancer receiving palliative chemotherapy were identified at diagnosis and interviewed at time of first treatment. The assessment was repeated at 1, 3, and 6 months. At each interview, QOL is measured using SEIQOL and the European Organization for Research and Treatment of Cancer 30-item QOL questionnaire (EORTC QLQ-C30). INTERIM RESULTS: To date, 25 patients have been assessed (21 male, 4 female; mean age, 66 years). In total, 2 1 cues have been nominated. The most common spontaneously nominated cues at all times were health (90%>, religion (SO%), and family (72%). Other popular cues were finances (39%), social life (25%), and leisure activities (25%). The initial (T,) mean (SD) SEIQOL score was 67.69 (11.5). At the l-month followup assessment (T,), the mean SEIQOL score was 67.09 (12.2), mean internal validity (R2) at T, was 0.89 (0.48), and R2 at T, was 0.89 (0.44), indicating high internal validity For EORTC QL2, normal probability score (rips) at T, was as follows: P = NS; mean (SD), 51.44 (20.5); median, 50. Values for nps at T, were as follows: P = NS; mean (20.33), 49.88; median, 50. Comparison with SEIQOL data showed a significant difference in overall QOL score at T, (P < 0.001) and T, (P = 0.005). CONCLUSIONS: There is a paucity of published QOL information in this patient population, despite QOL being the most important outcome measure. In this study, subjective QOL remained stable over time. However, there was a significant difference in the value of QOL scores when measures were anchored by health rather than the individual’s perception of QOL. Our results would indicate that subjective QOL can indeed be measured in this patient population.