The effect of anticoagulation on outcomes after liver and spleen injuries: A research consortium of New England centers for trauma (ReCONECT) study.

BACKGROUND: Liver and spleen injuries are the most commonly injured solid organs, the effects of anticoagulation on these injuries has not yet been well characterized. STUDY DESIGN: Multicenter retrospective study. RESULT: During the 4-year study period, 1254 patients, 64 (5%) on anticoagulation (AC), were admitted with liver and/or splenic injury. 58% of patients had a splenic injury, 53% had a liver injury and 11% had both. Patients on AC were older than non-AC patients (mean age 60.9 vs. 38.6 years, p < 0.001). The most common AC drug was warfarin (70%) with atrial fibrillation (47%) the most common indication for AC. There was no significant difference in AAST injury grade between AC and non-AC patients (median grade 2), but AC patients required a blood product transfusion more commonly (58 vs 40%, p = 0.007) particularly FFP (4 vs 19%, p < 0.01). Among those transfused, non-AC patients required slightly more PRBC (5.7 vs 3.8 units, p = 0.018) but similar amount of FFP (3.2 vs 3.1 units, p = 0.92). The two groups had no significant difference in the rates of initial non-operative management (50% (AC) vs 56% (non-AC), p = 0.3)) or failure of non-operative management (7 vs 4%, p = 0.16). AC patients were more likely to be managed initially with angiography (36 vs 20%, p = 0.001) while non-AC patients with surgery (24% vs 13%, p = 0.04). There was no significant difference in LOS and mortality. CONCLUSION: The use of anticoagulation did not result in a difference in outcomes among patients with spleen and/or liver injuries.

Feasibility of a Collaborative, Prospective Interdisciplinary Review and Pharmacy-Based Dispensing Process for Prothrombin Complex Concentrate.

BACKGROUND: Therapeutic options for rapid reversal of vitamin K antagonist therapy include 4-factor prothrombin complex concentrate (PCC4) and fresh frozen plasma (FFP). These agents have unique requirements for preparation, potential adverse effects, and cost-effectiveness considerations. OBJECTIVE: To retrospectively assess whether our process for collaborative prospective review and pharmacy preparation facilitates timely and safe warfarin reversal with PCC4 as compared with FFP and to compare effectiveness and safety of the agents in practice. METHODS: We performed a retrospective, single-center, before and after cohort study of patients requiring warfarin reversal for life-threatening bleeding or urgent invasive procedures over an 18-month period. The primary end point was time from ordering of reversal agent to administration. Secondary end points measured time to therapeutic effect and rates of adverse events. RESULTS: Of 98 patients studied, 72 received FFP, and 26 received PCC4. The median times from ordering to administration of FFP and PCC4 were 69 and 44 minutes, respectively ( P = 0.015). Median time from ordering to end of infusion was significantly shorter for PCC4 compared with FFP (54 vs 151 minutes, respectively; P < 0.0001). In all, 72% of PCC4 patients and 28% of FFP patients achieved the goal international normalized ratio (INR) of ≤1.4 at the first INR check ( P < 0.0001). Adverse reactions occurred in 4% of patients in each group. CONCLUSION: In routine clinical practice incorporating collaborative prospective review and dispensing from the institution's pharmacy, PCC4 was associated with faster administration, a higher rate of INR correction, and similar rates of adverse events compared with FFP.

Australian student nurse's knowledge of and attitudes toward primary health care: A cross-sectional study.

