Jennifer Kawi

Facilitators and barriers to adjustment of international nurses: an integrative review

BACKGROUND There is a scarcity of research focusing on issues encountered by international nurses (INs) in their adjustment to foreign health-care environments. Increasingly, INs are relied upon to address staffing shortages in many Western countries. As such, it is vital to identify what facilitates and what the barriers are to the successful adjustment in order to assist their integration into new workplace environments. AIM This integrative review identifies facilitators and barriers encountered by INs as they adjust to foreign health-care environments. METHOD Based on Coopers Five Stages of Integrative Research Review, a systematic search of eight electronic databases was conducted, combined with hand and ancestral searches. Two authors independently reviewed each qualified study for relevance and significance. Subsequently, facilitators and barriers were identified and categorized into themes and subthemes. FINDINGS Twenty-nine studies conducted in Australia, Canada, Iceland, UK and the USA were included in this review. Findings indicated that positive work ethic, persistence, psychosocial and logistical support, learning to be assertive and continuous learning facilitated the adjustment of INs to their new workplace environments. In contrast, language and communication difficulties, differences in culture-based lifeways, lack of support, inadequate orientation, differences in nursing practice and inequality were barriers. CONCLUSION The review findings provide the basis for the development and testing of an evidence-informed programme to facilitate the successful adjustment of INs to their new work environments.Background:  There is a scarcity of research focusing on issues encountered by international nurses (INs) in their adjustment to foreign health-care environments. Increasingly, INs are relied upon to address staffing shortages in many Western countries. As such, it is vital to identify what facilitates and what the barriers are to the successful adjustment in order to assist their integration into new workplace environments. Aim:  This integrative review identifies facilitators and barriers encountered by INs as they adjust to foreign health-care environments. Method:  Based on Coopers Five Stages of Integrative Research Review, a systematic search of eight electronic databases was conducted, combined with hand and ancestral searches. Two authors independently reviewed each qualified study for relevance and significance. Subsequently, facilitators and barriers were identified and categorized into themes and subthemes. Findings:  Twenty-nine studies conducted in Australia, Canada, Iceland, UK and the USA were included in this review. Findings indicated that positive work ethic, persistence, psychosocial and logistical support, learning to be assertive and continuous learning facilitated the adjustment of INs to their new workplace environments. In contrast, language and communication difficulties, differences in culture-based lifeways, lack of support, inadequate orientation, differences in nursing practice and inequality were barriers. Conclusion:  The review findings provide the basis for the development and testing of an evidence-informed programme to facilitate the successful adjustment of INs to their new work environments.

Self-Management Support in Chronic Illness Care: A Concept Analysis

Purpose: This article reports on the concept analysis of self-management support (SMS) to provide clarity for systematic implementation in practice. Background: SMS is a concept in its early phase of development. It is increasingly evident in literature on chronic illness care. However, the definition has been simplified or vague leading to variable SMS programs and inconsistent outcomes. Elucidation of SMS is necessary in chronic illness care to facilitate clear understanding and implementation. Method: Rodgers’ evolutionary concept analysis method was used to examine SMS. Data sources included systematic multidisciplinary searches of multiple search engines. Results: SMS refers to comprehensive sustaining approaches toward improving chronic illness outcomes consisting of patient-centered attributes (involving patients as partners; providing diverse, innovative educational modalities specific to patients’ needs; individualizing patient care), provider attributes (possessing adequate knowledge, skills, attitudes in providing care), and organizational attributes (putting an organized system of care in place, having multidisciplinary team approach, using tangible and social support). Implications: A well-clarified SMS concept is important in theory development. The attributes offer necessary components in SMS programs for systematic implementation, evaluation, and research. There is great potential that SMS can help improve outcomes of chronic illness care.

Predictors of Self-Management for Chronic Low Back Pain

AIMS (a) Identify variables that predict self-management (SM) of chronic low back pain (CLBP), and (b) evaluate differences in these variables between participants in specialty pain centers (SPCs) and primary care clinics (PCCs). BACKGROUND Chronic low back pain is highly prevalent in various healthcare settings. Self-management strategies are recommended in pain care guidelines to help address CLBP. However, the evidence of SM effectiveness in CLBP remains unclear. Self-management may be effective for only certain patients. Hence, identifying the predictors to SM of CLBP is essential to help recognize the best responders to SM programs. METHOD Secondary analysis was conducted on data collected from two CLBP primary research studies in SPCs (N=110) and PCCs (N=120). General linear modeling was utilized for the combined sample of 230 participants and for each practice setting. RESULTS Overall, in SPCs and PCCs combined, five variables were found to be predictors of SM: age, SM support, education, overall health, and helpfulness of pain management. In SPCs, SM support, support received from other than healthcare providers, religion or spirituality, and overall health were identified as significant predictors to SM. In PCCs, both SM support and overall health were also significant predictors. In addition, those with higher income scored better in SM. CONCLUSIONS Findings provide essential information to healthcare providers in intervening appropriately toward engaging CLBP patients in SM. Other strategies need to be identified for those who do not respond effectively to SM strategies.

Self-management and self-management support on functional ablement in chronic low back pain.

