Gender as a principle of the organization of clinical sleep research.

In 2014 the National Institutes of Health required researchers to examine sex as a biological variable. While this approach is necessary to ensure adequate and appropriate female inclusion in research studies, it puts researchers at high risk for attributing their findings to biological sex differences when instead they may be more appropriately attributed to the influence and expectations of gender. In this paper, we specify how gender works as a principle of the social organization of symptoms, experiences, research, and clinical practice using obstructive sleep apnea symptomology to illustrate these patterns. We draw from psychologist Sandra Bem's account differentiating three specific mechanisms of gender: gender polarization, androcentrism, and biological essentialism.

Systematic and integrative reviews: synthesising evidence for community nursing practice.

Ease of access to vast amounts of information presents significant opportunities and challenges for nurses in the community as they seek to base their practice on the best available evidence. Growing expectations around evidence-based practice have developed alongside developments in evidence synthesis, which adopts robust approaches to identifying, appraising and synthesising key evidence for clinical decision-making. The context in which evidence-based practice occurs is key, and this article discusses the skills and knowledge needed for community nurses to discern how evidence and information should influence their decisions to review and change approaches to clinical practice. Importantly, if nurses understand the status of evidence underpinning areas of practice, they can ensure that the preferences and needs of patients and families are met.

Linking to Improve Nursing Care and Knowledge: Evaluation of an Initiative to Provide Research Support to Clinical Nurses.

OBJECTIVES: The aim of this study is to describe and evaluate the impact of the Linking to Improve Nursing Care and Knowledge (LINK) project on increasing nurse-led clinical research. BACKGROUND: Nurse-generated research is the cornerstone of evidence-based practice and continues to be a marker of nursing excellence. However, the dearth of PhD-prepared nurses creates a challenge for creating an environment to promote clinical nursing research. We evaluated the LINK project, an academic-clinical partnership, to assess its impact and feasibility, for fostering nurse-led clinical research. METHODS: The LINK project created a formal command and control structure bringing together existing academic resources, including a PhD-prepared nurse researcher, a biostatistician, and a development of a formal research consultation request process. Measures tracked over a 12-month period included average response time, request volume, client satisfaction, institutional review board (IRB)-submitted protocols, and work products. RESULTS: All measures exceeded expectations with an average 1-day request response time, 35 requests, 98% client satisfaction, a 367% increase in nurse-led IRB approved protocols from the previous 12-month period, and 2 publications in peer-reviewed journals. CONCLUSIONS: The process and outcome measures indicate that the LINK project is feasible, sustainable, and reproducible. We were able to meet and, in many cases, exceed measurement goals. In addition, implementation science literature indicates that the most valid measure of a successful project rollout is user satisfaction and usefulness. The LINK project received consistently positive feedback.

Advancing a Culture of Clinical Nursing Research Through Collaborative Partnership Between Practice and Academia.

Engaging in clinical inquiry is a natural foundation for a nurse's critical thinking strategy and application to practice. Transforming clinical inquiry into a formal research question designed to improve patient care and/or the practice environment can, however, sometimes seem overwhelming to clinical nurses. It may even be seen as out of scope for their daily practice. As a result, aligning the trifold mission of service, education, and research at an Academic Health Sciences Center can be challenging unless there exists a purposeful strategy to achieve this goal. Since the publication of the Institute of Medicine "Future of Nursing Report" in 2010, Emory Healthcare Nursing and the Emory University Nell Hodgson Woodruff School of Nursing (SON) have sought to advance the vision and mission of strengthening and sustaining a culture of clinical inquiry to advance nursing science through nurse-led research. This vision also aligns with the American Association of Colleges of Nursing to identify paths for achieving enhanced partnerships between academic nursing and academic health centers. This goal has been conceptually important since then. In the last 2 years, there has been a renewed and invigorated commitment between Emory Healthcare Nursing and the Emory School of Nursing to forge a path for improving and sustaining a rigorous culture of collaborative and interprofessional research. This article describes the journey of the "One Emory Nursing" initiative, which spans from bedside/chairside to bench and back again. This work is built on a foundation of clinical nurses engaged in leading research that is designed to transform care in partnership with SON.

Supporting Clinical Nurses Through a Research Fellowship.

