Philip Esterhuizen

Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools

BackgroundThere is evidence of under-detection and poor management of pain in patients with dementia, in both long-term and acute care. Accurate assessment of pain in people with dementia is challenging and pain assessment tools have received considerable attention over the years, with an increasing number of tools made available. Systematic reviews on the evidence of their validity and utility mostly compare different sets of tools. This review of systematic reviews analyses and summarises evidence concerning the psychometric properties and clinical utility of pain assessment tools in adults with dementia or cognitive impairment.MethodsWe searched for systematic reviews of pain assessment tools providing evidence of reliability, validity and clinical utility. Two reviewers independently assessed each review and extracted data from them, with a third reviewer mediating when consensus was not reached. Analysis of the data was carried out collaboratively. The reviews were synthesised using a narrative synthesis approach.ResultsWe retrieved 441 potentially eligible reviews, 23 met the criteria for inclusion and 8 provided data for extraction. Each review evaluated between 8 and 13 tools, in aggregate providing evidence on a total of 28 tools. The quality of the reviews varied and the reporting often lacked sufficient methodological detail for quality assessment. The 28 tools appear to have been studied in a variety of settings and with varied types of patients. The reviews identified several methodological limitations across the original studies. The lack of a ‘gold standard’ significantly hinders the evaluation of tools’ validity. Most importantly, the samples were small providing limited evidence for use of any of the tools across settings or populations.ConclusionsThere are a considerable number of pain assessment tools available for use with the elderly cognitive impaired population. However there is limited evidence about their reliability, validity and clinical utility. On the basis of this review no one tool can be recommended given the existing evidence.

Art and Science in Health Care Research Pushing at Open Doors or Locked in Institutions

Research methods are usually dictated and driven by the research question. In the context of research in “closed” systems—for example, offender health settings—it is imperative that the research question takes into consideration the context in which the research is located. Conducting research that has action, transformation, and creativity at its heart is a significant challenge in closed cultures, for both the researcher and the researched. Using two exemplars, we question whether researchers should adopt a safe approach to researching these closed cultures and to what extent they should engage in methodological tensions and ethical dilemmas that provoke and support reflection on change. By reflecting on our previous research studies, we aim not so much to provide a definitive answer to this question but to suggest that researchers give careful consideration to the methods appropriate to both the context of the research and its purpose.

Intercultural–Global Competencies for the 21st Century and Beyond

Increased diversity exists in Anglo-Saxon countries, such as Australia, the United Kingdom, and the United States. By 2050, no single ethnic group is expected to be in a majority in the United States. Health care reform points to an urgent need for health care professionals, such as nursing, medicine, allied health, nutrition, and other interdisciplinary health care team members, to serve a multi-ethnic population by developing intercultural-global and 21st-century competencies. Nurse educators must acknowledge the need to familiarize themselves and integrate these competencies into university and continuing education programs by evaluating and reporting outcomes. All nurses can be expected to have these competencies as global citizens through local, intercultural, and global interactions and exchanges.

Compassionate communication in acute healthcare: establishing the face and content validity of a questionnaire:

The National Health Service is committed to measuring the quality of nursing care through adopting a number of indicators which are not nationally standardised. Compassionate communication is one indicator, but it is unclear how this is assessed or demonstrated in practice. This is primarily a methodological paper which aims to establish the face and content validity of a questionnaire to measure nurses’ non-verbal methods of compassionate communication with patients in acute healthcare. An existing questionnaire was amended to meet the study’s requirements. A ‘lay expert sample’ was used to rate the face validity and a ‘research expert sample’ to rate the content validity of the instrument. Modification of one response and adding instructions on how to complete the questionnaire meant that Version 2 potentially has high face validity. The questionnaire demonstrated excellent content validity (Scale-Content Validity Index = 0.85). Recommendations include pilot testing to further investigate the construct of non-verbal compassionate communication in an acute healthcare context. This research can be used to inform the measurement of compassionate communication and promote standardisation nationally.

Improving self-directed learning/intercultural competencies: breaking the silence.

Nurse educators need to develop innovative, technological curricula that foster intercultural competencies as essential components of a university education and break the silence with respect to lesbian, gay, bisexual, transgender, and queer (LGBTQ) health. Goals are to foster using these competencies to make LGBTQ content explicit in nursing curricula and in their professional organizations to promote equality and lessen disparities in this group.

Researchers' experiences of focus group dynamics in Singapore, Australia and the Netherlands: troubling multicultural assumptions

Increasingly, research is being undertaken with people from diverse cultures, with many countries revitalising the foundations of their cultural heritage. Cultural sensitivity is an essential skill for researchers, and researchers are challenged to carefully consider cultural contexts of all research and data collection methods. In this paper, we describe and reflect on our experiences of facilitating qualitative research, specifically focus groups, across three continents and using a postmodern approach, deconstruct focus group utility. We offer four strategies for conducting focus groups that provide practical guidance suggestions for qualitative researchers facilitating focus groups in these populations. Our reflections reinforce that understanding our own multicultural assumptions and biases, being reflexive and mindful and using the suggested strategies to facilitate focus groups in different cultures may prevent researchers from adopting essentialist cultural stereotypes.

