Crisis stabilisation services for people with intellectual disabilities: A systematic review.

People with intellectual and developmental disabilities sometimes engage in challenging behaviours. When behaviours escalate to the point where they pose imminent risk to the safety of people and environments, a crisis occurs that jeopardises community living and participation. In these situations, timely access to crisis stabilisation services is required. We conducted a systematic review of the literature to synthesise evidence on effective crisis stabilisation service models for challenging behaviours. A total of 46 publications met the inclusion criteria. The literature describes a spectrum of crisis stabilisation services of varying intensities including: outreach, outpatient, inpatient, respite, and capacity building through education and training. However, there is limited guidance on how to best structure service models. This review highlights the need for comprehensive and person-centred programme evaluations.

Impact of Undergraduate Research Experience on Professional Career Outcomes of Nurses.

BACKGROUND: The benefits of engaging undergraduate nursing students in research have been well-identified; however, little research has documented the long-term outcomes of this research assistant (RA) experience on nurses' professional careers. This study evaluated the impact of undergraduate research experience on participants' nursing professional career outcomes. METHOD: A comparative cross-sectional study was conducted with a purposive sample of two groups (N = 94; RAs = 32 and non-RAs = 62). The questionnaire was administered online. RESULTS: A comparison of participants' responses revealed statistically significant differences regarding scholarship activities and attitudes toward evidence-based practice. RAs had a greater likelihood of involvement in professional development and higher educational aspirations than non-RAs. CONCLUSION: Undergraduate nursing research experience appears to have a positive impact on evidence-based practice, professional involvement, continuing education, and scholarship activities. These findings support future investment in undergraduate nursing research experiences to build a knowledge-based workforce and advanced nursing scholarship. [J Nurs Educ. 2021;60(10):570-576.].

Interventions to Improve the Cast Removal Experience for Children and Their Families: A Scoping Review.

BACKGROUND: Cast removal can be a distressing experience for a child. This scoping review aims to provide a comprehensive review of interventions designed to reduce anxiety and improve the child's and family's experience of pediatric cast removal. METHODS: A scoping review was conducted (Medline, Embase, PsycINFO, CINAHL, Scopus, grey literature sources). INCLUSION CRITERIA: studies published January 1975-October 2019 with a primary focus on pediatric patients undergoing cast removal/cast room procedures. Screening, full text review, data extraction, and quality appraisal were conducted in duplicate. RESULTS: 974 unique articles and 1 video were screened. Nine articles (eight unique studies) with a total of 763 participants were included. Interventions included the following, alone or in combination: noise reduction, electronic device use, preparatory information, music therapy, play therapy, and child life specialist-directed intervention. Heart rate was used as a primary (88%) or secondary (12%) outcome measure across studies. Each study reported some positive effect of the intervention, however effects varied by age, outcome measure, and measurement timing. Studies scored low on outcome measure validity and blinding as assessed by the Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials. CONCLUSION: Various methods have been tested to improve the pediatric cast removal experience. Results are promising, however the variation in observed effectiveness suggests a need for the use of consistent and valid outcome measures. In addition, future research and quality improvement projects should evaluate interventions that are tailored to a child's age and child/family preference.

A qualitative study exploring parents' experiences with epinephrine use for their child's anaphylactic reaction.

BACKGROUND: Children with life threatening food allergies live with the constant threat of a fatal reaction, and caregivers must always be prepared to treat with an epinephrine auto-injector (EAI). This interpretive phenomenological study explored parents' perceptions and lived experiences with prescribed EAI use for their child. METHODS: The purposive sample included ten parents of five children under 12 years of age, diagnosed with a food allergy and prescribed with an EAI who recently experienced anaphylaxis. Data sources included digitally-recorded semi-structured interviews and a reflexive journal. RESULTS: Eight main themes emerged: perception of anaphylaxis, life challenges, isolation, anxiety, hesitation, guilt, influence of health care professionals, and lessons learned. Parents uniformly described multiple life challenges and feelings of isolation, anxiety and hesitation during a reaction that lead to subsequent guilt. CONCLUSIONS: Handling reactions correctly provided parents with confidence to treat subsequent reactions. Witnessing the effects of an EAI and receiving positive feedback from health care providers further strengthened their confidence to quickly and competently intervene in future reactions.

