Sanna Salanterä

Think-Aloud Technique and Protocol Analysis in Clinical Decision-Making Research

In this article, we aim to describe the practical aspects of research actions that should be taken into account when two methods—the think-aloud technique for data collection and protocol analysis as an analysis technique—are combined with research of decision making in acute clinical settings. These methods are rarely used together or written about in health care research. In addition, careful consideration of the pros and cons of study sampling, data collection, data management, and analysis techniques or approaches is still lacking when these methods are used in health care research. We discuss the background of the think-aloud technique and protocol analysis and review previous studies that have used these methods. The examples in the article are based on our study, in which we investigated the decision making of critical care experts. We find that the combination of the think-aloud technique and protocol analysis is applicable when investigating complex and overlapping decision-making processes and rapid, ad hoc decisions made by critical care experts.

Oral Glucose and Parental Holding Preferable to Opioid in Pain Management in Preterm Infants

ObjectivesThe purpose of this study was to compare the effectiveness of “facilitated tucking by parents” (FTP) in which a parent holds by her hands the infant in a side-lying flexed position offering support and skin contact, oral glucose, opioid (oxycodone), and placebo (oral water) in the context of heel stick and pharyngeal suctioning in very preterm infants. We hypothesized that nonpharmacologic methods equal the pharmacologic method and are superior to placebo in pain management. MethodsA prospective randomized placebo-controlled crossover trial. The study patients (n=20) were born at a mean gestational age of 28+1 weeks and were studied at postconceptional age of 28 to 32 weeks. Pain measurements with Premature Infant Pain Profile and Neonatal Infant Pain Scale covered the first 30 seconds after the beginning of the painful stimulus. ResultsPremature Infant Pain Profile scores were significantly lower with oral glucose (mean: 4.85±1.73, P≤0.001) and FTP (mean: 5.20±1.70, P=0.004) when compared with placebo (mean: 7.05±2.16) after heel stick. During pharyngeal suctioning, the scores were lowest with oral glucose (mean: 11.05±2.31, P=0.014) and FTP (mean: 11.25±2.47, P=0.034) compared with placebo (mean: 12.40±2.06). Opioid equaled placebo in both procedures. Neonatal Infant Pain Scale scores were significantly lower with FTP (P≤0.001) and opioid (P=0.018) after heel stick, and during pharyngeal suctioning with FTP (P=0.001) compared with placebo. We found significantly more short-term adverse effects per administration with oral glucose (21.25%) and oral water (12.5%) compared with opioid (5%) or FTP (5%). DiscussionOur study demonstrated that FTP is not just equal, but preferable to other pain management methods when both efficacy and safety are considered.

Nurses' knowledge about pharmacological and nonpharmacological pain management in children

The purpose of this study was to investigate the knowledge base and practices of Finnish nurses in the area of children in pain. The convenience sample consisted of 265 nurses working on childrens wards in university hospitals. Data were collected using an instrument designed for the study. The results showed that there remain gaps in the knowledge base of nurses with regard to both pharmacological and nonpharmacological pain management in children. The education and the area of expertise were significant influences on knowledge scores. Nurses used a fairly wide range of nonpharmacological pain alleviation methods but most of these were such that the nurse was in an active role and the child was passive. There is a clear need for further education. Nurses should take a more active role in seeking new information and also should be encouraged to use nonpharmacological methods that let the children be active participants in their own care.

Patient education and health-related quality of life: surgical hospital patients as a case in point.

The purpose of this study was to analyze the connections between patient education and health-related quality of life as an outcome variable. Data were collected among surgical hospital patients (n = 237) in Finland. On the basis of the results, there seems to be a positive relationship between received knowledge and health-related quality of life, and as such, the study produced knowledge about one quality indicator in nursing care. More research is needed to explore this connection in greater details.

