The feasibility of a social media-based foot self-management education and support program for adults with diabetes: A partially randomized preference trial.

Aim: To assess the feasibility of Diabetic Foot Care Group (DFCG), a social media-based self-management education and support intervention, for people with diabetes (PWD) empowerment in diabetes-related foot ulceration prevention. Methods: A partially randomized preference trial was conducted among 32 PWD. DFCG was implemented through Facebook. Participants in the intervention group joined the DFCG in addition to their usual care, while the control group received usual care. Data were collected online using questionnaires on participants' DFCG acceptance, engagement and preliminary efficacy on nine diabetes foot care-related outcomes at baseline, one, and three months post-intervention. Results: The participants' study intervention acceptability and engagement rates were 84.2% and 55.2%, respectively. DFCG efficacy rate compared to usual care was 88.9% to 22.2%. Three diabetes foot care-related outcomes increased significantly in the intervention group three-month post-intervention: foot self-care adherence (p = 0.001, ηp 2 = 0.35), preventive foot self-care practice (p = 0.002, ηp 2 = 0.33), and physical health status (p < 0.02, ηp 2 = 0.23). Conclusion: DFCG is feasible and could effectively improve diabetes foot care-related outcomes. Innovation: Social media is an innovative approach healthcare professionals could utilize to virtually support PWD in ongoing learning and engagement in optimal foot self-care activities. Trial registration: ClinicalTrials.gov, Identifier: NCT04395521.

Empowered management for pelvic pain: The experiences of women with persistent pelvic pain participating in an online self-directed self-management program while they wait for interprofessional care.

BACKGROUND: Persistent pelvic pain is pain sensed in or around the pelvis and is often associated with negative cognitive, behavioral, sexual, and emotional consequences. The lack of interprofessional persistent pelvic pain management programs that address the complex interplay of biopsychosocial factors result in lengthy wait times and negative health outcomes. Limited access to evidence informed self-management educational resources contributes to poor coping strategies. Evidence shows that self-management education and strategies support patients while they wait for care. However, very few studies explore the patient's lived experience of participating in an online educational program designed for persistent pelvic pain. OBJECTIVES: This study aims to understand the experience of women with persistent pelvic pain participating in an online, self-management education program ("Pelvic Pain Empowered Management" program) while awaiting care at an interprofessional pelvic pain clinic. DESIGN: A descriptive qualitative approach was used to explore the experiences of women participating in an online educational program designed for cis women with persistent pelvic pain. METHODS: We conducted semi-structured interviews with 11 women, transcribed the data verbatim using NVivo software (NVivo 12, QSR International Pty Ltd.), and analyzed inductively using previously established methods. RESULTS: We identified four main themes relevant to women's experiences of the program: (1) the program shaped expectations around upcoming pelvic pain appointments, (2) the program content is relevant and resonates with people with lived experience of persistent pelvic pain, (3) the program enhanced understanding of persistent pelvic pain, and (4) the program empowered people with skills and strategies to better manage their persistent pelvic pain. CONCLUSION: Our findings highlight how self-directed online patient education can be leveraged while persistent pelvic pain patients wait for care to support them in setting expectations around care and in engaging in pain self-management.

Patient Expectations and Therapeutic Alliance Affect Pain Reduction Following Lidocaine Infusion in an Interdisciplinary Chronic Pain Clinic.

