"Room to Reflect": A Pilot Workplace Resiliency Intervention for Nurses.

Rising workload demands for nurses necessitate the implementation of easily accessible and innovative clinician well-being resources on health care units. This pre/post pilot study sought to measure the impact of a mobile workplace intervention, "Room to Reflect" on staff nurse and nurse manager resilience. A mobile toolbox with a sound machine, Virtual Reality headset, and associated Quick Response code audio/video offerings, and a paper Pocket Guide of mindful restoration practices were provided to 7 health care units for a 3 month period. Pre/post questionnaires assessed perceived resilience using the Connor-Davidson Resilience scale, and intervention feasibility (ease of use), accessibility (spaces used), and effectiveness (restoration). Data analysis consisted of descriptive statistics, paired and independent samples t-tests, and Wilcoxon Signed Rank tests. From the pre (n = 97) to post (n = 57) intervention period, there was a significant difference in resilience for Clinician 3 staff nurses. A mean increase in resilience was noted among nurse managers following participation in the intervention, z = −2.03, p < 0.05. The Pocket Guide was the easiest offering to use, while VR offerings were accessed the most through Quick Response code. Space and time were the most common barriers to Room to Reflect use. Staff nurses felt supported by managers to use the program, and managers perceived that the program improved nurse job satisfaction.

A feasibility randomized controlled trial of a NICU rehabilitation program for very low birth weight infants.

Motor disability is common in children born preterm. Interventions focusing on environmental enrichment and emotional connection can positively impact outcomes. The NICU-based rehabilitation (NeoRehab) program consists of evidence-based interventions provided by a parent in addition to usual care. The program combines positive sensory experiences (vocal soothing, scent exchange, comforting touch, skin-to-skin care) as well as motor training (massage and physical therapy) in a gestational age (GA) appropriate fashion. To investigate the acceptability, feasibility and fidelity of the NeoRehab program in very low birthweight (VLBW) infants. All interventions were provided by parents in addition to usual care. Infants (≤ 32 weeks' GA and/or ≤ 1500 g birthweight) were enrolled in a randomized controlled trial comparing NeoRehab to usual care (03/2019-10/2020). The a priori dosing goal was for interventions to be performed 5 days/week. The primary outcomes were the acceptability, feasibility and fidelity of the NeoRehab program. 36 participants were randomized to the intervention group and 34 allocated to usual care. The recruitment rate was 71% and retention rate 98%. None of the interventions met the 5 days per week pre-established goal. 97% of participants documented performing a combination of interventions at least 3 times per week. The NeoRehab program was well received and acceptable to parents of VLBW infants. Programs that place a high demand on parents (5 days per week) are not feasible and goals of intervention at least 3 times per week appear to be feasible in the context of the United States. Parent-provided motor interventions were most challenging to parents and alternative strategies should be considered in future studies. Further studies are needed to evaluate the relationship between intervention dosing on long term motor outcomes.

Exploring Perceptions of Shift Length: A State-Based Survey of Registered Nurses.

OBJECTIVE: The aim of this study was to explore clinical nurses' perspectives of shift length. BACKGROUND: Discussions about scheduling practices, work rotations, and shift length are pervasive among nurses and nursing leadership. However, the science surrounding nurse perceptions of longer shifts is limited. METHODS: A survey instrument was developed and distributed to nurses engaged in the state's professional association. RESULTS: Data from 190 clinical nurses were included. When working a 40-hour work week, 76.3% reported a preference for 10-hour shifts, whereas 83.5% preferred a 12-hour shift during a 36-hour week. Those who chose longer shifts perceived improved work life balance and better patient care. Those identifying 8-hour shifts also pointed to work life balance as benefit. CONCLUSIONS: The results capture the voice of the nurse regarding shift length. The preference for the 10-hour shift within the 40-hour work week is novel. These results may assist with efforts to initiate change, improve the work environment and enhance home life.

Qualitative inquiry: a method for validating patient perceptions of palliative care while enrolled on a cancer clinical trial.

