Occupational Therapy Assessments of Cortical or Cerebral Visual Impairment: A Systematic Review.

IMPORTANCE: Cortical or cerebral visual impairment (CVI), a leading cause of visual dysfunction in children across the globe, can result in delayed development of fine and gross motor skills, functional mobility, and socialization, which affects all areas of occupation. No assessments are recommended for occupational therapy practitioners working with children with CVI. OBJECTIVE: To appraise the measurement properties and clinical utility of CVI assessments appropriate for use by occupational therapy practitioners. DATA SOURCES: MEDLINE via PubMed, Scopus, and Web of Science. STUDY SELECTION AND DATA COLLECTION: We followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines for systematic reviews of patient-reported outcome measures for relevant studies. FINDINGS: A total of 590 records yielded 15 studies of the measurement properties of 12 assessment tools, 8 patient-reported outcome measures and 4 clinician-reported or performance-based outcome measures. We report on the quality of measurement properties of 10 of the 12 outcome measures. None had high-quality evidence of content validity, structural validity, or test-retest reliability. Most had indeterminate internal consistency as a result of a lack of confirmatory factor analysis. Three instruments demonstrated high quality and sufficient construct validity. CONCLUSIONS AND RELEVANCE: On the basis of the COSMIN guidelines, all 12 outcome measures have the potential to be recommended but require further study before definitive recommendations can be made. What This Article Adds: This is the first systematic review of assessments of CVI feasible for use by occupational therapy practitioners. High-quality studies of measurement properties are lacking. Further examination of the measurement properties of outcome measures is required.

From the Other Side of the Bed: Lived Experiences of Registered Nurses as Family Caregivers.

BACKGROUND: To provide patient- and family-centered care, health care providers must understand the caregiver experience. Evidence suggests that registered nurses functioning as family caregivers (RNFCs) may have unique experiences and challenges. PURPOSE: The purpose of this study was to explore the lived experiences of RNFCs during an adult family member's episode of care in the southern United States. METHODS: A descriptive phenomenological approach was used to describe the essence of the RNFC experience throughout an episode of care. Twenty-five participants were recruited for semistructured, audio-recorded interviews. Data were analyzed using descriptive data analysis and constant comparison techniques. RESULTS: Participants were predominantly female (88%). The essence of the phenomenon was dual roles. Five themes emerged: (1) blurring the boundaries, (2) revealing my identity, (3) having insider knowledge, (4) managing expectations, and (5) learning from my experience. CONCLUSIONS: While caregiver experiences may be similar, RNFCs struggle with dual roles of registered nurse and caregiver, occasionally blurring boundaries of care.

Self-management Needs of Adults With Congenital Heart Disease.

BACKGROUND: Adults with congenital heart disease (CHD) are an emerging adult heart disease subset, now outnumbering the pediatric population with CHD. OBJECTIVE: We aimed to gain understanding and knowledge of what adults with CHD perceive as important for self-management and describe these needs across demographic factors, developmental characteristics, lesion severity, and quality of life. METHODS: We used a descriptive mixed-methods online survey merging 4 instruments: Adult CHD Self-management Experience Questionnaire; Adult CHD Demographic Questionnaire; Adaptive Behavior Assessment System, Third Edition; and Stanford Quality of Life Visual Numeric. Participants with CHD 18 to 30 years of age with initial defect repair before 12 months of age were recruited through support from the Adult Congenital Heart Association, clinic adult CHD support groups, and newspaper advertising. Thematic analysis for short-answer questions, descriptive analysis for demographic data and the visual numeric, and intrument-specific scoring assistant software for the Adaptive Behavior Assessment System were used. RESULTS: We received 22 responses from 13 women and 9 men. These individuals represented 15 different heart defect diagnoses, mostly of moderate or complex lesion severity. Most had postsecondary education and were employed. Four prominent themes emerged related to self-management: desire for connectivity-psychological support; a plan for the future-education about health and life expectations; coping needs-skills for mental stress; and access to care-navigation of healthcare systems. CONCLUSIONS: Future longitudinal research and replication studies with larger samples are needed. Educational materials and targeted interventions that promote self-management benefit the aging adult with CHD population.

Comparing Smoking Cessation Outcomes in Nurse-Led and Physician-Led Primary Care Visits.

Smoking is a significant public health concern in the United States, yet 50% of patients do not receive recommended tobacco use screening and counseling. This project compared smoking cessation rates in newly reimbursable nurse-led wellness visits with rates in physician-led visits. Although the findings were not statistically significant, they suggested that smoking cessation is at least equivalent in patients who attend nurse-led visits compared with physician-led visits and may be higher.