Pain experience is affected by both ascending nociceptive signals and descending modulation. Expectations can affect pain experience and augment treatment-induced analgesia through descending inhibitory modulation of pain. This open-label, prospective cohort study examined the association between participant expectation ratings and pain reduction in adult participants with chronic pain receiving an intravenous lidocaine infusion. We aimed to explore whether: 1) participants' expectations of treatment efficacy were associated with pain reduction over 8 weeks after infusion; and 2) participants' therapeutic alliance was associated with expectations and/or pain reduction. We recruited 70 participants with chronic pain scheduled for lidocaine infusion. Study measures included pain intensity (pre-treatment, post-treatment, and daily for 8 weeks), treatment expectations (EXPECT), and therapeutic alliance (Trust in Physician and Working Alliance Inventory-Short Revised). Baseline treatment expectations were significantly correlated with pain reduction (r = .42, P < .01). Therapeutic alliance was significantly correlated with expectations (r = .27, P < .05) and pain reduction (r = .38, P < .01). This study quantifies the contribution of: 1) treatment expectations; and 2) therapeutic alliance to the magnitude of lidocaine-induced pain reduction. Results generate the hypothesis that focused efforts to augment treatment expectations and therapeutic alliance could serve to improve pain treatment outcomes. PERSPECTIVE: This study evaluates the relationship between pain reduction and ratings of: 1) treatment expectations; and 2) therapeutic alliance following an intravenous lidocaine infusion. Results generate the hypothesis that focused efforts to augment treatment expectations and therapeutic alliance could serve to improve pain treatment outcomes.

Phenomenographic Approaches in Research About Nursing.

We propose that phenomenography is well-suited to research about nursing, given its focus on identifying variation in individuals' experiences, and inclusion of diverse voices and perspectives. Phenomenography explores qualitatively different ways in which a group of people experience a phenomenon, often using semi-structured interviews. The use of phenomenography is especially relevant in research about nursing which provides accounts of the experiences of nurses and patients within complex practice settings. We consider the tenets of phenomenography and examine phenomenography's relationship to and differences from phenomenology. We review literature published about phenomenographic research in nursing and reflect on the potential benefits of phenomenographic research about nursing. This paper adds to knowledge about use of phenomenography in research about nursing.

'The solution is we need to have a centre': a study on diabetes in Liberia.

In Liberia, one of the poorest nations in sub-Saharan Africa, the burden of diabetes is a growing concern. The high mortality and morbidity associated with diabetes have significant implications for individuals, families and society at large. The aim of this critical hermeneutic study was to explore what it is like to live with diabetes in Liberia. We recruited 10 participants from Monrovia, Liberia to partake in this study. Photovoice, a well-established participatory data collection approach was used to gather images and stories that represented participants' everyday experiences of living with diabetes. Three major themes were uncovered, highlighting the strengths, challenges and solutions related to living with diabetes in Liberia: strengths-engagement in diabetes self-management practices, focused on participants' commitment to engage in diabetes self-management practices despite the socioeconomic challenges they experienced; challenges-lack of social and economic support, focused on limited access to food, diabetes medications and supplies and diabetes education; and solutions-centre for diabetes education, care and support, focused on participants' recommendations for a community-based diabetes centre, a single point of access for meeting the needs of people with diabetes. A strong commitment to prioritize diabetes on Liberia's national health agenda and increased resources for diabetes care is needed to address the challenges experienced by people living with this chronic disease in Liberia.

Epigenetic instability caused by absence of CIZ1 drives transformation during quiescence cycles.

BACKGROUND: Cip1-interacting zinc finger protein 1 (CIZ1) forms RNA-dependent protein assemblies that stabilise epigenetic state, notable at the inactive X chromosome in females. CIZ1 has been linked with a range of human cancers and in mice genetic deletion of CIZ1 manifests as hyperproliferative lymphoid lineages in females. This suggests that its role in maintenance of epigenetic stability is linked with disease. RESULTS: Here, we show that male and female CIZ1-null primary murine fibroblasts have reduced H4K20me1 and that this compromises nuclear condensation on entry to quiescence. Global transcriptional repression remains intact in condensation-deficient CIZ1-null cells; however, a subset of genes linked with chromatin condensation and homology-directed DNA repair are perturbed. Failure to condense is phenotypically mimicked by manipulation of the H4K20me1 methyltransferase, SET8, in WT cells and partially reverted in CIZ1-null cells upon re-expression of CIZ1. Crucially, during exit from quiescence, nuclear decondensation remains active, so that repeated entry and exit cycles give rise to expanded nuclei susceptible to mechanical stress, DNA damage checkpoint activation, and downstream emergence of transformed proliferative colonies. CONCLUSIONS: Our results demonstrate a role for CIZ1 in chromatin condensation on entry to quiescence and explore the consequences of this defect in CIZ1-null cells. Together, the data show that CIZ1's protection of the epigenome guards against genome instability during quiescence cycles. This identifies loss of CIZ1 as a potentially devastating vulnerability in cells that undergo cycles of quiescence entry and exit.

