A theory-based research literacy intervention for nurses: A pilot study.

OBJECTIVES: Difficulties with understanding research literature can lead to nurses having low engagement with evidence-based practice (EBP). This study aimed to test the feasibility of an education intervention using an academic literacies approach to improve nurses' research literacy. METHODS: An interactive workshop was devised utilizing genre analysis and tested in a pre/post pilot study. EBP self-efficacy was measured at baseline and posttest using the Self-Efficacy in Evidence-Based Practice instrument (26 items on an 11-point scale for total scores from 0 to 260). Research comprehension was measured with a 10-question quiz (range 0-10). RESULTS: When analyzed with a paired t-test, EBP self-efficacy increased significantly (MD: 56.9, SD: 39.9, t = 4.5, df = 9, p < .001). Research comprehension also improved (MD: 1.1; SD: 1.1, t = 2.9, df 9, p < .01). The workshop evaluations (n = 9) were overwhelmingly positive. CONCLUSION: This novel approach to research pedagogy aligns well with adult learning theory and social learning theory and is suitable for small group learning in continuing education. There is considerable potential for further work in this area. Genre analysis shows promise as a strategy for teaching nurses to understand research literature.

Registered Nurses' experiences of reading and using research for work and education: a qualitative research study.

BACKGROUND: Considerable resources have been expended, both in universities and health workplaces to improve nurses' abilities to interact with research and research literature to enable their engagement with evidence-based practice. Despite these efforts, a considerable number of nurses experience difficulty with research literature and are reluctant to use it in practice. AIMS: This study aimed to explore the experiences and perceptions of Registered Nurses when they have been required to read and understand research literature for work or education. DESIGN: A qualitative descriptive study using online and in-person focus groups. METHODS: Focus groups (online and in-person) were conducted between June and November 2020. Forty participants were included. We used focus group recordings and field notes to collect data. Transcribed records of these focus groups were coded on the basis of similarity of meaning and then subjected to thematic analysis. RESULTS: Three distinct themes were identified from the data: 'coming into learning about research', fitting research into the reality of nursing life', and 'working towards using research.' Participants described their early experiences in learning about research, experiences both positive and negative in integrating research into practice, and their personal strategies for reading and using research, particularly in the context of significant anxiety about understanding the content of methods and results sections of quantitative research articles. CONCLUSION: This study goes beyond the barriers and facilitators dichotomy that has been the majority of the conversation about nurses' evidence-based practice engagement previously, and explores the issues underlying aversion to research literature. Many nurses struggle with the language, numbers, and/or statistics used in research and this requires educational interventions suited to the problem and the population.

Exploring the observer role and clinical reasoning in simulation: A scoping review.

AIM: This scoping review aimed to explore nursing students experience as simulation observers and their level of engagement in learning through use of clinical decision-making models and learning scaffolds. BACKGROUND: A gap continues to exist between the published empirical literature, the role and experiences of the simulation observer and teaching scaffolds that enhance learning outcomes, despite the increased understanding of simulation and its role in preparing nursing students for practice. Further, little is known about the nursing student's experience of clinical reasoning whilst observing simulation and the impact of scaffolding observations using clinical decision-making models. DESIGN: This scoping review was conducted using the methodological framework of Arksey and O'Malley (2005) and the PRISMA checklist for systematic reviews (Page et al., 2020). METHODS: A comprehensive search of the literature published in Medline and CINAHL databases between 1999 and 2020 was undertaken in May 2019. The studies selected for this review (n = 18) were analyzed thematically. The validated Mixed-Methods Appraisal Tool assessed quality of the quantitative, qualitative and mixed methods studies. RESULTS: The role of the observer in simulation was explored and included observation to transform practice in self and observation to transform practice in others, namely peers in the nurse role in simulation. Application of the MMAT indicated that of the 18 studies included only 6 (33.3%) had a clear research question. Research aims or objectives were found in another six studies (33.3%). In this review 13 studies (72%) included answers to the research question or aim, three (17%) did not and in two (11%) it was impossible to tell. CONCLUSIONS: Results of this review indicate the paucity of research relating to nursing student's experience of clinical reasoning while observing simulation. Further, it highlights the value of nurse educators optimizing the observer role and maximizing learning by scaffolding observer activities within the simulation experience.