This study examined self-management (SM), self-management support (SMS), and functional ablement in chronic low back pain (CLBP) patients and the role of SM in explaining the relationship of SMS to functional ablement. The pervasiveness of CLBP is alarming in todays health care. Although the literature is beginning to explicate the impact of SM and SMS in other chronic illnesses, these are yet to be clarified in CLBP. The adapted chronic care model guided this study. A nonexperimental, cross-sectional, descriptive design with mediation analysis was used. Through convenience sampling, 110 participants were recruited from two pain centers that used similar multimodal pain management practices. Although the findings showed lack of mediation, it was found that SM and SMS were strongly correlated. Furthermore, overall health was found to be a significant covariate to the functional ablement of CLBP patients. This study assists in advancing knowledge and contributing toward understanding SM, SMS, and functional ablement in CLBP. It is important to engage patients and health care providers in SM and SMS. More exploration is necessary to assess the influences of SM and SMS in CLBP outcomes toward improving the complex care of these patients.

Activation to Self-Management and Exercise in Overweight and Obese Older Women With Knee Osteoarthritis

Knee osteoarthritis (OA) affects approximately 1 in 10 adults in the United States, with higher prevalence in women, aggravated by increased weight. This quasi-experimental pilot study implemented an online self-management (SM) program for older overweight and obese women with knee OA combined with a two-arm progressive exercise trial (walking and stepping groups). After the 10-week intervention using an interprofessional approach, activation to SM scores were significantly higher in all participants (N = 16) and between groups, with a higher increase in the stepping group. Those with higher activation scores pre-intervention obtained higher scores post-intervention. Activation levels also increased significantly among all participants with majority at the highest activation level. Follow-up data at 6 weeks and 6 months showed sustained SM and health-directed behaviors. These findings, although preliminary, highlight the value of combined SM and progressive exercise intervention using an interprofessional approach. Further investigations are essential toward potential practice and policy changes.

Effects of Exercise on Select Biomarkers and Associated Outcomes in Chronic Pain Conditions: Systematic Review.

Background: Chronic pain is highly prevalent. Current management is challenged by lack of validated objective measures like biological markers. Clinical pain studies employing exercise interventions have evaluated biomarkers; however, it is unclear how exercise impacts biomarkers involved in pain pathways and whether these markers are associated with relevant pain-related outcomes. This systematic review evaluates data from clinical studies employing exercise interventions in chronic musculoskeletal nonmalignant pain conditions in which biomarkers in pain pathways were measured. Method: Published research studies from several databases were examined using the Jadad Scale for assessing the quality of clinical studies. Results: Twelve research studies were reviewed. Jadad scores ranged from 5 to 11 out of 13 points. Inflammatory markers were most commonly measured followed by neurotransmitter-related genes and metabolite-detecting genes. After exercise interventions, changes in biomarkers involved in neurotransmission and inflammation suggest a hypoalgesic exercise effect. Significant biomarker associations were found with pain intensity, fatigue, depression, anxiety, and quality of life. However, there were varying methodologies in the studies reviewed. Discussion: It remains a question whether biomarkers can be used as objective measures for risk assessment, diagnosis, or evaluation or as surrogate endpoints in chronic pain. Adequate sample sizes, optimal exercise dose determination, study replications, and longitudinal research studies with consistent methodologies are warranted. Regardless, the potential translational value of biomarkers in chronic pain is evident. Advancing nursing research in biomarkers is vital for moving the nursing discipline and clinical chronic pain practice forward. Developing a biobehavioral perspective in chronic pain is also necessary for comprehensive management.

Exploring Pain Management Among Asian Immigrants with Chronic Pain: Self-Management and Resilience

Asians immigrants (AIs) are one of the fastest growing racial groups in many countries globally. Despite pain prevalence, studies on chronic pain management among AIs is limited in the literature. An integrative review was conducted exploring the current state of science on chronic pain management among AIs. Several databases were used to identify related articles and 15 studies met the inclusion criteria. Two major themes emerged: (a) self-management, pertaining to how AIs take responsibility for their pain, and (b) resilience, their adaptive behaviors indicating low levels of pain-related dysfunction and burden despite chronic pain severity. Resilience plays a significant role in the mechanism by which self-management works in pain among AIs. Chronic pain management is a complex process where challenges to effective treatments exist. Findings have significant implications to healthcare providers and the general pain population. Future research directions include the necessity for increased participation of AIs in studies.

Headache and Neck Pain From Cervicocranial Fibromuscular Dysplasia

This was a case of headache and neck pain that developed into a three-vessel dissection because of a noninflammatory, nonatherosclerotic disease affecting the cervical and vertebral arteries called cervicocranial fibromuscular dysplasia (FMD). Cervicocranial FMD is not a rare disease, but it remains commonly underdiagnosed. With educated and prudent health care professionals, complications could be averted and lives could be saved. Four essential themes are highlighted. First, health care professionals need to ensure that the basic use of stethoscopes in assessing bruits is performed consistently, especially for young females. Furthermore, FMD needs to be another differential diagnosis for younger patients with new onset hypertension and stroke. Second, it is important to stress that this disease can affect anyone regardless of health and/or status. Last, the third and fourth themes emphasize that education and research are lacking on cervicocranial FMD. It is imperative that health care professionals stay updated with current knowledge to prevent misdiagnosis and underdiagnosis.