Examining the roles of depression, pain catastrophizing, and self-efficacy in quality of life changes following chronic pain treatment.

Background: Adults with chronic pain have a lower quality of life (QOL) compared to the general population. Chronic pain requires specialized treatment to address the multitude of factors that contribute to an individual's pain experience, and effectively managing pain requires a biopsychosocial approach to improve patients' QOL. Aim: This study examined adults with chronic pain after a year of specialized treatment to determine the role of cognitive markers (i.e., pain catastrophizing, depression, pain self-efficacy) in predicting changes in QOL. Methods: Patients in an interdisciplinary chronic pain clinic (N = 197) completed measures of pain catastrophizing, depression, pain self-efficacy, and QOL at baseline and 1 year later. Correlations and a moderated mediation were completed to understand the relationships between the variables. Results: Higher baseline pain catastrophizing was significantly associated with increased mental QOL (b = 0.39, 95% confidence interval [CI] 0.141; 0.648) and decreased depression (b = -0.18, 95% CI -0.306; -0.052) over a year. Furthermore, the relationship between baseline pain catastrophizing and the change in depression was moderated by the change in pain self-efficacy (b = -0.10, 95% CI -0.145; -0.043) over a year. Patients with high baseline pain catastrophizing reported decreased depression after a year of treatment, which was associated with greater QOL improvements but only in patients with unchanged or improved pain self-efficacy. Conclusions: Our findings highlight the roles of cognitive and affective factors and their impact on QOL in adults with chronic pain. Understanding the psychological factors that predict increased mental QOL is clinically useful, because medical teams can optimize these positive changes in QOL through psychosocial interventions aimed at improving patients' pain self-efficacy.

Contexte: Les adultes souffrant de douleur chronique ont une qualité de vie inférieure à celle de la population en général. La douleur chronique nécessite un traitement spécialisé pour répondre à la multitude de facteurs qui contribuent à l'expérience de la douleur d'un individu. De plus, la prise en charge efficace de la douleur nécessite une approche biopsychosociale pour améliorer la qualité de vie des patients.Objectif: Cette étude a examiné des adultes souffrant de douleur chronique après un an de traitement spécialisé pour déterminer le rôle des marqueurs cognitifs (c.-à-d. la catastrophisation de la douleur, la dépression, l'efficacité personnelle face à la douleur) dans la prévision des changements dans la qualité de vie.Méthodes: Les patients d'une clinique interdisciplinaire de la douleur chronique (N = 197) ont effectué des mesures de la catastrophisation de la douleur, de la dépression, du sentiment d'efficacité personnelle face à la douleur, ainsi que de la qualité de vie au départ et un an plus tard. Des corrélations et une médiation modérée ont été effectuées pour comprendre les relations entre les variables.Résultats: Une plus grande catastrophisation de la douleur au départ était significativement associée à une augmentation de la qualité de vie mentale (b = 0,39, intervalle de confiance à 95 % [IC] 0,141; 0,648) et à une diminution de la dépression (b = -0,18, IC à 95 % −0,306; −0,052) sur une année. En outre, la relation entre la catastrophisation de la douleur au départ et les changements en matière de dépression a été modérée par le changement dans le sentiment d'efficacité personnelle face à la douleur (b = − 0,10, IC à 95 % − 0,145; − 0,043) sur une année. Les patients démontrant une catastrophisation de la douleur élevée ont signalé une diminution de la dépression après un an de traitement, associée à de plus grandes améliorations dans la qualité de vie mais seulement chez les patients présentant un sentiment d'efficacité personnelle face à la douleur inchangée ou améliorée.Conclusions: Nos résultats mettent en évidence le rôle des facteurs cognitifs et affectifs et leur effet sur la qualité de vie chez les adultes souffrant de douleur chronique. Il est cliniquement utile de comprendre les facteurs psychologiques qui prédisent une augmentation la qualité de vie mentale, car les équipes médicales peuvent optimiser ces changements positifs dans la qualité de vie par des interventions psychosociales visant à améliorer le sentiment d'efficacité personnelle des patients face à la douleur.