Effectiveness of using simulation in the development of clinical reasoning in undergraduate nursing students: A systematic review.

AIM/OBJECTIVE: This systematic review examines the effectiveness of undergraduate nursing students' using simulation to acquire clinical reasoning. BACKGROUND: Use of simulation to positively impact practice outcomes is an established method in nursing education. Clinical reasoning is a graduate capability that contributes to safe practice, so developing clinical reasoning requires explicit scaffolding in undergraduate contexts. While research has primarily evaluated specific clinical reasoning frameworks, variability in clinical reasoning definitions has obscured simulation efficacy for clinical reasoning acquisition. DESIGN: This review uses the Joanna Briggs Institute Systematic Reviews approach. METHODS: An electronic database search was conducted to identify studies published from May 2009 to January 2020 using a three-step search strategy. Selected papers were assessed by at least two independent reviewers for inclusion criteria, methodological validity, and data extraction. Ten studies using quasi-experimental designs involving 1532 students were included. RESULTS: Evidence regarding the effectiveness of simulation for undergraduate nursing students' acquisition of clinical reasoning was limited but of high quality. Review results showed no statistically significant gains in clinical reasoning with a single simulation exposure. Two emerging concepts, situation awareness and teamwork support the enhancement of clinical reasoning within simulation. In order to draw future conclusions on the efficacy of simulation to develop clinical reasoning, more research is warranted. CONCLUSIONS: New insights about team-based simulations and situation awareness were identified as integral for development of clinical reasoning in the context of simulation. More consistent use of terminology in the context of simulation research is also recommended.

The Experiences and Perceptions of Nurses Interacting With Research Literature: A Qualitative Systematic Review to Guide Evidence-Based Practice.

BACKGROUND: There is an evidence that some nurses struggle with reading and using research. This struggle becomes a barrier to engaging in evidence-based practice (EBP). Personal beliefs, attitudes about research, and difficulties with research language and statistics have been reported as important variables in quantitative studies. AIMS: The aim of this review was to explore nurses' experiences and perceptions of interacting with research literature for work or educational purposes. METHODS: Studies eligible for inclusion were qualitative, published in English from years 2009-2020, and included registered nurses engaged in interaction with research literature for any work or educational purpose. The Joanna Briggs Institute's qualitative systematic review methods were used. RESULTS: We included 11 qualitative studies with 186 participants. Most studies used focus groups or semi-structured interviews to collect data. Overall, study quality was moderate. We extracted 29 findings, which were synthesized into five categories, and meta-aggregated into one synthesis. Research is a complex field of engagement for nurses, who simultaneously value its contribution to their profession and feel the burden of unsupported expectations. Nurses perceive a double standard in their workplaces where expectations of using evidence in practice are often discussed, but EBP education and access to literature can be hard to access. LINKING EVIDENCE TO ACTION: Educators conducting research education should consider the complex emotional reactions this activity may engender in participants who may feel unprepared by their previous experience or education. Clinicians and workplace leaders trying to encourage the use of evidence in practice should consider the source of any reluctance to engage. An observed lack of engagement in their staff may be related to issues with understanding the materials.

Comparison of simulation observer tools on engagement and maximising learning: a pilot study.

OBJECTIVES: This pilot study examined if the Clinical Reasoning Observer Worksheet (CROW) compared to a standard observer worksheet used during simulation, would enhance nursing students active learning behaviours and perceptions of clinical reasoning ability. METHODS: This pilot study was undertaken to test the design and processes for a future larger study and reports on preliminary evidence of efficacy of recruitment procedures and instrumentation in addition to student's learning outcomes. RESULTS: There was little overall difference in outcomes between groups who used either simulation observer worksheet. Overall, participants who used either worksheet perceived their ability to apply clinical reasoning to an episode of patient care increased. CONCLUSIONS: Modifications were identified as necessary for a larger study including changes to instrumentation, method of survey delivery and training of simulation facilitators. A more definitive evaluation will be achievable with a larger group of students in a main study with the suggested modifications.

