The Unexpected Death of a Child and The Experience of Emergency Service Personnel.

INTRODUCTION: In 2013, 55,000 infants and children, aged 0 to 14, died in the United States. Nearly 7,000 of those deaths were attributed to traumatic causes. A child's death significantly affects emergency service personnel (ESP) caring for children and families. This study explores the lived experience of ESP involved in unsuccessful pediatric resuscitation efforts and how this experience affects them professionally and personally. METHODS: A phenomenologic approach guided this study. Using an open-ended format, an interview was conducted with a purposive sample of ESP who experienced unexpected pediatric death. Eight ESP participated in semistructured, face-to-face interviews, ranging in length from 35 to 75 minutes. The research question asked: "What is it like for you when a child dies after an unsuccessful resuscitation attempt?" Data were analyzed using thematic analysis. RESULTS: Van Manen's 4 existentials guided this study, and 10 subthemes emerged that included: "what if," "dying before my eyes," "team," "what if it was were my child?/being a parent," "the environment," "being trapped," "wounded healer," "education," "anger," and "coping." DISCUSSION: This study explores the experience of ESP involved in unsuccessful pediatric resuscitation that resulted in unexpected pediatric death and ESP's perceptions of this experience: thoughts of loss, a sense of anger, and a lack of preparation to cope with unexpected pediatric death and the unknowns of life.

An educational pathway to fast track evidence-based practice at the bedside.

Enculturation of evidence-based practice (EBP) is a continuing challenge. This article describes a novel pathway for staff development educators to fast track the teaching-learning of the EBP skills set and the immediate full cycle application of the EBP process at point of care. The pathway, called EBP Literacy, offers an asynchronous stepwise approach to learning EBP in an iterative process from the bedside to bench side and back to the bedside.

Story sharing: enhancing nurse aide-resident relationships in long-term care.

National surveys often report nursing home deficiencies related to the preservation of residents' dignity and respectful care. Many nurse aides (NAs), who provide the majority of personal care, are unprepared to engage in empathic and meaningful relationships with residents. This article reports the findings of a pilot mixed method study comparing two interventions, Story Sharing (StS) and Communication Skills, on NA levels of mutuality, empathy, job attitude, and self-efficacy and resident levels of empathy and perceived caring behaviors. A quasi-experimental/interpretive phenomenological design was used. Total Mutuality and subscale (Shared Values, Affective Closeness, Shared Pleasurable Activities, Reciprocity) scores were significantly higher in the StS NA groups only, as were postintervention Empathy scores. Other trends are reported as well. StS is one approach toward helping NH staff and residents understand, respect, and connect with one another.

Enhancing relationships in long-term care: through story sharing.

Relationships between staff and residents in long-term care (LTC) are foundational to quality of life and high standards of care. Although nurse aides (NAs) provide more than 80% of personal care to nursing home residents, little research has focused on the NA-resident relationship or how NAs come to know and connect with their residents. This interpretive phenomenological study explored how a Story Sharing intervention initiates and enhances this relationship. Following the Story Sharing intervention, 84 volunteer NAs and 54 residents in six nursing homes were interviewed over a 6-month period. Analysis of these interviews revealed 9 patterns and 25 themes that describe how NAs and residents interact every day, along with innovative NA best practices. One theme, exemplifying a best practice, Restoring the Reciprocity of Care, is given. The findings have been incorporated into an extended Story Sharing Program for all LTC staff.

Lessons learned from 5 women as they transition into assisted living.

Relocation and transition to an assisted living facility (ALF) is considered a critical period for the prospective new resident both in the anticipatory time prior to admission and the early weeks post admission.(1) Administrators and health care providers at a large life care, aging-in-place facility in the southwest identified a need for improving supportive nursing interventions for easing the transition of newly admitted residents into the assisted living apartments. In response, a qualitative study exploring the expectations and experiences of five newly admitted residents was conducted over a six month period. Thirty-five interviews were tape-recorded, transcribed, and interpreted using content analysis. Four themes emerged: deciding to move, becoming dependent, remembering what was and yearning for the past, and creating a new community. Understanding the perspective of residents experiencing this transition may lead to innovative changes in ALF orientation programs, caring interventions, delivery of consumer directed care, and health provider educational strategies.

Story sharing: restoring the reciprocity of caring in long-term care.

Residents in long-term care facilities often experience an interruption in the reciprocity of caring, inadvertently cut off when they enter the unfamiliar surroundings of a residential health care system. This transition from the give and take of caring to being completely cared for often leads to a breakdown of meaning, a loss of identity, and loneliness. This article addresses how an intervention called story sharing can restore the reciprocity of caring. Beginning with a review of the significance and functions of storytelling and listening, a specific story sharing intervention-the mutual sharing of everyday experiences among nurse aides and the nursing home residents for whom they care-is described. The theoretical and practice implications of story sharing are discussed.

Lessons learned from complementary and integrative medicine curriculum change in a medical school.

OBJECTIVES: This paper describes a pilot study that examined lessons learned from the introduction of complementary and alternative medicine (CAM) elements into a medical school curriculum. METHODS: A qualitative approach was selected as a first step in evaluating the phenomenological experience of introducing the CAM Educational Project in 2000-05. In 2005, semi-structured interviews were conducted with faculty staff and graduating students who had participated in all 4 years of the CAM Project. Qualitative content was analysed focusing on linguistic data and contextual meaning. RESULTS: The overall response to the integration of CAM curricular elements into the medical school curriculum was positive among all faculty and graduating medical students. Participant experiences were often dependent on the perceived rigour of alternative approaches to a presenting patient problem, along with the importance attributed to openness to patient perspectives as part of evidence-based practices. There was an appreciation of the importance of developing increased awareness and utilisation of CAM in medical practice, as well as a recognition of resistance by some medical school faculty to CAM approaches. CONCLUSIONS: This evaluation of a specific CAM educational project suggests potentially transferable findings to other medical schools. Integrating CAM into the medical school curriculum requires a dedicated team if it is to result in a significant change. This change requires that CAM practices are visible to both students and faculty, that there is a co-operative climate, accessible resources, and institutional support, and that CAM content is embedded into the existing curriculum. All these factors combined can lead to sustainable integration of CAM content issues into the medical school curriculum.

Transition of new residents to long-term care: basing practice on residents' perspective.

Admission to a long-term care facility is a time of disorganization and adaptation. New residents experience transition breakdown beginning with a sense of homelessness as they learn the rules of institutional living. With the passage of time, residents may be able to create a place of their own. Story sharing is an important way to help new residents integrate into the unfamiliar long-term care facility.

Implementation of an evidence-based nursing practice model: disciplined clinical inquiry.

The implementation of a nursing practice model, Disciplined Clinical Inquiry (DCI), in the perioperative arena, is described. Using participatory action research, nurses are empowered to become reflective practitioners, competent in problem solving and evidence-based practices, collaborators, change agents, and patient advocates. Characteristics inherent in this model include flexibility, practicality, and partnerships between academia and clinicians. The successful DCI pilot test has led to a replication study with implications for other specialties.