Experience-based design: Empowering individuals while they wait for interprofessional chronic pain care.

OBJECTIVES: Chronic pain is highly prevalent and a leading cause of disability. Long wait times for interprofessional care provide an opportunity to introduce web-based interventions that improve psychosocial function and patients' readiness and ability to manage their condition. Here we describe the process of partnering with people with lived experience (PWLE) to develop an online self-management program enhanced by motivational interviewing. We also report the multiphase usability testing of the program. METHODS: PWLE were included in all aspects of this project from program inception to content creation, module development, usability testing, and knowledge dissemination. Phase 1 included the development of the interactive, web-based modules. This process involved weekly meetings and asynchronous content creation with a core team of interprofessional pain experts, researchers, and PWLE. Phase 2 included usability testing by our PWLE and clinical expert advisory. Phase 3 included survey-based usability testing with a sample of 10 PWLE. RESULTS: We created a chronic pain & motivational empowerment program includes a series of eight interactive educational web-based modules. Topics included: setting expectations, chronic pain explained, biopsychosocial factors, empowered management, self-awareness & compassion & acceptance, values, goal setting, and communication. The program is accompanied by a reflection journal and can be enhanced by one-on-one coaching sessions using a motivational interviewing approach. Phase two usability testing resulted in numerous content changes and the addition of accessibility features. Phase 3 usability testing with PWLE found the program highly accessible and easy to use. CONCLUSIONS: The engagement of our PWLE team member and advisors made the online program more relevant, sensitive and helpful to the needs of people with pain. PRACTICAL VALUE: This PWLE-centric project sets the foundation for future work to examine the feasibility and effectiveness of the program for supporting individuals with chronic pain self-manage.

Absorptive capacity in the adoption of innovations in health: a scoping review.

OBJECTIVE: The objective of this scoping review was to explore how absorptive capacity has been conceptualized and measured in studies of innovation adoption in health care organizations. INTRODUCTION: Current literature highlights the need to incorporate knowledge translation processes at the organizational and system level to enhance the adoption of new knowledge into practice. Absorptive capacity is a set of routines and processes characterized by knowledge acquisition, assimilation, transformation, and application. A key concept in organizational learning theory, absorptive capacity is thought to be critical to the adoption of new knowledge and innovations in organizations. To understand how absorptive capacity was conceptualized and measured in health care organizations, it was appropriate to conduct a scoping review to answer our research question. INCLUSION CRITERIA: This scoping review included published and unpublished primary studies (ie, experimental, quasi-experimental, observational, and qualitative study designs), as well as reviews that broadly focused on the adoption of innovations at the organizational level in health care, and framed innovation adoption as processes that rely on organizational learning and absorptive or learning capacity. METHODS: Searches included electronic databases (ie, MEDLINE, Embase, PsycINFO, CINAHL, and Scopus) and gray literature, as well as reference scanning of relevant studies. Study abstracts and full texts were screened for eligibility by two independent reviewers. Data extraction of relevant studies was also done independently by two reviewers. All discrepancies were addressed through discussion or adjudicated by a third reviewer. Synthesis of the extracted data focused on descriptive frequencies and counts of the results. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). RESULTS: The search strategies identified a total of 7433 citations. Sixteen papers were identified for inclusion, including a set of two companion papers, and data were extracted from 15 studies. We synthesized the objectives of the included studies and identified that researchers focused on at least one of the following aspects: i) exploring pre-existing capacity that affects improvement and innovation in health care settings; ii) describing factors influencing the spread and sustainability of organizations; iii) identifying measures and testing the knowledge application process; and iv) providing construct clarity. No new definitions were identified within this review; instead existing definitions were refined to suit the local context of the health care organization in which they were used. CONCLUSIONS: Given the rapidly changing and evolving nature of health care, it is important to understand both current best practices and an organization's ability to acquire, assimilate, transform, and apply these practices to their specific organization. While much research has gone into developing ways to implement knowledge translation, understanding an organization's internal structures and framework for seeking out and implementing new evidence as it relates to absorptive capacity is still a relatively novel concept.

