Karen Parsons

HIV testing in pregnancy: Using women's voices to inform policy

BACKGROUND In Canadian provinces with opt-out policies for maternal HIV screening, pregnant women are told HIV screening is routine and are provided with the opportunity to refuse. In Newfoundland and Labrador an opt-out screening policy has been in place since 1997. PURPOSE This research study aimed to (1) obtain an increased understanding of the information women receive about HIV/AIDS during the opt-out screening process and (2) to advance the policy related dialogue around best practices in HIV screening within the province of Newfoundland and Labrador. METHODS Twelve women who were between 14 and 35 weeks gestation participated. Interviews were transcribed verbatim and a thematic analysis was carried out. FINDINGS The major themes are that women have difficulty obtaining clear information about maternal HIV screening, are often not told they have the right to refuse maternal screening, and experience paternalism from physicians. CONCLUSION We recommend that physicians and other health care providers in be reminded that that current opt-out testing requires womens consent and that women must be given the option to refuse the test.

A randomized controlled trial of the effect of an intensive 1-year care management program on measures of health status in independent, community-living old elderly: the Eldercare project

BACKGROUND Primary care practitioners are familiar with the frail elderly and commonly have to deal with their multi-morbidity and their functional decline, both physically and mentally. However, there are well elderly with high quality of life and very few co-morbidities who seldom seek medical care. OBJECTIVE To determine if a nurse-based program of home-delivered care, linked directly with the primary care practitioner or primary care team, would improve quality of life, symptoms, satisfaction with care and utilization of community and medical services, in independent community living old elderly. DESIGN Randomized controlled trial. SETTING St. Johns, Newfoundland, Canada. PARTICIPANTS Two hundred and thirty-six independent, community-dwelling, cognitively functioning, people aged 80 years and older. INTERVENTION A nurse-based program of care, carried out in the patients home, that involved a detailed assessment of needs, the development of a plan to meet the needs, and up to eight visits to the patients home during a 1-year period to facilitate the meeting of those needs. CONTROL GROUP Usual care MAIN OUTCOME MEASUREMENTS Quality of Life measured using the SF-36 and the CASP-19 scales; symptomology using the Comorbidity Symptom Scale; patient satisfaction using the PSQ-18; and assessment of health care services (community services, emergency room visits, hospitalizations, use of diagnostic services and family doctor visits) through patient recall, family physician chart review and assessment of hospitalization records. RESULTS There were no statistical or meaningful differences between the intervention and control groups in any of the outcomes measured. CONCLUSION The intensive, home-delivered, program of care for the well old elderly did not have an impact on the outcomes measured.

Older nurses' experiences of providing direct care in hospital nursing units: a qualitative evidence systematic review protocol.

REVIEW QUESTION/OBJECTIVE The objective of this review is to understand the experience of older nurses providing direct care in hospital nursing units. The review question that will guide this review is: what is the experience of older nurses providing direct care in hospital nursing units? INCLUSION CRITERIA Types of participants: This review will consider studies that include registered nurses 45 years and older who work as direct care nurses on any type of in-patient hospital nursing unit. For the purposes of this study older nurses will be defined as 45 years and above as this is consistent with the literature. Studies that include nurses both over and under the age of 45 years will be included if findings for nurses 45 years and older can be separated from nurses under the age of 45 years. This review will exclude studies consisting entirely of enrolled nurses, licensed practical nurses, and licensed vocational nurses. The rationale for this is that registered nurses have a level of competence and skill that enables them to perform nursing competencies at a much different level than enrolled nurses, licensed practical nurses, and licensed vocational nurses, thus the nature of their nursing experience is most likely quite different. Types of intervention(s)/phenomena of interest: The phenomenon of interest is the experience of providing direct nursing care as experienced by the population of older nurses. Types of outcomes/context: The context is the provision of direct nursing care in an in-patient hospital nursing unit.