Marion E. Broome

Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center.

Objectives The purpose of this study was to examine the relationships between work satisfaction, stress, age, cohesion, work schedule, and anticipated turnover in an academic medical center. Background Data Nurse turnover is a costly problem that will continue as healthcare faces the impending nursing shortage, a new generation of nurses enter the workforce, and incentives provided to nurses to work for institutions increase. A variety of factors influence the retention of nurses in adult care settings, including work satisfaction, group cohesion, job stress, and work schedule. In general, previous research has documented positive relationships between work satisfaction, group cohesion, strong leadership, and retention rates and a negative relationship between stress, work schedule, and retention. In addition, age and experience in nursing are related to job satisfaction. Methods This study used a cross-sectional survey design in which nurses from 12 units in a 908-bed university hospital in the Southeast completed questionnaires on one occasion. The following factors were measured using self-report questionnaires: nurse perception of job stress, work satisfaction, group cohesion, and anticipated turnover. Results The more job stress, the lower group cohesion, the lower work satisfaction, and the higher the anticipated turnover. The higher the work satisfaction, the higher group cohesion and the lower anticipated turnover. The more stable the work schedule, the less work-related stress, the lower anticipated turnover, the higher group cohesion, and the higher work satisfaction. Job Stress, work satisfaction, group cohesion, and weekend overtime were all predictors of anticipated turnover. There are differences in the factors predicting anticipated turnover for different age groups. Conclusions As healthcare institutions face a nursing shortage and a new generation of nurses enter the workforce, consideration of the factors that influence turnover is essential to creating a working environment that retains the nurse.

Imagery reduces children's post-operative pain

&NA; This un‐blinded experimental study investigated the effectiveness of imagery, in addition to routine analgesics, in reducing tonsillectomy and/or adenoidectomy pain and anxiety after ambulatory surgery (AS) and at home. Seventy‐three children, aged 7–12, were recruited from five AS settings. Thirty‐six children randomly assigned to the treatment group watched a professionally developed videotape on the use of imagery and then listened to a 30‐min audio tape of imagery approximately 1 week prior to surgery (T1). They listened to only the audio tape 1–4 h after surgery (T2), and 22–27 h after discharge from AS (T3). The 37 children in the attention‐control group received standard care. Pain and anxiety were measured at each time‐point in both groups. Measures of sensory pain were the Oucher and amount of analgesics used in AS and home; affective pain was measured with the Facial Affective Scale (FAS). Anxiety was measured using the State Trait Anxiety Inventory for Children (STAIC). When controlling for trait anxiety and opioid and non‐opioid intake 1–4 h before the pain measures, MANCOVA showed significantly lower pain and anxiety in the treatment group at T2, but not at T3. When controlling for trait anxiety, a two‐way RM MANCOVA indicated no significant group differences in combined opioid and non‐opioid use between the groups, or between times. Appropriately trained health care providers should use imagery to reduce post‐operative pain following tonsillectomy and/or adenoidectomy in AS. Teaching parents about adequate home administration of analgesics may increase the effectiveness of imagery at home.

The influence of relationships on children's and adolescents' participation in research

BackgroundSince the 1950s, children and adolescents have been defined as a vulnerable group for research participation. In 1998, federal mandates were issued to include children in clinical research. ObjectivesThe purpose of this qualitative study was to describe children and adolescents’ understanding of research and the sociocultural factors that influenced them to become involved and continue participation in clinical research. The specific objective of the study findings reported here was to describe how relationships with adults (e.g., parents and investigators) influenced children and adolescent involvement in clinical research. MethodThis study employed qualitative methods, using semistructured interviews and narrative analytic techniques. There were 34 children and adolescent participants, (8–22 years of age) who had a diagnosis of either diabetes or a hematological malignancy. Participants were interviewed to obtain an understanding of their experience with the assent/consent process for a research study. All interviews were transcribed verbatim from the audiotapes. ResultsThree themes discussed in this article were related to the child/adolescent’s relationships with powerful adults: (a) faith in their parent(s), (b) relationships with members of the research/medical team, and (c) the child’s perception of what happens when a child/adolescent and his/her parent disagree about research participation. DiscussionChronically ill children are willing to dialog about their involvement in research trials, and describe how relationships with their parents and clinician/investigators influence them. They can articulate their ability and right to make the decisions about involvement in research, along with their parent(s).