Capability as a concept in advanced practice nursing and education: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify and map how the concept of capability in advanced practice nursing and education is described in the literature. INTRODUCTION: Advanced practice nursing and education is often described in terms of the achievement of competencies. The concept of capability has been proposed as a more accurate description of the attributes of advanced practice nursing. Definitions of capability in advanced practice nursing vary, but often focus on the integration of prior knowledge, skills, resources, judgment, and experience when solving unanticipated problems or working in new situations. INCLUSION CRITERIA: This review will consider studies addressing the concept of individual capability in any setting related to advanced practice nursing education and practice. The working definition of capability in this review is a combination of knowledge, skills, experience, and competencies that enables advanced practice nurses to provide appropriate care for patients in both familiar and unfamiliar clinical settings. Advanced practice nurses will include nurses with both graduate education and an expanded scope of practice. METHODS: Eight academic databases will be searched for qualitative, quantitative, and mixed methods study designs. The gray literature search will include policy and practice documents from nursing and health organization websites. Two reviewers will independently complete title and abstract screening prior to full-text review and data extraction. Articles published in English from 1975 to the present will be included. Other languages will be included if translations are available.

Barriers and facilitators to education experienced by students with disabilities in low- and middle-income African countries: a systematic review of qualitative evidence.

OBJECTIVE: This review sought to collect and synthesize studies that investigated the lived experience of barriers and facilitators to educational access and excellence for students with disabilities in low- and middle-income African countries. INTRODUCTION: Access to education in low- and middle-income African countries for students with disabilities is often inequitable. Although governments have developed policies and programs for student with disabilities, much of the literature guiding policy and program development has focused on the views of academics, parents, teachers, and political figures. INCLUSION CRITERIA: This systematic review considered studies that included participants who were students or trainees at the time of the study, have a disability, and were located in a low- and middle-income African country. The phenomena of interest were barriers and facilitators to educational success for students with disabilities. This review included qualitative, interpretive, and critical studies that drew on the experiences of students with disabilities. METHODS: An initial search was conducted in CINAHL and MEDLINE, followed by development of a full search strategy that was used for AMED, Embase, CINAHL, Global Health, MEDLINE, and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions, spanning from 1910-2021. Articles were limited to those published in English. The JBI approach was followed for study selection, critical appraisal, data extraction, data synthesis, and assessing confidence in the findings with ConQual. RESULTS: Thirteen qualitative studies were included from seven African countries, and included primary, secondary and postsecondary students. The data were qualitatively synthesized into 64 findings, within six categories, which then formed two synthesized findings. The synthesized findings were: barriers and challenges to engaging in education, and supports for educational success. CONCLUSIONS: This review is a synthesis of the lived experiences of students with disabilities in low- and middle-income African countries to understand, in their own words, the challenges and supports they encounter during their educational journeys. Although many barriers and supports reported by students with disabilities and other stakeholders (eg, parents, teachers, administrators) are similar to those identified in this review, our findings identify that integrated research that includes students with disabilities will provide contextual and individual factors that are crucial for students to achieve equitable access to education. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019137951.

Systematic Review and Meta-analysis on the Incidence, Prevalence and Determinants of Discomfort in Inflammatory Bowel Disease.

Background: The symptom burden in inflammatory bowel disease (IBD) has a significant negative impact on the health-related quality of life (HRQOL). Patients with IBD report physical, psychological and social discomfort even during remission. Aim: To synthesize the best available evidence to determine the worldwide incidence, prevalence and determinants of discomfort in adults with inflammatory bowel disease (IBD). Methods: Following PRISMA recommendations, we searched the Medline, CINAHL, PsycInfo, Embase, Cochrane, Campbell and JBI Evidence Synthesis databases for studies on either incidence or prevalence of discomfort in English until January 2021. Data were extracted using the Joanna Briggs Institute's standardized extraction tools. Data that directly reported or could be used to calculate the incidence and prevalence of discomfort were extracted. Ten studies were eligible for inclusion in this review. Overall, the methodological quality of the included studies was considered moderate. Data measuring the incidence of discomfort in 6 out of 10 identified studies using the same measurement tool (EQ-5D) were pooled in a meta-analysis. Additional results have been presented in a narrative form, including tables. Results: There is no standardized definition or tool utilized to describe or measure discomfort in IBD. Synthesized findings demonstrate that discomfort is prevalent among adults living with IBD. Determinants of discomfort included health literacy, disease activity, hospitalization/surgery, age and gender, delayed diagnosis, local practice standards and quality of IBD care. Conclusions: More research is needed to identify the impact of discomfort on health-related outcomes for people with IBD and consequently appraise discomfort interventions for their efficacy.