BACKGROUND: Nurses have a pivotal role in changing the focus of the health system toward a primary health care approach, yet little is known about the effectiveness of nursing students' educational preparation for this role. OBJECTIVES: The aim of the study was to investigate undergraduate Australian nursing students' knowledge of and attitudes toward the primary health care approach. DESIGN: A cross-sectional, descriptive research design was applied. SETTING: Two Australian universities, one with a rural base and one in the metropolitan area of Sydney, were involved. Both universities offer undergraduate and postgraduate nursing courses on multiple campuses. PARTICIPANTS: A convenience sample of 286 undergraduate nursing students, each of whom had completed a unit of study on PHC. All provided consent to participate in the study. METHODS: Data was collected using the Primary Health Care Questionnaire via online survey platform SurveyMonkey for a period of three weeks in June 2015. RESULTS: Total knowledge scores ranged from 19.68 to 95.78 with the mean knowledge score being 69.19. Total attitude scores ranged from 33.12 to 93.88 with a mean score of 70.45. Comparison of knowledge scores showed mean scores of students born in Australia were significantly higher than those of students who were born overseas (p=0.01), and mean scores of students enrolled in the metropolitan university were also significantly higher than mean scores of students' enrolled in the rural university (p=0.002). In terms of attitudes scores, mean scores of Australian-born students were significantly higher than those of students born overseas (p=0.001), and older students' mean attitude scores were shown to be significantly higher than younger students' (p<0.005). CONCLUSIONS: Student's age, country of origin and university location were shown to be significant influences on student's knowledge of and attitudes toward primary health care.

Factors influencing cancer treatment decision-making by indigenous peoples: a systematic review.

OBJECTIVE: We aim to systematically review studies that identify factors influencing cancer treatment decision-making among indigenous peoples. METHODS: Following the outline suggested by the Preferred Reporting Items for Systematic Review and Meta-analysis, a rigorous systematic review and meta-synthesis were conducted of factors that influence cancer treatment decision-making by indigenous peoples. A total of 733 articles were retrieved from eight databases and a manual search. After screening the titles and abstracts, the full text of 26 articles were critically appraised, resulting in five articles that met inclusion criteria for the review. Because the five articles to be reviewed were qualitative studies, the Critical Appraisal Skills Program toolkit was used to evaluate the methodological quality. A thematic synthesis was employed to identify common themes across the studies. RESULTS: Multiple socio-economic and cultural factors were identified that all had the potential to influence cancer treatment decision-making by indigenous people. These factors were distilled into four themes: spiritual beliefs, cultural influences, communication and existing healthcare systems and structures. CONCLUSION: Although existing research identified multiple factors influencing decision-making, this review identified that quality studies in this domain are scarce. There is scope for further investigation, both into decision-making factors and into the subsequent design of culturally appropriate programmes and services that meet the needs of indigenous peoples.

Factors relating to perioperative experience of older persons undergoing joint replacement surgery: an integrative literature review.

PURPOSE: The purpose of this literature review was to examine factors relating to the perioperative experience of older persons undergoing total hip and knee replacement surgery resulting from osteoarthritis. METHOD: A literature search was undertaken using databases CINAHL, PubMed, Scopus and Web of Science to provide relevant research articles. Articles were included if they examined the factors relating to the HRQOL, QOL and perioperative experience of older persons undergoing joint replacement surgery resulting from osteoarthritis. The use of Joanna Briggs Institute's critical appraisal checklist facilitated a systematic appraisal of studies with regard to the scientific rigor of the studies. RESULTS: Twenty-two publications were categorized into one main theme: "factors relating to perioperative experience" subcategorized into eight subthemes: "waiting time", "pain and disability", "mental health", "race/ethnicity, age and gender", "body image", "coping and social support", "patient education" and "care continuity". CONCLUSION: There is a need to conduct further research to examine the perioperative experience of older persons undergoing joint replacement surgery, in particular, the lived perioperative experience of a diverse race, ethnicity and culture in an Asian population. Implications for Rehabilitation Healthcare services should remain focused on reducing waiting time as prolonged waiting time for joint replacement surgery was detrimental to patients' HRQOL. Healthcare professionals need to identify strategies to improve the perioperative pain experience through patient education on pain management and positive social support to support the process of recovery. Patients' expectations of pain and their process of recovery were closely linked to patient education. One model of patient education that was seen to be successful and linked to good post-operative outcomes was care continuity model. Being actively involved in the care continuity results in better post-operative outcomes for the patient and their family.

The learning experiences of senior student nurses who take on the role of standardised patient: a focus group study.

