Sharron L. Docherty

Qualitative metasynthesis: Issues and techniques

There has been an accumulation of qualitative studies in recent years, but little cumulation of the understandings gained from them. Qualitative research appears endangered both by efforts to synthesize studies and by the failure to do so. Techniques used have included reciprocal translations of key metaphors and concepts and qualitative and quantitative comparative analyses to produce narrative and theoretical integrations. The major problem yet to be resolved is developing usable and communicable systematic approaches to conducting metasynthesis projects that maintain the integrity of individual studies.

Focus on qualitative methods interviewing children

The focus in health-related research on children has shifted from seeking information about children to seeking information directly from them. Children, even as young as three years old, can give graphic descriptions and have excellent recall of experiences related to adverse events, such as illness and hospitalization. Children use scripts as the primary means of anticipating, comprehending, and re-creating real-life experience. The content, timing, number, and structure of interviews will influence the completeness, accuracy, and consistency of childrens recall of events. Although at times conflicting, the findings from recent scholarship on childrens narrative competence will assist researchers to select the interviewing strategies most likely to yield faithful representations of experience.

Electronic Nursing Documentation as a Strategy to Improve Quality of Patient Care

PURPOSE Electronic health records are expected to improve the quality of care provided to hospitalized patients. For nurses, use of electronic documentation sources becomes highly relevant because this is where they obtain the majority of necessary patient information. METHODS An integrative review of the literature examined the relationship between electronic nursing documentation and the quality of care provided to hospitalized patients. Donabedians quality framework was used to organize empirical literature for review. RESULTS To date, the use of electronic nursing documentation to improve patient outcomes remains unclear. CONCLUSIONS AND IMPLICATIONS Future research should investigate the day-to-day interactions between nurses and electronic nursing documentation for the provision of quality care to hospitalized patients. CLINICAL RELEVANCE The majority of U.S. hospital care units currently use paper-based nursing documentation to exchange patient information for quality care. However, by 2014, all U.S. hospitals are expected to use electronic nursing documentation on patient care units, with the anticipated benefit of improved quality. However, the extent to which electronic nursing documentation improves the quality of care to hospitalized patients remains unknown, in part due to the lack of effective comparisons with paper-based nursing documentation.

Randomized clinical trial of therapeutic music video intervention for resilience outcomes in adolescents/young adults undergoing hematopoietic stem cell transplant: A report from the Children's Oncology Group

To reduce the risk of adjustment problems associated with hematopoietic stem cell transplant (HSCT) for adolescents/young adults (AYAs), we examined efficacy of a therapeutic music video (TMV) intervention delivered during the acute phase of HSCT to: 1) increase protective factors of spiritual perspective, social integration, family environment, courageous coping, and hope‐derived meaning; 2) decrease risk factors of illness‐related distress and defensive coping; and 3) increase outcomes of self‐transcendence and resilience.

Symptom experiences of children and adolescents with cancer.

This paper examines nursing research focused on the symptom experiences of children and adolescents with cancer, and the extent to which the perspective and methods of developmental science have been used in this research. CINALH, MEDLINE, and PSYCHLIT were searched for publications between 1990 and 2002. The researcher or research team had to include a nurse or developmentally oriented researchers from other disciplines. Studies focused exclusively on pain were excluded because of recent published reviews. While nurse researchers have contributed influential knowledge related to symptom experiences and symptom distress in children and adolescents with cancer, this research is still in a formative but exciting stage. Two nurse researchers and their teams laid the foundation for this research through their individual studies and collaborative multisite studies. In general, children and adolescents from 10 through 18 years of age were primarily studied; few studies focused on preschool children. Given the fact that these are rare populations, sample sizes were generally small, limiting power and generalizability. Gender, ethnicity, and socioeconomic status were rarely considered in analyses. Most studies used cross-sectional designs, although several included short-term longitudinal or repeated measure designs. To date, longitudinal designs focused on long-term outcomes have not been conducted. There were only a few qualitative studies. There was limited use of conceptual models or theories, and inadequate attention was paid to broader ecological perspectives in the children’s lives. Studies included a focus on global symptoms and on individual symptoms, particularly pain and fatigue. Few focused on nausea and vomiting. Operationalization of symptom distress generally involved adapting instruments designed for adults. A more explicit employment of a developmental science perspective in future studies would call for more longitudinal designs that conceptualize the symptom experience from the perspective of the child and that view their responses as complex and multidimensional in nature. This would necessitate measuring clusters of symptoms at multiple levels (e.g., emotional, behavioral, and biophysiological) using developmental data collection methods. Furthermore, attention needs to be paid in conceptualizing studies to ecological factors related to families, social networks, communities, and ethnicity, as well as to the ecology of the health care system, which likely influences the symptom experience of children.