After reviewing the literature, nurses at the bedside seeking answers to clinical questions may find their inquiries remain unanswered. This article describes the yearlong Research Fellows Program in which candidates, funded for 12 hours per month of research release time, answered formal research questions in a curriculum designed to provide the skills to complete their study. Five have completed their studies; 1 has received a grant to continue. Two are in process of submitting manuscripts to journals.

Translating research findings to clinical nursing practice.

AIMS AND OBJECTIVES: To describe the importance of, and methods for, successfully conducting and translating research into clinical practice. BACKGROUND: There is universal acknowledgement that the clinical care provided to individuals should be informed on the best available evidence. Knowledge and evidence derived from robust scholarly methods should drive our clinical practice, decisions and change to improve the way we deliver care. Translating research evidence to clinical practice is essential to safe, transparent, effective and efficient healthcare provision and meeting the expectations of patients, families and society. Despite its importance, translating research into clinical practice is challenging. There are more nurses in the frontline of health care than any other healthcare profession. As such, nurse-led research is increasingly recognised as a critical pathway to practical and effective ways of improving patient outcomes. However, there are well-established barriers to the conduct and translation of research evidence into practice. DESIGN: This clinical practice discussion paper interprets the knowledge translation literature for clinicians interested in translating research into practice. METHODS: This paper is informed by the scientific literature around knowledge translation, implementation science and clinician behaviour change, and presented from the nurse clinician perspective. We provide practical, evidence-informed suggestions to overcome the barriers and facilitate enablers of knowledge translation. Examples of nurse-led research incorporating the principles of knowledge translation in their study design that have resulted in improvements in patient outcomes are presented in conjunction with supporting evidence. CONCLUSIONS: Translation should be considered in research design, including the end users and an evaluation of the research implementation. The success of research implementation in health care is dependent on clinician/consumer behaviour change and it is critical that implementation strategy includes this. RELEVANCE TO PRACTICE: Translating best research evidence can make for a more transparent and sustainable healthcare service, to which nurses are central.

Investigating nurse practitioners in the private sector: a theoretically informed research protocol.

AIMS AND OBJECTIVES: To report a study protocol and the theoretical framework normalisation process theory that informs this protocol for a case study investigation of private sector nurse practitioners. BACKGROUND: Most research evaluating nurse practitioner service is focused on public, mainly acute care environments where nurse practitioner service is well established with strong structures for governance and sustainability. Conversely, there is lack of clarity in governance for emerging models in the private sector. In a climate of healthcare reform, nurse practitioner service is extending beyond the familiar public health sector. Further research is required to inform knowledge of the practice, operational framework and governance of new nurse practitioner models. DESIGN: The proposed research will use a multiple exploratory case study design to examine private sector nurse practitioner service. METHODS: Data collection includes interviews, surveys and audits. A sequential mixed method approach to analysis of each case will be conducted. Findings from within-case analysis will lead to a meta-synthesis across all four cases to gain a holistic understanding of the cases under study, private sector nurse practitioner service. Normalisation process theory will be used to guide the research process, specifically coding and analysis of data using theory constructs and the relevant components associated with those constructs. CONCLUSIONS: This article provides a blueprint for the research and describes a theoretical framework, normalisation process theory in terms of its flexibility as an analytical framework. RELEVANCE TO CLINICAL PRACTICE: Consistent with the goals of best research practice, this study protocol will inform the research community in the field of primary health care about emerging research in this field. Publishing a study protocol ensures researcher fidelity to the analysis plan and supports research collaboration across teams.

Promoting Bedside Nurse-Led Research Through a Dedicated Neuroscience Nursing Research Fellowship.

OBJECTIVE: We hypothesized that nurses would benefit from the fellowship model traditionally used to engage physicians in clinical research. The Neuroscience Nursing Research Center (NNRC) fellowship program was created as a model for engaging nurses at all levels of clinical practice to become active in clinical research. BACKGROUND: The NNRC was established in 2013 as a novel approach to promote bedside nurses as primary investigators in clinical research. METHODS: The NNRC developed 4 pathways to nursing research success: research fellowship, student-nurse internship, didactic training, and research consultation. RESULTS: Fellows have enrolled more than 900 participants in 14 studies. Nurses have presented more than 20 abstracts at 12 conferences and submitted 11 manuscripts for publication. The NNRC has provided research training to more than 150 nurses. CONCLUSIONS: The NNRC program is successful in engaging nurses in research. It shows promise to continue to develop nursing research that is applicable to clinicians and thus improve patient care.