BACKGROUND: Palliative care is a vital component of patient-centered care. It has increasingly become central to the management and care of seriously ill patients by integrating physical, psychosocial, and spiritual supportive services. Through qualitative inquiry, this paper examines cancer patients' perceptions of the process and outcomes of the pain and palliative care consultative services they received while enrolled in a clinical trial. METHODS: A qualitative analysis of open-ended questions was conducted from a sub-sample of patients (n = 34) with advanced cancers enrolled in a randomized controlled trial exploring the efficacy of a palliative care consult service. Two open-ended questions focused on patient perceptions of continued participation on their primary cancer clinical trials and their perceptions of interdisciplinary communication. RESULTS: THREE OVERARCHING THEMES EMERGED WHEN ASKED WHETHER RECEIVING PAIN AND PALLIATIVE CARE SERVICES MADE THEM MORE LIKELY TO REMAIN ENROLLED IN THEIR PRIMARY CANCER CLINICAL TRIAL: patients' past experiences with care, self-identified personal characteristics and reasons for participation, and the quality of the partnership. Four themes emerged related to interdisciplinary communication including: the importance of developing relationships, facilitating open communication, having quality communication, and uncertainty about communication between the cancer clinical trial and palliative care teams. CONCLUSIONS: Our findings suggest the importance of qualitative inquiry methods to explore patient perceptions regarding the efficacy of palliative care services for cancer patients enrolled in a cancer clinical trial. Validation of patient perceptions through qualitative inquiry regarding their pain and palliative care needs can provide insight into areas for future implementation research. TRIAL REGISTRATION: NIH Office of Human Subjects Research Protection OHSRP5443 and University of Pennsylvania 813365.

Beyond intuition: patient fever symptom experience.

CONTEXT: Fever is an important sign of inflammation recognized by health care practitioners and family caregivers. However, few empirical data obtained directly from patients exist to support many of the long-standing assumptions about the symptoms of fever. Many of the literature-cited symptoms, including chills, diaphoresis, and malaise, have limited scientific bases, yet they often represent a major justification for antipyretic administration. OBJECTIVES: To describe the patient experience of fever symptoms for the preliminary development of a fever assessment questionnaire. METHODS: Qualitative interviews were conducted with 28 inpatients, the majority (86%) with cancer diagnoses, who had a recorded temperature of ≥38°C within approximately 12 hours before the interview. A semi-structured interview guide was used to elicit patient fever experiences. Thematic analyses were conducted by three independent research team members, and the data were verified through two rounds of consensus building. RESULTS: Eleven themes emerged. The participants reported experiences of feeling cold, weakness, warmth, sweating, nonspecific bodily sensations, gastrointestinal symptoms, headaches, emotional changes, achiness, respiratory symptoms, and vivid dreams/hallucinations. CONCLUSION: Our data not only confirm long-standing symptoms of fever but also suggest new symptoms and a level of variability and complexity not captured by the existing fever literature. Greater knowledge of patients' fever experiences will guide more accurate assessment of symptoms associated with fever and the impact of antipyretic treatments on patient symptoms in this common condition. Results from this study are contributing to the content validity of a future instrument that will evaluate patient outcomes related to fever interventions.

Naturopathic management of females with cervical atypia: a delphi process to explore current practice.

BACKGROUND: Human papillomavirus is the most significant factor contributing to cervical cancer. Naturopathic doctors (NDs) implement an integrative approach to treat cervical atypia. This study explored practice consensus and variance among NDs. METHODS: A purposefully selected panel of six NDs participated in a modified Delphi study to validate practice. Three electronic web-based surveys were completed over nine months. RESULTS: Local and systemic treatments were included in all ND protocols. Six protocols included cervical cancer screening guidelines, green tea suppositories, and oral folic acid. Five protocols included oral green tea, diindoylemethane (DIM), and cartenoids. Four protocols incorporated Vitamin C. Two NDs considered escharotics when managing cervical atypia. All NDs included health behavior management in their protocols. CONCLUSION: Naturopathic management of cervical atypia varies across practitioners. However, in general, elements of management include (1) cervical cancer screening guidelines, (2) local and systemic treatments, (3) health behavior/lifestyle recommendations, and (4) immune system support.

Patients' and community leaders' perceptions regarding conducting health behavior research in a diverse, urban clinic specializing in rheumatic diseases.

BACKGROUND: Disparities in the incidence, prevalence, severity, care, and outcomes for rheumatic diseases exist among racial and ethnic groups compared with White Americans. OBJECTIVE: This paper describes a community-based participatory research (CBPR) approach engaging researchers, community leaders, and patients in purposeful dialogues related to the implementation of health behavior research in an urban rheumatic disease clinic. METHODS: Seven focused discussions were led in either English or Spanish. Discussions were audiotaped and transcribed verbatim. RESULTS: Six community leaders and nine patients participated in the seven scheduled focused discussions. Transcripts uncovered five major themes that assisted with study design: trust, patient-provider relationship, study implementation suggestions, decreased functional capacity, and access to healthcare. CONCLUSIONS: Engaging community partners and patients in informal and formal discussions from early phases of research design through implementation, followed by systematic application of these insights, may serve to accelerate the potential for translation from findings into improved clinical practice and optimal outcomes.

