Who Advances Nursing Science in Practice Settings and How?

Nurse scientist (NS) roles in clinical practice settings are key components of The Future of Nursing and ANCC Magnet® recognition. Despite increased opportunities for NS roles, leveraging these roles to advance nursing science remains at an early stage. We describe opportunities and challenges for NSs in clinical practice settings, highlighting the value of a strong partnership with chief nurse officers as critical for the success of NSs and outcomes associated with these roles.

Executive dysfunction is associated with self-care confidence in patients with heart failure.

AIM: To explore differences in self-care maintenance, management and confidence levels between American heart failure (HF) patients with and without executive dysfunction. BACKGROUND: Evidence indicates some aspect of cognitive impairment is prevalent in up to 75% of the HF patient population. Moreover, cognitive impairment has been identified as a barrier to adequate self-care contributing to poor outcomes. There is limited understanding of the role executive function, a domain of cognitive performance, has on self-care behaviors for patients with HF. METHOD: This secondary analysis examined the role of executive function, measured by the Clock Drawing Test (CDT), in relation to self-care measures. The Self Care of Heart Failure Index v6.2 (SCHFI v6.2) was used to measure self-care maintenance, management, and confidence. RESULTS: Participants had a mean age of 75.1 ± 12.5 years, identified as male (59.4%), with New York Heart Association (NYHA) class III (57.3%). Executive function impairment was present in 28% of the sample. Comparison of self-care maintenance and management scores between the two groups were not significant. However, participants with executive dysfunction demonstrated an average self-care confidence score of 48.6 ± 23.3, while participants with no executive function impairment demonstrated a higher average self-care confidence score of 61.5 ± 18.4. Differences in self-care confidence scores between the groups were statistically significant (p = .014). CONCLUSIONS: HF self-care confidence is considered a moderator of self-care behaviors. Understanding the influence executive function has on self-care confidence may lead to a better understanding of those needing greater support with self-care behaviors.

American Association of Heart failure nurses' knowledge, barriers and facilitators in conducting research.

BACKGROUND: To provide high-quality patient care, heart failure (HF) nurses must comprehend/use best evidence; however, HF nurses' ability to do so are unknown. OBJECTIVES: To describe HF nurses' research interest/involvement, confidence, facilitators/motivators, and barriers to lead/collaborate in research studies. METHODS: A descriptive design with convenience sampling and online data collection (Qualtrics) were used with American Association of HF Nurses members. Recruited/included nurses (n = 145) needed to be of any educational level and currently practicing in any practice setting in the United States. A 30-item, adapted instrument assessed research interest (one-question), involvement (two-questions), confidence (two-questions), facilitators (one-question), motivators (three-questions), and barriers (21-questions). RESULTS: Subjects (n = 145) were Caucasian (n = 124, 86.1 %) females (n = 137, 96.5 %) with an average age of 52.5 ± 10.38 years and 26.90±12.06 years of nursing experience. Nurses were interested in conducting nursing research (7.78/10±2.37) but involvement was low. Most frequently (n = 73, 50.3 %) nurses served as principal/co-investigators. Confidence with research participation was moderate (70.28/100±26.92) and in their ability to understand/apply research findings were low (21.68/100±80.07). The most frequently reported facilitator was the ability to control their own schedule/work (n = 30, 20.7 %) and the strongest motivator (n = 107, 73.8 %) was the perception presenting nursing research/EBP impacts HF care. The greatest reported barrier was the authority to seek research funding (2.39/5 ± 1.14). Nursing experience (p=.034), interest in participating in nursing research (p=.01), and how much presenting nursing research/EBP impacted one's performance review (p<.001) added to the prediction (R2=0.499, p<.001). CONCLUSIONS: The gained knowledge may promote development of innovative programs and educational opportunities to increase HF nurses' research activities.

Correlation of health literacy and learning style preference in persons with heart failure.