A scoping review of the role of health literacy in chronic kidney disease self-management.

BACKGROUND: Chronic kidney disease is a serious health condition and is increasing globally. Effective self-management could slow disease progression and improve health outcomes, although the contribution of health literacy and knowledge for self-management is not well known. AIM: To investigate the recent evidence of health literacy and the relationship between health literacy, knowledge and self-management of chronic kidney disease. METHODS: Arksey and O'Malley's framework informed this scoping review. Eligible studies involving adults with any grade of chronic kidney disease, measuring all dimensions of health literacy (i.e., functional, communicative, and critical), disease-specific knowledge and self-management, published in English between January 2005 and March 2020, were included. RESULTS: The scoping review found 12 eligible studies, with 11 assessing all dimensions of health literacy. No study examined health literacy, knowledge and self-management. When individuals had greater health literacy, this was associated with greater knowledge about the disease. Communicative health literacy was a significant predictor of medication, diet and fluid adherence, and overall self-management behaviours. CONCLUSION: This scoping review shows that disease-specific knowledge is important for health literacy and that health literacy is essential for effective self-management of chronic kidney disease. The implications of these relationships can inform strategies for the development of evidence-based patient education to support increased self-management. There is also a need for further research to explore these associations.

Inquiry-based learning and clinical reasoning scaffolds: An action research project to support undergraduate students' learning to 'think like a nurse'.

A period of re-negotiation is expected when introducing a new teaching and learning approach in a Bachelor of Nursing course. This study, underpinned by a social constructivist framework, used action research to uncover the interactions, challenges and outcomes when implementing an inquiry-based learning approach to support the development of students' clinical reasoning and capability to think like a nurse. Data collection involved non-participant observation of 32 tutorial groups (600 first-year students and 8 teachers) over the first two weeks of semester. Analysis was informed by Charmaz's social constructivist approach. The findings revealed three interconnected constructs: Opting in and out (students), Driving and reframing (teachers) and Creating and realising new understandings (both students and teachers). Introducing a new approach necessitated conscious planning and deliberate behaviour change on behalf of the teacher and student. Use of an inquiry-based learning approach which embedded clinical reasoning, investigative prompts and learning scaffolds in the form of case exemplars assisted students to 'think like a nurse'.

Cluster randomized controlled trial testing the effectiveness of a self-management intervention using the teach-back method for people with heart failure.

In this study, we examined the effectiveness of a self-management intervention delivered to people with heart failure in Vietnam. It used teach-back, a cyclical method of teaching content, checking comprehension, and re-teaching to improve understanding. A single-site cluster randomized controlled trial was conducted, and six hospital wards were randomized into two study groups. On the basis of ward allocation, 140 participants received either usual care or the teach-back heart failure self-management intervention plus usual care. The intervention involved, prior to discharge, an individual educational session on heart failure self-care, with understanding reinforced using teach-back, a heart failure booklet, weighing scales, diary, and a follow-up phone call 2 weeks post-discharge. The control group received usual care and the booklet. Outcomes were heart failure knowledge, self-care (maintenance, management and confidence), and all-cause hospitalizations assessed at 1 and 3 months (end-point). Upon completion of the study, the intervention group had significantly greater knowledge and self-care maintenance than the control group. Other outcomes did not differ between the two groups. The teach-back self-management intervention demonstrated promising benefits in promoting self-care for heart failure patients.

Evaluating the learning environment of nursing students: A multisite cross-sectional study.