Academic-Practice Partnerships: Driving and Supporting Educational Changes.

The 3 recognized missions of academic nursing-education, practice, and research-are not new. Yet, the continued separation of nursing education and service, with a lack of integration between schools of nursing and clinical practice, continues to be discussed as contributing to academic programs that produce graduates unready for clinical practice, research that does not adequately support clinical care needs, and isolation of both the nurse faculty from the clinical enterprise and clinicians from the education and research missions. Recently, academic-practice partnerships have been reemphasized as a concept and mechanism for supporting changes in nursing education and improving clinical care. This article highlights some of the driving forces behind the focus on academic-practice partnerships and summarizes 3 changes in education.

Educational Changes to Support Advanced Practice Nursing Education.

Educational factors limit the number of advanced practice registered nurse (APRN) graduates to meet the growing workforce demands. Healthcare dynamics are necessitating a shift in how nursing education envisions, creates, and implements clinical learning opportunities. The current clinical education model in APRN programs continues to be the same as it was 45 years ago when the student numbers were much smaller. New approaches in graduate nursing education are needed to address the shortage of APRNs in primary and acute care areas. Determining competency based on the number of clinical hours can be inefficient, ineffective, and costly and limits the ability to increase capacity. Little research exists in graduate nursing education to support the effectiveness and efficiency of current hours of clinical required for nurse practitioner students. Simulation and academic-practice partnership models can offer innovative approaches to nurse practitioner education for clinical training, with the goal of producing graduates who can provide safe, quality care within the complex practice-based environment of the nation's evolving healthcare system.

Trends in Perinatal Care and Implications for Frontline Nurse Leaders.

The perinatal trends presented in this article are based on recent topics from conferences, journals, the media, as well as from input from perinatal nurses. Trends in patient care are influenced by evidence known for decades, new research, emerging and innovative concepts in healthcare, patient and family preferences, and the media. Trends discussed in this article are rethinking the due date, birth outside the hospital setting, obstetric hospitalists as birth attendants, nitrous oxide for pain in childbirth, hydrotherapy and waterbirth in the hospital setting, delayed cord clamping, disrupters of an optimal infant microbiome, skin-to-skin care during cesarean surgery, and breast-sleeping and the breast-feeding dyad. In addition, the authors developed implications for perinatal nurses related to each trend. The goal is to stimulate reflection on evidence that supports or does not support current practice and to stimulate future research by discussing some of the current trends that may influence the care that perinatal nurses provide during the birthing year.

Contributions of the sandwich doctoral program to methodological approaches: an experience report. / Contribuições do programa de doutorado sanduíche nas abordagens metodológicas: relato de experiência.

Objective To share our experience on theoretical and methodological insights we have gained as researchers working together during the Sandwich Doctoral Program. Method This is a descriptive experience report. Results We have incorporated restoration thinking into a study on patient safety culture and will enhance knowledge translation by applying principles of deliberative dialogue to increase the uptake and implementation of research results. Conclusion Incorporating new approaches in Brazilian nursing research plays a key role in achieving international participation and visibility in different areas of nursing knowledge.

District nurses' perceptions of osteoporosis management: a qualitative study.

UNLABELLED: Underdiagnosis of osteoporosis is common. This study investigated Swedish district nurses' perceptions of osteoporosis management. They perceived the condition as having low priority, and the consequences of this perception were insufficient awareness of the condition and perceptions of bone-specific medication as unsafe. They perceived, though, competency when working with fall prevention. INTRODUCTION: Undertreatment of patients with osteoporosis is common. Sweden's medical care strategy dictates prioritisation of various conditions; while guidelines exist, osteoporosis is not prioritised. The aim of this study was to investigate district nurses' perceptions of osteoporosis management within Sweden's primary health care system. METHODS: Four semi-structured focus group interviews were conducted with 13 female district nurses. The interviews were analysed using thematic analysis. RESULTS: The overall theme was perceiving osteoporosis management as ambiguous. The themes were perceiving barriers and perceiving opportunities. These subthemes were linked to perceiving barriers: (i) insufficient procedures, lack of time and not aware of the condition; (ii) insufficient knowledge about diagnosis and about fracture risk assessment tools; (iii) low priority condition and unclear responsibility for osteoporosis management; and (iv) bone-specific medication was sometimes perceived to be unsafe. These subthemes were linked to perceiving opportunities: (i) professional competency when discussing fall prevention in home visit programs, (ii) willingness to learn more about osteoporosis management, (iii) collaboration with other professionals and (iv) willingness to identify individuals at high risk of fracture. CONCLUSIONS: Osteoporosis was reported, by the district nurses, to be a low-priority condition with consequences being unawareness of the condition, insufficient knowledge about bone-specific medications, fracture risk assessment tools and procedures. These may be some of the explanations for the undertreatment of osteoporosis. At the same time, the district nurses described competency performing the home visits, which emerged as an optimal opportunity to discuss fall prevention and to introduce FRAX with the aim to identify individuals at high risk of fracture.

