Communicating cancer risk in the primary care consultation when using a cancer risk assessment tool: Qualitative study with service users and practitioners.

BACKGROUND: Cancer risk assessment tools are designed to help detect cancer risk in symptomatic individuals presenting to primary care. An early detection of cancer risk could mean early referral for investigations, diagnosis and treatment, helping to address late diagnosis of cancer. It is not clear how best cancer risk may be communicated to patients when using a cancer risk assessment tool to assess their risk of developing cancer. OBJECTIVE: We aimed to explore the perspectives of service users and primary care practitioners on communicating cancer risk information to patients, when using QCancer, a cancer risk assessment tool. DESIGN: A qualitative study involving the use of individual interviews and focus groups. SETTING AND PARTICIPANTS: Conducted in primary care settings in Lincolnshire with a convenience sample of 36 participants (19 service users who were members of the public) and 17 primary care practitioners (general practitioners and practice nurses). RESULTS: Participants suggested ways to improve communication of cancer risk information: personalizing risk information; involving patients in use of the tool; sharing risk information openly; and providing sufficient time when using the tool during consultations. CONCLUSION: Communication of cancer risk information is complex and difficult. We identified strategies for improving communication with patients involving cancer risk estimations in primary care consultations.

Psychometric Evaluation of the Mock Code Self-Efficacy Scale.

AIM: This study's purpose is to psychometrically evaluate the Mock Code Self-Efficacy Scale. This tool was developed to measure senior baccalaureate nursing students' level of self-efficacy as it pertains to mock codes. BACKGROUND: Cardiopulmonary resuscitation is an essential component of nursing education. METHOD: The Mock Code Self-Efficacy Scale was analyzed for item characteristics, face validity, content validity, reliability, and dimensionality in a sample of senior-level nursing students (n = 153) enrolled in a critical care nursing course. RESULTS: The scale was found to be multidimensional with reliabilities ranging from .75 to .87. Items evidenced a ceiling effect, perhaps due to the instruction given prior to completing the instrument. The instrument evidenced both content and face validity. CONCLUSION: The instrument now can be used to assess if increased self-efficacy is a mediating variable for students to correctly transfer skills learned in a mock code to the clinical setting.

Exploring the experiences of young people nursed on adult wards.

This paper reports on a study of experiences of young people aged 14 to 18 years who were nursed on acute adult hospital wards in NHS hospitals in England. In spite of British government guidelines, young people from 14 years of age continue to be admitted to adult wards in the UK. Although much has been written about the transition of the young person to adult services, there is little research about the experiences of young people who are nursed on adult wards. Hermeneutic phenomenology was used to explore the lived experiences of eight young people who had been nursed on adult wards between 2004 and 2010. Data were collected in 2010. In-depth interviews were recorded, transcribed and analysed using Colaizzi's framework ( Colaizzi, 1978 ). Themes explored included expectations of what the experience may be like, young people's first impressions of the ward environment, the feelings of the young person while in hospital, the attitudes of people towards them including, both staff and other patients, and future admissions and how they would cope with readmissions. Better provision needs to be made for young people including appropriately trained staff, adolescent-friendly environments and areas in adult wards that are dedicated to adolescents.

Psychometric evaluation of the Clinical Skills Self-Efficacy Scale.

AIM: This study uses self-efficacy as a theoretical framework for clinical skills instruction. BACKGROUND: Questions remain regarding the mechanism through which instruction on clinical skills in simulated laboratory settings enables students to successfully incorporate these skills in a clinical setting. Research is needed to determine what type of simulated instruction motivates students to successfully transfer clinical skills learned in a simulated laboratory to patients in a clinical setting. Therefore, the purpose of this study was to psychometrically evaluate an instrument designed to measure clinical skills self-efficacy in nursing students. METHOD: The instrument was administered to 191 sophomore, junior, and senior-level nursing students. RESULTS: This study provides beginning evidence to support the psychometric properties of the investigator-developed Clinical Self-Efficacy Scales (CSES). CONCLUSION: Future research needs to focus on investigating the relationship between increased self-efficacy and the successful enactment of clinical skills.

Failing a student nurse: a new horizon of moral courage.