The use of clinical simulation involving standardised patients is increasing in nursing education programmes. In this study, we sought to identify whether participation in simulation through taking on the role of standardised patients benefited student nurses in terms of knowledge and skill development, and if so, how. Data was collected in two focus group interviews with fifteen senior undergraduate nursing students in 2011 and subjected to processes of thematic analysis. Four main themes were identified--seeing the nurse through the eyes of the patient, using observation skills, using reflection and evaluation. Being in the standardised patients role provided students with the opportunity to apply the clinical skills of observation, reflection and evaluation to gain new insights into their own practice, particularly their communication skills. Although there were unique learning opportunities for senior student nurses offered by their experience as standardised patient, more research is need to determine how well this knowledge is translated into practice as they take on the role of registered nurses in the future.

The role of intrinsic motivation in a group of low vision patients participating in a self-management programme to enhance self-efficacy and quality of life.

Self-management programmes have previously been found to decrease health problems, enhance quality of life and increase independence. However, there is no literature that examines the influence of the participants' intrinsic motivation on the outcomes of such programmes. This study examined the role of intrinsic motivation in a pilot low vision self-management programme to enhance self-efficacy and quality of life of the programme participants. A positive association was observed between the female participants' perceived choice and perceived competence, two underlying dimensions of the Intrinsic Motivation Inventory. In addition, a positive correlation was observed between the younger participants' perceived competence and the change in their quality of life. The findings provide some support for consideration of participants' intrinsic motivation in the development of effective self-management programmes.

Knowledge, attitudes, and practices associated with menopause: a multi-ethnic, qualitative study in Singapore.

We explored knowledge, attitudes, and practices associated with the menopause transition particular to women in the multi-ethnic cultural context of Singapore. Fifty-eight Chinese, Malay, and Indian Singaporean women participated in interviews that were audiorecorded, transcribed verbatim, and analyzed using thematic analysis. Women from all three ethnicities described an attitude of acceptance surrounding menopause and the changes associated with it. While they thought it was important to be informed, they did not seek out information about menopause and did not view health professionals as useful sources of information. Management practices were diverse and rarely involved accessing health professionals.

Primary health care as a philosophical and practical framework for nursing education: rhetoric or reality?

At least three decades after primary health care (PHC) took nursing by storm it is time to re-examine the philosophical shift to a PHC framework in pre-registration nursing curricula and overview factors which may hinder or promote full integration of PHC as a course philosophy and a contemporary approach to professional practice. Whilst nurse education has traditionally focused on preparing graduates for practice in the acute care setting, there is continuing emphasis on preparing nurses for community based primary health roles, with a focus on illness prevention and health promotion. This is driven by growing evidence that health systems are not responding adequately to the needs and challenges of diverse populations, as well as economic imperatives to reduce the burden of disease associated with the growth of chronic and complex diseases and to reduce the costs associated with the provision of health care. Nursing pre-registration programs in Australia and internationally have philosophically adopted PHC as a curriculum model for preparing graduates with the necessary competencies to function effectively across a range of settings. Anecdotal evidence, however, suggests that when adopted as a program philosophy PHC is not always well integrated across the curriculum. In order to develop a strong and resilient contemporary nursing workforce prepared for practice in both acute and community settings, pre-registration nursing programs need to comprehensively consider and address the factors impacting on the curricula integration of PHC philosophy.

Student feedback on teaching: some issues for consideration for nurse educators.

In this paper, we outline some key points about student feedback for nurse educators to consider. For nursing students, providing feedback offers an opportunity to communicate whether relevant and effective learning has occurred. Given the importance of student feedback for the quality of learning and teaching, and the significant resources invested in it, it is essential that accurate feedback is obtained and responded to by nurse educators. The aim of this paper, therefore, is to present an overview of factors influencing the quality and reliability of student feedback of their theoretical and clinical learning experiences, and ways the feedback might be used by educators for improving teaching and career enhancement. Nurse educators need to be prepared to respond to well-intentioned feedback without undue defensiveness to ensure good and effective teaching. Ultimately, feedback systems that are well managed should benefit nursing students, nurse educators and their respective institutions.

Young Singaporean women's knowledge of cervical cancer and pap smear screening: a descriptive study.