State of the research on credentialing: the Institute of Medicine Standing Committee on Credentialing Research in Nursing.

This column is presented to report an update on the status of research on credentialing in nursing by the director of the Institute for Credentialing Research at the American Nurses Credentialing Center. The author presents an overview of the 5 meetings held to explore this topic and recommendations for further study.

The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial.

OBJECTIVE: To determine the clinical effectiveness and cost-effectiveness of nurse-led care (NLC) for people with rheumatoid arthritis (RA). METHODS: In a multicentre pragmatic randomised controlled trial, the assessment of clinical effects followed a non-inferiority design, while patient satisfaction and cost assessments followed a superiority design. Participants were 181 adults with RA randomly assigned to either NLC or rheumatologist-led care (RLC), both arms carrying out their normal practice. The primary outcome was the disease activity score (DAS28) assessed at baseline, weeks 13, 26, 39 and 52; the non-inferiority margin being DAS28 change of 0.6. Mean differences between the groups were estimated controlling for covariates following per-protocol (PP) and intention-to-treat (ITT) strategies. The economic evaluation (NHS and healthcare perspectives) estimated cost relative to change in DAS28 and quality-adjusted life-years (QALY) derived from EQ5D. RESULTS: Demographics and baseline characteristics of patients under NLC (n=91) were comparable to those under RLC (n=90). Overall baseline-adjusted difference in DAS28 mean change (95% CI) for RLC minus NLC was -0.31 (-0.63 to 0.02) for PP and -0.15 (-0.45 to 0.14) for ITT analyses. Mean difference in healthcare cost (RLC minus NLC) was £710 (-£352, £1773) and -£128 (-£1263, £1006) for PP and ITT analyses, respectively. NLC was more cost-effective with respect to cost and DAS28, but not in relation to QALY utility scores. In all secondary outcomes, significance was met for non-inferiority of NLC. NLC had higher 'general satisfaction' scores than RLC in week 26. CONCLUSIONS: The results provide robust evidence to support non-inferiority of NLC in the management of RA. TRIAL REGISTRATION: ISRCTN29803766.

Reflections on the added value of using mixed methods in the SCAPE study.

AIM: To reflect on the added value that a mixed method design gave in a large national evaluation study of specialist and advanced practice (SCAPE), and to propose a reporting guide that could help make explicit the added value of mixed methods in other studies. BACKGROUND: Recently, researchers have focused on how to carry out mixed methods research (MMR) rigorously. The value-added claims for MMR include the capacity to exploit the strengths and compensate for weakness inherent in single designs, generate comprehensive description of phenomena, produce more convincing results for funders or policy-makers and build methodological expertise. DATA SOURCES: Data illustrating value added claims were drawn from the SCAPE study. REVIEW METHODS: Studies about the purpose of mixed methods were identified from a search of literature. DISCUSSION: The authors explain why and how they undertook components of the study, and propose a guideline to facilitate such studies. CONCLUSION: If MMR is to become the third methodological paradigm, then articulation of what extra benefit MMR adds to a study is essential. The authors conclude that MMR has added value and found the guideline useful as a way of making value claims explicit. IMPLICATIONS FOR PRACTICE/RESEARCH: The clear articulation of the procedural aspects of mixed-methods research, and identification of a guideline to facilitate such research, will enable researchers to learn more effectively from each other.

Breaking from binaries - using a sequential mixed methods design.