Rapid reviews and the methodological rigor of evidence synthesis: a JBI position statement.

ABSTRACT: The demand for rapid reviews has exploded in recent years. A rapid review is an approach to evidence synthesis that provides timely information to decision-makers (eg, health care planners, providers, policymakers, patients) by simplifying the evidence synthesis process. A rapid review is particularly appealing for urgent decisions. JBI is a world-renowned international collaboration for evidence synthesis and implementation methodologies. The principles for JBI evidence synthesis include comprehensiveness, rigor, transparency, and a focus on applicability to clinical practice. As such, JBI has not yet endorsed a specific approach for rapid reviews. In this paper, we compare rapid reviews versus other types of evidence synthesis, provide a range of rapid evidence products, outline how to appraise the quality of rapid reviews, and present the JBI position on rapid reviews. JBI Collaborating Centers conduct rapid reviews for decision-makers in specific circumstances, such as limited time or funding constraints. A standardized approach is not used for these cases;instead, the evidence synthesis methods are tailored to the needs of the decision-maker. The urgent need to deliver timely evidence to decision-makers poses challenges to JBI's mission to produce high-quality, trustworthy evidence. However, JBI recognizes the value of rapid reviews as part of the evidence synthesis ecosystem. As such, it is recommended that rapid reviews be conducted with the same methodological rigor and transparency expected of JBI reviews. Most importantly, transparency is essential, and the rapid review should clearly report where any simplification in the steps of the evidence synthesis process has been taken.

Reviews of Literature in Nursing Research: Methodological Considerations and Defining Characteristics.

Despite the availability of guidelines about the different types of review literature, the identification of the best approach is not always clear for nursing researchers. Therefore, in this article, we provide a comprehensive guide to be used by health care and nursing scholars while choosing among 4 popular types of reviews (narrative, integrative, scoping, and systematic review), including a descriptive discussion, critical analysis, and decision map tree. Although some review methodologies are more rigorous, it would be inaccurate to say that one is preferable over the others. Instead, each methodology is adequate for a certain type of investigation, nursing methodology research, and research paradigm.

Pain-Related Fear in Adults Living With Chronic Pain: Development and Psychometric Validation of a Brief Form of the Tampa Scale of Kinesiophobia.

OBJECTIVE: To develop and validate a brief version of the Tampa Scale of Kinesiophobia (TSK) while preserving content validity in a mixed chronic pain population. DESIGN: Cross-sectional study. SETTING: Tertiary care interdisciplinary chronic pain clinic. PARTICIPANTS: Adults with chronic pain (N=933; mean age, 53.5±15.7 years; 63% women). INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: TSK-11 measured at intake. Self-reported data from a patient registry were extracted from November 2017 to October 2019. RESULTS: An exploratory factor analysis identified a 2-factor structure from the TSK-11 and item reduction resulted in a 7-item TSK (TSK-7) with 61.2% explained variance and Cronbach's alphas of 0.76 and 0.70 for each of the 2 factors. To maximally reduce the number of items without affecting internal consistency, a 5-item TSK (TSK-5) with 72% explained variance was also explored. Strong correlations were found between the newly developed brief TSK versions and TSK-11 (r>0.93), suggesting good concurrent validity. TSK-11, TSK-7, and TSK-5 had similar convergent validity with moderate correlations for pain catastrophizing (r=0.57, 0.58, 0.54), depression (r=0.45, 0.46, 0.42), pain interference (r=0.43, 0.44, 0.40), and pain acceptance (r=-0.57, -0.59, -0.55). CONCLUSIONS: These 2 brief versions of the TSK may help to simplify questionnaires across chronic pain centers where multiple outcome measures are used for a complete biopsychosocial assessment of patients.

