Informing the design of hemodynamic monitoring displays.

In the ICU, an extensive array of variables from the hemodynamic monitoring display is routinely analyzed. However, the development of new display technologies is proceeding without adequate study of the monitoring tasks and behaviors of a primary user group--critical-care nurses. Semistructured interviews focusing on the cognitive aspects of the hemodynamic monitoring task were conducted with 14 critical-care nurses. A systematic content analysis of qualitative data identified cognitive tasks that had applicability to the design of monitoring displays. The cognitive tasks of hemodynamic monitoring were (1) selective data acquisition, (2) applying meaning to the variables and understanding relationships between parameters, (3) controlling hemodynamics by titrating medications and intravenous fluids, and (4) monitoring complex trends of multiple interacting variables and patient response to interventions. Recommendations include designing the monitoring display to match the mental constructs and cognitive tasks of the user by applying conceptual meaning to the variables, highlighting relationships between variables, and presenting a "big picture" view of the patient's condition. Monitoring displays must also present integrated trends that illustrate the dynamic relationship between interventions and patient response.

Reducing parenting stress in families with irritable infants.

BACKGROUND: Caring for an infant with unexplained, persistent crying is one of the most stressful events for new parents. Infant irritability, also referred to as infantile colic, occurs in 10-25% of all infants and is the most common parental concern reported in the first year of life. OBJECTIVE: The aim of this study was to evaluate the effectiveness of a home-based nursing intervention in reducing parenting stress in three groups of families with irritable infants, using data from a larger evaluation study. METHODS: A two-site, randomized clinical trial was conducted with 121 infants and their parents. Infants were randomized to a treatment or a control group. A third group of infants (n = 43) was added as a posttest-only comparison. The level of parenting stress was measured by the Parenting Stress Index (PSI) at baseline, after the 4-week intervention, and at the 8-week follow-up visit. RESULTS: A repeated measures analysis of variance (ANOVA) was used to compare the two groups across the three time points (baseline, immediately after the 4-week intervention, and at the 8-week follow-up visit). The results revealed a reduction in total parenting stress over time for both the treatment and control groups. Mothers in the treatment group reported reduced parenting stress on the parent-child dysfunctional interaction subscale (p = .04). Total parenting stress scores were found to be significantly higher for mothers in the posttest-only group (p = .009). CONCLUSION: Initial parenting stress levels were high in all participants. Parent feedback at the exit interview indicated that the nurse visits for data collection were also viewed as helpful in reducing the stress level associated with parenting these irritable infants. This home-based program was perceived as helpful in improving the interactions between parents and their irritable infants.

Effectiveness of an intervention for colic.

An intervention for infant irritability or colic was evaluated in a randomized clinical trial. A total of 121 full-term irritable infants (2 to 6 weeks old) were randomized to routine care or the home-based intervention program. A third group (n=43) of irritable infants were entered into a post-test-only group. Following the 4-week intervention, the treatment group infants cried 1.7 hours less per day than the infants in the control group (p=0.02). The findings support the emerging view of infant colic as a behavioral pattern that is responsive to environmental modification and structured cue-based care.

An intervention program for families with irritable infants.

PURPOSE: To describe and evaluate a home-based nursing intervention program, the REST routine, which incorporates the use of infant behavior assessment, pattern recognition, individualized infant schedules, specific management strategies, and parent education and support. STUDY DESIGN AND METHOD: A two-site clinical trial was conducted on 164 healthy full-term infants with excessive unexplained irritability or colic. Infants between the ages of 2 to 6 weeks were randomized to routine care or a home-based intervention program (n = 121). A third group (n = 43) of infants too old at entry for randomization (mean age = 10.4 weeks) were entered into a posttest-only group. RESULTS: Infants in the REST routine treatment group cried 1.3 hours per day on average following the intervention program as compared to the control group crying 3 hours per day (p = .02). Infant irritability was resolved (< 1 hour) in 62% of the treatment group while only in 29% of the control group at the time of the 8-week follow-up visit (p = .04). CLINICAL IMPLICATIONS: Families in both the treatment and control groups reported benefiting from a nurse visiting in their home to inquire about their infant and their well-being. Options for individualizing the program for those most in need of intensive home visiting and other delivery modes for the intervention are areas for further investigation.

Appreciative inquiry and leadership transitions.

In times of accelerated change accompanied by leadership transitions, appreciative inquiry (AI) and sensemaking skills are necessary. AI is a philosophy, a model of change, and a set of tools and techniques that support discovery, dreaming, design, and creation of a vision that inspires people in an organization to move toward a collective destiny. Sensemaking involves sizing up a situation to create a framework for decision-making, creating a context for communication, linking with others, and focusing on what is and what could be. Sensemaking can be facilitated by applying appreciative leadership techniques. In this article, the story of the University of Utah College of Nursing's and the faculty's experience with an AI process illustrates the application of the AI leadership strategy to navigating organizational change and a leadership transition.

Current beliefs and management strategies for treating infant colic.