BACKGROUND: Identifying students' experiences of the university and clinical learning environments informs quality improvement of courses. OBJECTIVES: To investigate undergraduate nursing students' perceptions of their education environment and the facilitators and barriers to learning, during university and clinical experiences. DESIGN: Multi-site cross-sectional survey. SETTING: Four universities in Vietnam. PARTICIPANTS: Undergraduate nursing students (n = 891). METHODS: Between May and August 2016, Vietnamese versions of the Dundee Ready Education Environment Measure (Nursing) and the modified Clinical Learning Environment Inventory measured students' perceptions of university and clinical environments respectively. Two additional open-ended questions elicited perceptions of facilitators and/or barriers to clinical learning. RESULTS: The university environment was rated as needing improvement and significant differences between universities and year of study detected. University environment mean scores were significantly higher in second year students compared with those in the third or fourth years of study. Active teaching and interpersonal relationships at university were rated positively. Overall, clinical environment scores were mid-range and second year students' mean scores were significantly higher than third or fourth years. Clinical placements greater than four weeks duration had significantly higher mean score than two week placements. CONCLUSIONS: Evaluation of university and clinical experiences assists with identifying potential areas of interruption to nursing students' transfer of learning. In both learning environments, Vietnamese students' experiences were similar to those experienced in Western countries in that interpersonal relationships with teachers and ward staff were key factors perceived to influence learning. A notable difference in this study was the hospital environment in Vietnam had features unique to this country that interrupted students' transfer of learning. Globally it is a priority for nurse educators to facilitate both on and off campus environments that promote students' learning. Assessing these environments is a useful strategy for quality improvement of courses.

Translation and validation of a Vietnamese version of the modified Clinical Learning Environment Inventory (V-CLEI).

The quality of students' experiences in an education environment directly affect learning outcomes. In an applied profession such as nursing, students undertake work-integrated learning in unpredictable health settings where multiple influences interact. Understanding students' perspectives with a valid instrument is the first step in improving learning environments and maximizing learning outcomes. It is important that language and cultural nuances are accounted for when instruments are translated. This paper reports translation and psychometric properties of the Vietnamese language version (V-CLEI) of the modified English language Clinical Learning Environment Inventory (CLEI) (Newton et al., 2010). The V-CLEI was tested with a convenience sample of 209 Vietnamese nursing students to assess clinical learning experiences in hospitals in central Vietnam. The internal consistency, test-retest reliability, content validity and factor structure of the V-CLEI were examined. Results indicate that the V-CLEI is unlikely to be valid and reliable in the Vietnamese context and revision is required. This study informs research, particularly the different cultural dimensions considered when translating and adapting instruments.

Self-management intervention using teach-back for people with heart failure in Vietnam: A cluster randomized controlled trial protocol.

Globally, the increasing prevalence of heart failure is a burden on health-care systems, especially in under-resourced countries, such as Vietnam. We describe a prospective single-site, cluster randomized controlled trial of an intervention designed to teach adult patients about heart failure and how to undertake self-care activities. The intervention, delivered by a nurse, comprises of an individual teaching session using teach-back, a heart failure booklet, weighing scales, a diary to document daily weight, and a follow-up phone call 2 weeks after hospital discharge. Teach-back is a process of asking patients to repeat information and for the nurse to fill any gaps or misunderstanding until adequate understanding is demonstrated. The control group will receive usual education plus the heart failure (HF) booklet. A total of 140 participants will be allocated into two study groups. The level of randomization is at the ward level. The primary outcome (HF knowledge) and secondary outcomes (self-care behaviors and all-cause hospitalizations) will be measured at 1 and 3 months. This study will make an important contribution regarding a protocol of teach-back and chronic disease self-management.

Parenting and childhood atopic dermatitis: A cross-sectional study of relationships between parenting behaviour, skin care management, and disease severity in young children.