Longitudinal Study of Changes in Occupational Therapy Students' Perspectives on Frames of Reference.

We explored students' views of the value of frames of reference (FoR) as they progressed through the didactic portion of an occupational therapy program. Thirty-four occupational therapy students were provided with a definition of FoR and asked to provide overall thoughts and impressions about FoR and their value 4 times over a period of 15 mo. Data were analyzed using phenomenological traditions, including open coding and analysis of themes. Throughout the program, students' understanding of how to use FoR evolved as they learned to implement them in practice. Opinions of the use of FoR seemed to be influenced by the students' perceptions of the use of FoR by their Level I fieldwork supervisors. Themes from the narrative data are described and their implications discussed.

Does noninvasive electrical stimulation of acupuncture points reduce heelstick pain in neonates?

AIM: Noninvasive electrical stimulation at acupuncture points (NESAP) for analgesia is used in children, but has not been widely studied in neonates. The purpose of this study was to determine whether NESAP alone or in combination with sucrose relieved heelstick pain in neonates. METHODS: Term neonates (n = 162) receiving routine heelsticks for newborn screening were enrolled following parental consent. All infants received facilitated tucking and non-nutritive sucking. Neonates were randomised to standard care, sucrose, NESAP or sucrose plus NESAP. NESAP (3.5 mA, 10 Hz) or sham was administered over four acupuncture points. The Premature Infant Pain Profile (PIPP), heart rate variability (HRV) and salivary cortisol were used to measure heelstick pain. RESULTS: PIPP scores among all four treatment groups increased during heelstick, F (9,119) = 1.95, p = 0.05 and NESAP therapy had no significant effect on PIPP scores. However, PIPP scores from baseline to heelstick increased the most in the two groups not receiving sucrose (p < 0.01). Mean PIPP scores remained below five during the heelstick in all four groups, indicating minimal or no pain. Differences in HRV and salivary cortisol among groups were insignificant. CONCLUSION: NESAP at 3.5 mA, 10 Hz is not effective in relieving pain during heelsticks in neonates.

Web Camera Use of Mothers and Fathers When Viewing Their Hospitalized Neonate.

BACKGROUND: Mothers and fathers of neonates hospitalized in a neonatal intensive care unit (NICU) differ in their experiences related to NICU visitation. PURPOSE: To describe the frequency and length of maternal and paternal viewing of their hospitalized neonates via a Web camera. METHODS/SEARCH STRATEGY: A total of 219 mothers and 101 fathers used the Web camera that allows 24/7 NICU viewing from September 1, 2010, to December 31, 2012, which included 40 mother and father dyads. We conducted a review of the Web camera's Web site log-on records in this nonexperimental, descriptive study. FINDINGS/RESULTS: Mothers and fathers had a significant difference in the mean number of log-ons to the Web camera system (P = .0293). Fathers virtually visited the NICU less often than mothers, but there was not a statistical difference between mothers and fathers in terms of the mean total number of minutes viewing the neonate (P = .0834) or in the maximum number of minutes of viewing in 1 session (P = .6924). Patterns of visitations over time were not measured. IMPLICATIONS FOR PRACTICE: Web camera technology could be a potential intervention to aid fathers in visiting their neonates. Both parents should be offered virtual visits using the Web camera and oriented regarding how to use the Web camera. IMPLICATIONS FOR RESEARCH: These findings are important to consider when installing Web cameras in a NICU. Future research should continue to explore Web camera use in NICUs.

The effects of massage therapy to induce sleep in infants born preterm.

PURPOSE: The aim of this study was to determine whether massage therapy can be used as an adjunct intervention to induce sleep in infants born preterm. METHODS: Thirty infants born at a minimum of 28 weeks gestational age, who were at the time of the study between 32 and 48 weeks adjusted gestational age, were randomly assigned to receive massage therapy on 1 day and not receive massage on an alternate day. The Motionlogger Micro Sleep Watch Actigraph recorded lower extremity activity on the morning of each day. RESULTS: No significant difference was found between groups for sleep efficiency (P = .13) during the time period evaluated. Groups differed significantly during the time period after the massage ended with more infants sleeping on the nonmassage day (χ = 4.9802, P = .026). CONCLUSIONS: Massage is well tolerated in infants born preterm and infants do not fall asleep faster after massage than without massage.