AIMS AND OBJECTIVES: To assess the knowledge of young female Singaporeans regarding cervical cancer and pap smear, the intention to participate in pap smear and whether there is any relationship between knowledge and intention to participate in pap smear screening. BACKGROUND: While cervical cancer has poor prognosis in the later stages, pap smear is effective in identifying precancerous lesions, which are more treatable. Pap smear screening is available to women in Singapore, but its uptake is opportunistic. Research has shown that knowledge about pap smear and cervical cancer is important determinant of screening behaviour in Singaporean women. DESIGN: Cross-sectional descriptive correlational design was used. METHODS: Three hundred and ninety-three young Singaporean undergraduates, aged 18-25 years, were recruited via convenience sampling from a local university over a four-month period. Data were collected through self-administered questionnaires. RESULTS: Majority of the participants knew the term 'pap smear' and its function. However, knowledge of the risk factors for cervical cancer was lacking among the young women. Knowledge of pap smear and cervical cancer had a weak correlation with the intention to go for the future uptake of pap smear. CONCLUSIONS: Educational efforts among younger Singaporean women on the knowledge of pap smear and risk factors for cervical cancer are needed. Improving knowledge will enable them to understand the importance of reducing exposure to risk factors and regular pap smear screening. RELEVANCE TO CLINICAL PRACTICE: All health professionals working with young Asian women should be prepared to educate and counsel young women to participate in pap smear screening according to current guidelines. In particular, knowledge of the age to attend the first pap smear and the recommended frequency for screening need to be targeted for health education.

The menopause transition experiences of Chinese Singaporean women: an exploratory qualitative study.

BACKGROUND: Menopause, a developmental occurrence that takes place in midlife, marks the end of a woman's fertile phase. Cultural norms, social influences, and personal perceptions related to menopause may influence its meaning and how each woman experiences this transition. Little is known about the menopausal experiences of Asian women. PURPOSE: This study explores the menopause transition experiences of ethnic Chinese women in Singapore. METHODS: Using a qualitative design, the researchers conducted audio-taped interviews in 2010 with 14 menopausal and postmenopausal Chinese Singaporean women aged 40-60 years. Thematic analysis was used to analyze interviews. RESULTS: Two main themes were identified: (a) experiencing symptoms and (b) managing symptoms during menopause transition. The most commonly reported symptoms were abnormal bleeding, hot flushes, and emotional changes. Most participants described their transition to be uneventful and ordinary and reported two significant symptoms at most. The strategies women used to manage their transition included using Western and traditional Chinese medical interventions and seeking support from family and friends. CONCLUSIONS: This study provides new insights into how ethnic Chinese women in Singapore experience menopause transition. Findings can assist nurses and healthcare workers in the local context to better understand menopausal women's needs and guide nurses to implement suitable health promotional strategies for women under their care in both hospital and community settings. IMPLICATIONS FOR PRACTICE: Although ethnicity is not necessarily a determinant of symptom experience during menopause transition, health education for menopausal women should be based on knowledge of culture-specific practices. Nurses caring for menopausal women in hospital and community settings in Singapore should evaluate the use of medications prescribed by Western and Chinese herbal medical professionals as well as those that are self-prescribed.

Patients' experiences on donation of their residual biological samples and the impact of these experiences on the type of consent given for the future research use of the tissue: a systematic review.