BACKGROUND: The development of child behaviour and parenting difficulties is understood to undermine treatment outcomes for children with atopic dermatitis. Past research has reported on correlates of child behaviour difficulties. However, few research studies have sought to examine parenting confidence and practices in this clinical group. OBJECTIVES: To examine relationships between child, parent, and family variables, parent-reported and directly-observed child and parent behaviour, parents' self-efficacy with managing difficult child behaviour, self-reported parenting strategies, and disease severity. DESIGN: Cross-sectional study design. PARTICIPANTS: Parent-child dyads (N=64) were recruited from the dermatology clinic of a paediatric tertiary referral hospital in Brisbane, Australia. Children had a diagnosis of atopic dermatitis of ≥3months and no other chronic health conditions except asthma, allergic rhinitis, or allergy. METHODS: Parents completed self-report measures assessing child behaviour; parent depression, anxiety, and stress; parenting conflict and relationship satisfaction; self-efficacy with managing difficult child behaviour, and use of ineffective parenting strategies; and self-efficacy for managing atopic dermatitis, and performance of atopic dermatitis management tasks. The Scoring Atopic Dermatitis index was used to assess disease severity. Routine at-home treatment sessions were coded for parent and child behaviour. RESULTS: Pearson's and Spearman's correlations identified relationships (p<0.05) between self-efficacy with managing difficult child behaviour and child behaviour problems, parent depression and stress, parenting conflict and relationship satisfaction, and household income. There were also relationships between each of these variables and use of ineffective parenting strategies. Greater use of ineffective parenting strategies was associated with more severe atopic dermatitis. Using multiple linear regressions, child behaviour and household income explained unique variance in self-efficacy for managing difficult child behaviour; household income alone explained unique variance in use of ineffective parenting strategies. Self-efficacy for managing difficult child behaviour and self-efficacy for managing atopic dermatitis were positively correlated (rho=0.48, p<0.001), and more successful self-reported performance of atopic dermatitis management tasks correlated with less permissive (r=0.35, p=0.005) and less authoritarian (r=0.41, p=0.001) parenting. Directly observed aversive child behaviour was associated with more severe atopic dermatitis, parent stress, and parent-reported child behaviour problems. CONCLUSION: This study revealed relationships between parents' self-efficacy and parenting practices across the domains of child behaviour management and atopic dermatitis management. Parents of children with more severe atopic dermatitis may have difficulty responding to child behaviour difficulties appropriately, potentially impacting on illness management. Incorporating parent and parenting support within treatment plans may improve not only child and family wellbeing, but also treatment outcomes.

Interventions for improving the research literacy of nurses: a systematic review.

BACKGROUND: Despite the importance of research literacy for nurses, many nurses report feeling unable to effectively read and understand research, which in turn results in lower research utilization in practice. Nurses themselves identify poor experiences with trying to understand and use research as factors that contribute to a reluctance to utilize research. This reluctance often leads nurses to seek other sources of information, such as colleagues, instead. OBJECTIVES: The objective of this review was to identify the effectiveness of research literacy interventions on the research literacy of registered nurses. INCLUSION CRITERIA: Registered nurses.Interventions of interest were those that evaluated the effectiveness of workplace educational programs or interventions conducted in a healthcare organization or tertiary-level educational facility aiming to improve or increase registered nurses' understanding of research literature.Outcomes of interest were research literacy, measured explicitly or as research knowledge, research understanding, use of research evidence in practice, and/or ability to critically appraise research.We considered experimental study designs such as randomized controlled trials, nonrandomized controlled trials, quasi-experimental, and before and after studies. SEARCH STRATEGY: A wide range of databases were searched in order to provide the most complete possible review of the evidence. Initial keywords used were: "research litera*", "research education", "research knowledge", "evidence-based practice education". METHODOLOGICAL QUALITY: Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION: Data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. DATA SYNTHESIS: Quantitative data would have been, if possible, pooled in statistical meta-analysis using the Cochrane Collaboration's Review Manager 5.2 software. As statistical pooling was not possible, the findings are presented in narrative form including tables and figures where appropriate to aid in data presentation. RESULTS: The majority of included studies were single-group pre-test/post-test designs (n=7). One was a post-test only two-group comparison and two were two-group quasi-experimental studies. Included studies were conducted in Taiwan, Japan, Hong Kong, Australia, United Kingdom and United States. The total number of registered nurses in the included studies was 453. The educational interventions were conducted in universities (n=6) and healthcare facilities (n=4). Most included studies were published (n=9), with one unpublished study. CONCLUSIONS: The evidence on educational interventions, while not strong, is indicative of the types of interventions which are likely to be effective. Online or face-to-face interventions using interactive teaching strategies, such as activities, role-play and discussions, and which are underpinned by an appropriate behavioral or education theory, are likely to increase research literacy. IMPLICATIONS FOR RESEARCH: More rigorous experimental studies of educational interventions for nurses' research literacy are warranted, in order to demonstrate the effectiveness of different course and program designs. Future studies should consider longer periods of follow-up to test the longevity of the effect, as education needs to have lasting effects to be beneficial to the recipients.