The factors preventing registered nurses from failing students in practice are multifaceted and have attracted much debate over recent years. However, writers rarely focus on what is needed to fail an incompetent pre-registration nursing student in their final placement. This hermeneutic study explored the mentor experience of failing a pre-registration nursing student in their final placement. A total of 19 mentors were recruited from 7 different healthcare organisations in both inner city and rural locations in the southeast of England. Participants took part in individual reflective interviews about their experience of failing a pre-registration nursing student in their final placement. These experiences were interpreted through a hermeneutic discovery of meaning. The new horizon of understanding which developed as a result of this research is framed within the context of moral stress, moral integrity and moral residue with the overall synthesis being that these mentors' stories presented a new horizon of moral courage.

A descriptive analysis of nursing satisfaction: first-time versus non-first-time medical-surgical patients.

Patient assessment of satisfaction is very important in achieving high patient-retention rates in a highly competitive environment (Bendall-Lyon & Powers, 2004). This study's purpose was to analyze the perception of nursing satisfaction with first-time versus non-first-time medical-surgical patients. The study involved a patient satisfaction questionnaire sent to 2,265 discharged inpatients in a 537-bed teaching hospital in northeastern Ohio. Group means and standard deviations indicate no difference between first-time and non-first-time admits in nursing care satisfaction; therefore, it's difficult to conclude why patients' assessments were so similar. Quite possibly, all patients recognize the hard work and efforts of registered nurses.

Health care missions: changing the local landscape.

A nurse changed local healthcare access in a remote area by going to serve the Aymara people in Bolivia as a missionary after her retirement in the United States. Resources for exploring healthcare missions as a second career are offered.

Psychometric Evaluation of the Addiction Self-Efficacy Scale.

Background and Purpose: To psychometrically evaluate a new investigator-developed 14-item Addiction Self-Efficacy Scale (ASES). Methods: One hundred seventy-one subjects (114 male and 57 female) were recruited from an in-house rehabilitation program. Subjects were given the 14-item ASES between days 25 and 30 of the treatment program. Results: The item means ranged from 7.19 to 9.34. There was a ceiling effect on all 14 items. The ASES was found to be multidimensional with two factors accounting for 64% of the total variance explained. Reliability of subscale 1 with nine items was .92 whereas, subscale 2 with five items had a reliability of .86. Conclusions: The ASES has evidence of reliability, face validity, and content validity.

Barriers and facilitators to implementing a cancer risk assessment tool (QCancer) in primary care: a qualitative study.

AIM: We aimed to explore service users' and primary care practitioners' perspectives on the barriers and facilitators to implementing a cancer risk assessment tool (RAT), QCancer, in general practice consultations. BACKGROUND: Cancer RATs, including QCancer, are designed to estimate the chances of previously undiagnosed cancer in symptomatic individuals. Little is known about the barriers and facilitators to implementing cancer RATs in primary care consultations. METHODS: We used a qualitative design, conducting semi-structured individual interviews and focus groups with a convenience sample of service users and primary care practitioners. FINDINGS: In all, 36 participants (19 service users, 17 practitioners) living in Lincolnshire, were included in the interviews and focus groups. Before asking for their views, participants were introduced to QCancer and shown an example of how it estimated cancer risk. Participants identified barriers to implementing the tool namely: additional consultation time; unnecessary worry; potential for over-referral; practitioner scepticism; need for training on use of the tool; need for evidence of effectiveness; and need to integrate the tool in general practice systems. Participants also identified facilitators to implementing the tool as: supporting decision-making; modifying health behaviours; improving speed of referral; and personalising care. CONCLUSIONS: The barriers and facilitators identified should be considered when seeking to implement QCancer in primary care. In addition, further evidence is needed that the use of this tool improves diagnosis rates without an unacceptable increase in harm from unnecessary investigation.

Self-forgiving processes in therapy for romantic relationship infidelity: An evidence-based case study.

Self-forgiveness is related to positive connections with self and others and may be particularly important for clients who have hurt others. Relational hurt is heightened within the most intimate relationships and is particularly salient in cases of romantic relationship infidelity. Therefore, self-forgiveness may be indicated for romantic partners who have engaged in infidelity. This evidence-based case study examines the treatment of a Caucasian woman in her early 50s who presented with self-unforgiveness following marital infidelity. An 8-week manualized individual counseling program for self-forgiveness was used, which incorporates emotion-focused therapy techniques and principles of positive psychology to facilitate clients' engagement with a 4-component therapeutic model of self-forgiveness-responsibility, remorse, restoration, and renewal. This evidence-based case study demonstrated the importance of emotion-focused techniques in the client's emotional recovery, as well as the ways in which the intervention served as a eudaimonic process that resulted in the client's personal and relational well-being. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Psychometric Evaluation of the Revised Clinical Skills Self-Efficacy Scale.

