Pragmatism in Evidence-Based Practice - Not to the Extreme, Please.

Over the years, I have written many articles on the subject of evidence-based practice (EBP). At times, the writing has been entirely derogatory; at others, it has been a bit more forgiving. In attempting to crystalize my notion of evidence in practice, I have concluded that pragmatism is a central driver of the process and that such pragmatism may attempt to whitewash the problem of bias in order to make findings useful for clinicians. To further clarify my position, the ideas of pragmatism, EBP, and bias are considered here.

The What, Who, and How of Power.

This column concerns the power of an RO1 grant from the federal government of the United States. To that end, a discussion of the philosophical viewpoints of power, the process of applying for federal grants, and a consideration of a more inclusive process will ensue.

Moral Distress Experienced by US Nurses on the Frontlines During the COVID-19 Pandemic: Implications for Nursing Policy and Practice.

Introduction: The ongoing COVID-19 pandemic represents the largest contemporary challenge to the nursing workforce in the 21st century given the high stress and prolonged strain it has created for both human and healthcare supply resources. Nurses on the frontlines providing patient care during COVID-19 have faced unrivaled psychological and physical demands. However, no known large-scale qualitative study has described the emotions experienced by nurses providing patient care during the first wave of the COVID-19 pandemic in the US. Objective: Therefore, the purpose of this study was to qualitatively describe the emotions experienced by US nurses during the initial COVID-19 pandemic response. Methods: One hundred individual interviews were conducted with nurses across the United States from May to September of 2020 asking participants to describe how they felt taking care of COVID-19 patients. All interviews followed a semi-structured interview guide, were audio recorded, transcribed, verified, and coded by the research team. Results: Participants narratives of the emotions they experienced providing patient care during COVID-19 unequivocally described (1) moral distress, and moral distress related (1.1) fear, (1.2) frustration, (1.3) powerlessness, and (1.4) guilt. In sum, the major emotional response of nurses across the US providing patient care during the pandemic was that of moral distress. Conclusion: Investments in healthcare infrastructures that address moral distress in nurses may improve retention and reduce burnout in the US nursing workforce.

Best Available Evidence or Truth for the Moment: Bias in Research.

The subject of this column is the nature of bias in both quantitative and qualitative research. To that end, bias will be defined and then both the processes by which it enters into research will be entertained along with discussions on how to ameliorate this problem.

Reflexivity: Should It Be Mandated for Qualitative Reporting?

Reflexivity and its importance to the process of qualitative research is examined in this column. To that end, the definition of reflexivity is entertained followed by a discussion related to its inclusion in several versions of standards of qualitative research. Finally, a consideration of how reflexivity in articles should be written is undertaken.

The Necessity of Diversity for Expanding Knowledge.

Consideration of the idea of diversity of knowledge is the subject of this column since it is meant as an introduction to the article about recruitment strategies in minority populations during Covid-19.

Privacy: An Elusive Concept.

The subject of this Research Issues Column is privacy as it applies to healthcare. To that end, the notion of privacy from the perspective of the law is considered, followed by a consideration of its linkage to healthcare. This serves as an introduction to research on opinions of physicians and nurses in Turkey about the nature of privacy for the patients they serve.

Vulnerability.

A brief consideration of the concepts of vulnerability and resilience are presented in this column. It will serve as an introduction to the main article that considers conducting qualitative research on vulnerable populations during the time of COVID-19.

Videoconferencing: Is It Satisfactory.

Consideration of the impact of COVID-19 on conducting research studies is the subject of this column. First, it is argued that presence is critical to some qualitative methods and especially for those who use the Parse methods. Second, the use of e-mail, telephone, and videoconferencing is examined in terms of their advantages and disadvantages in relation to obtaining knowledge about a phenomenon of interest.

New Knowledge for the Profession: Case for Using Nursing Theory.

First, the authors of this column reiterate the need for using nursing theory as a foundation for nursing research and practice. A study underpinned by Johnson's behavioral model is presented as an excellent example of the use of nursing theory to guide research in the care of people with heart failure.

Nurse-led Care Program with Patients with Heart Failure Using Johnson's Behavioral System Model: A Randomized Controlled Trial.

Patients with heart failure experience system imbalance and have multiple symptoms. A nurse-led care program based on Johnson's behavioral system model was used to improve the balance of the behavioral system of heart failure patients. One hundred and fifty patients were randomly assigned into two groups. In the experimental group, the patient's status was evaluated by a behavioral subsystem assessment tool related to the level of imbalance. The patients in the intervention group received care individually based on their worst subsystem scores over a period of 2 weeks. The results showed significant improvement in restorative, ingestive, eliminative, aggressive/protective, dependency, and achievement (p < .05) subsystems in the experimental group. However, no significant difference was seen in sexual and affiliative (p > .05) subsystems.

Grit: Is It Required for Nursing Research?

