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Issue 122 - 15 Jan 2010



1. Editor-in-Chief's Introduction
by Alison J. Tierney. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1 

Discusses the revised guidelines for JAN authors.

2. Simulation-based learning in nurse education: systematic review.
Journal of Advanced Nursing, January 2010, Volume 66 Issue 1

Aim. This paper is a report of a review of the quantitative evidence for medium to high fidelity simulation using manikins in nursing, in comparison to other educational strategies.
Background. Human simulation is an educational process that can replicate clinical practices in a safe environment. Although endorsed in nursing curricula, its effectiveness is largely unknown.
Review methods. A systematic review of quantitative studies published between 1999 and January 2009 was undertaken using the following databases: CINAHL Plus, ERIC, Embase, Medline, SCOPUS, ProQuest and ProQuest Dissertation and Theses Database. The primary search terms were 'simulation' and 'human simulation'. Reference lists from relevant papers and the websites of relevant nursing organizations were also searched. The quality of the included studies was appraised using the Critical Appraisal Skills Programme criteria.
Results. Twelve studies were included in the review. These used experimental or quasi-experimental designs. All reported simulation as a valid teaching/learning strategy. Six of the studies showed additional gains in knowledge, critical thinking ability, satisfaction or confidence compared with a control group (range 7–11%). The validity and reliability of the studies varied due to differences in design and assessment methods.
Conclusion. Medium and/or high fidelity simulation using manikins is an effective teaching and learning method when best practice guidelines are adhered to. Simulation may have some advantage over other teaching methods, depending on the context, topic and method. Further exploration is needed to determine the effect of team size on learning and to develop a universal method of outcome measurement.

3. Review summaries.
Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
Overground physical therapy gait training for chronic stroke patients with mobility deficits; Promoting and supporting self-care management for adults living in the community with physical chronic illness: a systematic review of the effectiveness and meaningfulness of the patient-practitioner encounter; Peri-operative glycaemic control regimens for preventing surgical site infections in adults; The effects of on-screen, point of care computer reminders on processes and outcomes of care.

RESEARCH PAPERS - Original Research
4. Determinants of hospital nurse intention to remain employed: broadening our understanding
by Ann E. Tourangeau et al. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
This paper is a report of a study to identify nurse reported determinants of intention to remain employed and to develop a model explaining determinants of hospital nurse intention to remain employed.
Background. A worsening shortage of nurses globally suggests that efforts must be made to promote retention of nurses. However, effective retention promotion strategies depend on understanding the factors influencing nurse retention.
Methods. A descriptive study using focus group methodology was implemented. Thirteen focus groups including 78 nurses were carried out in two Canadian provinces in 2007. Thematic analysis strategies were incorporated to analyse the data.
Findings. Eight thematic categories reflecting factors nurses described as influencing their intentions to remain employed emerged from focus groups: (1) relationships with co-workers, (2) condition of the work environment, (3) relationship with and support from one's manager, (4) work rewards, (5) organizational support and practices, (6) physical and psychological responses to work, (7) patient relationships and other job content, and (8) external factors. A model of determinants of hospital nurse intention to remain employed is hypothesized.
Conclusion. Findings were both similar to and different from previous research. The overriding concept of job satisfaction was not found. Rather, nurse assessments of satisfaction within eight thematic categories were found to influence intentions to remain employed. Further testing of the hypothesized model is required to determine its global utility. Understanding determinants of intention to remain employed can lead to development of strategies that strengthen nurse retention. Incorporation of this knowledge in nurse education programmes is essential.

5. Tobacco smoking habits among nursing students and the influence of family and peer smoking behaviour
by Emanuela Biraghi & Anna Maria Tortorano. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
This paper is a report of a study assessing tobacco smoking habits among nursing students and how these are influenced by family members and peers.
Background. Tobacco smoking among nursing students is a serious problem because of the public role model of these future healthcare professionals.
Methods. The smoking attitude of nursing students attending the 3 year full-time course at the University of Milan in the academic years 2006–2007 and 2007–2008 was investigated. A total of 820 students filled in the self-administered questionnaire and 812 valid questionnaires were returned. The response rate was 87%.
Results. Forty-four percent of the 812 students were tobacco smokers and 7% former smokers. Among the smoking students 75% had at least one smoking parent, 47% had at least one smoking brother or sister and 87% saw smoking friends.
Conclusion. There is an urgent need to implement effective anti-smoking measures among nursing students. Decreasing the number of smokers among healthcare professionals would discourage people from smoking and would increase the credibility of anti-smoking campaigns.

