Journal of Clinical Nursing

Goodman, Benny

doi: 10.1111/jocn.12862pmid: 25959932

Johnston, Bridget; Larkin, Philip; Connolly, Michael; Barry, Catriona; Narayanasamy, Melanie; Östlund, Ulrika; McIlfatrick, Sonja

doi: 10.1111/jocn.12791pmid: 25706903

Aims and objectives To report an integrative review of evidence relating to dignity‐conserving care in palliative care settings. It will also suggest avenues for future research. Background Research suggests that dignity is welcomed by those receiving palliative and end of life care. However, as dignity is a subjective term, it is not always explicit how this may be employed by nurses. Given that the preferred place of care for patients with palliative care needs is the home, the issue of dignity may be particularly important for community nurses. Therefore, synthesising evidence of dignity‐conserving care for community nurses caring for people with palliative care needs provides clarity in a complex area of palliative care research. Design Integrative literature review. Method The review involved key bibliographic and review databases CINAHL, MEDLINE, EMBASE, ASSIA and PsycInfo. Medical Subject Headings and free terms were undertaken for articles published from January 2009–September 2014 and retrieved papers were assessed against inclusion criteria. Final included articles were reviewed for reported dignity‐conserving care actions, which were classified under nine themes of the Dignity Model. Results Thirty‐one articles were included. Nine Dignity Model themes were used to classify care actions: Level of Independence; Symptom Distress; Dignity‐Conserving Perspectives; Dignity‐Conserving Practices; Privacy Boundaries; Social Support; Care Tenor; Burden to Others; and Aftermath Concerns. Reported care actions included listening, conveying empathy, communication and involving patients in care. Conclusion Care actions could be classified under most of Dignity Model themes. However, there were less reported care actions related to Level of Independence and Aftermath Concerns, which meant that these had to be formulated independently. Future research should be structured around these areas to determine appropriate care actions for nurses to give dignity‐conserving care that addresses these specific themes. Relevance to clinical practice Synthesising the available evidence of dignity‐conserving care identifies evidence‐based care actions and provides guidance to nurses in clinical practice caring for patients with palliative care needs. Future opportunities for research are identified to guide promotion of dignity in palliative care.

Sousa, Vanessa Emille Carvalho; Lopes, Marcos Venícios de Oliveira; Silva, Viviane Martins; Keenan, Gail M

doi: 10.1111/jocn.12815pmid: 25808159

Aims and objectives The purpose of this study was to identify the key clinical indicators of ineffective breathing pattern among paediatric patients. Background When nurses perform clinical reasoning, certain characteristics represent the clinical indicators necessary to confirm the presence of a particular diagnosis. Some quantitative studies have reported the prevalence of ineffective breathing pattern in different samples of patients. However, these findings should be synthesised. Design Meta‐analysis of quantitative nursing studies. Methods Studies were identified via systematic searches of CINAHL, LILACS, PubMed and Scopus using the key search terms ‘ineffective’, ‘breathing’ and ‘pattern’. Additional quality‐related inclusion criteria were gleaned from the Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy, the Standards for Reporting of Diagnostic Accuracy and the Quality Assessment of Diagnostic Accuracy Studies. The pertinent results from each study were extracted and analysed via meta‐analysis. Results Six studies using paediatric populations met the inclusion criteria. Summary measures indicated that the following defining characteristics had the highest accuracy values for ineffective breathing pattern among children: bradypnoea, dyspnoea, nasal flaring, orthopnoea, tachypnoea and the use of accessory muscles to breathe. Conclusion This meta‐analysis provides information regarding the accuracy of the clinical indicators of ineffective breathing pattern from studies sampling diverse paediatric populations. Relevance to clinical practice Nurses can better use clinical indicators to infer the presence of ineffective breathing pattern when they are aware of the most relevant defining characteristics. Nursing students and professionals can also improve their critical thinking abilities and diagnostic reasoning based on these findings.