OBJECTIVE: The purpose of the study was to describe demographic and health literacy correlates of learning style in older adults with heart failure (HF). METHODS: Cross sectional data on learning styles (VARK Questionnaire, 16 items) and health literacy (S-TOFHLA, 36 items) were collected. Preferred learning style was determined and correlated to health literacy and demographic measures. RESULTS: 116 participants with heart failure (M age = 75.1 (SD 12.5) years, M health literacy of 19 (SD 11.5). Most identified as male (59 %); with inadequate health literacy (67 %). Thirty percent reported a multimodal learning style preference with a kinesthetic (r = .33, p = .03) and not a visual preference (r = -.49, p < .001). Among unimodal learning styles, the most frequent was kinesthetic (26.7 %). Those with lower literacy levels were older (r = -.44, p = <.001), had less education (r = .48, p < .001) and reported a kinesthetic learning preference (r = .37, p = .001). CONCLUSION: Older individuals identifying as male, with low health literacy, preferred a kinesthetic approach to HF education. Future research should consider the linkage between education tailored to learning style, health literacy and outcomes. PRACTICE IMPLICATIONS: Assessment of learning style should be completed prior to an educational encounter.

How can health literacy influence outcomes in heart failure patients? Mechanisms and interventions.

Health literacy is discussed in papers from 25 countries where findings suggest that approximately a third up to one half of the people in developed countries have low health literacy. Specifically, health literacy is the mechanism by which individuals obtain and use health information to make health decisions about individual treatments in the home, access care in the community, promote provider-patient interactions, structure self-care, and navigate health care programs both locally and nationally. Further, health literacy is a key determinant of health and a critical dimension for assessing individuals' needs, and, importantly, their capacity for self-care. Poorer health knowledge/status, more medication errors, costs, and higher rates of morbidity, readmissions, emergency room visits, and mortality among patients with health illiteracy have been demonstrated. Individuals at high risk for low health literacy include the elderly, disabled, Blacks, those with a poverty-level income, some or less high school education, either no insurance or Medicare or Medicaid, and those for whom English is a second language. As a consequence, health literacy is a complex, multifaceted, and evolving construct including aspects of social, psychological, cultural and economic circumstances. The purpose of this paper is to describe the mechanisms and consequences of health illiteracy. Specifically, the prevalence, associated demographics, and models of health literacy are described. The mechanism of health illiteracy's influence on outcomes in heart failure is proposed. Tools for health literacy assessment are described and compared. Finally, the health outcomes and general interventions to enhance the health outcomes in heart failure are discussed.

Oral Chemotherapy Laboratory Monitoring and Follow-Up: A Review of the Literature.

BACKGROUND: There are many inefficiencies related to oral chemotherapy (OC) laboratory monitoring and follow-up in the ambulatory clinic setting. Patients with cancer prescribed OC have a higher risk of adverse events when there is inconsistent laboratory test result reporting and follow-up from their oncology provider. OBJECTIVES: The aim of this article is to improve OC laboratory monitoring by identifying potential barriers and opportunities for reliable communication between patients and providers in the outpatient clinical setting. METHODS: A literature review found 76 articles, of which 15 were selected for review. Six themes were synthesized and discussed. FINDINGS: Healthcare systems use technology, standard pathways, and clear patient-provider communication following laboratory testing to ensure patient safety. Implementing and testing evidence-based solutions and structured frameworks to identify gaps in outpatient laboratory monitoring and follow-up can improve patient satisfaction and safety during OC treatment.

Pediatric Hematology/Oncology Nurse Spirituality, Stress, Coping, Spiritual Well-being, and Intent to Leave: A Mixed-method Study.

Background: Intense emotional demands of oncology nursing create a stressful work environment and increase the likelihood of leaving. The study aims to explore, describe, and understand how pediatric hematology/oncology nurses caring for chronically ill or dying patients use their spirituality to cope with job stress, maintain spiritual well-being (SWB), and continue to work in this specialty. Methods: A concurrent mixed-method research design consisted of a web-based survey and interview. Data collection included demographics, intent to leave questions, and four valid and reliable research instruments measuring spirituality, stress, coping, and SWB. A responsive interview guide directed interviews. Results: Quantitative analysis (n = 130) revealed moderate to high levels of spirituality, moderate stress, coping, and SWB. Stress and SWB were weakly, inversely correlated (r = -.221, p = .011) indicating lower stress was associated with greater SWB. Coping and SWB were weakly, positively correlated (r = .248, p = .005) indicating greater coping was associated with greater SWB. An intent to leave in the next year was reported by 5.4%. Emerging themes from qualitative data (n = 22) included faith-informed or existential spirituality, work environment, and emotional/psychological stressors such as feeling overwhelmed or witnessing suffering and coping through self-care and spirituality. Dimensions of SWB included spiritually based coping and life's meaning and purpose. Intent to leave was related to the work environment or travel distance. Discussion: A nurse's spirituality offers a mechanism for coping with accumulated losses and grief encountered in clinical practice and in turn supports SWB.

