Martha K. Swartz

The PRISMA Statement: A Guideline for Systematic Reviews and Meta-Analyses

In this editorial space of the previous issue of the Journal, I offered some thoughts relative to the history of and the need for a higher level of research synthesis to advance nursing science (Swartz, 2010). The need for more sophisticated and uniform standards regarding the development of integrated literature or systematic reviews was particularly noted. Systematic reviews in the literature have become more important as a means of keeping clinicians up to date on advances in the field and as a method of developing clinical practice guidelines. Systematic reviews are also important in identifying research questions and in justifying to granting agencies that further research in a specific area is needed. In response to the need to elevate the quality of systematic reviews in numerous disciplines, in 1996 an international group released the Quality of Reporting of Meta-Analyses (QUORUM) Statement, a set of guidelines that provided standards for reporting metaanalyses of randomized controlled trials (Moher et al., 1999). This set of guidelines recently has been revised to include additional standards for systematic reviews aswell asmeta-analyses andhas been renamedPRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The updated PRISMA statement is based on the conceptual and practical advances that have been made in the science of systematic reviews. PRISMA also has adopted the definition used by the Cochrane Collaboration: ‘‘a systematic review

Parenting Preterm Infants: A Meta-Synthesis

Purpose:To synthesize the findings of qualitative studies on parenting preterm infants and present a framework that will enable clinical nurses to provide better care. Study Design and Methods:A meta-ethnographic approach was used to synthesize the findings of 10 qualitative research studies that focused on parenting the preterm infant upon hospital discharge and on into the toddler years. Results:Five themes of parenting preterm infants emerged: adapting to risk, protecting fragility, preserving the family, compensating for the past, and cautiously affirming the future. Clinical Implications:Nurses provide expert care, anticipatory guidance, and education for NICU babies and families, but should also foster the inclusion of all family members in the NICU setting, provide opportunities for parental peer support, establish effective systems of continuity of care, and advocate for parents of preterms in policy-making arenas.

Characterizing nurse practitioner practice by sampling patient encounters: An APRNet study

PurposeThe purpose of this study was to characterize nurse practitioners (NPs) practice by using reports of patient encounters to more accurately reflect practice patterns than has been previously performed. This study was part of a larger primary care practice survey by a consortium of 20 practice-based research networks (PBRNs). Therefore, comparisons, when appropriate, were also made between this network of NPs (Advanced Practice Registered Nurse Network, APRNet) and the other 19 physician-run research networks. Data sourcesA descriptive survey was developed by the 20 PBRN consortium under grants from the Agency for Healthcare Research and Quality. The consortiums goal was to collect primary care data over a 6-month period and to document and compare primary care practice in the United States. The data were collected immediately following members encounters with patients rather than from billing spreadsheets. Nineteen PBRNs may have had NPs in the practices that comprised their networks. However, the data from these NPs were collected under the study ID numbers of the physician owners of each practice. APRNet, therefore, was the sole research network comprised exclusively of NPs who collected and reported data under their own study ID numbers. ConclusionsAcute health problems comprised 45% of all episodes treated by NPs compared to 30% of episodes for exacerbations of chronic conditions and 24.5% for nonillness and health promotion visits. In addition, our findings suggest that NPs provide counseling in 84% (vs. 61% for physicians) of their primary care visits, regardless of the reason for visit, and the type of counseling varies by the type of NP. Implications for practiceDespite many studies on the comparability and outcomes of NP practice, the need to identify, clarify, and document the practices of NPs in primary care settings remains. The present survey provides an important and useful first step in providing a systematic way to characterize these practices through a survey of APRNs immediately following their patient encounters.

Developmental Status of Children of Teen Mothers: Contrasting Objective Assessments With Maternal Reports

INTRODUCTIONnDescriptive study compared adolescent mothers subjective perceptions of their childrens development with objective developmental assessments.nnnMETHODSnA volunteer sample of mother/child pairs was recruited from an urban high school. Thirty-three mothers completed the Ages and Stages Questionnaire (A&SQ). The Bayley Scales of Infant Development (BSID) was administered to children.nnnRESULTSnOn the BSID, group mean scores all fell within the normal range. However, almost 20% of individual children had one or more delays. Almost 73% of mothers accurately assessed their childrens development on the A&SQ when compared with BSID results. Eighteen percent of mothers suspected delays when no delays were objectively identified. A single mother identified delay in a different domain than that identified on the BSID.nnnDISCUSSIONnFindings that almost 20% of these children had developmental delays support other research that children of adolescent mothers are at risk for delays. Findings that teen mothers varied in their abilities to assess their childrens development reinforce the need for education of teen mothers about child development. Further study is needed to determine the best models of this education in school and community settings.

