WIC Peer Counselors Support Breastfeeding Among WIC Participants.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children, also known as WIC, is associated with improved health outcomes for participants. The role of WIC Peer Counselors was created to support breastfeeding among WIC participants. OBJECTIVE: This Naturalistic Inquiry study explored the perceptions and experiences of 9 WIC Peer Counselors located in Southeast Texas. METHODS: The WIC Peer Counselors were recruited via purposive and snowball sampling and participated in semi-structured face-to-face interviews. Data collection, analysis, and trustworthiness adhered to established guidelines. RESULTS: Study findings revealed the novel approaches the WIC Peer Counselors used to encourage, initiate, support, and sustain WIC participants' breastfeeding, including using tools of their craft, involving and educating family members, making themselves accessible 24/7, and identifying the need for equipment and supplies. CONCLUSIONS: The WIC Peer Counselors' understanding of the breastfeeding culture of their WIC clients and their unique ability to establish and maintain rapport with them make WIC Peer Counselors ideally suited resources to meet the WIC goal of increasing breastfeeding and thereby improving the health of the nation. Health care providers should recognize the valuable, yet unrecognized and underutilized, contributions of WIC Peer Counselors and consider referring pregnant and postpartum dyads to WIC for breastfeeding education and support.

"I still feel so lost": experiences of women receiving SANE care during the year after sexual assault.

OBJECTIVE: Emergency caregivers provide initial care to women sexual assault (SA) survivors. An improved understanding of the issues facing this population can aide emergency care practitioners in providing high quality care. The goal of this study was to share the experiences of women SA survivors with the emergency care practitioners that care for them. METHODS: English-speaking adult women (n = 706) who received SA Nurse Examiner (SANE) evaluation within 72 hours of SA at 1 of 13 geographically distributed sites were enrolled in a prospective, longitudinal multi-site observational study. We qualitatively analyzed responses to the open-ended question: "What do you think is most important for researchers to understand about your experience since the assault?" asked 1 week, 6 weeks, 6 months, and 1 year after enrollment. RESULTS: Themes from responses (n = 1434) from 590 women (84% of study sample) fell into 12 broad categories: daily life, justice, medical, and social services, mental health, physical health, prior trauma, recovery, romantic relationships, safety, self, shame, and social interactions. Responses demonstrated that the assault permeates many aspects of assault survivors' daily lives. CONCLUSIONS: Qualitative analyses of open-ended responses from a large cohort of women SA survivors receiving SANE care highlight the challenges for survivors and can increase understanding among the emergency care practitioners who care for them. The authors propose a brief acronym to help emergency care practitioners recall important messages for SA survivors.

Health care utilization by women sexual assault survivors after emergency care: Results of a multisite prospective study.

BACKGROUND: Approximately, 100,000 US women receive emergency care after sexual assault each year, but no large-scale study has examined the incidence of posttraumatic sequelae, receipt of health care, and frequency of assault disclosure to providers. The current study evaluated health outcomes and service utilization among women in the 6 weeks after sexual assault. METHODS: Women ≥18 years of age presenting for emergency care after sexual assault to twelve sites were approached. Among those willing to be contacted for the study (n = 1080), 706 were enrolled. Health outcomes, health care utilization, and assault disclosure were assessed via 6 week survey. RESULTS: Three quarters (76%) of women had posttraumatic stress, depression, or anxiety, and 65% had pain. Less than two in five reported seeing health care provider; receipt of care was not related to substantive differences in symptoms and was less likely among Hispanic women and women with a high school education or less. Nearly one in four who saw a primary care provider did not disclose their assault, often due to shame, embarrassment, or fear of being judged. CONCLUSION: Most women receiving emergency care after sexual assault experience substantial posttraumatic sequelae, but health care in the 6 weeks after assault is uncommon, unrelated to substantive differences in need, and limited in socially disadvantaged groups. Lack of disclosure to primary care providers was common among women who did receive care.

