An Integrative Review of the Influences on Decision-Making of Young People About Human Papillomavirus Vaccine.

The human papillomavirus (HPV) vaccine is a key intervention in the prevention of HPV infection and associated cancers. This review emphasizes the importance of understanding what influences decision-making about this vaccine. Guided by the work of Whittemore and Knafl, and Pluye and Hong, we identified 25 studies, from which four prominent themes emerged: fear and risk, pain, parental involvement, and involvement of others. Fear of cervical cancer was a strong motivation to receive the vaccine, and the extent of parental involvement also had an impact on decision-making. Recommendations to receive the vaccine by health-care providers were also an important influence. School nurses are fundamental to the promotion and delivery of the HPV vaccine and should stress the significant role that it plays in the prevention of cancer. Additionally, school nurses should ensure that discussions about HPV infection and vaccine include parents where appropriate and should distinctly recommend vaccination to those eligible.

Vaccination timeliness in preterm infants: An integrative review of the literature.

AIMS AND OBJECTIVES: To take a systematic approach to reviewing the scientific literature examining the timeliness of vaccination in preterm infants and to identify any factors associated with timeliness. BACKGROUND: Preterm infants are vulnerable to infection and guidance advocates they are vaccinated in accordance with their full-term peers. Vaccination is well tolerated and protective immune responses are observed, yet some early enquiries suggest that preterm infants experience unwarranted delays. The recent surge in pertussis cases and the increase in vaccinations administered make this a topic requiring further exploration. DESIGN: An integrative review of the empirical literature. METHODS: Studies were identified following a search of Medline, Academic Search Premier, Cochrane Database of Systematic Reviews and the Cumulative Index to Nursing and Allied Health Literature. The review methods used were influenced by a narrative synthesis approach. The retrieval of papers adhered to recognised reporting standards. RESULTS: Fourteen studies were identified, which indicated that infants with the lowest gestational ages and birthweights experience the greatest delays. Vaccination timeliness is influenced by hospitalisation and increased postdischarge follow-up. There was a lack of consensus to indicate that parental socio-economic status and level of education were indicators for a delay. The studies propose that many delays are unjustified and not according to genuine contraindications. CONCLUSION: This review indicates that preterm infants are not vaccinated in a timely manner. Those involved in vaccinating preterm infants must be informed of the genuine contraindications to avoid unnecessary delays putting preterm infants at an increased risk of infection. RELEVANCE TO CLINICAL PRACTICE: Care providers should acknowledge the risk of a delay in preterm infants and actively promote vaccination in this population. Regular training should help to negate the occurrence of inappropriate delays, and careful discharge planning is needed to ensure that preterm infants are vaccinated on time.

How helpful are mnemonics in the development of a research question?

BACKGROUND: The formulation of a research question is a vital first step in the research process and the significance of this is well reported in the literature; a well-structured question increases the outcome of useable findings. To aid the development of a research question, a number of frameworks in the form of mnemonics have been identified. It is suggested that the application of these mnemonics may result in confusion rather than provide helpful guidance. AIM: To present an overview of some of the mnemonically identified frameworks and consider how they may support the development of a research question. DISCUSSION: The use of mnemonics can help to develop questions for empirical research or to identify published evidence. The oldest and most commonly cited mnemonic is PICO, which is most often discussed in association with quantitative approaches. Other mnemonics share similarities with PICO, although may be more aligned to particular research approaches. Along with a flexible approach to their use, the characteristics required to establish an effective research question may support the application of published mnemonics. CONCLUSION: The availability of frameworks in the form of mnemonics can help in the development of a research question, but their use and limitations must be fully understood. A flexible approach to their use is vital and this may also be helped by considering the characteristics of an effective research question. IMPLICATIONS FOR PRACTICE: When developing research questions, nurse researchers and nurses with a role in academic supervision should use the available mnemonics as a guide rather than rigidly adhering to them. They should also be aware of the characteristics of a good research question and advise students accordingly.

Aspirating during the intramuscular injection procedure: a systematic literature review.

AIMS AND OBJECTIVES: To review the available evidence on aspirating when administering intramuscular injections and suggest recommendations for practice. BACKGROUND: The process of aspiration has been ingrained in the intramuscular injection procedure, and whilst many policies no longer recommend this practice, it often continues to be taught and practiced. The result is a variation in this procedure not always consistent with an evidence-based approach. DESIGN: A systematic literature review. METHODS: A systematic approach to searching the literature was undertaken using identified academic databases from inception to May 2014. Citation searching identified additional data sources. Six studies met the search criteria. RESULTS: The majority of health professionals do not aspirate for the recommended 5-10 seconds. Administering an injection faster without aspiration is less painful than injecting slowly and aspirating. The main influences on the decision of whether or not to aspirate are based on what health professionals are taught and fear of injecting into a blood vessel. CONCLUSIONS: In the paediatric vaccination setting, the practice of aspirating during the administration of an intramuscular injection is unnecessary and there is no clinical reason to suggest that these principles may not be applied when using the deltoid, ventrogluteal and vastus lateralis sites in other settings. Owing to its proximity to the gluteal artery, aspiration when using the dorsogluteal site is recommended. Nurses must be supported in all settings, by clear guidance which rejects traditional practice and facilitates evidence-based practice. RELEVANCE TO CLINICAL PRACTICE: Educators need to ensure that their knowledge is up to date so that what they teach is based on evidence. This may be facilitated via regular educational updates. Further research and subsequent guidance are needed to support evidence-based practice in intramuscular injection techniques in all nursing settings.

Metaethnographic Synthesis of Fathers' Experiences of the Neonatal Intensive Care Unit Environment During Hospitalization of Their Premature Infants.

OBJECTIVE: To synthesize existing qualitative findings about fathers' experiences of the neonatal intensive care unit (NICU) environment. DATA SOURCES: Relevant key terms including preterm, father, and NICU were used to search the databases of CINAHL Plus, Academic Search Premier, MEDLINE, and PsychInfo. STUDY SELECTION: Only primary qualitative studies were included. Studies were excluded that did not focus on the NICU environment. DATA EXTRACTION: Twenty-four studies were included. All authors critically appraised and extracted data relating to fathers' experiences in the NICU using an agreed data extraction form. DATA SYNTHESIS: Findings were synthesized by translating the initial concepts and findings from an identified key paper into the data from the remaining 23 studies. Initially this was done separately by each author followed by further group discussion and synthesis. Emergent themes included Proximity, Parental Autonomy, Vulnerability, Communication and Exclusion, and Isolation. CONCLUSIONS: The needs of fathers to interact and be involved with their infants' care was a prominent factor that enhanced their experiences in the NICU. Staff in the NICU can play a key role in facilitating this interaction through encouragement and reassurance.