AIM: This review aimed to critically appraise, synthesise and present the best available evidence related to the experiences of patients who have donated their residual biological samples and the impact of this experience on the type of consent given for future research use of these tissues. METHOD: The three-step search strategy aimed to find both published and unpublished studies published in English between 1990 and 2010 in electronic databases (PubMed, CINAHL, Scopus, Embase, PsycINFO, Mednar, PROQUEST). Using the standardised data extraction tool from the Joanna Briggs Institute, the Qualitative Assessment and Review Instrument, 131 findings were extracted from the 18 papers included in this review. These findings generated 19 categories and four synthesised findings. RESULTS: The synthesised findings generated were related to the different stages of the handling of leftover tissue. The first synthesised finding: patient consent to the use of leftover tissue is a complex interaction between many factors and not solely driven by perceptions of benefits to self or others, relates to the collection of the leftover tissue - the initial consent process. The second synthesised finding: healthcare institutions and regulatory authorities must provide clear and transparent safeguards and controls, and communicate these to the patient prior to the consenting process, outlines the issues affecting consent during the processing and storage of the tissues in biobanks or research institutions. The third synthesised finding: views on ownership and rights to the further use of the leftover tissue varies between individual patients and influences their willingness to consent to further use, demonstrates the concerns relating to the safeguards on the collection and storage of leftover tissue. The fourth synthesised finding: patients have opposing views on the use of their leftover tissue for commercial purposes, reflecting the differing community beliefs around using leftover tissue for research which may provide a commercial benefit to some, but not all, the community. CONCLUSION: For leftover tissues to be used, patients must clearly understand: the type of consent they are providing (opt in or opt out); the parameters for the future research use of their leftover tissues; the safeguards put into place to protect the individual and the donated tissue from unethical use; and the commercial implications of their consent. IMPLICATIONS FOR PRACTICE: This review provides information on patient's experiences on the collection, storage, distribution and future use of leftover tissue. These preferences need to be understood when designing a prospective model of consent regimen which respects patient's confidentiality and wishes. The information in this review is especially important for policy-makers designing a prospective model of consent regimen for the use of existing and previously collected biological samples with no consent taken. IMPLICATIONS FOR RESEARCH: Further research is needed to ascertain what factors specifically influence patient's willingness to consent for the use of leftover tissue. Factors for further exploration include the effects of culture, religion and age. Additionally, further research is required to inform the development of specific consent regimes for the use of leftover tissue for commercial, stem cell and genetic research.

Elderly patients' experiences of care received in the emergency department: a systematic review.

BACKGROUND: Elderly patients admitted into the emergency department present with high levels of illness acuity and severity, accompanied by multiple and complex medical and psychosocial issues, creating challenges for health care professionals to provide appropriate care. OBJECTIVE: To determine the best available evidence on elderly patients' experiences of care received in the emergency department. INCLUSION CRITERIA: The review considered studies that included male and female patients of all ethnic groups who were 65 years old and above, and admitted to the emergency department with urgent and non-urgent health-related issues. Both quantitative and qualitative studies were included. The phenomena of interest were the experiences of elderly patients in the emergency department. SEARCH STRATEGY: A three-step search strategy was utilised in this review. The following databases were searched for articles published in English before year 2010: CINAHL, Medline, Scopus, PsycINFO, Mednar and Cochrane library. METHODOLOGICAL QUALITY: Each paper was assessed independently by two reviewers for methodological quality prior to inclusion in the review using standardised critical appraisal checklists from the Joanna Briggs Institute. DATA COLLECTION: Data were extracted using standardised data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (MAStARI) for descriptive/case series, and Qualitative Assessment and Review Instrument (QARI) for interpretive and critical research. DATA SYNTHESIS: The findings from the quantitative study were presented in a narrative summary. The findings from the qualitative papers were pooled using JBI-QARI, involving the aggregation of findings to generate a set of statements that represent that aggregation. RESULTS: A total of five papers were included in this review. The quantitative evidence demonstrated elderly patients' satisfaction level with care received in the emergency department was related to the length of waiting time and the information and pain management received. Two syntheses were generated from 12 unequivocal or credible findings from the qualitative evidence: 1) Health care professionals should be aware of the intolerable factors of the waiting experiences and appreciate the positive attitudes of elderly patients at the emergency department in order to improve the care provided; 2) There is a need for improvement for nursing staff to deliver the appropriate attention needed by elderly patients and meet their expectations to deliver professional and competent nursing care. CONCLUSIONS: This review found that elderly patients had negative experiences, which mainly occurred during the waiting period and were related to long waiting time and physical environment. They were generally satisfied with the care they received from nurses. However, they expressed the need for more physiological, psychological and information support IMPLICATIONS FOR PRACTICE: Waiting time should be shortened for elderly patients. Patients' physiological and psychological needs should be paid more attention. The physical environment and facility design of the emergency department should be made more patient friendly. Complete information and clear answers to questions should be provided. IMPLICATIONS FOR RESEARCH: Future studies are needed to better understand elderly patients' needs and their experiences of care at the emergency department; to develop strategies that may improve elderly patients' experiences; to compare the experiences and satisfaction levels of those who have shorter versus longer periods of waiting time; and to explore health care professionals' perception of the care provided to elderly patients in the emergency department.

