Mary-Anne Ramis

A Delphi study to validate an advanced practice nursing tool.

AIM This paper is a report of a study conducted to validate an instrument for measuring advanced practice nursing role delineation in an international contemporary health service context using the Delphi technique. BACKGROUND Although most countries now have clear definitions and competency standards for nurse practitioners, no such clarity exists for many advanced practice nurse roles, leaving healthcare providers uncertain whether their service needs can or should be met by an advanced practice nurse or a nurse practitioner. The validation of a tool depicting advanced practice nursing is essential for the appropriate deployment of advanced practice nurses. This paper is the second in a three-phase study to develop an operational framework for assigning advanced practice nursing roles. METHOD An expert panel was established to review the activities in the Strong Model of Advanced Practice Role Delineation tool. Using the Delphi technique, data were collected via an on-line survey through a series of iterative rounds in 2008. Feedback and statistical summaries of responses were distributed to the panel until the 75% consensus cut-off was obtained. RESULTS After three rounds and modification of five activities, consensus was obtained for validation of the content of this tool. CONCLUSION The Strong Model of Advanced Practice Role Delineation tool is valid for depicting the dimensions of practice of the advanced practice role in an international contemporary health service context thereby having the potential to optimize the utilization of the advanced practice nursing workforce.

Advanced practice nursing role development: factor analysis of a modified role delineation tool

AIM   This study reports the use of exploratory factor analysis to determine construct validity of a modified advanced practice role delineation tool. BACKGROUND   Little research exists on specific activities and domains of practice within advanced practice nursing roles, making it difficult to define service parameters of this level of nursing practice. A valid and reliable tool would assist those responsible for employing or deploying advanced practice nurses by identifying and defining their service profile. This is the third article from a multi-phase Australian study aimed at assigning advanced practice roles. METHODS   A postal survey was conducted of a random sample of state government employed Registered Nurses and midwives, across various levels and grades of practice in the state of Queensland, Australia, using the modified Advanced Practice Role Delineation tool. Exploratory factor analysis, using principal axis factoring was undertaken to examine factors in the modified tool. Cronbachs alpha coefficient determined reliability of the overall scale and identified factors. RESULTS   There were 658 responses (42% response rate). The five factors found with loadings of ≥400 for 40 of the 41 APN activities were similar to the five domains in the Strong model. Cronbachs alpha coefficient was 0·94 overall and for the factors ranged from 0·83 to 0·95. CONCLUSION   Exploratory factor analysis of the modified tool supports validity of the five domains of the original tool. Further investigation will identify use of the tool in a broader healthcare environment.

Using user‐friendly telecommunications to improve cardiac and diabetes self‐management programme: a pilot study

Previous studies exploring the incidence and readmission rates of cardiac patients admitted to a coronary care unit (CCU) with type 2 diabetes [1] have been undertaken by the first author. Interviews of these patients regarding their experiences in managing their everyday conditions [2] provided the basis for developing the initial cardiac–diabetes self-management programme (CDSMP) [3]. Findings from each of these previous studies highlighted the complexity of self-management for patients with both conditions and contributed to the creation of a new self-management programme, the CDSMP, based on Bandura’s (2004) self-efficacy theory [4]. From patient and staff feedback received for the CDSMP [3], it became evident that further revision of the programme was needed to improve self-management levels of patients and possibility of incorporating methods of information technology (IT). Little is known about the applicability of different methods of technology for delivering self-management programmes for patients with chronic diseases such as those with type 2 diabetes and cardiac conditions. Although there is some evidence supporting the benefits and the great potential of using IT in supporting self-management programmes, it is not strong, and further research on the use of IT in such programmes is recommended [5–7]. Therefore, this study was designed to pilot test feasibility of the CDSMP incorporating telephone and text-messaging as follow-up approaches.

The Effectiveness of Psychosocial Interventions for Cognitive Dysfunction in Cancer Patients Who Have Received Chemotherapy: A Systematic Review

Background Chemotherapy-related cognitive dysfunction (CRCD) refers to problems with memory, attention span, or concentration, experienced by patients with cancer who have had chemotherapy. CRCD can have a significant negative effect on a patients quality of life. The exact cause of CRCD is unknown but is presumed to be multifactorial. Objective To conduct a systematic review of the effectiveness of psychosocial interventions designed to treat CRCD. Methods Participants of interest to the review were over 18 years of age, diagnosed with cancer, and receiving chemotherapy or had received chemotherapy in the past. Interventions of interest were methods to improve cognitive function. Included study designs were randomized controlled trials, quasi-experimental trials, and quantitative observational studies. The primary outcome of interest was level of cognitive function. A three-step search strategy was utilized to identify studies published from 1985 to 2011 from a wide range of databases. Joanna Briggs Institute systematic review methods were used but findings were analyzed using the Cochrane Collaboration Review Manager 5.1 program. Weighted mean differences with 95% confidence intervals were calculated from the continuous data. Results Searching identified 3,109 potentially relevant articles and 120 full-text articles were retrieved. Two further papers were sourced from reference lists of retrieved articles. From 122 papers, six were suitable for critical appraisal and six were included in the analysis. Meta-analysis was conducted on two cognitive behavioral therapy (CBT) trials for the outcome of inability to concentrate. Significant effect was seen for one CBT intervention at 20 weeks (p = .004). Significant effect from CBT on quality of life was seen at 6-month follow-up (p < .05). Conclusions Despite some evidence of an effect, there is insufficient evidence at this stage to strongly recommend any of the interventions to assist in decreasing the effects of CRCD, except in terms of improving quality of life.

Rehabilitation programs after the implantation of transfemoral osseointegrated fixations for bone-anchored prostheses: a systematic review protocol

REVIEW QUESTION The primary objective of this scoping review is to characterize rehabilitation programs for individuals with transfemoral amputation following the implantation of screw-type or press-fit osseointegrated fixations for bone-anchored prostheses.The secondary objective of this review is to describe partial weight bearing exercises including static and dynamic exercises as well as use of walking aids in each rehabilitation program for screw-type and press-fit fixations.The third objective of this review is to compare key rehabilitation parameters for various partial weight bearing exercises (e.g. type of training prosthesis, loading time and progression, monitoring of loading, loading direction, instructions given to patients and the use of loading regulators) within each program for screw-type and press-fit fixations (intra-variability) and between programs for screw-type and press-fit fixations (inter-variability).The specific review questions are.

The effectiveness of communication interventions in providing older people with information on access to in-home health and social care services: a systematic review protocol

The objective of this review is to locate, critically appraise and synthesize evidence on the effectiveness of communication strategies for providing older people access to information regarding in-home health and social care services. The review question is: What is the effectiveness of communication interventions in providing older people with information about in-home health and social care services?