BACKGROUND AND PURPOSE: This study's purpose was to psychometrically evaluate the revised Clinical Skills Self-Efficacy Scale (CSES). Self-efficacy is a predictor of an individual's behavior in situations such as learning to implement a new clinical nursing skill. METHODS: Subjects were nursing students (N = 214). The CSES, an investigator-developed instrument designed to measure nursing students' perceptions of their self-efficacy as it relates to selected clinical skills, was used to measure clinical skills self-efficacy. The instrument consisted of 9 clinical skills. RESULTS: There was evidence from 2 prior pilot studies both supporting the CSES's reliability and validity. CONCLUSIONS: Self-efficacy may be one way to explain the relationship between clinical skills instruction and the successful enactment of these clinical skills.

Evidence-based prevent catheter-associated urinary tract infections guidelines and burn-injured patients: a pilot study.

The objective of this pilot study was to describe effectiveness of an evidence-based guideline designed to prevent catheter-associated urinary tract infection (CA-UTI) in reducing CA-UTI in the burn-injured patient population. The study used a pre- and post-bundle implementation comparison design. Inclusion criteria included burn-injured patients of all ages with an indwelling urinary catheter. Patient demographic data were collected by medical record review when informed of a CA-UTI. The Rosswurm-Larrabee Model six-step process model guided implementation of practice change. The sample included eight burn-injured patients (7-88 years). Catheter day range was 1 to 27 days. Each patient had a clear indication for an indwelling urinary catheter; the need for accurate urinary output measurement in a critically injured patient. Four patients had a catheter placed twice during the stay. Nurses reported using a bladder scanner to assess bladder volume for post-operative patients with urinary retention avoiding use of an indwelling urinary catheter in some cases. Integration of evidence-based guidelines in practice resulted in a reduced CA-UTI rate, reduced catheter days, increased days between CA-UTI, and outperformance of the national benchmark statistic. In 2013, the burn unit reduced catheter days by about 75% and reduced infection incidence by >90% in three quarters after implementation of the practice changes. The unit was able to sustain a CA-UTI rate of zero for 248 days.

Preoperative teaching and hysterectomy outcomes.

This study used a theoretical model to determine whether an efficacy-enhancing teaching protocol was effective in improving immediate postoperative behaviors and selected short- and long-term health outcomes in women who underwent abdominal hysterectomies. The model used was the self-efficacy theory of Albert Bandura, PhD. One hundred eight patients in a 486-bed teaching hospital in the Midwest who underwent hysterectomies participated. The participation rate was 85%, and the attrition rate was 17% during the six-month study. The major finding was that participants in the efficacy-enhancing teaching group ambulated significantly longer than participants in the usual care group. This is an important finding because the most prevalent postoperative complications after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein thrombosis, and postoperative ambulation has been shown to decrease or prevent all of these complications. This finding could affect the overall health status of women undergoing hysterectomies.

A global service-learning experience for nursing students in Tanzania: a model for collaboration.

PURPOSE: This article addresses a model for creating a short-term global service-learning program. The Global Standards for the Initial Education of Professional Nurses and Midwives guided the development of a collaborative program involving a school of nursing in the Midwestern United States and one in Tanzania. CONCLUSIONS: Evaluation of the school of nursing and subsequent collaborative planning led to development and implementation of a 3-week global service-learning experience for nursing students. PRACTICE IMPLICATIONS: International academic partnerships, developed in accordance with WHO standards, will enhance educational experiences for nursing students both in the United States and abroad.

Curriculum-based emergent literacy assessment in early childhood.

Speech-language pathologists who work in early childhood settings are concerned with monitoring and evaluating progress and making appropriate instructional adjustments to promote at-risk children's language and literacy development. Curriculum-based assessment can be effective in providing practitioners with this type of information. This article discusses processes and procedures for implementing curriculum-based assessment and suggests methods that professionals can use to teach assessment tasks to children who struggle with the task demands.