Palliative care outcomes in surgical oncology patients with advanced malignancies: a mixed methods approach.

PURPOSE: To prospectively compare outcomes and processes of hospital-based early palliative care with standard care in surgical oncology patients (N = 152). METHODS: A randomized, mixed methods, longitudinal study evaluated the effectiveness of a hospital-based Pain and Palliative Care Service (PPCS). Interviews were conducted presurgically and at follow-up visits up to 1 year. Primary outcome measures included the Gracely Pain Intensity and Unpleasantness Scales and the Symptom Distress Scale. Qualitative interviews assessed social support, satisfaction with care, and communication with providers. Survival analysis methods explored factors related to treatment crossover and study discontinuation. Models for repeated measures within subjects over time explored treatment and covariate effects on patient-reported pain and symptom distress. RESULTS: None of the estimated differences achieved statistical significance; however, for those who remained on study for 12 months, the PPCS group performed better than their standard of care counterparts. Patients identified consistent communication, emotional support, and pain and symptom management as positive contributions delivered by the PPCS. CONCLUSIONS: It is unclear whether lower pain perceptions despite greater symptom distress were clinically meaningful; however, when coupled with the patients' perceptions of their increased resources and alternatives for pain control, one begins to see the value of an integrated PPCS.

Developing a Model of the Benefits and Burdens of Research Participation in Cancer Clinical Trials.

BACKGROUND: Recruiting and retaining human participants in cancer clinical trials is challenging for many investigators. Although we expect participants to identify and weigh the benefits and burdens of research participation for themselves, it is not clear what burdens adult cancer participants perceive in relation to benefits. We identify key attributes and develop an initial conceptual framework of benefit and burden based on interviews with individuals enrolled in cancer clinical research. METHODS: Semistructured interviews were conducted with a purposive sample of 32 patients enrolled in cancer clinical trials at a large northeastern cancer center. Krueger's guidelines for qualitative methodology were followed. RESULTS: Respondents reported a range of benefits and burdens associated with research participation. Benefits such as access to needed medications that subjects otherwise might not be able to afford, early detection and monitoring of the disease, potential for remission or cure, and the ability to take control of their lives through actively participating in the trial were identified. Burdens included the potentiality of side effects, worry and fear of the unknown, loss of job support, and financial concerns. CONCLUSIONS: Both benefit and burden influence research participation, including recruitment and retention in clinical trials. Dimensions of benefit and burden include physical, psychological, economic, familial, and social. Understanding the benefit-burden balance involved in the voluntary consent of human subjects is a fundamental tenet of research and important to ensure that subjects have made an informed decision regarding their decision to participate in clinical research.

Validating the clinical research nursing domain of practice.

PURPOSE/OBJECTIVES: To develop and validate a taxonomy for the domain of clinical research nursing. DESIGN: Survey. SETTING: Clinical research settings in the United States. SAMPLE: A purposefully selected expert panel of 22 nurses who were actively practicing or supervising in a clinical research environment. METHODS: A study team consisting of nurses with experience in clinical research synthesized peer-reviewed articles, academic curricula, professional guidelines, position descriptions, and expert opinion. Using the Delphi technique, three rounds of surveys were conducted to validate the taxonomy. The three sequential questionnaires were completed over five months. MAIN RESEARCH VARIABLES: Activities performed by nurses in a clinical research setting. FINDINGS: A taxonomy for clinical research nursing was validated with five dimensions and 52 activities: Clinical Practice (4 activities), Study Management (23 activities), Care Coordination and Continuity (10 activities), Human Subjects Protection (6 activities), and Contributing to the Science (9 activities). CONCLUSIONS: This study validated activities for direct care providers and nurses with the primary focus of research coordination. The findings identify a variety of activities that are unique to nurses in a clinical research setting. IMPLICATIONS FOR NURSING: Nurses play an integral role in the clinical research enterprise. Validating a taxonomy for the specialty of clinical research nursing allows for roles to be compared across settings, competency requirements to be defined, and nursing organizations to be guided in the development of specialty certification.

Evaluating a hybrid web-based basic genetics course for health professionals.

