Jenny Ploeg

A Systematic Review of Interventions for Elder Abuse

The purpose of this study was to use rigorous systematic review methods to summarize the effectiveness of interventions for elder abuse. Only eight studies met our inclusion criteria. Evidence regarding the recurrence of abuse following intervention was limited, but the interventions for which this outcome was reported failed to reduce, and may have even increased, the likelihood of recurrence. Elder abuse interventions had no significant effect on case resolution and at-risk caregiver outcomes, and had mixed results regarding professional knowledge and behavior related to elder abuse. The included studies had important methodological limitations that limit our ability to draw conclusions about the effectiveness of these interventions.

Pain Management Decision Making Among Long-Term Care Physicians and Nurses

The purpose of this study is to explore attitudes and beliefs that affect decisions about prescribing and administering pain medications in older adults who live in long-term care (LTC), with a particular emphasis on those with cognitive impairment. At each of the four participating LTC facilities, data were gathered from three separate groups of health care professionals: physicians, registered nurses, and registered practical nurses. Based on grounded theory, a model was developed that highlighted critical decision points for nurses and physicians regarding pain management. The major themes that emerged from the data concerned pain assessment (lack of recognition of pain, uncertainty about the accuracy of pain assessment and diagnosis) and treatment (reluctance to use opioids, working to individualize pain treatments, issues relating to physician trust of the nurse on prescribing patterns). These findings may facilitate the development of innovative approaches to pain management in LTC settings.

A cross-sectional study of emotional intelligence in baccalaureate nursing students.

Emotional intelligence (EI) has been identified as a set of competencies necessary for workplace success. EI is deemed essential for effective nursing practice, yet little research has been done in nursing. The purpose of this study was to describe the EI scores of baccalaureate nursing students and to determine if there was a difference among the students across the four years of the program. A cross-sectional design was used to examine the EI scores of 100 female nursing students (25 in each of the four years). Students completed the BarOn Emotional Quotient Inventory Short (EQ-i:S), a 51-item self-report questionnaire that includes scores for a total EQ and 5 subscales. Undergraduate nursing students in each of the four years of the program had EI scores within the emotionally and socially effective functioning capacity, identifying them as being able to establish satisfying interpersonal relationships, and work well under pressure. The difference in total EQ scores between students in Year 1 and Year 4 was statistically significant (p= or <.05) as were the scores in the interpersonal and the stress management subscales (p= or <.05) with students in Year 4 scoring higher than those in Year 1. Implications for nursing education are discussed.

The Role of Nursing Best Practice Champions in Diffusing Practice Guidelines: A Mixed Methods Study

BACKGROUND While the importance of nursing best practice champions has been widely promoted in the diffusion of evidence-based practice, there has been little research about their role. By learning more about what champions do in guideline diffusion, the nursing profession can more proactively manage and facilitate the role of champions while capitalizing on their potential to be effective leaders of the health care system. AIM To determine how nursing best practice champions influence the diffusion of Best Practice Guideline recommendations. METHODS A mixed method sequential triangulation design was used involving two phases: (1) key informant interviews with 23 champions between February and July 2006 and (2) a survey of champions (N= 191) and administrators (N= 41) from September to October 2007. Qualitative findings informed the development of surveys and were used in interpreting quantitative information collected in phase 2. RESULTS Most interview and survey participants were female, employed full-time, and had worked in practice for over 20 years. Qualitative and quantitative findings suggest that champions influence the use of Best Practice Guideline recommendations most readily through: (1) dissemination of information about clinical practice guidelines, specifically through education and mentoring; (2) being persuasive practice leaders at interdisciplinary committees; and (3) tailoring the guideline implementation strategies to the organizational context. CONCLUSIONS AND IMPLICATIONS Our research suggests that nursing best practice champions have a multidimensional role that is well suited to navigating the complexities of a dynamic health system to create positive change. Understanding of this role can help service organizations and the nursing profession more fully capitalize on the potential of champions to influence and implement evidence-based practices to advance positive patient, organizational, and system outcomes.

Moral distress experienced by health care professionals who provide home-based palliative care

Health care providers regularly encounter situations of moral conflict and distress in their practice. Moral distress may result in unfavorable outcomes for both health care providers and those in their care. The purpose of this study was to examine the experience of moral distress from a broad range of health care occupations that provide home-based palliative care as the initial step of addressing the issue. A critical incident approach was used in qualitative interviews to elicit the experiences on moral distress from 18 health care providers drawn from five home visiting organizations in south central Ontario, Canada. Most participants described at least two critical incidents in their interview generating a total of 47 critical incidents. Analyses of the critical incidents revealed 11 issues that triggered moral distress which clustered into three themes, (a) the role of informal caregivers, b) challenging clinical situations and (c) service delivery issues. The findings suggest that the training and practice environments for health care providers need to be designed to recognize the moral challenges related to day-to-day practice.