An exploration of Singaporean parental experiences in managing school-aged children's postoperative pain: a descriptive qualitative approach.

AIMS AND OBJECTIVES: To enhance understanding of the experience of parents in managing their children's postoperative pain in Singapore. BACKGROUND: Parents play a significant role in their hospitalised child's postoperative pain care. Their active involvement may contribute to accurate pain assessment and effective pain management for their child. However, there is a lack of in-depth research exploring the experience of parents involved in their children's postoperative pain management. DESIGN: This study adopted a descriptive qualitative approach, which is situated in the interpretive paradigm. METHOD: Semi-structured interviews were conducted to collect data from 14 parents whose children were hospitalised in one of the three paediatric surgical wards in a hospital in Singapore in December 2009. Thematic analysis was used to analyse the data. RESULTS: Three themes were identified: 'Actions used by parents to alleviate their child's postoperative pain', 'Factors influencing parents' management of their child's postoperative pain' and 'Parents' needs in the process of caring for their child's postoperative pain'. Parents used a range of non-pharmacological pain relief interventions for their child. Parental roles and expectations, bond between parent and child, support from nurses, family and own religious beliefs, as well as children's age and maturity level were factors which promoted parental participation, whereas parents' negative feelings, knowledge deficit and nurses' busy schedule were hindering factors. Parents expressed needs for more involvement in their child's care, adequate rest and information support from nurses. CONCLUSIONS: This study highlights the importance of involving parents in their child's postoperative pain management. It provides evidence for health care professionals to pay attention to factors that may influence parental participation and, therefore, guide their practice. RELEVANCE TO CLINICAL PRACTICE: Nurses need to provide parents with support and education to facilitate their roles and improve their child's postoperative pain management.

An exploratory study of traditional birthing practices of Chinese, Malay and Indian women in Singapore.

OBJECTIVES: to explore the traditional birthing practices of Singaporean women. RESEARCH DESIGN: a qualitative study using a phenomenological approach. Data were collected using individual interviews, which were audio-recorded and transcribed verbatim. Colaizzi's phenomenological method was used to analyse the data. SETTING: obstetric outpatient clinics in a tertiary hospital in Singapore. PARTICIPANTS: a purposive sample of 30 women, 1-3 months postpartum. FINDINGS: two broad themes emerged-following tradition and challenging tradition. KEY CONCLUSIONS: Singaporean women experiencing pregnancy and childbirth follow tradition through the influence of their mother and mother-in-law and because of worry over consequences that may result if they do not. Tradition is also challenged through the modification or rejection of traditional practices and changing family roles and expectations. IMPLICATIONS: health professionals need to provide accurate information on traditional birthing practices and scientific evidence to support or refute such practices with the aim of preventing women from adhering to practices that are hazardous to them and the baby.

Parental involvement in their school-aged children's post-operative pain management in the hospital setting: a comprehensive systematic review.