INTRODUCTION: The purpose of this study was to describe the current beliefs about the etiology of colic as well as current management approaches used by pediatric health care providers. METHOD: An open-ended, short- answer survey concerning beliefs about the etiology and treatment of colic was conducted at major National Association of Pediatric Nurse Associates and Practitioners and American Academy of Pediatric meetings. The two groups of providers surveyed, pediatric nurse practitioners (PNPs) (n = 216) and pediatricians (n = 215), were similar in age and years of practice. RESULTS: PNPs were more likely to define colic as "excessive crying." No differences were found in the beliefs regarding etiology of colic. Pediatricians reported seeing more colicky infants per month. A strong relationship existed between etiology and primary treatment approach. Statistically significant differences were found between PNPs and pediatricians in approaches to management of colic. DISCUSSION: Colic remains a prevalent and mysterious malady, with a critical need for more evidence-based treatment protocols. Differences in approaches used by providers were found, with PNPs more likely to use behavioral and environmental approaches to treatment.

A mentored experience (KO1) in maternal-infant research.

Funding mechanisms that require a mentor provide a unique opportunity to implement the research mentoring that is recognized as increasingly important in nursing. Little has been written about how to create and sustain the roles of mentor and principal investigator within a funded arrangement. This article analyzes one research mentoring relationship focused on maternal-infant interaction research and implemented through the Federal KO1 (Mentored Research Scientist Development Award) grant mechanism. Methods used are personal reflections on the 4-year mentorship experience and literature review using the National Library of Medicine database from 1990 to 2001. The mentoring relationship within the National Institutes of Health KO1 award is characterized by the personal commitment, common interests, and long-term professional development that are essential qualities of traditional mentoring but differs in that it is structured by the aims, activities, and length of each award. Effective participation requires organization, focus, and self-direction on the part of the mentored principal investigator and expertise, altruism, and generativity on the part of the mentor. A grant-based mentoring relationship can provide mutual benefits to the researcher and mentor but both must attend to sustaining and enriching the relationship.

Comparison of two measures of parent-child interaction.

BACKGROUND: The numerous parent-child interaction measures available include few that are appropriate to brief clinical encounters or to research settings where time, cost, space, and subject burden are critical factors. OBJECTIVES: This study compares the newer Mother-Infant Communication Screening (MICS) with the established Nursing Child Assessment Satellite Training (NCAST) Teaching Scale (NCAT). METHODS: Theoretical foundations, development, administration, support, and published psychometrics for the two scales are contrasted. Videotapes of 171 caregiver-child interactions in an urban, Hispanic, high-risk sample (children aged 5 months to 36 months) were scored by two trained coders who had established inter-rater reliabilities of.90 (NCAT) and.85 (MICS). RESULTS: Validity correlation coefficients were r =.504, p <.001 for total scores and r =.492, p <.001 for the two most comparable subscales. Distress was defined more narrowly by the MICS. Internal consistencies were.89 to.94 (MICS total scores) (depending on choice of subscales used) and.79 (NCAT). CONCLUSIONS: The NCAT has established strengths for use in clinical practice and research and provides dyadic and separate mother and child scores. The MICS is more feasible for brief clinical screening and performed in this study with promising correlate validity and internal consistency across ages (infancy through 3 years). Interpretation would be strengthened if more clinical studies verifying scores with risk categories were performed and if normative data were established.

Adaptation of a cardiac monitor for collection of infant sleep data and development of a computer program to categorize infant sleep state.

This article describes the adaptation of a cardiac Holter monitor to more conveniently collect and store infant sleep data. The cardiac monitor was first adapted to connect to a sleep mattress, then refined until readable infant sleep signal data were produced. System data were compared to data collected by a live observer of infant sleep (kappa = 0.84). The IRB-approved testing used newborn infants, conducted with parental consent. Development of a rule-based computer program was designed to categorize the physiologic data into infant sleep wake states. The cardiac monitor was found to be lightweight, portable, battery powered, nonintrusive, and safe for collecting infant sleep data. Preliminary assessment of the validity of the program in scoring infant sleep was compared to hand scored data (kappa = 0.76). Refinement of the system and software program is ongoing and expected to greatly facilitate the study of infant state behavior.

Building research competence in nursing through mentoring.

PURPOSE: To explore how mentoring can be used to build research competence in nursing in various professional and geographic settings. ORGANIZING CONSTRUCT: The traditional concept of mentoring in interdisciplinary health professions and its application to nursing research. METHODS: Literature review of MEDLINE and CINAHL databases 1990-2001 and personal reflections on mentoring and mentored experiences. FINDINGS: Mentoring relationship models identified include: traditional mentor and protégé, team, peer, inclusive, and mentoring forward. E-mentoring strategies facilitate interactions for long-distance relationships. Discrete projects, multiple mentor sources, and mutually beneficial peer relationships can enable mentoring across one's career. Psychosocial dimensions of mentoring support creative work. When scholarly productivity with funded research is the desired outcome, intense involvement of a protégé with an expert researcher is essential. CONCLUSION: Choices among mentoring models can be made in accordance with resources, priorities, and objectives congruent with a given nursing setting and time, but optimum scholarly productivity requires experts and sustained support.

Characteristics of school-age children who had colic as infants: mothers' views.

ISSUES AND PURPOSE: To describe the behavioral style and personality characteristics of young school-age children who were identified as colicky infants and the parents' perspective of any residual behaviors or effects. DESIGN AND METHODS: A qualitative descriptive design with mothers of 12 children identified with colic as infants and 8 mothers of children who did not have colic. RESULTS: Three themes of children who had colic: independence/self-reliance, activity, and emotional lability/intensity. PRACTICE IMPLICATIONS: Children generally were perceived as normal and healthy. Residual feelings, parent-child interaction issues, and perceived or real persistent child characteristics may surface in families who experienced colic, especially during stressful periods.