Models of epistemic and ontological cognition: a new perspective of occupational therapy education.

Epistemic and ontological cognition (EOC) involve beliefs about knowledge and knowing. These include beliefs about the certainty and complexity of knowledge and the means of justifying knowledge, for example, through authority figures or personal experience. Research has shown that these beliefs can influence learning and achievement, and that they may be specific to a particular domain. The EOC that define a particular health profession and influence its production, acceptance, and use of knowledge have been termed practice epistemology. Despite the importance of its practice epistemology, little research has been done related to EOC in occupational therapy. This paper describes models of EOC as a basis for understanding their implications for occupational therapy epistemology, education, and practice.

Teaching ill-structured problem solving using occupational therapy practice epistemology.

ABSTRACT Epistemic and ontological cognition (EOC) have to do with an individual's beliefs about knowledge and knowing. Research has shown that EOC have an influence on learning and achievement. EOC may be discipline-specific with a profession being defined by its practice epistemology. If an individual's EOC is inconsistent with the profession's practice epistemology, the student or practitioner may struggle with effectively solving ill-structured occupational performance problems. The purpose of this paper is to increase awareness of the constructs of EOC, to describe its importance to occupational therapy education and practice, and to provide recommendations for educators and researchers. Specific examples are detailed and recommendations for future research are proposed.

Physiologic effects of retinopathy of prematurity screening examinations.

PURPOSE: Preterm infants weighing less than 1500 g routinely undergo a series of eye examinations to screen for retinopathy of prematurity (ROP). While these examinations are important for the prevention of blindness, infants may suffer adverse physiologic events during and after the examination. The procedure includes administration of mydriatic eye drops that may be absorbed systemically and physical manipulation of the eye that is accompanied by stress and pain. The purpose of the study was to monitor changes in infant health status and adverse physiologic events in the 2 days after ROP eye screening. SUBJECTS: The study used 50 preterm infants with a mean gestational age of 32 weeks, undergoing their first ROP examination in a NICU located in a university medical center. DESIGN: This pilot study used a prospective, descriptive design. METHODS: Physiologic changes and illness events were recorded before and for 2 days after the eye examination, using tools that tracked parameters of respiratory, cardiovascular, gastrointestinal, and neurological status. Data were collected directly from daily audits of medical records. McNemar's test for comparing paired proportions and the signed rank test were used for comparing significance of physiologic changes before and after the ROP eye examination. PRINCIPAL RESULTS: Apnea events increased significantly (P = .04) in the 24- to 48-hour period after the eye examination compared with apnea events before the eye examination. These results were based on 39 infants who were not receiving ventilator support. There was a significant difference in the frequency of oxygen desaturation events between infants with and without apnea (0-24 hours after examination, P < .002; 25-48 hours after examination, P < .001). There were no significant differences in heart rate, cyanosis, gastric residuals, or seizures after the eye examinations. CONCLUSIONS: The ROP examinations may be associated with increased apnea, a clinically significant problem. Nursing implications include careful monitoring of infants during and after ROP eye examinations, discharge teaching for caregivers, and continued research on nursing interventions to prevent adverse physiologic events.

Why don't all nurse practitioners precept? A comparative study.

BACKGROUND: Preceptors are integral in nurse practitioner (NP) education. A shortage of willing preceptors limits graduations from NP programs. However, little is known about why NPs decide not to precept. PURPOSE: To identify the factors significantly associated with NPs' status as currently, previously, or never precepting, using the Integrated Behavioral Model as the conceptual framework. METHODOLOGY: This was a cross-sectional, comparative, descriptive study of NPs using survey methodology. Our survey was based on published surveys with items added and adapted to reflect our framework. Subscales included personal factors, primary determinants of intent to precept, and external factors. We mailed recruitment postcards, with an online survey link, to all NPs in Arkansas. Data were analyzed using bivariate and stepwise multinomial logistic regression for each subscale. RESULTS: We obtained 261 responses. Participants who had previously and/or never precepted differed from current preceptors on multiple variables on bivariate analysis. Predictive personal factors included experience and hours worked per week. Predictive primary determinants included knowing NPs that precept, support for precepting, recognition of preceptors, and clinical expertise. Predictive external factors included space, liability, having a "gatekeeper," NP program, importance of precepting, and number of requests. CONCLUSIONS: Different factors predict NPs who currently, previously, and have never precepted. However, frequency of requests predicted both nonprecepting groups. Various supports in the clinical setting and program factors predicted one or other nonprecepting group. IMPLICATIONS: Strategies should be developed to ensure all potential preceptors are recruited, increase support for precepting, and ensure educational programs meet preceptors' needs.