Learner-centred teaching in a non-learner-centred world: An interpretive phenomenological study of the lived experience of clinical nursing faculty.

BACKGROUND: With the growing complexities in the contemporary health care system, there is a challenge of preparing nurses for the practice demands. To this end, learner-centred teaching has emerged in many nursing curricula in Canada and evidence indicates its effectiveness in developing the essential practice skills in nursing students. It is important to examine the experience of the clinical faculty members who implement learner-centred teaching, as doing so would provide an insight to the factors that may hinder the implementation of learner-centred teaching in the practice settings. OBJECTIVE: This phenomenological study aimed to address two research questions: what does learner-centred teaching mean to clinical nurse faculty? What is the lived experience of clinical nursing faculty who incorporate learner-centred teaching? METHODS: Ten clinical nurse faculty members who had at least two years of clinical teaching experience volunteered to participate in the study. Data were collected using a semi-structured interview guide and audio recorder. Additional data sources included a demographic survey and a reflective journal. RESULTS: Multiple sub-themes emerged from this study from which three significant themes were consolidated: diversity of meanings, facilitators of LCT, and barriers to LCT. However, an overarching theme of "learner-centred teaching in a non-learner-centred world" was coined from participants' accounts of their experiences of barriers in incorporating LCT in the practice settings. CONCLUSION: A collaborative effort between faculty and the stakeholders is paramount to a successful implementation of learner-centred teaching in practice settings.

Prenatal, Obstetric and Perinatal Factors Associated With the Development of Childhood-Onset Type 2 Diabetes.

OBJECTIVE: To explore associations among prenatal, obstetric and perinatal factors and the development of childhood-onset type 2 diabetes. METHODS: This retrospective, case-control study utilized administrative data housed at the Manitoba Centre for Health Policy. De-identified health records were examined from a sample of 270 children (aged 10 to 17 years at time of diagnosis) with type 2 diabetes and 1341 children without type 2 diabetes matched for age, sex and geographic location. Patients and control subjects were linked to their de-identified biological mothers' health records. Prenatal, obstetric and perinatal factors were investigated. Univariate and multivariable conditional regression analyses were conducted to identify key factors associated with the development of type 2 diabetes in children. RESULTS: The mean age at diagnosis was 13.1 years, and 61% of patients were girls. The majority (71.1%) of children with type 2 diabetes resided in rural areas. Exposure to maternal pregestational diabetes increased the odds of childhood-onset type 2 diabetes nearly 6-fold, and exposure to gestational diabetes carried a 4-fold increased risk. Breastfeeding was found to be protective, decreasing the risk of childhood-onset type 2 diabetes (odds ratio = 0.52, 95% confidence interval = 0.36-0.74). Low maternal income was significantly associated with development of childhood-onset type 2 diabetes (odds ratio = 6.67, 95% confidence interval = 3.01-14.79). CONCLUSIONS: Health and social policies and programs are needed to provide financial, educational and clinical resources that target women whose pregnancies are affected by poverty, type 2 diabetes or gestational diabetes. Breastfeeding should be encouraged to aid in the prevention of childhood-onset type 2 diabetes.

A descriptive qualitative examination of knowledge translation practice among health researchers in Manitoba, Canada.

