Judith Gedney Baggs

Nurses' and resident physicians' perceptions of the process of collaboration in an MICU.

Ten intensive care unit nurses and 10 medical resident physicians were interviewed to compare their perceptions of the process of nurse-physician collaboration. The grounded theory method for concept development recommended by Strauss and Corbin (1990) was used. The core of the process of collaboration for both groups was working together. Two major antecedent conditions were found: being available, which included being in the right place, having time, and having appropriate knowledge; and being receptive, which included being interested in collaboration and having respect and trust for the other profession. The major outcomes of working together were described as improving patient care, feeling better in the job, and controlling costs. The findings of the study pull together disparate concepts associated with collaborative practice and provide direction for future research.

Blinding in peer review: the preferences of reviewers for nursing journals

AIM This paper is a report of a study to assess the beliefs and preferences of reviewers for nursing journals about blinding of authors to reviewers, reviewers to authors, neither or both. BACKGROUND Blinding of author and reviewer names in the manuscript review process has been of interest to nursing editors, but reports that are based on data rather than simply opinion concern the editorial practices of biomedical rather than nursing journals. There has been no study of nursing journal reviewer beliefs and preferences related to blinding. METHOD A descriptive web-based survey was conducted. The sample included 1675 anonymous reviewers, recruited through 52 editors of nursing journals from their review panels. Data were collected in 2007. FINDINGS Double-blinding of reviews was the most common method reported. Ninety per cent of respondents reported that the papers they received to review did not include author names. When author names were blinded, 62% of reviewers could not identify the authors of papers; another 17% could identify authors < or =10% of the time. Double-blinding was the method preferred by 93.6% of reviewers, although some identified some advantages to an unblinded open review process. CONCLUSION Nursing journal reviewers are generally very satisfied with double-blinding and believe it contributes to the quality of papers published. Editors or editorial boards interested in a more open review process could consider alternatives such as offering authors and reviewers the option to unblind themselves. Simply announcing that the review process will henceforth be unblinded would probably lead to loss of reviewers.

Quality nursing care for hospitalized patients with advanced illness: Concept development

The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attributes of competence, caring, professionalism, and demeanor were identified as common components of quality care across various patient populations, the caring domain increased in importance when patients with advanced illness perceived themselves as vulnerable. Assessment of quality nursing care for patients with advanced illness needs to include measures of patient perceptions of vulnerability.

Hemodynamic and regional blood flow response to milrinone in patients with severe congestive heart failure: A dose-ranging study

This study was undertaken to assess the hemodynamic efficacy, changes in regional blood flow, and safety of milrinone over a range of intravenous bolus injections (12.5 to 125 micrograms/kg), a continuous 18-hour infusion (0.2 to 0.7 microgram/kg/min), and following oral administration. All eighteen patients with New York Heart Association class III or IV congestive heart failure demonstrated hemodynamic improvement following intravenous bolus therapy. Dose-related increases in cardiac index occurred, ranging from a 12 +/- 6% increase following a 12.5 micrograms/kg bolus to a 37 +/- 10% increase after 75 micrograms/kg. Pulmonary wedge pressure fell 17 +/- 5% following 12.5 micrograms/kg and 28 +/- 9% following 75 micrograms/kg. Little change was apparent during the continuous infusion except for a late increase in cardiac index, but similar changes occurred in response to a single oral dose. Forearm blood flow increased significantly after 3 hours in the two higher infusion groups, but there was no consistent change in hepatic blood flow. We conclude that hemodynamic parameters and forearm blood flow are improved in patients with severe congestive heart failure following intravenous and short-term oral milrinone therapy.

End-of-life care for older adults in ICUs.

This review was undertaken to present and critique the most recent (1990-2000) empirical evidence about end-of-life care for older adult patients in ICUs, their families, and care providers. The studies (including descriptive, correlational, longitudinal, and intervention) were found using a combination of these terms: (a) intensive care (units) or critical care (units), and (b) critical illness, critically ill patients, terminally ill, terminal care, life support care, or palliative care. The computerized databases searched were CINAHL and MEDLINE. Only published studies of persons 44 years of age or older, written in English, and conducted in the U.S. or Canada were included. Research was not limited to studies conducted by or written by nurses. Excluded were articles focused on physiology, for example, studies of treatment for specific conditions, and articles focused on predictors of ICU outcomes. Findings and Implications for Research There is little research specifically focused on end-of-life care of older adults in ICUs. Most research has been retrospective, and most has involved either providers or patients and families but not both. Research is needed in many areas. The mechanism by which age affects choice of care needs further exploration. The experience of patients, families, and providers and how those experiences change with interventions needs investigation. The influence of the ICU culture, variation in decisions made and reasons for that variation, the decision-making process, and variations in care, all require further attention. Four domains were identified for research needed to improve care for older adults at the end of life in intensive care: symptom relief, communication improvement, psychological support, and relationship improvement. No one has assessed whether the ICU is a good place for transition to palliation to occur, or whether it would be better to transfer patients to another type of unit.

