Rasika Jayasekara

Focus groups in nursing research: Methodological perspectives

Focus groups have been increasingly used as a data collection method in nursing research. The key feature of focus groups is the active interaction among participants to explore their views and opinions. In this respect, focus groups are distinct from other methods such as Delphi groups, nominal groups, brainstorming, and consensus panels, which seek to determine a consensus between participants. Compared with other data collection methods, it can be concluded that the real strength of focus groups is not simply in exploring what participants have to say, but in providing insights into the sources of complex behaviors and motivations. The aim of this paper is to present an overview of the focus group as a research tool in nursing research, particularly in nursing education.

Issues, challenges and vision for the future of the nursing profession in Sri Lanka: a review

BACKGROUND Reviewing the current situation and future development of nursing profession in Sri Lanka enables one to understand not only the nature of its successes and problems, but more importantly, in what way plans for the future will impact on the profession. AIM To explore the issues and challenges concerning nursing regulation, administration, services and education in Sri Lanka and how they will impact on developing nursing professionalism. METHODS A literature search was conducted using MEDLINE and CINAHL limited to articles in the English and Sinhala languages published between 1976 and November 2007. The reference lists of all identified reports and articles were searched for additional studies. Personal communication, unpublished reports and government records and websites were also used to obtain information on nursing service, regulation, administration and education in Sri Lanka. Hand searching of relevant Sri Lankan journals and government reports was undertaken to reveal any additional literature. CONCLUSION The Sri Lankan nursing profession is being very tardy in asserting its professional status in the health sector. There has been minimal effort to improve the standards of nursing services and education, mainly because of inadequate and disjointed involvement of those who are responsible for improving the health services in Sri Lanka. However, nursing services and education in Sri Lanka are being scrutinized as nurses today show more concern about their professional roles, education and status.

Effect of educational components and strategies associated with insulin pump therapy: a systematic review

OBJECTIVES The objectives of this review were to establish the effectiveness of approaches to the provision of education for adults with type 1 diabetes using or initiating insulin pump therapy (IPT), and identify the best available evidence on the association between intervals and duration of follow up and the stated outcome criteria. INCLUSION CRITERIA This review considered all studies and papers that involved adults (aged 16 years or over) with type 1 diabetes using IPT as their primary form of therapy who participated in education or training, with no restrictions placed on gender or comorbidities. All forms of education, including resources utilised during education were included in the review. SEARCH STRATEGY The search strategy sought to find both published and unpublished studies and papers written in the English language. An initial limited search of MEDLINE and CINAHL databases was undertaken to identify optimal search terms. A second search using all identified key words and index terms was then undertaken based on key words specific to each database across all included databases from 1998 to February 2008. Thirdly, the reference lists of all identified reports and articles were searched for additional studies. METHODOLOGICAL QUALITY Two independent reviewers assessed the methodological quality of retrieved papers using the corresponding checklist from the System for the Unified Management, Assessment and Review of Information (SUMARI) package. RESULTS A total of 142 studies were identified as potentially relevant to the review question in the first and second steps of the literature search. Based on the title and abstract, 24 papers that were relevant to the review topic were retrieved for evaluation of methodological quality. Following this stage, 20 papers were excluded. Whilst searching the reference lists of the selected studies (n = 4), one paper met the inclusion criteria. Therefore, a total of five descriptive studies were included in the review. The included papers reported a variety of educational methods and different outcome measures. CONCLUSION In general, it is difficult to draw a strong conclusion regarding the effectiveness of components and strategies associated with IPT because of a lack of high-quality comparative studies, small sample sizes and a variability of reported methods in the included studies. However, included descriptive studies explored a range of issues related to the effectiveness of IPT therapy, and the educative requirements of patients. It is clear that type 1 diabetes patients initiating and utilising IPT need a comprehensive range of advice, education and training. The mixture of group and individual teaching, multidisciplinary teams as educators, educational materials, long-term training with multiple sessions and a variety of educational contents may all be effective for delivering IPT education and training.

A comprehensive systematic review of evidence on the effectiveness and appropriateness of undergraduate nursing curricula.

Objectives  The objective of this review was to appraise and synthesise the best available evidence on the effectiveness and appropriateness of undergraduate nursing curricula. Inclusion criteria  This review considered research papers that addressed the effectiveness and appropriateness of undergraduate nursing curricula. Studies of higher evidence levels were given priority over lower-evidence studies. Participants of interest were undergraduate nursing students, nursing staff and healthcare consumers. Nursing staff outcomes, consumer outcomes and system outcomes (e.g. competency, satisfaction, critical thinking skills, healthcare consumer rights and cost-effectiveness) that impact on the evaluation of undergraduate nursing curricula were considered in the review. Search strategy  The search strategy sought to find both published and unpublished studies and reports limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken, followed by an analysis of the text contained in the title and abstract, and of the index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. Finally, the reference list of all identified reports and articles was searched for additional studies. Methodological quality  Each paper was assessed by two independent reviewers for methodological quality before inclusion in the review using an appropriate critical appraisal instrument from the Unified Management, Assessment and Review of Information (SUMARI) package. Results  A total of 16 papers, experimental and textual in nature, were included in the review. The majority of papers was descriptive and examined the relationships between nursing curricula and specific learning outcomes such as critical thinking skills. Because of the diverse nature of these papers, meta-analysis of the results was not possible and this section of the review is presented in narrative form. In this review, four undergraduate nursing curriculum models were identified: integrated curriculum, subject-centred curriculum, problem-based learning, and an integrated critical thinking model. It was possible to examine the effectiveness of an integrated curriculum model and a subject-centred curriculum model; however, the other two models could not be compared because of a lack of evidence. Conclusion  The evidence regarding the effectiveness and appropriateness of undergraduate nursing curricula is notably weak because of the paucity of high-quality comparative studies and meaningful outcome measures of available studies. Therefore, no strong conclusion can be made regarding the effectiveness and appropriateness of undergraduate nursing curricula.