A day in the lives of APNs in the U.S.

ursing associations,state boards of nursing, and certification bodies routinely collect information that describes the professional activities of nurses in advanced practice. Traditionally, the focus of such surveys has been on demographic data about the nurses, their academic background, professional roles, functions, salaries, benefits, and the average number of hours worked and patients seen. Recent surveys of nurse practitioners (NPs) highlight the effects of rapid changes in the health care delivery system. In particular, scientific and technological advancements have enabled health care providers to treat and prolong the lives of individuals with chronic illness or disability.Also,a reduced length of patient hospital stay has been associated with the influence of managed care organizations and the high cost of inpatient care for individuals with complex or chronic illness. For nurses in advanced practice, these changes have resulted in health care roles that are relatively dynamic and often in a state of flux. In a role delineation study for pediatric nurse practitioners (PNPs), Brady and Neal found that 10% of their study population were employed in emergent care settings and inpatient units. They also reported that the practice of PNPs in office settings with a pediatrician was associated with a relatively greater level of management responsibility in the treatment of pediatric conditions and illnesses when compared with practice sites such as clinics or outpatient centers. Similarly, a pilot study of recent PNP graduates from six university programs by Jackson et al found that slightly less than half of the respondents were practicing in a primary care setting, and that more than one-third practiced in a specialty care setting. The reported role functions for these PNPs are now more likely to include case management, staff development, consultation, administration of programs or personnel,policy and program development, and implementation of research. Druss and colleagues, in their study on national trends in health care as provided by nonphysician clinicians (primarily NPs and physician assistants), reported that the extent of preventative and maternity care by these practitioners increased between 1987 and 1997. However, few details were given about the clinical content of these patient encounters. Moody, Smith and Glenn further described the practice patterns of NPs in Tennessee with an emphasis on the demographic characteristics and health problems of clients, and the therapeutic services offered by the NPs. Using an instrument adapted from the National Ambulatory Medical Care Survey, this study of 44 NPs revealed that the most frequent patient illnesses were hypertension, otitis media, upper respiratory infections and diabetes mellitus. Patient counseling and teaching were the most frequently Martha K. Swartz, PhDc, APRN, BC, PNP Margaret Grey, DrPH, CPNP, FAAN Janet D. Allan, PhD, RN, CS, FAAN Nancy Ridenour, PhD, RN, CS, FNC, FAAN Christine Kovner, PhD, RN, FAAN Patricia Hinton Walker, PhD, RN, FAAN Lucy Marion, PhD, RN, CS, FAAN

Predictors of Health-Related Quality of Life in Asthmatic Children

For children with asthma, their perceived health-related quality of life (HRQL) is viewed as a valid outcome measure with which to evaluate care and guide clinical interventions. Numerous clinical variables have been associated with HRQL, but few studies have addressed the role of family functioning in relationship to this outcome. The current study extends the findings of an earlier meta-analysis that indicated that family functioning and illness severity were significant predictors of health-related quality of life in children with asthma. Sixty children and 60 parents or guardians participated in this study of school-age asthmatic children who, over the preceding year, received regular care at a pediatric respiratory clinic for their asthma symptoms. Demographic information was obtained from the adults, who also completed standard measures assessing family stress, adaptation, and cohesion. The children were interviewed by the investigator and completed scales to assess HRQL. The major outcome of intere...

Connecting with chronically ill patients to improve treatment adherence.

This study presents an integrative review of the literature assessing the relationships among a patients style in coping with a long-term health condition, the patient-practitioner therapeutic alliance, and treatment adherence among chronically ill adults. Evidence-based recommendations to improve nurse practitioner-patient therapeutic alliance and treatment adherence are suggested.

A look back at research synthesis.

The need to effectively synthesize the results of research studies has been recognized for more than 200 years. Early scholars acknowledged that science must bemore than an accumulation of facts; otherwise, it might come to a standstill, effectively crushed under its own weight. Yet, while science is supposed to be cumulative, the methodologies for building cumulative evidence were not developed until the 20th century. A variety of terms are used to describe the various processes of integrating research evidence: research synthesis, systematic review, integrative review, metaanalysis, and meta-synthesis. Statistical methods to reduce imprecision and bias when quantitatively synthesizing research results were the first to be developed in theearly 1900s. In 1932, Fisherdevelopeda technique for combining the P values that came from independent tests of the samehypothesis (Fisher, 1932). Interest in research synthesis among statisticians continued through the Second World War, and the term meta-analysis ultimately was coined by Glass (Glass, 1976). AfterWorldWar II, social scientists began to recognize that the need to organize and evaluate accumulating bodies of evidence was far more complex than simply a choice of statistical methods. They acknowledged the need for methodological rigor to ensure the validity of research reviews, just as is required for primary research. Health researchers were relative latecomers to research synthesis. In the 1970s, critical summaries of randomized clinical trials began to appear in the literature, and The Cochrane Database of Systematic Reviews was launched by the Cochrane Collaboration of the United Kingdom in 1995 (Tovey, 2010). Today the various terms used to describe syntheses of the literature that support evidence-based practice seem to be used interchangeably. The term systematic review appears frequently in medical publications, whereas

A decade later.

EVOLUTION IN CONTEXT Contemporary evolution, or rapid genetic changes within populations, is ubiquitous, but one of the earliest demonstrations of natural selection’s short-term dynamics was observed in the streams of Trinidad. Starting in the early 1980s, researchers transferred guppies from communities with cichlid predators to bodies of water with only smaller predators called killifish, which eat only small, young guppies. The guppies in the new, low-predation environment grew larger and reproduced later than guppies that lived in cichlid-infested waters. Females also began having fewer, but larger young, and the intervals between their litters got longer. Over the long term, killifish evolved to be smaller and less abundant. Laboratory experiments confirmed that changes were hard-wired and heritable.