Health professionals, particularly nurses, continue to struggle with the expanding role of genetics information in the care of their patients. This paper describes an evaluation study of the effectiveness of a hybrid basic genetics course for healthcare professionals combining web-based learning with traditional face-to-face instructional techniques. A multidisciplinary group from the National Institutes of Health (NIH) created "Basic Genetics Education for Healthcare Providers" (BGEHCP). This program combined 7 web-based self-education modules with monthly traditional face-to-face lectures by genetics experts. The course was pilot tested by 186 healthcare providers from various disciplines with 69% (n=129) of the class registrants enrolling in a pre-post evaluation trial. Outcome measures included critical thinking knowledge items and a Web-based Learning Environment Inventory (WEBLEI). Results indicated a significant (p<0.001) change in knowledge scores. WEBLEI scores indicated program effectiveness particularly in the area of convenience, access and the course structure and design. Although significant increases in overall knowledge scores were achieved, scores in content areas surrounding genetic risk identification and ethical issues regarding genetic testing reflected continued gaps in knowledge. Web-based genetics education may help overcome genetics knowledge deficits by providing access for health professionals with diverse schedules in a variety of national and international settings.

Defining clinical research nursing practice: results of a role delineation study.

Clinical research nursing is a specialty nursing practice focused on the care of research subjects and implementation of clinical research. A five-dimensional model (Clinical Practice [CP], Study Management, Care Coordination and Continuity, Contributing to the Science [CS], Human Subjects Protection) has been validated nationally to represent the domain of clinical research nursing practice. The purpose of this study was to describe the frequency and importance of activities within each dimension as performed by nurses in clinical research and to describe differences between roles. One thousand and four nurses from the NIH Intramural Campus in Bethesda, Maryland, were invited to participate in an anonymous web-based survey. Participants (N = 412) were predominantly female (90%) with ≥11 years research experience (70%). Two hundred eighty-eight respondents (70%) identified themselves as clinical research nurses (CRNs) and 74 (18%) as research nurse coordinators (RNCs). CP activities were reported most frequent and important whereas CS activities were least frequent and important. CRN and RNC activity frequency differed across all dimensions (p < 0.001) with CRNs reporting significantly higher levels of CP activities and significantly lower levels in other dimensions. Delineating specialty activities and practice across roles enhances the understanding of nurses' role in clinical research and provides groundwork for role-based training.

Implementing evidence-based practice: effectiveness of a structured multifaceted mentorship programme.

AIM: This paper is a report of the effectiveness of a structured multifaceted mentorship programme designed to implement evidence-based practice in a clinical research intensive environment. BACKGROUND: Barriers to implementing evidence-based practice are well-documented in the literature. Evidence-based practice is associated with higher quality care and better patient outcomes than care that is steeped in tradition. However, the integration of evidence-based practice implementation into daily clinical practice remains inconsistent, and the chasm between research and bedside practice remains substantial. METHODS: This quasi-experimental mixed methods study included three focused discussions with nursing leadership and shared governance staff as well as pre- (N = 159) and post-intervention (N = 99) questionnaires administered between June 2006 and February 2007. Online questionnaires included measures of organizational readiness, evidence-based practice beliefs, evidence-based practice implementation, job satisfaction, group cohesion and intent to leave nursing and the current job. Results. Participants in the evidence-based practice mentorship programme had a larger increase in perceived organizational culture and readiness for evidence-based practice and in evidence-based practice belief scores than those who did not participate. Qualitative findings suggested that leadership support of a culture for evidence-based practice and the dedication of resources for sustainability of the initiative needed to be a priority for engaging staff at all levels. CONCLUSION: These findings corroborate other studies showing that nurses' beliefs about evidence-based practice are significantly correlated with evidence-based practice implementation and that having a mentor leads to stronger beliefs and greater implementation by nurses as well as greater group cohesion, which is a potent predictor of nursing turnover rates.

The New York Heart Association Classes and functional status: what are we really measuring?

The New York Heart Association (NYHA) Classes are used to appraise the status of patients with heart disease and evaluate treatment outcomes in clinical and research settings. Ambiguity exists concerning the construct the Classes represent and the optimal way to capture and interpret the information. This article examines the NYHA Classes within the context of a published functional status framework by Leidy. The framework proposes that (1) physiological indicators provide information on capacity, (2) physical activity characterizes performance, and (3) symptoms accompanying activity offer insight into reserve. It is proposed that the NYHA Classes provide a summary statement of both the reduction in reserve accompanying a decline in capacity and the concomitant increase in capacity utilization required to maintain performance in patients with heart disease. This premise is illustrated quantitatively through secondary analysis of data from 22 patients with ischemic heart disease and left ventricular dysfunction.