Ethnic differences in quality of life in persons with heart failure.

BACKGROUND: Chronic illness burdens some groups more than others. In studies of ethnic/racial groups with chronic illness, some investigators have found differences in health-related quality of life (HRQL), whereas others have not. Few such comparisons have been performed in persons with heart failure. The purpose of this study was to compare HRQL in non-Hispanic white, black, and Hispanic adults with heart failure. METHODS: Data for this longitudinal comparative study were obtained from eight sites in the Southwest, Southeast, Northwest, Northeast, and Midwest United States. Enrollment and 3- and 6-month data on 1212 patients were used in this analysis. Propensity scores were used to adjust for sociodemographic and clinical differences among the ethnic/racial groups. Health-related quality of life was measured using the Minnesota Living with Heart Failure Questionnaire. RESULTS: Significant ethnic/racial effects were demonstrated, with more favorable Minnesota Living with Heart Failure Questionnaire total scores post-baseline for Hispanic patients compared with both black and white patients, even after adjusting for baseline scores, age, gender, education, severity of illness, and care setting (acute vs. chronic), and estimating the treatment effect (intervention vs. usual care). The models based on the physical and emotional subscale scores were similar, with post hoc comparisons indicating more positive outcomes for Hispanic patients than non-Hispanic white patients. CONCLUSION: Cultural differences in the interpretation of and response to chronic illness may explain why HRQL improves more over time in Hispanic patients with heart failure compared with white and black patients.

Correlates of fatigue in patients with heart failure.

This study was conducted to determine the prevalence of fatigue and identify its demographic, clinical, and psychological correlates in 150 heart failure (HF) patients (73% men, 66% Caucasian, mean age 55.0 years, mean ejection fraction 26.7%+/-11%), from a single HF center, using the Profile of Mood States-Fatigue Subscale, the Minnesota Living With Heart Failure Questionnaire, and the Beck Depression Inventory. Sociodemographic and clinical data were obtained through self-report and chart abstraction. High levels of fatigue were reported in 50.4% of men and 51.2% of women. In a multivariate model, maximal workload, physical health, emotional health, and depression explained 51% of the variance in fatigue (P<.001). Fatigue in patients with HF is associated with both clinical and psychosocial variables, offering a number of targets for intervention. These findings suggest the need for multiple risk factor intervention strategies that improve physical and emotional health to decrease fatigue. Patients with depression warrant particular scrutiny.

Evaluation of a Web-based education and counseling pilot program for older heart failure patients.

Web-based communication has been reported as a feasible management tool for heart failure (HF) patients and has also been documented to positively impact quality of life (QOL). The feasibility and effectiveness of a Web-based educational and HF management program among older HF patients (60 years and older), however, have not been previously explored. Therefore, a prospective study was conducted. QOL (physical and mental health) and perceived control (PC) scores of 40 participants were measured (baseline and 3 months) and retrospectively compared with an age- and sex-matched control group of 40 patients receiving HF care as usual. Between-group differences over time were statistically significant in the QOL mental health component and PC scores. The authors' findings demonstrate the beneficial effects of a Web-based program on QOL and PC in older patients with HF. This approach may be potentially beneficial in delivering educational and behavioral support to this high-risk group in ways that are affordable and accessible.

Impact of obesity on quality of life and depression in patients with heart failure.