Challenges in Conducting End-of-Life Research in Critical Care

Critical care units present some unique challenges to the researcher, especially when the research topic of interest is related to end-of-life care. The purpose of this article is to address some of the methodological and practical issues related to conducting end-of-life research in the critical care setting. Recruitment barriers include gaining access to a clinical site, gaining access to patients, and prognostic uncertainty. Additional barriers include challenges related to informed consent, data collection, the research team, and ethical considerations. Strategies are described that can be used to guide researchers to conduct end-of-life research successfully in critical care.

Ethical concerns of nursing reviewers: An international survey

Editors of scientific literature rely heavily on peer reviewers to evaluate the integrity of research conduct and validity of findings in manuscript submissions. The purpose of this study was to describe the ethical concerns of reviewers of nursing journals. This descriptive cross-sectional study was an anonymous online survey. The findings reported here were part of a larger investigation of experiences of reviewers. Fifty-two editors of nursing journals (six outside the USA) agreed to invite their review panels to participate. A 69-item forced-choice and open-ended survey developed by the authors based on the literature was pilot tested with 18 reviewers before being entered into SurveyMonkeyTM. A total of 1675 reviewers responded with useable surveys. Six questions elicited responses about ethical issues, such as conflict of interest, protection of human research participants, plagiarism, duplicate publication, misrepresentation of data and ‘other’. The reviewers indicated whether they had experienced such a concern and notified the editor, and how satisfied they were with the outcome. They provided specific examples. Approximately 20% of the reviewers had experienced various ethical dilemmas. Although the majority reported their concerns to the editor, not all did so, and not all were satisfied with the outcomes. The most commonly reported concern perceived was inadequate protection of human participants. The least common was plagiarism, but this was most often reported to the editor and least often led to a satisfactory outcome. Qualitative responses at the end of the survey indicate this lack of satisfaction was most commonly related to feedback provided on resolution by the editor. The findings from this study suggest several areas that editors should note, including follow up with reviewers when they identify ethical concerns about a manuscript.

Rooming-in for elderly surgical patients.

Elderly patients are at risk for developing acute confusion during hospitalization. Rooming-in, an intervention frequently used for pediatric patients, was compared to usual care in a sample of 24 elderly patients hospitalized for orthopedic surgery. Although confusion during hospitalization, complicate rate, and length of stay did not differ between patients who did and did not have rooming-in, the family members and friends who roomed in were very satisfied with the experience. These findings suggest that rooming-in is feasible and highly satisfactory to the patients family and/or friends.

Online Survey of Nursing Journal Peer Reviewers: Indicators of Quality in Manuscripts

Nursing journal peer reviewers (N = 1,675) completed a 69-item online survey that assessed their views on manuscripts’ contributions to nursing, priorities in writing reviews, use of journal impact factor, and other areas related to indicators of quality. They reported using contribution to knowledge or research evidence, topic of current interest, and newly emerging area as indicators of a manuscript’s contribution to nursing. In writing their reviews, research rigor and clinical relevance of the manuscript were high priorities. Those familiar with the concept of impact factor were significantly more often not nurses; not United States residents; involved in research; and most often reviewed for journals that published only research or a scholarly mix of research, reviews, policy, and theory. When judging a paper’s contribution, nursing journal peer reviewers weigh both research and clinical interests. Most reviewers do not use impact factors and place clinical considerations ahead of impact factors.

Relationship Quality in Non-Cognitively Impaired Mother-Daughter Care Dyads: A Systematic Review.

More than 60 million Americans provide care to a family member; roughly two thirds are women providing care to aging mothers. Despite the protective nature of relationship quality, little attention has been given to its role in mother–daughter care dyads, particularly in mothers without cognitive impairment. A systematic appraisal of peer-reviewed, English language research was conducted. Nineteen articles met criteria. When relationship quality is positive, mother–daughter dyads enjoy rewards and mutuality, even when conflict occurs. Daughters grow more emotionally committed to mothers’ over the care trajectory, despite increasing demands. Daughters’ commitment deepens as mothers physically decline, and mothers remain engaged, emotional partners. When relationship quality is ambivalent or negative, burden, conflict, and blame conspire, creating a destructive cycle. Avenues for continuing study, including utilizing the dyad as the unit of analysis, troubled dyads, longitudinal assessment, and end of life context, are needed before interventions to improve mother–daughter relationship quality may be successfully implemented.