6. Continuity of care and monitoring pain after discharge: patient perspective
by Rosa Suñer Soler et al. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
This paper is a report of a study conducted to evaluate, from the patients' perspective, a Liaison and Continuity of Care Programme coordinating care provision between a hospital and primary care centres.
Background. Promoting continuity of care between hospitals and primary care improves quality of care, patient satisfaction and decreases further hospitalizations. However, inadequate pain management is common after discharge.
Method. A sample of patients from the Liaison and Continuity of Care Programme were included in a longitudinal study in 2007. We conducted standardized telephone interviews at 24 hours, 7 days, 1 and 3 months after discharge. Outcome measures included readmission, time between hospital discharge and readmission, information level at discharge, patient satisfaction, queries about care and information related to perceived state of health and pain.
Results. Eighty-three adult patients (average age 69·3, 50·6% males) who needed continued care at discharge were followed. Ten participants died during follow-up, and seven required readmission. A total of 49·4% of patients stated that they had understood the information given at discharge very well or perfectly. At 24 hours after discharge, 30% already had doubts about their state of health and the management of their condition. In relation to perceived health, only 25·3% stated that this was good or very good. Prevalence of pain 24-hours after discharge was 58·3% in surgical patients and 17·1% in other patients.
Conclusion. The preparation and education of patients and family members should be improved before discharge, and appropriate written information must be given, especially if a patient has pain or requires complex care.

7. Effect of supportive care on the anxiety of women with suspected breast cancer
by Mei-Nan Liao et al. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
This paper is a report of a study of the effect of supportive care on anxiety levels of women with suspected breast cancer during the diagnostic period.
Background. Informational and psychosocial support has been shown to improve care outcomes for women with breast cancer. However, little is known about the effect of supportive care on women's psychological status during the breast cancer diagnostic period.
Methods. For this longitudinal quasi-experimental study, 122 participants were recruited from a large teaching hospital in Taiwan. The experimental group (n = 62) received a supportive care programme that included health education pamphlets about breast cancer diagnosis and treatment, three face-to-face sessions of informational and emotional support, and two follow-up telephone consultations. The control group (n = 60) received routine care. Data were collected from October 2006 to April 2007 using the State-Trait Anxiety Inventory at baseline (notification of need for breast biopsy), before biopsy, and after receiving biopsy result (diagnosis).
Findings. After adjusting for covariance of breast discomfort, regular breast self-examination, and biopsy result, the anxiety levels of women receiving supportive care were significantly lower before biopsy (P = 0·017) and after diagnosis (P = 0·001) than those of women receiving routine care.
Conclusion. Supportive care that incorporates informational and emotional support and follow-up telephone consultations can decrease anxiety levels of women with suspected breast cancer. These findings can serve as a reference for clinical nursing staff to improve care quality during the breast cancer diagnostic period by providing women with individualized and culturally sensitive care.

8. Dietary and fluid compliance: an educational intervention for patients having haemodialysis
by Shahram Baraz et al. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
This paper is a report of a study conducted to determine the effect of an educational intervention on dietary  and fluid compliance in patients having haemodialysis.
Background. Many of the clinical problems experienced by patients having haemodialysis are related to their failure to eat appropriate foods and restrict their fluid intake. Educational intervention in patients having haemodialysis to improve their compliance with dietary and fluid restrictions appears to be effective.
Methods. Sixty-three patients having haemodialysis in three general hospitals in Tehran, Iran, were allocated into two groups at random for oral and/or video education. They were asked to give demographic and medical data. Bimonthly average values of serum potassium, sodium, calcium, phosphate, albumin, creatinine, uric acid, and blood urea nitrogen and interdialytic weight gain were measured before and after the teaching programmes. The data were collected in 2007.
Findings. Compliance in terms of biochemical parameters and interdialytic weight gain was observed in 63·5% and 76·2% of patients in the oral and video teaching groups respectively. Statistically significant correlations were observed between demographic variables (age, educational level and occupation) and dietary and fluid compliances (P < 0·001). There was no difference between the effectiveness of two educational interventions.
Conclusion. Nurses should emphasize sodium compliance in patients having haemodialysis and explain its adverse effects, such as excessive weight gain, hypertension, and peripheral oedema.