Comparative analysis of NLN NCLEX-RN readiness exam performance: BSN versus ADN

This well-argued paper focuses on the success rate of National Council Licensure Examination for Registered Nurses (NCLEX-RN) and the importance of passing this examination. While the author illuminates presumably one aspect of the US system of nursing education, as an outsider it is difficult for me to understand what the different measurements and/or instruments are or why so much importance is attached to this licensure examination. The importance of ensuring licensure is, apparently, undisputedly important; however, Jeffereys (2007) identifies the risk related to the self-esteem of an individual student in the case of failure to pass the licensure examination as something educators need to bear in mind in terms of attrition. From a European perspective (and some US perspectives) nursing education fits within a nursing philosophy. The contextuality of the educational approach appears lacking in this article. It appears as though rote learning is advocated to pass the NCLEX-RN test and that this becomes the focus of the nursing programme, rather than teaching students to nurse. Previous authors have gone so far as to challenge the concept of standardised examination for nurse education (Wellard, et al., 2007) arguing that the knowledge needed by a nurse in current practice comprises theoretical, tacit and personal elements. From a different perspective, the link with actual knowledge application in the clinical setting appears lacking in that the author maintains that learning ‘new nursing-related materials’ in practice shows a negative correlation with NCLEX-RN success and that ‘new graduates are discouraged to undergo job orientation’ while preparing for the examination. This is an odd statement in the light that other research has indicated that experiential learning is considered to be a powerful form of learning (Fowler, 2008). Other authors have also explored the need for deep learning. Leung, et al. (2008) discuss the negative effects of rote learning on critical thinking skills, Parker and Myrick (2009) discuss the strengths of patient simulation in developing clinical judgement and problem-solving skills and Duers and Brown (2009) explore the value (and risks) of formative assessment, indicating the importance of personal student/lecturer contact. Journal of Research in Nursing ©2009 SAGE PUBLICATIONS Los Angeles, London, New Delhi and Singapore VOL 14 (5) 463–464 DOI: 10.1177/ 1744987109106818 R E V I EW

Rhetoric versus reality: The role of research in deconstructing concepts of caring

Our aim was to employ a critical analytic lens to explicate the role of nursing research in supporting the notion of caring realities. To do this, we used case exemplars to illustrate the infusion of such discourses. The first exemplar examines the fundamental concept of caring: using Florence Nightingales Notes on Nursing, the case study surfaces caring as originally grounded in ritualized practice and subsequently describes its transmutation, via competing discourses, to a more holistic concept. It is argued that in the many and varied attempts to define the dynamic concept of care, caring has now become paradoxically, a more fragmented concept despite attempts to render it more holistic and inclusive. In the second exemplar, one of the authors draws on her personal experience of the gap between theory and practice, so pronounced that it pushed the author to revisit the concept of evidence-based practice and nursing education. In our third and final exemplar, we refer to the absence of knowledge and practice generated through natural enquiry and curiosity, an absence which has led to production of corporate led rhetoric. Drawing together the central arguments of the three exemplars, we reflect on the influential role of nursing research in enabling the deconstruction of taken for granted assumptions such as caring, evidence-based practice and empowerment; assumptions which have been generated by discourses riddled with confusion and alienation from the reality of practice and the natural spirit of professional enquiry.

A nurse’s phenomenological enquiry into doctors’ end-of-life decision making:

This paper is based on an exploratory study conducted in a UK NHS oncology unit, informed by the interpretation of hermeneutic phenomenology by Van Manen and Dahlberg et al. Four senior oncology doctors (trainees) were recruited using homogenous purposive sampling. In-depth interviews were conducted to understand participants’ lived experience of decision making for oncology patients near the end of life. Analysis followed a line-by-line approach, with consideration of the lifeworld existentials identified by (Van Manen, 1990). Common themes were uncovered of empathy, the unacknowledged influence; dichotomy and conflict; and subverted emotion (uncovered through reflection). Findings are discussed in relation to current clinical decision-making theory, particularly cognitive continuum theory, current UK end of life care policy and practice, role socialisation and inter-professional team working.

Review: Evaluation of leadership practices: how to develop a vision

This paper provides some insight into the cognitive development of a vision; however, the nurse leaders’ actual decision-making process remains elusive. While the inclusion and commitment of all staff to a shared vision is discussed in the literature review, this paper provides little insight into the choice behind inductive or deductive approaches. In addition, the idea of a vision being an ‘idealised mental image’ on the part of the leader, as suggested in the paper, appears contrary to the concept of encouraging commitment by all team members. According to Barbuto (2005), Judge and Piccolo (2004) and the NHS Leadership Academy (2011) support for all team members to contribute in their own way to a common vision, and feel responsible for developing practice to meet the set objectives, is fundamental to transformational leadership. The underlying construct is that the vision should represent the norms and values of the team members, their ambitions for the future of their department and how they envisage achieving the (attainable) goals they have been instrumental in setting. An important perspective has been highlighted in this paper, namely the perception of ‘not working’ when thinking or developing practical applications of abstract thoughts. This is a well-known phenomenon within the nursing discipline, where staff are meant to appear physically busy at all times (Stickley and Freshwater, 2009). Seemingly, this was a hurdle encountered by the nurse leaders who felt unable to engage their full team due to its size or other obstacles although this is not discussed in the paper. One could argue that it would be appropriate to engage the full team in different ways in order to cultivate interest in, and understanding of, the importance of a shared vision (Stanley, 2006). It would be interesting to know where the difficulty lay in involving all members of the team. Was this due to their multidisciplinary nature – as often is the case of the large teams; or did the difficulty lie in involving members related to specific disciplines, as has been described elsewhere (Esterhuizen and Kooijman, 2001). In all cases, the leader as a role model is paramount to present the vision as a ‘way of being’ rather than a ‘task’ needing to be achieved. In other words, the leader needs to function as a conduit between stakeholders: organisational