Cognitive behavioural therapy for older adults with depression: a review.

Abstract Background: Depression is a major public health concern of global significance. The illness diminishes overall quality of life and has been associated with significant distress and disability in physical, interpersonal, and social role functioning. Over the past few decades, a consensus has evolved that cognitive behavioural therapy (CBT) can be an effective treatment for depression in older adults; however, little attention has been given to its effect on them. Aims: The purpose of this review was to examine the current use of CBT and its effect on older adults with depression. Method: A web-based literature search was performed to identify original research articles published from 2000 to 2013 using a three-step search strategy. Results: Evidence indicates that cognitive behavioural therapies are likely to be efficacious in older people when compared with treatment as usual. This is consistent with the findings of several systematic reviews and meta-analyses undertaken across a wider age range. Conclusions: Given that many older adults with depression are reluctant to accept antidepressant medication or unable to tolerate their side effects, CBT can be used as an option in treating depression in older adults.

Antidepressants for depression during pregnancy

The objectives are as follows: To assess the safety of antidepressant use, compared with placebo or psychological therapy, for the treatment of pre-existing and ante-natal depression during pregnancy. To assess the effectiveness of antidepressant use, compared with placebo or psychological therapy, for the treatment of pre-existing and ante-natal depression during pregnancy.

The effectiveness of clinical education models for undergraduate nursing programs: A systematic review

Clinical nurse education is a major part of all undergraduate programs preparing nurses for competent professional practice. While research mostly evaluated specific clinical education models, few studies compared different type of models and limited attention has been given to the effect on student learning outcomes. This systematic review aimed to examine the effectiveness of clinical education models for undergraduate nursing programs. This systematic review utilised the Joanna Briggs Institute systematic review approach (JBI, 2014). A web-based literature search was conducted to identify research studies published from 2002 to 2015 using a three-step search strategy. All selected papers were assessed by at least two independent reviewers for inclusion criteria, methodological validity, and data extraction in the review. This systematic review included nine studies including two pre-post-test studies with a control group totalling 1893 participants including 1286 nursing students. The evidence regarding the effectiveness of clinical education models for undergraduate nursing programs is notably weak; however this review found limited evidence that the clinical facilitator model is preferable to the preceptor model and the Clinical Education Unit (CEU) model provided greater engagement and an enhanced learning environment compared with the standard facilitation model.

Nursing Education in Sri Lanka Challenges and Vision for the Future

In Sri Lanka, pre-registration nursing education is moving from diploma level to a university bachelor degree in consistent with many countries around the world. In this transitional stage, understanding of the evolution and existing situation of nursing education in Sri Lanka provides perspective on the origins of current successes and dilemmas, and enables the development of strategies and plans for future trends in the profession.

Evidence Based National Framework for Undergraduate Nursing Education in Sri Lanka

Introduction In Sri Lanka, nursing education is moving from diploma nursing certificate to a university bachelor degree. In this transitional stage, the development of an evidence based national level framework for undergraduate nursing education is a crucially important step to improve nursing education and nursing service in Sri Lanka. The overall purpose of this PhD research study was to develop an evidence-based national framework for undergraduate nursing education in Sri Lanka. Method My PhD research study has involved conducting critical reviews of literature, two systematic reviews, developing a draft conceptual framework, testing its appropriateness and feasibility with key stakeholders via focus group discussions in Sri Lanka, and formulating the final national framework for nursing education in Sri Lanka. Results The systematic reviews revealed that the evidence regarding the effectiveness and appropriateness of undergraduate nursing curricula is notably weak and direct transfer of the curriculum model from one country to another is not appropriate without first assessing the cultural context of both countries. The conceptual framework, which was developed using the finding of systematic reviews and literature reviews, consists of widely recognized nursing concepts in international and local contexts. However, some concepts cannot be directly applicable because of cultural and economic impediments. Discussion This study identified several factors that shape the approach to nursing education in Sri Lanka. These factors include: Western influence; Sri Lanka’s cultural influence; the current healthcare system and demand for healthcare; nursing systems and regulation; medical dominance; financial support; and Sri Lanka’s education system. All of these factors influence the conceptualization of nursing and educational strategies needed to effectively and appropriately prepare nurses in Sri Lanka. This study proposes seven recommendations to support the implementation of the study findings into practice in Sri Lanka.

Respiratory function monitoring to reduce mortality and morbidity in newborn infants receiving resuscitation

Three to six per cent of all newborn infants in neonatal intensive care units require respiratory resuscitation at birth. PPV is used during resuscitation to establish a functional residual capacity and to deliver an appropriate tidal volume (VT) to achieve adequate gas exchange. During this process, clinical judgement such as observing the infant’s chest wall movements, heart rate and oxygen saturation has been used to determine the effectiveness of the ventilation. However, in neonatal resuscitation, this practice should be guided by RFM such as airway pressure, gas flow, VT, peak inflation pressure and positive end expiratory pressure. This is because excessive delivery of VT could overinflate the neonate lungs causing volutrauma and insufficient VT could result in inadequate gas exchange during resuscitation. Currently there is insufficient evidence to determine the efficacy and safety of RFM in addition to clinical assessment during PPV at neonatal resuscitation.