BACKGROUND: Paediatric pain management remains a challenge in clinical settings. Parents can contribute to the effective and accurate pain assessment and management of their child. No systematic reviews regarding the parental involvement in their child's post-operative pain management have been published. OBJECTIVE: To determine the best available evidence regarding parental involvement in managing their children's post-operative pain in the hospital setting. INCLUSION CRITERIA: The review considered studies that included parents of all ethnic groups with children aged between 6 to 12 years old who were hospitalised and undergone surgery of any kind with post-operative surgical or incision site pain where care was provided in acute hospital settings. The phenomena of interest were the experiences of parents in managing their children's post-operative pain. SEARCH STRATEGY: A three-step search strategy was utilised in each component of this review. Major databases searched included: MEDLINE, CINAHL, Scopus, ScienceDirect, the Cochrane library, PubMed as well as Google Scholar. The search included published studies and papers in English from 1990 to 2009. METHODOLOGICAL QUALITY: Each included study was assessed by two independent reviewers using the appropriate appraisal checklists developed by the Joanna Briggs Institute (JBI). DATA COLLECTION: Quantitative and qualitative data were extracted from the included papers using standardised data extraction tools from the JBI, Meta-analysis Statistics Assessment and Review Instrument data extraction tool for descriptive/case series and the JBI-Qualitative Assessment and Review Instrument data extraction tool for interpretive and critical research. DATA SYNTHESIS: The five quantitative studies included in this review were not suitable for meta-analysis due to clinical and methodological heterogeneity and therefore the findings are presented in a narrative form. The two qualitative studies were from the same study, therefore meta-synthesis was not possible. Hence the results of the studies were presented in a narrative format. RESULTS: Seven papers were included in this review. The evidence identified topics including: pharmacological and non-pharmacological interventions carried out by parents; the experience of concern, fear, helplessness, anxiety, depression, frustration and lack of support felt by parents during their child's hospitalisation; communication issues and knowledge deficits; need for information by parents to promote effective participation in managing their child's post-operative pain. CONCLUSION: This review revealed pharmacological and non-pharmacological interventions carried out by parents to alleviate their children's post-operative pain. Obstacles and promoting factors influencing parents' experiences as well as their needs in the process of caring were identified. IMPLICATIONS FOR PRACTICE: Parents' roles in their child's surgical pain management should be clarified and their efforts acknowledged, which will encourage parents' active participation in their child's caring process. Nurses should provide guidance, education and support to parents. IMPLICATIONS FOR RESEARCH: More studies are needed to examine parents' experiences in caring for their child, investigate the effectiveness of education and guidance provided to parents by the nurses and explore the influence of parents' cultural values and nurses' perceptions of parental participation in their child's care.

Patients' experiences towards the donation of their residual biological samples and the impact of these experiences on the type of consent given for secondary use: A systematic review.

EXECUTIVE SUMMARY: Background Residual or leftover clinical tissues are valuable resources for biomedical research. There is on-going discussion about the methodological, legal, and ethical issues on the collection, storage and use of these tissues for future research. This systematic review will consider qualitative studies previously conducted, which report on patients' preferences, experiences and willingness to donate their tissues.Objectives The aim of this review was to critically appraise, synthesize and present the best available evidence related to the experiences of patients toward consent when donating their leftover tissue for research.Search strategy The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized. An initial limited search of MEDLINE and CINAHL was undertaken, followed by analysis of text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms was then undertaken across all included databases. Thirdly, the reference lists of all identified reports and articles were searched for additional studies.Data collection & analysis The standardised data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to extract data from each paper. The qualitative research findings were presented as thematic pooling using the JBI-QARI approach in a narrative form. During the analysis, 131 study findings from 18 publications were aggregated into 19 categories to form four synthesized findings.Main results The synthesized findings generated were: (1) Healthcare professionals should be aware that patients' consent to the use of their left-over tissues are influenced by many and varied factors. Primarily these factors included: benefits to self and other and trust in research and researchers; (2) Healthcare institutions and regulatory authorities must provide strict safeguards and controls in order to maintain privacy and confidentiality of the patients; (3) Healthcare professionals should be aware that the views on ownership and rights to the tissues will vary between individual patients; (4) Healthcare professionals, institutions and regulatory authorities should be aware that patients have different views on the commercial use of their tissues.Discussion Patients would prefer that institutions requesting donation of leftover tissues establish a good governance system for the collection and storage of tissues, as well as a system for protecting the rights and confidentiality of patients. Most patients prefer to have an ethical and effective system, which decides the future use of their tissues, especially when a full informed consent is not obtained from the patients at time of donation and subsequent use.Implications for Practice The results from this review can assist researchers and policy makers to understand the experiences of patients and their attitudes and preferences on the collection, storage, distribution and use of their leftover tissue for research. This is especially so when designing a prospective model of consent regimen, to respect patients' needs and make recommendations for the use of existing and previously collected biological samples with no consent taken.Implications for Research Further qualitative research can be undertaken to ascertain patients' expectations when they donate their tissues; the type of consent model to be used; the perceived risks of genetic and stem cells research; and the effects of culture, religion and age on patients' willingness to donate their leftover tissues for future research.