AIM: To outline the traditional worldviews of healthcare research and discuss the benefits and challenges of using mixed methods approaches in contributing to the development of nursing and midwifery knowledge. BACKGROUND: There has been much debate about the contribution of mixed methods research to nursing and midwifery knowledge in recent years. DATA SOURCES: A sequential exploratory design is used as an exemplar of a mixed methods approach. The study discussed used a combination of focus-group interviews and a quantitative instrument to obtain a fuller understanding of women's experiences of childbirth. REVIEW METHODS: In the mixed methods study example, qualitative data were analysed using thematic analysis and quantitative data using regression analysis. DISCUSSION: Polarised debates about the veracity, philosophical integrity and motivation for conducting mixed methods research have largely abated. A mixed methods approach can contribute to a deeper, more contextual understanding of a variety of subjects and experiences; as a result, it furthers knowledge that can be used in clinical practice. CONCLUSION: The purpose of the research study should be the main instigator when choosing from an array of mixed methods research designs. Mixed methods research offers a variety of models that can augment investigative capabilities and provide richer data than can a discrete method alone. IMPLICATIONS FOR PRACTICE/RESEARCH: This paper offers an example of an exploratory, sequential approach to investigating women's childbirth experiences. A clear framework for the conduct and integration of the different phases of the mixed methods research process is provided. This approach can be used by practitioners and policy makers to improve practice.

Evaluation of time-varying and cumulative effects in nursing in a longitudinal study.

BACKGROUND: Traditional statistics in longitudinal data analysis are likely to be insufficient in nursing studies, in which the time varying characteristics of explanatory variables and cumulative effects require additional consideration. OBJECTIVES: The aims of this study were to introduce alternative longitudinal approaches for incorporating time-varying variables and cumulative effects, to discuss their strengths, and to highlight key issues that nursing researchers should recognize before and while undertaking such analyses. RESULTS: The three alternative models provide differing analytical outcomes based on the research focus. The baseline tracking model was used to estimate the stability effect of an intervention program, detecting risk factors early. The temporal sequence of potential cause and effect was incorporated further in the time-dependent model. The cumulative model was used to explore whether cumulative intervention effects existed. CONCLUSION: Nurse researchers should incorporate alternative methods into the longitudinal data analysis tools they commonly use when facing explanatory variables with time variations or cumulative effects on the variable being measured.

Infant health effects of a nurse-community health worker home visitation programme: a randomized controlled trial.

BACKGROUND: Home visiting is supported as a way to improve child health and development. Home visiting has been usually provided by nurses or community health workers (CHWs). Few studies compared the child health advantages of a nurse-CHW team approach over nurse prenatal and postnatal home visiting. METHODS: A randomized trial was conducted with Medicaid-insured pregnant women in Kent County, Michigan. Pregnant women were assigned to a team intervention including nurse-CHW home visitation, or standard community care (CC) including nurse home visitation. Morbidity was assessed in 530 infants over their first 12 months of life from medical claims and reported by the mother. RESULTS: There were no differences in overall child health between the nurse-CHW intervention and the CC arm over the first year of life. There were fewer mother-reported asthma/wheezing/croup diagnostics in the team intervention group among infants whose mothers have low psychosocial resources (13% vs. 27%, P = 0.01; adjusted OR = 0.4, P = 0.01). There were no differences in diagnosed asthma/wheezing/croup documented by medical claims. There were no differences in immunizations, hospitalizations and ear infections. CONCLUSIONS: There was no strong evidence that infant health was improved by the addition of CHWs to a programme of CC that included nurse home visitation. Targeting such interventions at common health problems of infancy and childhood or at diagnosed chronic conditions may prove more successful.

Comparison of methodologic quality and study/report characteristics between quantitative clinical nursing and nursing education research articles.

AIM: To compare the methodologic quality and study/report characteristics between quantitative clinical nursing and nursing education research articles. BACKGROUND: The methodologic quality of quantitative nursing education research needs to advance to a higher level. Clinical research can provide guidance for nursing education to reach this level. METHOD: One hundred quantitative clinical research articles from-high impact journals published in 2007 and 37 education research articles from high impact journals published in 2006 to 2007 were chosen for analysis. RESULTS: Clinical articles had significantly higher quality scores than education articles in three domains: number of institutions studied, type of data, and outcomes. CONCLUSION: The findings indicate three ways in which nursing education researchers can strengthen the methodologic quality of their quantitative research. With this approach, greater funding may be secured for advancing the science of nursing education.