9. Transformational experiences in adult-to-adult living-donor liver transplant recipients (p 69-81)
by Akemi Watanabe & Tomoko Inoue. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
This paper is a report of a study conducted to explore the transformational experiences of adult-to-adult living-donor liver transplant recipients.
Background. Living-donor liver transplant was developed to overcome the shortage of cadaveric livers available for transplantation. However, living-donor liver transplant generates multifaceted psychosocial problems for recipients.
Method. Data were collected from 2002 to 2004 through in-depth interviews and participant observations. We adopted a phenomenological approach that examined the experience of 30 recipients.
Findings. We classified the experiences into three types: common, innate and unrealized. Analysis of the transcripts revealed four themes, all with associated sub-themes. The first theme, guilt and concrete issues, includes anguish when thinking about survival by hurting a potential donor and problems associated with donor and cost. The second theme, let it happen includes leave it to fate; ambivalence; and worry about the donor candidate and whether he/she will change their mind. The third theme, pain, includes extreme physical and mental pain for me and the donor; and worry about cost. The fourth theme, balancing gains and losses, includes grateful for and hoping to enjoy my new life; burden of new body; difficulty in adapting to modified life plan; and changes in family relationships.
Conclusion. Nursing practice should be developed to (1) give support to patients and their families during decision-making; (2) give support for the dramatic life change; (3) help recipients accept the reality of the
transplant; and (4) help achieve the essential balance between feelings of attainment and loss.

10. Patients with dysphagia: experiences of taking medication 
by Jennifer Kelly et al. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
This paper is a report of a study exploring the experiences of taking medication for older people with dysphagia.
Background. Dysphagia is a common problem, especially amongst older people, and affects ingestion of food, fluids and medicines. With the number of elders in the population increasing, and currently accounting for one-third of prescribing volume in the United Kingdom, dysphagia is becoming a major problem in terms of medicine administration and therapy.
Method. In 2007, we carried out interviews with 11 patients in one county of England who had different degrees of dysphagia. The interview transcriptions were analysed using Colaizzi's technique.
Results. Six inter-related themes were identified from the data: (a) the wide spectrum and variability of dysphagia; (b) medication formulation; (c) information exchange between patients and healthcare professionals; (d) factors affecting medication adherence; (e) strategies used to improve swallowing; (f) the central function of swallowing as eating and drinking.
Conclusion. It is vital to ensure that each patient has an individualized medication regimen, and for patients with dysphagia the formulation of the medicine is as important as the active ingredients.

11. Determination of standard times of nursing activities based on a Nursing Minimum Dataset
by Dries Myny et al. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
This paper is a report of a study conducted to determine the standard time per nursing activity and the proportion of nursing time covered by the nursing activities of the Belgian Nursing Minimum Dataset compared to the total time of a nurse shift, and to evaluate the correlation between hospital size and standard times of nursing activities.
Background. Because of a shrinking workforce and rising workload, nursing managers need tools that help them to allocate their staff to the wards. Such tools should be based on objective time measurements.
Methods. The study was performed in surgical, internal medicine and elder care wards in an acute hospital care setting. In the first phase, a two-round Delphi-procedure was used to operationalize the definitions of nursing activities. In the second phase, the standard time for each nursing activity was determined, based on data collected over a 6-month period during 2006–2007. A combination of 13,292 work sampling observations by external observers, 3000 recordings of direct time measurement by self-recording and subjective time assessments yielded times that were used to analyse the duration of the nursing activities.
Results. A standard time for 102 nursing activities was established. The coverage of the Belgian Nursing Minimum Dataset in the surgical, internal medicine and elder care wards was 47·5%, 46·4% and 51·0% respectively. The Belgian Nursing Minimum Dataset was found to cover almost 70% of direct and indirect nursing care.
Conclusion. Further research is needed to assess the impact on the standard times of nursing activities of inefficient organizational structures and different cultural interpretations of the way an activity is conducted.