Investigating Specialized Chronic Pain Care Among Emerging Adults.

BACKGROUND: AIMS: To investigate characteristics of emerging adults accessing a specialized chronic non-cancer pain clinic and describe interventions offered and utilized by this group. DESIGN: A retrospective chart review was conducted of emerging adults and middle-aged adults with chronic pain receiving care over a six-month period. SETTING: A chronic pain clinic in Southeastern Ontario. PARTICIPANTS: 82 participants comprised of 41 emerging adults (aged 18-29) and 41 middle-aged adults (aged 30-64) METHODS: Groups were matched on sex and number of pain sites. Demographic and pain characteristics, interventions, referrals, and clinic utilization were examined using bivariate and multivariate analysis. RESULTS: Emerging adults reported lower pain severity scores (t(80) = -2.15, p = .035), were more likely to receive referrals for additional consultation and/or diagnostic investigations (X2(1, n = 82) = 4.97, p = .026) and to have at least one psychology visit (X2 = 7.29, p = .007). Moreover, emerging adults with higher depression scores were more likely to see a psychologist (OR 1.23, 95% CI 1.014-1.492). CONCLUSIONS: Pain presentation and care patterns differed between emerging adults and middle-aged adults. Increased use of non-pharmacologic interventions in emerging adults may reflect differences in pain presentations as well as clinician's sensitivity to emerging adult's particular developmental needs but further research is needed. Further research is needed to contribute to nurses' understanding of the quality and efficacy of pain management approaches.

Measuring Scope of Practice Enactment Among Primary Care Registered Nurses.

BACKGROUND: Scope of practice enactment is poorly understood in the primary care setting. PURPOSE: The following research objectives were addressed: (1) to revise and adapt the Actual Scope of Practice (ASCOP) questionnaire for use in the primary care setting, and (2) to determine internal consistency, construct validity, and sensitivity of the modified instrument. METHODS: To address the first objective, a narrative literature review and synthesis and an expert panel review was conducted. To address the second objective, a cross-sectional survey of 178 registered nurses who worked in primary care was conducted. RESULTS: The ASCOP, with few modifications, addressed key attributes of nursing scope of practice in the primary care setting. The modified instrument yielded acceptable alpha coefficients ranging from 0.66 to 0.91. Total mean score of 4.8 (SD = .67) suggests that registered nurses within interprofessional primary care teams almost always engage in activities reflected in the modified instrument. CONCLUSIONS: The modified instrument is the first instrument validated to measure nursing scope of practice enactment in the primary care setting. Findings from this study support the use of the modified ASCOP questionnaire as a reliable and valid measure of scope of practice enactment among primary care registered nurses.

Poder interprofissional em cuidados intensivos: reflexão filosófica a partir de perspectivas foucaultianas e críticas / Poder interprofesional en cuidados intensivos: reflexión filosófica a partir de perspectivas foucaultianas y críticas / Interprofessional Power in Acute Care: Philosophical Reflection using Foucauldian and Critical Perspectives

Resumo Objetivo Discutir as relações de poder entre profissionais de saúde em ambientes de cuidado intensivo e sua interferência no processo de construção do conhecimento. Métodos Neste artigo filosófico, exploramos a influência das relações de poder na construção do conhecimento, a partir das perspectivas foucaultiana e crítica de Gramsci e Freire em relação às práticas de enfermagem e cuidados de saúde. Resultados Há quatro fontes de poder organizacional (tomada de decisão, critério, controle de recursos e controle de conhecimento/rede) que atuam em diferentes níveis das organizações de saúde. As unidades de terapia intensiva são um importante segmento do ambiente de saúde, e a complexidade no cotidiano dos profissionais desse setor pode dificultar as relações de poder no processo de construção do conhecimento. Por exemplo, quando profissionais externos à equipe da UTI, que detêm conhecimentos específicos, precisam ser contatados para auxiliar em casos, como durante o processo de doação e transplante de órgãos. Nesta situação, é necessário desconstruir o poder competitivo para construir o poder colaborativo. Conclusão Usando as perspectivas de Freire e Gramsci, argumentamos que a falta de conhecimento contribui para o poder competitivo, que pode ser superado se os indivíduos envolvidos participarem no processo de aprendizagem em direção ao poder colaborativo. Portanto, as estratégias ou ações para lidar com os desequilíbrios de poder interprofissional podem contribuir para a transformação e mudança mútua.