Identifying the best research design to fit the question. Part 2: qualitative designs

Qualitative research methods have become increasingly important as ways of developing nursing knowledge for evidence-based nursing practice. Qualitative research answers a wide variety of questions related to nursings concern with human responses to actual or potential health problems. The purpose of qualitative research is to describe, explore, and explain phenomena being studied.1 Qualitative research questions often take the form of what is this? or what is happening here? and are more concerned with the process rather than the outcome.2 This editorial provides an overview of qualitative research, describes 3 common types of qualitative research, and gives examples of their use in nursing. Sampling refers to the process used to select a portion of the population for study. Qualitative research is generally based on non-probability and purposive sampling rather than probability or random approaches.3 Sampling decisions are made for the explicit purpose of obtaining the richest possible source of information to answer the research questions. Purposive sampling decisions influence not only the selection of participants but also settings, incidents, events, and activities for data collection. Some of the sampling strategies used in qualitative research are maximum variation sampling, stratified purposeful sampling, and snowball sampling.3 Qualitative research usually involves smaller sample sizes than quantitative research.4 Sampling in qualitative research is flexible and often continues until no new themes emerge from the data, a point called data saturation . Many data collection techniques are used in qualitative research, but the most common are interviewing and participant observation.5 Unstructured interviews are used when the researcher knows little about the topic, whereas semi-structured interviews are used when the researcher has an idea of the questions to ask about a topic. Participant observation is used to observe research participants in as natural a setting as possible. The types of participant …

An integrative review of the factors influencing new graduate nurse engagement in interprofessional collaboration

AIM To analyse critically the barriers and facilitators to new graduate nurse engagement in interprofessional collaboration. BACKGROUND The acculturation of new graduate nurses must be considered in strategies that address the global nursing shortage. Interprofessional collaboration may support the transition and retention of new graduate nurses. DESIGN Whittemore and Knafls revised framework for integrative reviews guided the analysis. DATA SOURCES A comprehensive multi-step search (published 2000-2012) of the North American interprofessional collaboration and new graduate literature indexed in the CINAHL, Proquest, Pubmed, PsychINFO and Cochrane databases was performed. A sample of 26 research and non-research reports met the inclusion criteria. REVIEW METHODS All 26 articles were included in the review. A systematic and iterative approach was used to extract and reduce the data to draw conclusions. RESULTS The analysis revealed several barriers and facilitators to new graduate engagement in interprofessional collaboration. These factors exist at the individual, team and organizational levels and are largely consistent with conceptual and empirical analyses of interprofessional collaboration conducted in other populations. However, knowledge and critical thinking emerged as factors not identified in previous analyses. CONCLUSION Despite a weak-to-moderate literature sample, this review suggests implications for team and organizational development, education and research that may support new graduate nurse engagement in IPC.

Designing, Implementing, and Evaluating Mobile Health Technologies for Managing Chronic Conditions in Older Adults: A Scoping Review

Background The current landscape of a rapidly aging population accompanied by multiple chronic conditions presents numerous challenges to optimally support the complex needs of this group. Mobile health (mHealth) technologies have shown promise in supporting older persons to manage chronic conditions; however, there remains a dearth of evidence-informed guidance to develop such innovations. Objectives The purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults. Methods A 5-stage scoping review methodology was used to map the relevant literature published between January 2005 and March 2015 as follows: (1) identified the research question, (2) identified relevant studies, (3) selected relevant studies for review, (4) charted data from selected literature, and (5) summarized and reported results. Electronic searches were conducted in 5 databases. In addition, hand searches of reference lists and a key journal were completed. Inclusion criteria were research and nonresearch papers focused on mHealth technologies designed for use by community-living older adults with at least one chronic condition, or health care providers or informal caregivers providing care in the home and community setting. Two reviewers independently identified articles for review and extracted data. Results We identified 42 articles that met the inclusion criteria. Of these, described innovations focused on older adults with specific chronic conditions (n=17), chronic conditions in general (n=6), or older adults in general or those receiving homecare services (n=18). Most of the mHealth solutions described were designed for use by both patients and health care providers or health care providers only. Thematic categories identified included the following: (1) practices and considerations when designing mHealth technologies; (2) factors that support/hinder feasibility, acceptability, and usability of mHealth technologies; and (3) approaches or methods for evaluating mHealth technologies. Conclusions There is limited yet increasing use of mHealth technologies in home health care for older adults. A user-centered, collaborative, interdisciplinary approach to enhance feasibility, acceptability, and usability of mHealth innovations is imperative. Creating teams with the required pools of expertise and insight regarding needs is critical. The cyclical, iterative process of developing mHealth innovations needs to be viewed as a whole with supportive theoretical frameworks. Many barriers to implementation and sustainability have limited the number of successful, evidence-based mHealth solutions beyond the pilot or feasibility stage. The science of implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. Additionally, changing needs as cohorts and technologies advance are important considerations. Lessons learned from the data and important implications for practice, policy, and research are discussed to inform the future development of innovations.

Nursing Roles in End-of-Life Decision Making in Critical Care Settings

This study used a grounded theory approach to formulate a conceptual framework of the nursing role in end-of-life decision making in a critical care setting. Fourteen nurses from an intensive care unit and cardio-respiratory care unit were interviewed. The core concept, Supporting the Journey, became evident in four major themes: Being There, A Voice to Speak Up, Enable Coming to Terms, and Helping to Let Go. Nurses described being present with patients and families to validate feelings and give emotional support. Nursing work, while bridging the journey between life and death, imparted strength and resilience and helped overcome barriers to ensure that patients received holistic care. The conceptual framework challenges nurses to be present with patients and families at the end of life, clarify and interpret information, and help families come to terms with end-of-life decisions and release their loved ones.

Seeking to Understand Telephone Support for Dementia Caregivers

Caregivers of persons with dementia encounter particular challenges in their roles and often experience unmet needs for information and emotional support. This article describes a qualitative descriptive study designed to explore the intervention of telephone support for such caregivers. Data were collected from both caregivers and telephone support providers. Results revealed that telephone support met four specific needs of dementia caregivers: the need for (a) information and education, (b) referral and/or assistance required to navigate through the system, (c) emotional support, and (d) caregiver support that is convenient and hassle free. Caregivers’ main experience with the intervention was the sense of companionship, whereas service providers experienced mixed feelings of helplessness and an opportunity to empower caregivers.