Critiquing Research Evidence for Use in Practice: Revisited.

Nurse practitioners need to critically appraise the abundance of research evidence and clinical practice guidelines to make astute decisions about the implementation of the best available evidence to clinical practice. There are numerous ways to appraise research and practice guidelines that are designed to inform clinical practice with the overall goals of improving patient outcomes. This article presents existing tools to appraise the research evidence in addition to a guide for providers on critical appraisal of a research study.

Implementation of a professional portfolio: a tool to demonstrate professional development for advanced practice.

The literature has a gap related to professional development for APRNs. In the United States, many health care organizations use clinical advancement programs for registered nurses, but APRNs are not often included in these programs. If APRNs are included, advancement opportunities are very limited. At CMC, implementation of a professional portfolio resulted in increased satisfaction among APPs regarding their ability to showcase professional growth and expertise, as well as the uniqueness of their advanced practice. Use of the professional portfolio led to improved recognition by APS and organizational leaders of APP performance excellence during the annual performance evaluation, as well as improved recognition among APP colleagues in terms of nominations for honors and awards.

Novice to expert: the evolution of an advanced practice evaluation tool.

Professional performance evaluation provides an opportunity to measure the practice of health providers within healthcare settings. Standardized evaluation can be challenging as a result of diverse practice arenas, multiple evaluators and standards of care. Using Benner's novice to expert model, a Performance Excellence and Accountability tool (PEAC Tool(©)) has been designed to measure advanced practice providers performance based upon facets of professional practice. This article discusses development, practical implementation and evaluation of a PEAC Tool(©).

Health-related quality of life in children and adolescents with sickle cell disease.

OBJECTIVE: To assess health-related quality of life (HRQOL) in children and adolescents with sickle cell disease (SCD). DESIGN, SETTING, AND PARTICIPANTS: The PedsQL 4.0 Generic Scales, a multidimensional self-report instrument that has been shown to be valid and reliable for use in children and adolescents with chronic illness, consists of 23 items that assess physical, emotional, social, and school functioning. Questionnaires were administered to 124 children and adolescents (ages 8 to 18 years, child self-report) with SCD (100 sickle cell anemia, 24 sickle ß zero thalassemia) and their parents (parent-proxy report). Summary scores for children's and parents' ratings of overall HRQOL and psychosocial health and subscale scores for physical, emotional, social, and school functioning were compared with published data for healthy children. Both summary and subscale scores for children with SCD also were compared with those of their parents. RESULTS: Children with SCD and their parents rated overall HRQOL and all subdomains of HRQOL lower than did healthy children and their parents (P < .001). Children with SCD rated their own HRQOL significantly better than their parents did for overall HRQOL and all subdomains (P < .001) except emotional functioning (P = .06). CONCLUSIONS: Children with SCD and their parents perceived overall HRQOL and all HRQOL subdomains to be lower than scores reported in healthy children. Therefore, successful therapeutic efforts to improve HRQOL could represent important advances in the health of children with SCD.

Effects of distraction on pain, fear, and distress during venous port access and venipuncture in children and adolescents with cancer.

This study evaluates the effect of self-selected distracters (ie, bubbles, I Spy: Super Challenger book, music table, virtual reality glasses, or handheld video games) on pain, fear, and distress in 50 children and adolescents with cancer, ages 5 to 18, with port access or venipuncture. Using an intervention-comparison group design, participants were randomized to the comparison group (n = 28) to receive standard care or intervention group (n = 22) to receive distraction plus standard care. All participants rated their pain and fear, parents rated participant fear, and the nurse rated participant fear and distress at 3 points in time: before, during, and after port access or venipuncture. Results show that self-reported pain and fear were significantly correlated (P = .01) within treatment groups but not significantly different between groups. Intervention participants demonstrated significantly less fear (P <.001) and distress (P = .03) as rated by the nurse and approached significantly less fear (P = .07) as rated by the parent. All intervention parents said the needlestick was better because of the distracter. The authors conclude that distraction has the potential to reduce fear and distress during port access and venipuncture.

Ethnicity, traditional health beliefs, and health-seeking behavior: guardians' attitudes regarding their children's medical treatment.

INTRODUCTION: The purpose of this research was to examine ethnic variation in attitudes about traditional health beliefs concerning the use of home remedies and self-medicating behavior among guardians for their children. METHOD: As part of a community health care utilization study of children, questions were included regarding guardians' traditional health beliefs. Survey questions were adapted from the National Health Interview Survey or developed by the researchers. A cross-sectional stratified sample of households with children (n = 1606) were surveyed by random digit dialing. RESULTS: Two of four traditional health belief questions were significantly associated with ethnicity. Differences were observed for (a) guardians' willingness to treat their children with home remedies rather than use a health care provider if the condition was nonemergent and (b) their belief that some home remedies are better than prescribed drugs for curing illness (P <.01). DISCUSSION: Some traditional health beliefs among guardians differed by ethnicity. However, differences between the two minority groups were as pronounced as differences between minority and nonminority guardians. An understanding of the diversity of ethnic attitudes about traditional health beliefs is necessary for those involved in the delivery of health care. A stereotypical view that larger proportions of minorities subscribe to traditional health beliefs than do Whites is not supported in this research.