Resumen Objetivo Discutir las relaciones de poder entre profesionales de salud en ambientes de cuidado intensivo y su interferencia en el proceso de construcción del conocimiento. Métodos En este artículo filosófico, exploramos la influencia de las relaciones de poder en la construcción del conocimiento a partir de las perspectivas foucaultianas y la crítica de Gramsci y de Freire en relación con las prácticas de enfermería y los cuidados de salud. Resultados Hay cuatro fuentes de poder organizativo (toma de decisión, criterio, control de recursos y control de conocimiento/red) que actúan en distintos niveles de las organizaciones de salud. Las unidades de cuidados intensivos son un importante sector del ambiente de la salud, y la complejidad en la labor cotidiana de los profesionales de ese sector puede dificultar las relaciones de poder en el proceso de construcción del conocimiento. Por ejemplo, cuando profesionales externos al equipo de la UCI, que tienen conocimientos específicos, tienen que ser contactados para auxiliar en algunos casos, como durante el proceso de donación y trasplante de órganos. En esta situación se hace necesario deconstruir el poder competitivo para construir el poder colaborativo. Conclusión Usando las perspectivas de Freire y de Gramsci, argumentamos que la falta de conocimiento contribuye para el poder competitivo, que se puede superar si los individuos involucrados participan en el proceso de aprendizaje en dirección al poder colaborativo. Por lo tanto, las estrategias o las acciones para hacer frente a los desequilibrios de poder interprofesional pueden contribuir con la transformación y el cambio mutuo.

Abstract Objective To discuss the power relations among health care professionals in acute care settings and its interference in the process of knowledge building. Methods In this philosophical paper, we explored the influence of power relations on knowledge building using a Foucauldian and critical perspective of Gramsci and Freire related to nursing and health care practices. Results There are four sources of organizational power (decision-making, discretion, control of resources, and control of knowledge/network) that act at different levels of healthcare organizations. Intensive care units are an important segment of healthcare setting, and the complexity involved in the daily activities of professionals in this sector can lead to difficult power relations in the process of knowledge building. For instance, when professionals external to the ICU team that hold specific knowledge need to be contacted to help in cases, such as during organ donation and transplantation process. In this situation it is necessary to deconstruct the competitive power in order to build the collaborative power. Conclusion Using Freire's and Gramsci's perspectives we argued that lack of knowledge contributes to competitive power which can be overcome if involved individuals engage in the learning process towards a collaborative power approach. Therefore, strategies or action to address interprofessional power imbalances can contribute mutual transformation and change.

Healthcare Simulation Use to Support Guidelines Implementation: An Integrative Review.

INTRODUCTION: Simulation-based education is a useful teaching and learning strategy that can help to implement guidelines into healthcare settings. Therefore, the purpose of this paper is to collate, synthesize, and analyze the literature focusing on the use of simulation as an educational strategy to support guidelines implementation among healthcare providers (HCPs). MATERIALS AND METHODS: Integrative literature review using the methodology proposed by Ganong. RESULTS/DISCUSSION: Twenty-three articles were selected, the majority (n=19, 82%) used simulation in practice settings and pre- and post-test measurement (n=16, 69%). All studies that assessed simulation effects highlighted that the use of simulation improved the measured outcomes related to guideline implementation. Simulation-based education can be an effective strategy to support guidelines implementation among HCPs, but aspects such as cost involved, time constraints, training of educators, and the HCPs' learning needs can affect its applicability. Future research should focus on more transparent reports related to the guidelines for simulation content, virtual learning, costs of simulation, and measurement of the long-term effects of simulation-based education.