The following is a short introduction to the column concerning barriers and insights in recruiting participants for nursing research. It supports the notion that grit is required for nursing research and that consists of perseverance and passion.

Patients' Perceptions of Nursing Care in a University Hospital.

Patient satisfaction with nursing is an important indicator of the quality of the nursing services. This study used The Patient Perception of Hospital Experience With Nursing (PPHEN) scale (Dozier, Kitzman, Ingersol, Holmberg, & Schultz, 2001) to determine the nursing care perception of patients in a Turkish tertiary care hospital. The study design was descriptive comparative and used convenience sampling. In total, 566 patients volunteered to take part in the study. The patient satisfaction level with nursing was found to be below average; patient satisfaction showed no meaningful differences between genders, marital status, or the clinics where the patient was hospitalized, but significantly higher levels of satisfaction were found with higher levels of education, younger age, higher incomes, and being employed. Overall, the patients considered that nursing care needs improvement, especially in terms of the provision of information and psychosocial support.

Prevention and treatment of oral mucositis among cancer patients in the hematology-oncology setting: a best practice implementation project.

INTRODUCTION: Oral mucositis refers to mucosal damage and occurs in the oral, pharyngeal, and laryngeal cavities. When patients with cancer get oral mucositis, the painful condition can cause difficulties in eating, drinking, and swallowing and may compromise the patient's nutritional status. It also may be drastically associated with infections, resulting in longer hospitalizations. OBJECTIVES: The aim of this project was to promote best practices related to oral mucositis prevention and treatment for patients in the hematology-oncology setting. METHODS: This implementation project was conducted in the hematology-oncology setting at a medical center in Taiwan. The current project adopted the clinical audit methodology and integrated Lewin's Change Theory, using the JBI Practical Application of Clinical Evidence System software. Seven audit criteria that represented best practice recommendations for prevention and treatment of mucositis were used. A preimplementation audit was conducted with 30 nurses and 30 patients to measure compliance between current practice and best practice. From that audit we identified barriers and facilitators to practice change by undertaking a Getting Research into Practice analysis. A post implementation audit was conducted with 50 nurses and 50 patients at 4 months after implementing the best practice recommendations for mucositis to determine long-term compliance. RESULTS: The seven criteria showed an improvement: nurses who received education about oral care protocols increased from 40 to 100%, patients who received education about oral care protocols increased from 23 to 98%, and patients who followed oral hygiene care protocols, including brushing of teeth, increased from 27 to 96%. There were small improvements in the following criteria: compliance with ongoing assessment of the oral cavity increased from 97 to 100%, nurses who conducted an oral pain assessment increased from 97 to 98%, and patients who followed the therapeutic oral care regimens increased from 88 to 100%. However, nurses who conducted initial assessment of the oral cavity remained at 96%. CONCLUSION: The implementation of best practice for enhancing prevention and treatment of oral mucositis for cancer patients in four hematology-oncology settings is possible. Lewin's Change Theory underpinned the project, which integrated blended learning strategies and communication skills which contributed to the success of this implementation project.

Collaboration: Does It Require Pragmatic Thought?

The authors of this column consider the subject of collaboration in terms of healthcare practice, research, and education. To that end, the concept of pragmatism is discussed as a precursor to collaboration followed by consideration of specific instances of collaboration in practice, research, and education. Additionally, the consequences of collaboration are discussed.

The Nature of Truth: The Need for Peer Review.

The necessity of having peer review is the subject of this column. To that end, the nature of truth, standards by which quantitative and qualitative research studies are judged, and predatory publishing are considered along with an example of the adverse impact of scientific misconduct. Finally, a call for more intense peer review is put forth.

Introduction to Research Issues Column.

The following introduction discusses education related to evidence-based practice in nursing curricula.

Nurses' Experiences in End-of-Life Care in the PICU: A Qualitative Systematic Review.

The experiences of end-of-life care by nurses in the pediatric intensive care unit are the subject of this systematic review. Six qualitative articles from three different countries were chosen for the review using methods from Joanna Briggs Institute. The themes discovered included the following: insufficient communication, emotional burden, moral distress from medical futility, strengthening resilience, and taking steps toward hospice. These themes are discussed in detail followed by recommendations for practice to assist nurses in their quest for a good death for their pediatric patients.

Meta-Aggregation: Just What Is It?

This is a brief introduction to the Research Issues Column.

Losing a partner: Do continuing bonds bring solace or sorrow?

The purpose of this qualitative descriptive study, underpinned by the humanbecoming paradigm, was to bring forth a deeper understanding about continuing bonds with a deceased spouse and describe the transformative process of losing a partner. Each of six participants dialogued with researchers on three to four occasions about the life and death of their loved one, continuing bonds with the deceased, struggles they have encountered, and dreams of the future. It was discovered that participants told a story that changed over time, struggled with continuing bonds, suffered with loneliness and desired new intimate relationships.