The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review.

BACKGROUND: Chronic diseases are increasing worldwide and have become a significant burden to those affected by those diseases. Disease-specific education programs have demonstrated improved outcomes, although people do forget information quickly or memorize it incorrectly. The teach-back method was introduced in an attempt to reinforce education to patients. To date, the evidence regarding the effectiveness of health education employing the teach-back method in improved care has not yet been reviewed systematically. OBJECTIVES: This systematic review examined the evidence on using the teach-back method in health education programs for improving adherence and self-management of people with chronic disease. INCLUSION CRITERIA: Adults aged 18 years and over with one or more than one chronic disease.All types of interventions which included the teach-back method in an education program for people with chronic diseases. The comparator was chronic disease education programs that did not involve the teach-back method.Randomized and non-randomized controlled trials, cohort studies, before-after studies and case-control studies.The outcomes of interest were adherence, self-management, disease-specific knowledge, readmission, knowledge retention, self-efficacy and quality of life. SEARCH STRATEGY: Searches were conducted in CINAHL, MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, ProQuest Nursing and Allied Health Source, and Google Scholar databases. Search terms were combined by AND or OR in search strings. Reference lists of included articles were also searched for further potential references. METHODOLOGICAL QUALITY: Two reviewers conducted quality appraisal of papers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. DATA EXTRACTION: Data were extracted using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument data extraction instruments. DATA SYNTHESIS: There was significant heterogeneity in selected studies, hence a meta-analysis was not possible and the results were presented in narrative form. RESULTS: Of the 21 articles retrieved in full, 12 on the use of the teach-back method met the inclusion criteria and were selected for analysis. Four studies confirmed improved disease-specific knowledge in intervention participants. One study showed a statistically significant improvement in adherence to medication and diet among type 2 diabetics patients in the intervention group compared to the control group (p < 0.001). Two studies found statistically significant improvements in self-efficacy (p = 0.0026 and p < 0.001) in the intervention groups. One study examined quality of life in heart failure patients but the results did not improve from the intervention (p = 0.59). Five studies found a reduction in readmission rates and hospitalization but these were not always statistically significant. Two studies showed improvement in daily weighing among heart failure participants, and in adherence to diet, exercise and foot care among those with type 2 diabetes. CONCLUSIONS: Overall, the teach-back method showed positive effects in a wide range of health care outcomes although these were not always statistically significant. Studies in this systematic review revealed improved outcomes in disease-specific knowledge, adherence, self-efficacy and the inhaler technique. There was a positive but inconsistent trend also seen in improved self-care and reduction of hospital readmission rates. There was limited evidence on improvement in quality of life or disease related knowledge retention.Evidence from the systematic review supports the use of the teach-back method in educating people with chronic disease to maximize their disease understanding and promote knowledge, adherence, self-efficacy and self-care skills.Future studies are required to strengthen the evidence on effects of the teach-back method. Larger randomized controlled trials will be needed to determine the effectiveness of the teach-back method in quality of life, reduction of readmission, and hospitalizations.

The Effectiveness of Interventions for Improving the Research Literacy of Nurses: A Systematic Review.