BACKGROUND: The effect of obesity on health related quality of life (HRQOL) and depression in a number of disease states is well documented, but its impact in heart failure (HF) patients remains speculative. We therefore examined the relationship between obesity, HRQOL, and depression in 358 patients with HF. METHODS AND RESULTS: Comparative analyses were conducted to determine if body mass index (BMI) was associated with HRQOL and depression in three groups of patients with HF-normal weight (BMI 18.5-24.9 kg/m2, n = 100), overweight (BMI 25-29.9 kg/m2, n = 141), and obese (BMI > or = 30 kg/m2, n = 117). Obese patients were younger than normal and overweight participants; all other demographic and clinical characteristics were similar. HRQOL and depression scores were significantly higher (worse) for obese patients. Body mass index was significantly correlated with all 3 scales of HRQOL (overall, r2 = .160; physical, r2 = .162; and mental, r2 = .217) as well as with depression (r2 = .166). CONCLUSION: Obese patients with HF are more likely to have poorer HRQOL, physical health, emotional well-being and depressive symptoms. Poorer HRQOL is predictive of worse outcomes in patients with HF; however, given the apparent obesity paradox in HF, further investigation of the impact of obesity in HF is urgently required.

Developing a Web-based education and counseling program for heart failure patients.

This paper describes a 2-phase method utilized to develop and evaluate the feasibility of a Web-based program targeted to the specific learning needs of elderly patients with heart failure. In the first phase, informational resources specific to the needs of elderly patients were identified using aspects of participant-focused research. Data from 69 patients were obtained through a structured interview and later reviewed with health care providers and patient representatives. Items deemed important by the patients and health care providers were incorporated into the Internet-based program that was drafted for the study. The second phase of the process entailed obtaining data to support the acceptability and feasibility of the intervention by providing 12 patient volunteers access to the Internet-based program that was developed. After 2 weeks, the authors contacted the volunteers and asked them about their experiences with accessing and navigating the Web page. The authors found that elderly persons with limited computer skills can and will use Web resources to obtain information when given adequate instructions on how to access the Web pages.

Clinical Nurse Specialist Roles in Conducting Research: Changes Over 3 Years.

PURPOSE: The aim of this study is to describe clinical nurse specialists' characteristics, interest, confidence, motivators, and barriers in conducting research. DESIGN: This study was a descriptive, multicohort design. METHODS: Clinical nurse specialists were recruited electronically through national and local organizations to complete anonymous surveys 3 times, over 3 years. Comparative analyses included χ and Kruskal-Wallis tests. RESULTS: Of 2052 responders (initial, n = 629; 18 months, n = 465; and 3 years, n = 958), mean (SD) participant age was 50.3 (9.3) years. Overall, 41.7% of participants were involved as principal or coinvestigators in research. Interest in conducting nursing research (on a 0-100 scale) was 61.1 (38.4) and was lowest among the 18-month time point participant group (score, 39.1 [32.2]) and highest at the 3-year time point (68.3, [30.7]; P < .001). Confidence in conducting research, discussion of statistics, and perceptions of motivators and barriers to conducting research did not differ across time period groups. Access to literature and mentors and research knowledge were the most prevalent barriers to conducting research. CONCLUSIONS: Less than 42% of clinical nurse specialists conducted research and the rate did not change between different time groups. Access and knowledge barriers to conducting research were prominent. Workplace leaders need to consider resources and support of academic educational opportunities to increase research conduct by clinical nurse specialists.

Two-year follow-up of quality of life in patients referred for heart transplant.

BACKGROUND: Assessment of physical and mental health has become one of the ultimate tests of health-related quality of life (HRQOL) for patients with advanced heart failure. Little is known, however, about the comparative effects of surgical or medical treatment on the HRQOL of these chronically ill patients over time. METHODS: We examined 77 patients (74% of whom were male), aged 56.1 +/- 12.7 years who were referred for heart transplant evaluation at a single heart failure center to describe the effects of time and treatment status on changes in HRQOL scores (physical and mental health and depression) using the Short Form-12 and the Beck Depression Inventory at 2 time points during their illness trajectory. The 2 evaluations on average were 2 years apart (mean 24.5 +/- 2.8 months). All patients were evaluated at baseline, and 3 groups were identified at the time of the 2-year follow-up: transplant recipients (n = 17), transplant candidates (n = 13), and medically stable patients considered too well to receive a transplant (n = 47). Nonparametric statistics were used to analyze group differences in HRQOL scores. The significance level was set at a P value less than .05. RESULTS: Demographic and HRQOL scores were not significantly different among the 3 groups at baseline. During follow-up, physical health and depression scores significantly improved over time in all patients, but changes in mental health were minimal. Group comparisons showed that although all patients continued to have low HRQOL scores at the time of follow-up evaluation, medically stable patients had higher mental health scores and less depressive symptoms than their counterparts. CONCLUSION: Our results support the need for ongoing HRQOL assessment with an emphasis on timely recognition and treatment of psychologic distress throughout the heart failure illness trajectory. Heart transplant recipients and candidates equally need special attention and follow-up because they both seem to have emotional and psychologic repercussions.