BACKGROUND: The importance of effective translation of health research findings into action has been well recognized, but there is evidence to suggest that the practice of knowledge translation (KT) among health researchers is still evolving. Compared to research user stakeholders, researchers (knowledge producers) have been under-studied in this context. The goals of this study were to understand the experiences of health researchers in practicing KT in Manitoba, Canada, and identify their support needs to sustain and increase their participation in KT. METHODS: Qualitative semi-structured interviews were conducted with 26 researchers studying in biomedical; clinical; health systems and services; and social, cultural, environmental and population health research. Interview questions were open-ended and probed participants' understanding of KT, their experiences in practicing KT, barriers and facilitators to practicing KT, and their needs for KT practice support. RESULTS: KT was broadly conceptualized across participants. Participants described a range of KT practice experiences, most of which related to dissemination. Participants also expressed a number of negative emotions associated with the practice of KT. Many individual, logistical, and systemic or organizational barriers to practicing KT were identified, which included a lack of institutional support for KT in both academic and non-academic systems. Participants described the presence of good relationships with stakeholders as a critical facilitator for practicing KT. The most commonly identified needs for supporting KT practice were access to education and training, and access to resources to increase awareness and promotion of KT. While there were few major variations in response trends across most areas of health research, the responses of biomedical researchers suggested a unique KT context, reflected by distinct conceptualizations of KT (such as commercialization as a core component), experiences (including frustration and lack of support), and barriers to practicing KT (for example, intellectual property concerns). CONCLUSIONS: The major findings of this study were the continued variations in conceptualization of KT, and persisting support needs that span basic individual to comprehensive systemic change. Expanding the study to additional regions of Canada will present opportunities to compare and contrast the state of KT practice and its influencing factors.

Emergency department interventions for persons with dementia presenting with ambulatory care-sensitive conditions: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this scoping review is to examine and map, within existing literature, the characteristics of emergency department/urgent care interventions, strategies or contextual factors, implemented to reduce unnecessary hospitalization of people with dementia (PWD) presenting at the emergency department/urgent care with ambulatory care-sensitive conditions (ACSC).More specifically, the review questions are.

Stakeholders' Perspectives towards the Use of the Comprehensive Health Assessment Program (CHAP) for Adults with Intellectual Disabilities in Manitoba.

BACKGROUND: No standardized tool is used in Canada for comprehensive health assessments of adults with intellectual disabilities. This study was conducted to determine the feasibility of implementing the Comprehensive Health Assessment Program (CHAP) in Manitoba, Canada. METHOD: This was a qualitative study using a purposive sample of physicians, nurse practitioners, support workers and families. Data were collected through individual interviews and focus groups and were analysed using content analysis. RESULTS: Use of the CHAP was perceived as beneficial for persons with intellectual disabilities. Improved continuity of care was of the reported benefits. Six barriers for the future implementation of the CHAP were identified including the time required to complete the CHAP, and the perceived lack of physicians' willingness to do comprehensive assessments. CONCLUSION: The future implementation of the CHAP was strongly supported. For its successful implementation, training of healthcare professionals and support staff and change in regulations and policies were recommended.

Prevalence of Parastomal Hernia and Factors Associated With Its Development.

PURPOSE: The purpose of this study was to identify risk factors for development of a parastomal hernia (PH). DESIGN: Cross-sectional survey. SETTING AND SUBJECTS: The target population comprised 2854 persons receiving services from the Manitoba Ostomy Program. Seven hundred sixty-four responses were received, yielding a response rate of 29.3%. Respondents average age was 70 years (SD = 12.8); 425 (55.6%) had a colostomy, 236 (30.8%) had an ileostomy, 63 (8.2%) had a urostomy, and 40 (5.2%) indicated other types of stomas or fistula. INSTRUMENTS: A questionnaire was developed by the authors that collected the following data: demographics, relevant medical history, personal and lifestyle factors, surgery-related factors, pre- and postoperative care factors, and information about the presence of a PH and physical and lifestyle effects related to a PH. Devices to enable respondents to measure the size of their stoma and abdominal girth were included in the survey package. The survey tool took approximately 30 to 45 minutes to complete. METHODS: An informational pamphlet and introductory letter were mailed 2 weeks before the survey was mailed. This was followed by a reminder letter. Bivariate analyses were completed in order to identify potential associations between all variables and a diagnosis of a PH; multivariate analysis was then completed to determine which factors were associated with an increased likelihood of a PH. RESULTS: Significant univariate associations were found between a diagnosis of a PH and diverticulitis, cirrhosis, benign prostatic enlargement, previous diagnosis of hernia, a smoking history, type of ostomy, stoma size, and continuous variables age and abdominal girth. Multiple regression analysis indicated that patients who underwent stoma surgery for cancer had larger stomas (1.5 to >3 in), and a colostomy were more likely to develop a PH. CONCLUSIONS: The results of this study indicate that PHs are prevalent. Additional research is needed to determine more effective intervention for preventing and managing a PH.