"Help me figure this out": Qualitative explorations of patient experiences with cancer pathology reports.

OBJECTIVE: For patients with a new cancer diagnosis, the pathology report is a critical tool to support diagnosis and decision-making, yet they are designed for providers, not patients. We sought to qualitatively explore patients' experiences receiving and interpreting pathology reports for breast and colorectal cancers. METHODS: We conducted four focus groups with patients (n = 23) who had received diagnostic or surgical pathology reports for breast cancer, colorectal cancer or polypectomy. Focus groups discussed patients' experiences with pathology reports and recommendations for improving the patient-centeredness of report design. Focus groups were transcribed and thematic analysis was used to explore patient perspectives. RESULTS: Participants described experiences with pathology reports that were fraught with confusion and variability. Three central themes were identified related to how 1) the experience receiving the pathology report, 2) the pathology report language, and 3) the format of pathology reports all influence patient understanding and ability to engage in treatment decision-making. CONCLUSION: Due to their complex medical language and challenging framing, traditional pathology reports can contribute to the confusion and uncertainty patients experience as they navigate a new cancer diagnosis.

Recruitment Issues in Emerging Adult Populations: Focus on Adult Congenital Heart Disease.

High-quality nursing research is important to healthcare and is precipitated by successful participant recruitment. Young adults aged 18 to 30 years are particularly difficult to recruit due to transitions during this time, which makes it more problematic to locate these individuals and may make it more difficult for them to prioritize the need for participation. This paper includes data from two cross-sectional survey design pilot studies that aimed to enroll young adults with congenital heart disease using a variety of recruitment methods. The number of participants enrolled in these two pilot studies (7 and 22) was much lower than expected but the recruitment challenges encountered were consistent with other research studies that have recruited young adult populations. After presenting these data and a discussion of the relevant literature, we conclude with proposed strategies for research recruitment of young adults for nurse scientists who directly impact evidence-based literature and practice with research contributions.

Improving the impact of clinical documentation through patient-driven co-design: experiences with cancer pathology reports.

OBJECTIVE: With the unprecedented rise of patient access to clinical documentation through electronic health records, there is a need for health systems to understand best practices for redesigning clinical documentation to support patient needs. This study used an experience-based co-design approach to inform the redesign of cancer pathology reports to improve their patient-centeredness and impact on patient engagement. MATERIALS AND METHODS: Multiple methods for data collection and stakeholder engagement were used, including Delphi prioritisation with breast and colorectal cancer experts (n=78) and focus groups with patients with cancer (n=23) in the Seattle area. Iterative rounds of consensus generation and reflection were used to elicit themes and design recommendations for the development of patient-centred pathology reports on cancer care. RESULTS: Although each cancer type had nuanced elements to consider, common design requirements emerged around two key themes: (1) clinical documentation language should be framed in a way that informs and engages patients, and (2) clinical documentation format should be leveraged to enhance readability and information flow. Study activities illuminated detailed recommendations to improve the patient-centeredness of pathology reports based on patients' and clinicians' lived experience. DISCUSSION: The design requirements that emerged from this study provide a framework that can guide the rapid development of patient-centred pathology reports for all cancer types. Even further, health systems can replicate these methods to guide experience-based co-design of clinical documentation for contexts beyond cancer care. CONCLUSION: This work offers practice-based learnings that can more effectively guide health systems in their clinical documentation redesign efforts.

A study of critical reasoning in online learning: application of the Occupational Performance Process Model.

This study examined the effect of an online guided independent study on critical reasoning skills. Twenty-one first-semester Master of Occupational Therapy students completed an online assignment designed to facilitate application of the Occupational Performance Process Model (Fearing & Clark) and kept reflective journals. Data from the journals were analyzed in relation to the three sets of questions, question type and results of the Watson-Glaser Critical Thinking Appraisal (WGCTA). This assignment appeared to be effective for enhancing awareness and use of critical reasoning skills. Differences in patterns of critical reasoning between students with high and low WGCTA scores and results of an inductive analysis of the journal entries are discussed. Future research investigating the types of feedback that effectively facilitate development of critical reasoning and whether students with high and low WGCTA scores might benefit from different types of instruction and/or feedback is recommended.

Psychometric Properties of the Authentic Leadership Inventory in the Nursing Profession.