Ethical Challenges Encountered by Clinical Trials Nurses: A Grounded Theory Study.

OBJECTIVES: To investigate the ethical challenges experienced by oncology clinical trials nurses (OCTNs) during the management of CTs and to examine how they resolve those conflicts. SAMPLE & SETTING: 12 licensed RNs who had been practicing as full- or part-time OCTNs for a minimum of two years at various academic medical centers in the United States. METHODS & VARIABLES: Classical grounded theory (CGT), an inductive methodology used to explore a social process in which little is known and to develop a theory grounded in the data, was used, in addition to CGT data analysis strategies. RESULTS: CGT data analysis revealed the OCTNs' main concern (implementing an undefined job) and the way in which the OCTNs resolve this concern through the process of figuring it out. Figuring it out consists of learning as they go, utilizing their assets, standing their ground, and managing hope. IMPLICATIONS FOR NURSING: Although some nursing research provides examples of ethical challenges OCTNs might encounter in practice, there is little information regarding how nurses manage those encounters. A theoretical understanding of the OCTNs' experiences managing ethical challenges fills a gap in the nursing literature and provides a framework for how OCTNs manage and respond to challenges in professional practice.

Mentoring up: A grounded theory of nurse-to-nurse mentoring.

AIMS AND OBJECTIVES: To generate a theoretical explanation of nurse-to-nurse mentoring in the clinical setting. BACKGROUND: Despite an abundance of mentoring literature, the processes involved between nurses in mentoring relationships have yet to be studied. Nursing literature has focused on mentor attributes and relationship outcomes rather than focusing on theoretical discovery. DESIGN: Classical grounded theory (CGT). METHODS: CGT procedures (constant comparative method, coding and memoing) were used to analyse interview data exploring fifteen nurse protégés' experiences of mentoring. RESULTS: Confidencing, the protégés' need to become confident in the professional role, emerged as the main concern of study participants. Three dimensions are threaded throughout nurse-to-nurse mentoring: earnest intentions, filial bond and trust-worthiness. Earnest intentions are the sincere attitude that protégés and mentors demonstrate regarding their mentoring relationship. An exclusive, familial-type connection, filial bond, attends to the affective needs of protégés and mentors. Trust-worthiness, the explicit feeling of trust between protégés and mentors, strengthens as each demonstrates being worthy of the other's trust. Mentoring Up theory explains five phases of mentoring: seeding, opening, laddering, equalising and reframing. The initial phases are periods of relationship discovery (seeding) and testing (opening). Laddering is an intense period of reciprocal interactions between mentors and protégés. Equalising begins as protégés perceive themselves to be equal to their mentors in terms of their professional capability. Protégés reflect on the meaning of the relationship in the reframing phase. CONCLUSIONS: Mentoring Up is a dense theory that reveals insights, explanations and predictions for initiating, developing and engaging in mentoring relationships. Mentoring Up fills a gap in the existing literature and provides a framework for future mentoring research. RELEVANCE TO CLINICAL PRACTICE: The theory has implications for healthcare organisations, nursing education and individual nurses. Mentoring Up expounds on the interpersonal connections and reciprocal interactions vital for successful nurse-to-nurse mentoring.

Exerting Capacity.

Patient safety has been at the forefront of nursing research since the release of the Institute of Medicine's report estimating the number of preventable adverse events in hospital settings; yet no research to date has incorporated the perspectives of bedside nurses using classical grounded theory (CGT) methodology. This CGT study explored the perceptions of bedside registered nurses regarding patient safety in adult acute care hospitals. Data analysis used three techniques unique to CGT-the constant comparative method, coding, and memoing-to explore the values, realities, and beliefs of bedside nurses about patient safety. The analysis resulted in a substantive theory, Exerting Capacity, which explained how bedside nurses balance the demands of keeping their patients safe. Exerting Capacity has implications for health care organization leaders, nursing leaders, and bedside nurses; it also has indications for future research into the concept of patient safety.