Consent (assent) for research with pediatric patients

OBJECTIVES To discuss the unique terms and conditions relative to the assent of children and the consent of their parents for research participation, to describe the capabilities of children as they influence understanding of and willingness to participate in research, and to discuss issues related to research participation. DATA SOURCES Research articles, review articles, clinical experience, and government policies. CONCLUSIONS The participation of children in research is complex. Developmental limitations, the imbalance of power between children and adults, and, in some cases, their compromised health status can influence the willingness of children to participate in clinical research. IMPLICATIONS FOR NURSING PRACTICE Health care providers and researchers must be aware of the need of children to have full disclosure and clear descriptions about research in age-appropriate language. Obtaining a childs agreement to participate in research should be carefully planned and implemented.

Children in Research: The Experience of Ill Children and Adolescents

The purpose of this study was to describe children’s and adolescents’ experiences with clinical research. Thirty-four children and adolescents, age 8 to 22, who had a diagnosis of either diabetes or a hematological malignancy participated. Two major themes were identified: (a) understanding about research and (b) involvement in the decision to participate in the clinical trial. Children’s and adolescents’ understanding of research was influenced by their age, their diagnosis, and their previous experience with research. The involvement in the decision to participate was quite variable across age and disease groups. For instance, the recruitment process was markedly different for children with diabetes than for those with cancer. The structure of the trials for diabetics differed on several dimensions, including duration, offering of monetary incentives, and clear distinctions between standard treatment and experimental protocols.

Quality of reporting Randomized Controlled Trials (RCTs) in the nursing literature: Application of the Consolidated Standards of Reporting Trials (CONSORT)

In the era of evidence-based practice (EBP), Randomized Controlled Trials (RCTs) may provide the best evidence of the efficacy of nursing interventions and yet the quality of RCT reporting in nursing literature has not been evaluated. The purposes of this study were to apply the Consolidated Standards of Reporting Trials (CONSORT) statement to published reports of nursing science, examine how adequately the published reports adhere to the statement, and examine the effect of the adoption of CONSORT on the quality of the RCT published reports. One hundred RCTs from 2002-2005 were identified from 4 nursing journals. Articles were randomly assigned to 4 reviewers and the quality of the published reports was evaluated using a modified CONSORT checklist. There was no difference between the 4 journals in the quality of the published reports of RCTs based on the modified CONSORT checklist employed (F = 1.27, P =.29). The quality of reporting of RCTs improved significantly in the only journal, Nursing Research, to adopt the CONSORT statement during the study period (t =-2.70, P =.01). Adoption of CONSORT is recommended as it may lead to an overall improvement in quality of reporting of RCTs in nursing journals. The profession may also wish to explore the use or development of standards similar to CONSORT but ones more appropriate for the types of research typical of that published by nurse scientists.

Relationship Between a Preceptorship Experience and Role Socialization of Graduate Nurses

The purpose of this quasi-experimental study was to determine the effect of preceptorship on the socialization of the baccalaureate graduate nurse into roles of professional nurses. Two groups, one having a preceptorship experience in the final quarter of their baccalaureate program (n = 33) and one having the traditional course (n = 33), participated in the study. Both groups completed Schwerians Six-Dimension Scale of Nursing Performance on three testing occasions: prior to the course, immediately following the course, and the six months after graduation. There was a significant interaction effect between group and time. The preceptor group at the 6-month follow-up scored significantly higher on four of the six subscales as well as on the overall socialization instrument.

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.

School-Age Childrens Fears of Medical Experiences

The purpose of this study was to explore the experiences in health-care settings children report being afraid of. A 29–item Likert-type questionnaire was developed based on interviews with 140 school-age children. Another sample of 84 children was then administered the Child Medical Fear Scale (CMFS) in a school setting. Findings reveal that medical fear scores, in general, declined with age in this group of children. There were no significant differences in overall fear scores for children of different age groups. However, younger children did rate certain items related to intrusive procedures as most fearful. There were no strong, significant relationships between reported fear levels and gender, race, or other sociodemographic variables. Further study using the tool with hospitalized and chronically ill children is suggested. Recommendations for use of the CMFS in clinical practice include use of the scale to assess an individual childs fear level prior to providing preparation as well as its use as e...

Conducting Empirical Research on Informed Consent: Challenges and Questions

She informed consent projects (ICPs) we describe here were designed to produce (1) new and improved methods for the informed consent process, (z) methods for confronting the challenges of obtaining consent for special or vulnerable populations, and (3) data to help inform and guide public policy development (Table 1). From the outset, the project investigators identified a number of conceptual and practical concerns and challenges in conducting empirical research on informed consent. These concerns and challenges were shared by all the investigators, despite the significant variability in the research methods used and the populations studied. Experienced researchers will recognize that some of these concerns and challenges are common to many kinds of research involving human subjects. Some, however, are unique to research on informed consent. We describe these matters for the purpose of fostering ongoing dialogue about the challenges researchers face in studying the informed consent process. Common Research Challenges