12. Intimate male partner violence in the migration process: intersections of gender, race and class
by Sepali Guruge et al. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
This paper is a report of a s tudy of Sri Lankan Tamil Canadian immigrants' perspectives on factors that contribute to intimate male partner violence in the postmigration context.
Background. Increasing evidence illustrates the extent and nature of intimate male partner violence and its links to a range of physical and mental health problems for women around the world. However, there has been little health sciences research on intimate male partner violence in the postmigration context in Canada.
Methods. Data were collected for this qualitative descriptive study in 2004 and 2005, through individual interviews with community leaders (n = 16), four focus groups with women and four with men from the general community (n = 41), and individual interviews with women who had experienced intimate male partner violence (n = 6). The research was informed by a postcolonial feminist perspective and an ecosystemic framework.
Findings. Participants' conceptualization of the production of intimate male partner violence in the postmigration context involved (a)experiences of violence in the premigration context and during border crossing; (b) gender inequity in the marital institution; (c) changes in social networks and supports; and (d) changes in socioeconomic status and privilege.
Conclusion. Increasing immigration requires that nurses pay attention to and respond appropriately to women's unique needs, based on complex and interrelated factors that produce intimate male partner violence in the postmigration context.

13. How nurses seek and evaluate clinical guidelines on the Internet (p 114-127)
by Fenne Verhoeven et al. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
This paper is a report of a study conducted to assess nurses' information-seeking strategies and problems encountered when seeking clinical guidelines on the Internet, and to investigate the criteria they apply when evaluating the guidelines and the websites communicating the guidelines.
Background. As nurses are increasingly taking on clinical responsibilities, they should be able to use the Internet to access up-to-date clinical guidelines. Currently, nurses' information-seeking skills remain rather limited.
Method. In 2008, a convenience sample of 20 nurses solved scenario-based tasks using the Internet to seek clinical guidelines regarding methicillin-resistant Staphylococcus aureus while thinking aloud.
Results. General background information and universal precautions were successfully identified by participants, in contrast to more specific precautions. Nurses' information-seeking skills appeared rather basic, as they employed a limited number of search terms and consulted a limited number of websites. Ineffective searches were mainly caused by a mismatch between the guidelines and nurses' tacit knowledge. Perceived practical relevance and information completeness were the most frequently applied quality criteria. Accuracy and disclosures, which are emphasized in existing e-health literature, were considered less important. As long as information matched nurses' practical and experiential wisdom, they were satisfied.
Conclusion. Nurses appeared to rely predominantly on tacit knowledge during the search process and while evaluating the retrieved guidelines. This is dangerous because nurses' reliance on inaccurate information might result in inadequate behaviour. It is therefore essential to expand nurses' current information base by tailoring both navigation structure and the guideline communication to dovetail with nurses' tacit knowledge.

14. Redefining relationships and identity in young adults with type 1 diabetes
by Carina Sparud-Lundin et al. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
This paper is a report of a study exploring the meaning of interactions with and supports of self-management from parents and other significant others for young adults with type 1 diabetes.
Background. Adolescence and young adulthood is known to be a critical period for people living with diabetes in terms of diabetes control, which is why support from significant others is of utmost importance during the transition to adult life.
Method. A grounded theory approach was used. Interviews with 13 young adults with type 1 diabetes and 13 parents 2 years after transfer to adult diabetes care were conducted during 2006–2007. Internet communication between young people on a diabetes website was also included in the constant comparative analysis.
Findings. Transition to adult life for young adults with diabetes was characterized by a relational and reflexive process leading to ongoing redefinition of relationships and identity. Parents were perceived as the most reliable supporters, compared to partners, siblings and other significant others. Chat friends can also become important through emotional, social and diabetes-related support in internet communication. The young adults showed growing awareness of their own capacities, shortcomings and emotional reactions, reflections which contribute to a redefinition of self.
Conclusion. Further research is needed to explore how contemporary interactions contribute to development of the self. By focusing on supporting relationships, nurses are in a strategic position to develop knowledge and modify clinical programmes that promote diabetes management and care by taking supporting interactions into account from a contemporary point of view.