Ensuring Treatment Fidelity in a Multi-site Behavioral Intervention Study: Implementing NIH Behavior Change Consortium Recommendations in the SMART Trial

The Stories and Music for Adolescent/Young Adult Resilience during Transplant (SMART) study (R01NR008583; U10CA098543; U10CA095861) is an ongoing multi‐site Childrens Oncology Group randomized clinical trial testing the efficacy of a therapeutic music video intervention for adolescents/young adults (11–24 years of age) with cancer undergoing stem cell transplant. Treatment fidelity strategies from our trial are consistent with the National Institutes of Health (NIH) Behavior Change Consortium Treatment Fidelity Workgroup (BCC) recommendations and provide a successful working model for treatment fidelity implementation in a large, multi‐site behavioral intervention study. In this paper, we summarize 20 specific treatment fidelity strategies used in the SMART trial and how these strategies correspond with NIH BCC recommendations in five specific areas: (1) study design, (2) training providers, (3) delivery of treatment, (4) receipt of treatment, and (5) enactment of treatment skills. Increased use and reporting of treatment fidelity procedures is essential in advancing the reliability and validity of behavioral intervention research. The SMART trial provides a strong model for the application of fidelity strategies to improve scientific findings and addresses the absence of published literature, illustrating the application of BCC recommendations in behavioral intervention studies. Copyright

African American mothers' responses to hospitalization of an infant with serious health problems.

Purpose: To describe African American mothers’ experiences related to the hospitalization of an infant with serious health problems. Design: Retrospective descriptive. Sample: 19 African American mothers with premature and term infants who were hospitalized at birth for serious health problems related to sequelae of prematurity or birth defect. Main Outcome Variable: African American mothers’ recollections about the hospitalization of their seriously ill infant. Results: The mothers worried primarily about when the baby could go home. Their greatest source of stress was separation from the infant. Seeing their sick infant was also stressful and evoked shock, fear, denial, guilt, and helplessness. Mothers sought hope by seeking information and cues from the infant and by praying to God. Mothers established a relationship with their infant by visiting regularly and by learning how to care for him. Some mothers feared getting attached to an infant who might die. Mothers’ highest source of satisfaction was support from the health care team.

Nursing strategies to support family members of ICU patients at high risk of dying

OBJECTIVES To explore how family members of ICU patients at high risk of dying respond to nursing communication strategies. BACKGROUND Family members of ICU patients may face difficult decisions. Nurses are in a position to provide support. Evidence of specific strategies that nurses use to support decision-making and how family members respond to these strategies is lacking. METHODS This is a prospective, qualitative descriptive study involving the family members of ICU patients identified as being at high risk of dying. RESULTS Family members described five nursing approaches: Demonstrating concern, building rapport, demonstrating professionalism, providing factual information, and supporting decision-making. This study provides evidence that when using these approaches, nurses helped family members to cope; to have hope, confidence, and trust; to prepare for and accept impending death; and to make decisions. CONCLUSION Knowledge lays a foundation for interventions targeting the areas important to family members and most likely to improve their ability to make decisions and their well-being.

Advancing Symptom Science Through Use of Common Data Elements.

BACKGROUND Use of common data elements (CDEs), conceptually defined as variables that are operationalized and measured in identical ways across studies, enables comparison of data across studies in ways that would otherwise be impossible. Although healthcare researchers are increasingly using CDEs, there has been little systematic use of CDEs for symptom science. CDEs are especially important in symptom science because people experience common symptoms across a broad range of health and developmental states, and symptom management interventions may have common outcomes across populations. PURPOSES The purposes of this article are to (a) recommend best practices for the use of CDEs for symptom science within and across centers; (b) evaluate the benefits and challenges associated with the use of CDEs for symptom science; (c) propose CDEs to be used in symptom science to serve as the basis for this emerging science; and (d) suggest implications and recommendations for future research and dissemination of CDEs for symptom science. DESIGN The National Institute of Nursing Research (NINR)-supported P20 and P30 Center directors applied published best practices, expert advice, and the literature to identify CDEs to be used across the centers to measure pain, sleep, fatigue, and affective and cognitive symptoms. FINDINGS We generated a minimum set of CDEs to measure symptoms. CONCLUSIONS The CDEs identified through this process will be used across the NINR Centers and will facilitate comparison of symptoms across studies. We expect that additional symptom CDEs will be added and the list will be refined in future work. CLINICAL RELEVANCE Symptoms are an important focus of nursing care. Use of CDEs will facilitate research that will lead to better ways to assist people to manage their symptoms.

Sleep quality in children with juvenile rheumatoid arthritis.

Children with juvenile rheumatoid arthritis (JRA) report poor sleep quality, daytime sleepiness, fatigue, anxiety, and altered mood. Sleep disturbances in school-aged children are an issue of serious concern. Children are at an age when sleep is of primary importance to physical and intellectual growth, and sleep disturbances that begin in childhood may persist into adulthood. In this article we will review what is currently known about sleep in children with JRA, the influence of medications on sleep quality, the potential impact of poor sleep quality on daily life issues, and complementary/alternative modalities that may be effective in reducing sleep disturbances.