The influence of staff training on challenging behaviour in individuals with intellectual disability: a review.

Many individuals with intellectual disability engage in challenging behaviour. This can significantly limit quality of life and also negatively impact caregivers (e.g., direct care staff, family caregivers and teachers). Fortunately, efficacious staff training may alleviate some negative side effects of client challenging behaviour. Currently, a systematic review of studies evaluating whether staff training influences client challenging behaviour has not been conducted. The purpose of this article was to identify emerging patterns, knowledge gaps and make recommendations for future research on this topic. The literature search resulted in a total of 19 studies that met our inclusion criteria. Articles were separated into four staff training categories. Studies varied across sample size, support staff involved in training, study design, training duration and data collection strategy. A small sample size (n = 19) and few replication studies, alongside several other procedural limitations prohibited the identification of a best practice training approach.

Listening to those who are living with HIV and tobacco dependence and exploring their health care context.

The emergence of antiretroviral therapies extends the life span of people diagnosed with HIV and shifts health priorities toward chronic disease management. People living with HIV (PLWH) who smoke cigarettes are more likely than nonsmokers to develop health conditions such as pneumonia, cancer, emphysema, and heart disease. Our mixed methods study utilized semi-structured interviews (n = 29) to explore PLWH perceptions of tobacco and its role in their lives. We also explored HIV health care services and tobacco dependence treatment. Local HIV clinic staff (n = 4) participated in interview and focus group discussions that examined their practices and clinic services concerning tobacco dependence treatment. A brief survey of Canadian AIDS Society members shed light on trends in clinic-based tobacco dependence treatments (n = 24). The following themes emerged: competing health priorities for PLWH; interest in quitting; and disconnect between tobacco use, health, and living.

Nursing student perceptions of disability and preparation to care for people with intellectual disabilities.

As people with intellectual disabilities live longer and develop more chronic illnesses, nurses will have increasing contact with them. Therefore, nurses must have both an accurate understanding of and a positive attitude toward this population to ensure optimal nursing care is received. A cross-sectional survey of second-year and fourth-year nursing students measured their perceptions of disability, their contact with people with intellectual disabilities, and their perceptions of education to prepare them to care for people with intellectual disabilities. Students most often identified disability as physical, using a wheelchair to represent that perception. Students were confident in their ability to transfer many of the skills they learned to care for people with intellectual disabilities but identified a need for more education about providing that care. Curricular changes to enhance nursing students' awareness and understanding of people with intellectual disabilities are recommended.

Provision of smoke-free homes and vehicles for kindergarten children: associated factors.

Many children continue to be exposed to environmental tobacco smoke (ETS) each day. To describe the factors associated with providing a smoke-free home (PSFH) and vehicle (PSFV) for kindergarten children, a cross-sectional descriptive study was conducted in Manitoba, Canada, with 551 mothers and primary caregivers responding. A social-ecologic model of health behavior guided the study. In the bivariate analysis, being better educated, living with a partner, and having a higher income were associated with PSFH. In the multivariable logistic regression analysis, the variables most predictive for PSFH were living with a partner and the mother's self-efficacy, and for PSFV, the most predictive variables were the mother's self-efficacy and ETS knowledge. Smoking behaviors are complex and must be considered broadly within all levels of influence if nurses are to assist parents in protecting their children.

Oppression: a concept analysis and implications for nurses and nursing.

PURPOSE: To synthesize the literature's discussions on oppression and to explore its implications for nurses and nursing. SOURCE: Published literature. CONCLUSION: Oppression requires a set of norms that are determined by a dominant group and a belief of the inferiority of those outside the dominant group. The attributes of oppression are unjust treatment, the denial of rights, and the dehumanizing of individuals. Nurses and the nursing profession both work with oppressed groups and are themselves an oppressed group. By helping their oppressed and vulnerable patients resist the status quo, nurses will begin resisting their own oppressed environment, which will eventually lead to freedom for their patients and themselves.