15. Gerontological care in nursing education programmes
by Mieke Deschodt et al. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
This paper is a report of a study conducted to identify the coverage of gerontological care in baccalaureate nursing education programmes.
Background. Although in recent years the average age of patients has increased, nurses do not always have the knowledge, competencies, and attitudes necessary to care for older people. Its complexity is not recognized.
Method. A descriptive cross-sectional mail survey of 17 baccalaureate nursing education programmes in Flanders, Belgium, was performed in 2007.
Findings. While there was great variability among nursing education programmes in terms of gerontology courses, clinical placements, and number of experts, it was encouraging that most programmes had integrated gerontology content into non-gerontology courses, all programmes offered gerontology clinical placements, and many nursing educators were considered to be experts in gerontology. Lack of interest in care for older people in general, lack of gerontology-related competencies within curricula, and a negative image of gerontological care were reported as the most frequently-encountered barriers to incorporating gerontological care aspects into curricula.
Conclusion. Because a minority of nursing students choose the gerontology specialist option, gerontology content in basic nursing curricula should be increased. A minimum standard curriculum and specific competencies for care of older people should be formulated for all baccalaureate nursing education programmes. Strengthening educators' expertise and investing in role models remain important priorities for the nursing profession.

16. Coping with breast cancer: between diagnosis and surgery (p 149-158)
by Sigrunn Drageset et al. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
This paper is a report of a descriptive study of coping strategies used by women between diagnosis of breast cancer and surgery.
Background. Although research has suggested that the initial phase of breast cancer is important in the overall process of coping, there have been few qualitative studies conducted in the period between diagnosis and surgery to describe women's experiences and coping efforts in the midst of stress.
Method. Individual interviews were conducted with 21 women with newly diagnosed breast cancer who were awaiting surgery. Data were collected from February 2006 to February 2007 at a Norwegian university hospital. Transcripts were analysed using methods of qualitative content analysis.
Findings. Prominent themes about coping between diagnosis and surgery were: step-by-step, pushing away, business as usual, enjoying life, dealing with emotions, preparing for the worst and positive focus. The women were highly aware of the threat of death, but at the same time hopeful and optimistic. In general, they wanted to be treated as usual. Pity and compassion could increase their feelings of fear and vulnerability. Emotions were dealt with either by openness or by holding back.
Conclusion. Avoiding being overwhelmed by emotional reactions was a major goal for the women. Their coping strategies displayed similar patterns but diverged on some points. In general they needed to manage the situation in their own way. By being aware of women's individual needs and different coping strategies, nurses and other healthcare professionals can improve support to women in this vulnerable situation.

17. Critical care nurses' experiences of grief in an adult intensive care unit
by Melanie Shorter & Louise Caroline Stayt. Journal of Advanced Nursing, January 2010, Volume 66 Issue 1
This paper is a report a study of critical care nurses' experiences of grief and their coping mechanisms when a patient dies.
Background. The goal of patients entering critical care is survival and recovery. However, despite application of advanced technologies and intensive nursing care, many patients do not survive their critical illness. Nurses experience death in their everyday work, exposing them to the emotional and physical repercussions of grief.
Method. This study adopted a Heideggerian phenomenological approach, interviewing eight critical care nurses. Data collection occurred in 2007/8. Interviews were transcribed verbatim and themes generated through Colaizzi's framework.
Findings. Participants reported feelings of grief for patients they had cared for. The death of a patient was reported as being less traumatic if the participant had perceived the death to be a 'good death', incorporating expectedness and good nursing care. They described how a patient's death was more significant if it 'struck a chord', or if they had developed 'meaningful engagement' with the patient and relatives. They denied accessing formal support: however, informal conversations with colleagues were described as a means of coping. Participants exhibited signs of normalizing death and described how they disassociated themselves emotionally from dying patients.
Conclusion. There are many predisposing factors and circumstantial occurrences that shape both the nature of care of the dying and subsequent grief. Repeated exposure to death and grief may lead to occupational stress, and ultimately burn out. Emotional disengagement from caring for the dying may have an impact on the quality of care for both the dying patient and their family.

18. Healthcare Team Vitality Instrument (HTVI

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