Internet-based peer support for parents: A systematic integrative review

OBJECTIVES The Internet and social media provide various possibilities for online peer support. The aim of this review was to explore Internet-based peer-support interventions and their outcomes for parents. DESIGN A systematic integrative review. DATA SOURCES The systematic search was carried out in March 2014 in PubMed, Cinahl, PsycINFO and Cochrane databases. REVIEW METHODS Two reviewers independently screened the titles (n=1793), abstracts and full texts to decide which articles should be chosen. The inclusion criteria were: (1) an Internet-based community as an intervention, or at least as a component of an intervention; (2) the participants in the Internet-based community had to be mothers and/or fathers or pregnant women; (3) the parents had to interact and communicate with each other through the Internet-based community. The data was analysed using content analysis. When analysing peer-support interventions only interventions developed by researchers were included and when analysing the outcomes for the parents, studies that focused on mothers, fathers or both parents were separated. RESULTS In total, 38 publications met the inclusion criteria. Most of the studies focused on Internet-based peer support between mothers (n=16) or both parents (n=15) and seven focused on fathers. In 16 studies, the Internet-based interventions had been developed by researchers and 22 studies used already existing Internet peer-support groups, in which any person using the Internet could participate. For mothers, Internet-based peer support provided emotional support, information and membership in a social community. For fathers, it provided support for the transition to fatherhood, information and humorous communication. Mothers were more active users of Internet-based peer-support groups than fathers. In general, parents were satisfied with Internet-based peer support. The evidence of the effectiveness of Internet-based peer support was inconclusive but no harmful effects were reported in these reviewed studies. CONCLUSIONS Internet-based peer support provided informational support for parents and was accessible despite geographical distance or time constraints. Internet-based peer support is a unique form of parental support, not replacing but supplementing support offered by professionals. Experimental studies in this area are needed.

Young registered nurses' intention to leave the profession and professional turnover in early career: a qualitative case study.

In a time of global nursing shortages an alarming number of young registered nurses have expressed a willingness to leave the profession. In this qualitative case study we investigate in depth why young nurses leave nursing profession and reeducate themselves for a new career. The study is based on longitudinal interviews of three young registered nurses in Finland. These nurses were first interviewed between December 2006 and May 2007, when they were 29–32 years old and having an intention to leave the profession. The second interview took place four years later, from January 2011 to March 2011 when all of them had made the transition to a new career. Data were analyzed in two stages. In the first stage, comprehensive career story narratives were formed on the basis of the interviews. In the second stage, emerging themes in these stories were compared, contrasted, and interpreted in the context of the overall career histories. Nursing as a second career choice and demanding work content as well as poor practice environment and the inability to identify with the stereotypical images of nurses were main themes that emerged from these career stories. The results of this interpretative qualitative study reflect a shift toward insights into understanding professional turnover as a complex and long-lasting process.

Coping strategies for hospital‐related fears in pre‐school‐aged children

Aim:  The aim of this study was to describe the child‐reported coping strategies for hospital‐related fears in 4–6‐year‐old children.

Ketoprofen and tramadol for analgesia during early recovery after tonsillectomy in children

Background:  Pain following tonsillectomy is often intense. Nonsteroidal anti‐inflammatory drugs and opioids are effective, but both can cause adverse effects. Tramadol may be a viable alternative for post‐tonsillectomy pain. This study was designed to compare the analgesic effects of ketoprofen and tramadol during the early recovery period after tonsillectomy.

Coping with hospital-related fears: experiences of pre-school-aged children.

AIM This paper is a report of a study of how 4- to 6-year-old children cope with their fears associated with hospitalization and how they explain their experiences. BACKGROUND Pre-school-aged children are particularly vulnerable to the effects of stress and fear during hospitalization. Children cope with their fears through problem-oriented, emotion-oriented, and function-oriented coping strategies. Even pre-school-aged children can express their emotions and expectations quite well orally. However, little is known about the coping strategies of 4- to 6-year-old children related to hospital fears and the meaning of coping for children. METHOD A qualitative method was chosen using a purposive sample of 89 children. The data were gathered using semi-structured interviews from 2004 to 2006. The data were analysed using Colaizzis method for phenomenological analysis. FINDINGS The childrens experiences of coping with hospital fears consisted of ten main clusters: pleasure, positive images, security, confidence, care, understanding the meaning of the situation, participating, asking for help, readjustment and protecting oneself. The coping strategies during hospitalization described by the children were familiar to them and part of their everyday lives. CONCLUSION It is important to observe and support the childs individual coping strategies. Pre-school-aged children need information and guidance to orientate themselves in unknown situations and to participate in decisions concerning their everyday life. Most of all, they need opportunities to play and experience pleasure. Children can also be taught coping strategies that give them an active, positive role.

Nursing activities and outcomes of care in the assessment, management, and documentation of children's pain

This study describes how assessment and documentation of childrens acute postoperative pain is managed by nurses in university hospitals in Finland. A survey was conducted of 303 nurses working in childrens wards of university-affiliated hospitals, and at the same time a retrospective chart review of 50 consecutive cases of operation of acute appendicitis was carried out. Charts were analyzed by content analysis, and the results of the survey are reported with percentage distribution and nonparametric statistical calculations. The results indicate that nurses assess pain mainly by observing the childs behavior and changes in physiology. Pain measurement instruments are rarely used, and nurses do not recognize them. The documentation of pain care is unsystematic and does not support the continuity of care. There is a clear need for development of assessment and documentation practices in the studied hospitals. Future research should look at the postoperative care of pain at home as well as care in non-university-affiliated hospitals.