BACKGROUND AND PURPOSE: A valid and reliable Authentic Leadership (AL) measurement instrument is paramount as nursing leadership research grows. The purpose of this study was to analyze the reliability and construct validity of the Authentic Leadership Inventory (ALI) among nurses. METHODS: This study was a cross-sectional, prospective design that explored the relationship between registered nurses' (RNs) perceptions of AL qualities in nurse managers in a random sample of RNs working in an acute care setting. RESULTS: A Cronbach α 0.96 confirmed reliability. Exploratory factor analysis determined a one-factor structure. Confirmatory factor analysis utilized the one-factor structure for a final best-fit model (χ2 = 107.3, df = 70, p = .003; TLI = 0.95, CFI = 0.96, RMSEA = 0.08). CONCLUSIONS: This study gives support to using the ALI with the nursing profession.

CE: Original Research: Predicting Injurious Falls in the Hospital Setting: Implications for Practice.

UNLABELLED: : BACKGROUND: Despite years of research and increasingly evidence-based practice, falls continue to be the most commonly reported adverse events experienced by hospitalized adults. Yet a majority of the relevant research has focused on predicting and preventing falls in general; there has been little focus on injurious falls. PURPOSE: The purpose of this retrospective study was to determine which patient factors are associated with injurious falls in hospitalized adults. METHODS: The study site's adverse event reporting database was used to identify 1,369 patients who fell between January 1, 2006, and October 31, 2013. Of these, 381 (27.8%) subjects suffered injurious falls. Variables of interest included age, sex, fall history, use of diuretics, use of central nervous system medications, cognitive impairment, primary discharge diagnoses, abnormal laboratory values, impaired mobility, and body mass index. FINDINGS: Bivariate analysis revealed a statistically significant association between injurious falls and having a primary discharge diagnosis of "symptoms, signs, and ill-defined conditions." Having this discharge diagnosis was a significant predictor of injurious falls. CONCLUSIONS: Findings from this study may help hospital clinicians to better identify which patients are most at risk for injurious falls and to create better fall-related injury prevention interventions.

Systemic Absorption of Cyclopentolate and Adverse Events After Retinopathy of Prematurity Exams.

PURPOSE: Preterm infants undergoing Retinopathy of Prematurity Eye Exams (ROPEE) may experience adverse events, possibly from systemic absorption of cyclopentolate. The purpose of this study was to analyze the association between adverse events and drug levels found in neonates undergoing ROPEE. MATERIALS AND METHODS: 25 infants were randomized into two groups during routine ROP screening: 5 infants for blood collection before mydriatic drops and 20 for blood collection 1 h after eye drops. Blood was collected onto dried blood spot cards, extracted, and analyzed for cyclopentolate and phenylephrine using liquid chromatography and mass spectrometry. Relationships between drug levels and adverse events were assessed. RESULTS: Cyclopentolate (range 6-53 ng/ml) was observed in 15 of 18 infants, while phenylephrine was not detected. Levels of cyclopentolate were significantly higher in infants who were on oxygen (p = 0.01). There was a significant association between cyclopentolate levels and gastric residuals in tube-fed infants not receiving oxygen (p = 0.01). CONCLUSIONS: Cyclopentolate levels varied among preterm infants after ROPEE. Cyclopentolate was positively associated with increased gastric residuals. Underlying medical conditions requiring oxygen administration may affect absorption and metabolism of cyclopentolate. There is a need to predict infants at risk for high blood levels of cyclopentolate in order to prevent or treat adverse events after ROPEE.

Longitudinal Study of Occupational Therapy Students' Beliefs About Knowledge and Knowing.

Research has demonstrated the importance of beliefs about knowledge and knowing, or epistemic and ontological cognition (EOC), to learning and achievement; however, little research has examined occupational therapy students' EOC or determined whether occupational therapy programs promote its development. This study examined changes in EOC over 18 mo of didactic coursework in an occupational therapy program. Thirty-one students completed the Epistemic Beliefs Inventory at the beginning, middle, and end of 18 mo of didactic coursework. Results indicated no difference in ontological cognition. However, change occurred in epistemic cognition, with students demonstrating statistically significantly weaker beliefs in justification of knowledge by an omniscient authority by the end of the didactic portion of the program. Although causal inferences cannot be made from this small study of one cohort of occupational therapy students, it is possible that intensive study in the discipline of occupational therapy contributed to change in these students' epistemic cognition.