BACKGROUND: Internationally, a considerable body of research exists examining why nurses do not use evidence in practice. Consistently, the research finds that lack of knowledge about research or discomfort with understanding research terminology are among the chief reasons given. Research education is commonly included in undergraduate nursing degree programs, but this does not seem to translate into a strong understanding of research following graduation, or an ability to use it in practice. AIM: The objective of this review was to identify the effectiveness of workplace, tertiary-level educational, or other interventions designed to improve or increase postregistration nurses' understanding of research literature and ability to critically interact with research literature with the aim of promoting the use of research evidence in practice in comparison to no intervention, other intervention, or usual practice. METHODS: A wide range of databases were searched for quantitative studies of registered nurses receiving educational interventions designed to increase or improve their understanding of research literature in tertiary or workplace settings. Two reviewers working independently critically appraised the relevant papers and extracted the data using Joanna Briggs Institute instruments. Data are presented as a narrative summary as no meta-analysis was possible. RESULTS: Searching identified 4,545 potentially relevant papers, and after the sifting of titles and abstracts, 96 papers were selected for retrieval. On examination of full-text versions, 10 of the 96 retrieved papers were found to meet the inclusion criteria. Included studies were low to moderate quality. Interactive or activity-based learning seems to be effective in terms of improving research knowledge, critical appraisal ability, and research self-efficacy. Utilizing a program with a strong base in an appropriate theory also seems to be associated with greater effectiveness, particularly for workplace interventions. LINKING EVIDENCE TO ACTION: The included studies strongly favored interactive interventions, and those utilizing theory in their construction. Therefore, these types of interventions should be implemented to improve the effectiveness of research education for nurses as well as their research literacy.

Childhood atopic dermatitis: a cross-sectional study of relationships between child and parent factors, atopic dermatitis management, and disease severity.

BACKGROUND: Successful management of atopic dermatitis poses a significant and ongoing challenge to parents of affected children. Despite frequent reports of child behaviour problems and parenting difficulties, there is a paucity of literature examining relationships between child behaviour and parents' confidence and competence with treatment. OBJECTIVES: To examine relationships between child, parent, and family variables, parents' self-efficacy for managing atopic dermatitis, self-reported performance of management tasks, observed competence with providing treatment, and atopic dermatitis severity. DESIGN: Cross-sectional study design. Participants A sample of 64 parent-child dyads was recruited from the dermatology clinic of a paediatric tertiary referral hospital in Brisbane, Australia. METHODS: Parents completed self-report questionnaires examining child behaviour, parents' adjustment, parenting conflict, parents' relationship satisfaction, and parents' self-efficacy and self-reported performance of key management tasks. Severity of atopic dermatitis was assessed using the Scoring Atopic Dermatitis index. A routine home treatment session was observed, and parents' competence in carrying out the child's treatment assessed. RESULTS: Pearson's and Spearman's correlations identified significant relationships (p<.05) between parents' self-efficacy and disease severity, child behaviour difficulties, parent depression and stress, parenting conflict, and relationship satisfaction. There were also significant relationships between each of these variables and parents' self-reported performance of management tasks. More profound child behaviour difficulties were associated with more severe atopic dermatitis and greater parent stress. Using multiple linear regressions, significant proportions of variation in parents' self-efficacy and self-reported task performance were explained by child behaviour difficulties and parents' formal education. Self-efficacy emerged as a likely mediator for relationships between both child behaviour and parents' education, and self-reported task performance. Direct observation of treatment sessions revealed strong relationships between parents' treatment competence and parents' self-efficacy, outcome expectations, and self-reported task performance. Less competent task performance was also associated with greater parent-reported child behaviour difficulties, parent depression and stress, parenting conflict, and relationship dissatisfaction. CONCLUSION: This study revealed the importance of child behaviour to parents' confidence and practices in the context of atopic dermatitis management. Children with more severe atopic dermatitis are at risk of presenting with challenging behaviour problems and their parents struggle to manage the condition successfully.