Emergency department focused bedside echocardiography in massive pulmonary embolism.

BACKGROUND: Massive pulmonary embolism (PE) is a common consideration in unstable patients presenting to the emergency department (ED) with chest pain, dyspnea, or cardiac arrest. It is a potentially lethal condition necessitating prompt recognition and aggressive management. Conventional diagnostic modalities in the ED, including chest computed tomography angiography and ventilation-perfusion scanning, require the unstable patient to leave the department, and raise concerns over renal injury. Several case reports document findings of massive PE on echocardiography performed in the ED; however, none was performed, interpreted, and acted upon in the form of thrombolytic therapy by an emergency physician without the additional benefit of a cardiologist's interpretation or a confirmatory imaging study. OBJECTIVE: We present a case that illustrates the utility of ED focused bedside echocardiography in suspected massive PE and briefly review direct and indirect ultrasound findings of acute PE. CASE REPORT: A case of massive PE in a 61-year-old woman is reported. In this patient with marked dyspnea, progressive hemodynamic instability, and contraindications to definitive imaging, ED focused bedside echocardiography provided valuable information that strongly suggested the diagnosis and led to alteplase administration. To our knowledge, this case represents the first report of thrombolytic therapy administration for acute massive PE based solely on clinical presentation and an emergency physician-performed bedside echocardiogram. CONCLUSION: In the hands of an experienced emergency physician ultrasonographer, ED focused bedside echocardiography provides a safe, rapid, and non-invasive diagnostic adjunct for evaluation of the patient suspected of having massive PE.

Genitourinary imaging in the emergency department.

The emergency medicine (EM) specialist has a wide-ranging armamentarium of imaging modalities available for use in the patient with genitourinary complaints. This article covers the various imaging options, with a discussion of the advantages and disadvantages of each of these different modalities. Special emphasis is placed on point-of-care EM ultrasound performed by the EM specialist at the patient bedside.

Caring in telehealth.

The overall goal of this study was to explore and describe the perceptions of advanced practice nurses (APNs) about caring while providing primary care using telehealth technology. This study used naturalistic inquiry methodology to elicit the subjective perceptions and reflections of a sample of APNs about how they convey caring in the context of telehealth. Thirteen APNs, selected by purposive and snowball sampling, participated in the study. The data for the study consisted of interviews conducted by e-mail using a semistructured interview guide. Data analysis used the constant comparison method; rigor and trustworthiness of the study procedures were established using the criteria of credibility, confirmability, dependability, and transferability. The findings of this study revealed that the APNs conveyed caring to their telehealth patients by (1) being with them, (2) personifying the images, and (3) possessing certain attributes. The major constructs that emerged from the data together formed a model of how APNs conveyed caring in telehealth. The findings provide insights and increase the understanding of how caring in telehealth was perceived by APNs. The findings of the study can make important contributions in improving our profession's preparation of future telehealth APNs. The study findings also can lend themselves to developing an instrument to measure caring in telehealth. The study findings also contribute to the nursing literature in a number of ways.

Evaluation of an informal peer group experience on baccalaureate nursing students' emotional well-being and professional socialization.

Although studies have documented the importance of the academic environment in promoting positive outcomes among students, few quantitative studies in nursing have been performed to identify strategies through which a nurturing learning environment can be created. A randomized two-group pretest-posttest design was used to investigate effects of an informal peer group experience on baccalaureate nursing students' emotional well-being and professional socialization as caring practitioners. Groups did not differ significantly on the outcomes measured in this study. As a whole, students showed statistically significant increases in anxiety, depression, and negative affect, along with decreased self-esteem and positive affect during the junior year of nursing school. Psychological problems and stress-related symptoms have been well documented among college students in general and professional students in particular. Although the findings from this study are not unique, they suggest the need to reconsider strategies by which the affective and professional socialization goals of undergraduate nursing education can be achieved.