Nursing journal clubs and the clinical nurse specialist.

PURPOSE/OBJECTIVES: The purpose of this article was to describe the clinical nurse specialist's role in developing and implementing a journal club. Tools for critiquing clinical and research articles with an application of each are provided. BACKGROUND: The journal club provides a forum through which nurses maintain their knowledge base about clinically relevant topics and developments in their specific clinical discipline, analyze and synthesize the relevant scientific literature as evidence, and engage in informal discussions about evidence-based and best practices. RATIONALE: The value of journal clubs includes nursing staff education, review of and support for evidence-based practice, promotion of nursing research, and fostering of organization-wide nursing practice changes. DESCRIPTION: The process for establishing a journal club and suggested appraisal tools are discussed. In addition, strategies for overcoming barriers to the implementation of a journal club are outlined. Suggested article review questions and a reporting format for clinical and research articles are provided with examples from 2 articles. Finally, a glossary of terms commonly used by research scientists and manuscript writers are listed and additional resources provided. OUTCOME/CONCLUSION: The clinical nurse specialist's role in developing and implementing a journal club will be facilitated through the use of this article. IMPLICATIONS: Enhanced nursing staff education, evidence-based practice, organization-wide nursing practice changes, and nursing research may be conducted following the implementation of a nursing journal club.

Perceived control reduces emotional stress in patients with heart failure.

We studied patients with heart failure (HF) to determine if perceived control reduces emotional distress (i.e., anxiety, depression and hostility) in chronic, debilitating cardiac illness and whether the demographic, clinical and psychologic characteristics of patients with high and low perceived control differed. Psychological assessment of 222 patients with heart failure included an evaluation of perceived control using the Control Attitudes Scale, as well as anxiety, depression and hostility using the Multiple Affect Adjective Checklist. Using multivariate analysis to control for differences in demographic and clinical characteristics, we found that patients with high perceived control had significantly greater 6-minute walk distances and less emotional distress than patients with low perceived control. Interventions designed to increase perceived control may be an important aspect of HF care, but require testing in randomized trials.

Correlates of health-related quality of life in patients with heart failure.

BACKGROUND: The purpose of this study was to explore health-related quality of life (HRQOL) in patients with advanced heart failure undergoing heart transplantation evaluation. The overall aim of the study was to determine whether patients' demographic characteristics, functional status, neuroticism, social network, social support, spirituality, and time since symptom onset are related to the physical and mental components of a patient's HRQOL. METHODS: A descriptive, correlational design was used. Patients (N = 61) were recruited from 2 university-affiliated, outpatient, heart failure programs. Data were collected from chart review, a 6-minute walk, and patient-completed instruments. HRQOL, including physical and mental health components, was assessed with use of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). RESULTS: Demographic characteristics, functional status, neuroticism, social network, social support, spirituality, and time since symptom onset explained 26% of the variability in the physical health component of HRQOL and 44% of the variability in the mental health component of HRQOL in patients with advanced heart failure. In analyzing the data for the most parsimonious model, New York Heart Association classification, 6-minute walk distance, and neuroticism explained 49% of the variability in the mental health component of HRQOL. CONCLUSIONS: New York Heart Association classification, 6-minute walk distance, and neuroticism are related to the mental health component of HRQOL and can be easily included in the assessment of patients with heart failure who are undergoing heart transplantation evaluation. The findings of the current study require replication but may be used to identify patients with heart failure who are potentially at risk for reduced HRQOL.