Provenzi, Livio; Santoro, Elena

doi: 10.1111/jocn.12828pmid: 25850518

Aims and objectives To systematically review the experience of fathers of preterm infants hospitalised in the Neonatal Intensive Care Unit. Background Family‐centred care is more and more acknowledged in Neonatal Intensive Care Units, advocating for active engagement of both parents in the care journey. Nonetheless, fathers' Neonatal Intensive Care Unit experience has received limited research attention. Design Systematic review of qualitative studies. Methods Four electronic databases (CINHAL, ISI Web of Science, PubMed, Scopus) were explored and studies published between 2000–2014 were included. Preferred Reporting Item for Systematic Reviews and Meta‐analysis (PRISMA) and Joanna Briggs Institute (JBI) Critical Appraisal Tool for Qualitative Studies guidelines were adopted. Key themes were extracted and synthesised. Results Five main themes resuming fathers' experience of preterm birth and Neonatal Intensive Care Unit stay were identified from 14 studies. Themes were: emotional roller‐coaster, paternal needs, coping strategies, self‐representation and caregiving engagement. These dimensions were found to be dynamically shaped across three critical turning points: preterm birth, Neonatal Intensive Care Unit stay and at home. Conclusions Neonatal Intensive Care Unit fathers of preterm infants experience ambivalence, a set of different needs and coping strategies. They modify their self‐representations along the Neonatal Intensive Care Unit journey and needs specific nursing support and intervention to sustain caregiving engagement and transition to parenthood. Relevance to clinical practice A systematic and deepened understanding of preterms' fathers lived experience in Neonatal Intensive Care Unit would be helpful to inform nursing practice. Specific action priorities are suggested within the frame of family‐centred care.

Hochner, Hagit; Tenfelde, Sandi M; Abu Ahmad, Wiessam; Liebergall‐Wischnitzer, Michal

doi: 10.1111/jocn.12836pmid: 25850885

Aims and objectives The aims of this systematic review and meta‐analysis were to summarise current knowledge regarding gum chewing intervention for activation of the gastrointestinal (GI) system following caesarean delivery. Background GI symptoms such as nausea, vomiting and defecatory difficulties are bothersome for women following a caesarean delivery. There is category A recommendation to not withhold oral intake postoperatively. However, current practice guidelines vary widely on time to initiate oral feeding post caesarean delivery, and additional research is needed. Gum chewing has been shown to stimulate the GI system in other postoperative patient populations. Design A systematic review and meta‐analysis. Methods An electronic review was undertaken using the following resources: PubMed (Medline), CINAHL, EMBASE and ClinicalTrials.gov databases. Key words used in various combinations included cesarean section; cesarean delivery; postoperative chewing gum; bowel movement; bowel function and complications. Results A total of 171 articles were found of which 166 were excluded: 157 were duplicates and the remainder did not meet the inclusion criteria. Five randomised control trials were included in the meta‐analysis, focusing on gum chewing as an intervention as compared with a nongum chewing intervention, with a total of 846 participants. Compared with the nongum chewing group, gum chewing showed a beneficial impact on the major outcomes of digestive system activation, including bowel sound, gas passage and defecation. Conclusions This meta‐analysis supports the effectiveness of gum chewing post caesarean delivery as a noninvasive/nonpharmacological intervention for reactivation of bowel movement. Relevance to clinical practice Gum chewing in the immediate postoperative period following caesarean delivery may provide a socially acceptable, low‐cost and safe intervention to reduce postcaesarean delivery GI complications and restore GI function.

Oh, HyunSoo; Lee, Seul; Kim, JiSun; Lee, EunJu; Min, HyoNam; Cho, OkJa; Seo, WhaSook

doi: 10.1111/jocn.12778pmid: 25665020

Aims and objectives This study was conducted to develop a family relocation stress scale by modifying the Son's Relocation Stress Syndrome Scale, to examine its clinical validity and reliability and to confirm its suitability for measuring family relocation stress. Background The transfer of ICU patients to general wards is a significant anxiety‐producing event for family members. However, no relocation stress scale has been developed specifically for families. Design A nonexperimental, correlation design was adopted. Methods The study subjects were 95 family members of 95 ICU patients at a university hospital located in Incheon, South Korea. Face and construct validities of the devised family relocation stress scale were examined. Construct validity was examined using factor analysis and by using a nomological validity test. Reliability was also examined. Results Face and content validity of the scale were verified by confirming that its items adequately measured family relocation stress. Factor analysis yielded four components, and the total variance explained by these four components was 63·0%, which is acceptable. Nomological validity was well supported by significant relationships between relocation stress and degree of preparation for relocation, patient self‐care ability, family burden and satisfaction with the relocation process. The devised scale was also found to have good reliability. Conclusions The family relocation stress scale devised in this study was found to have good validity and reliability, and thus, is believed to offer a means of assessing family relocation stress. Relevance to clinical practice The findings of this study provide a reliable and valid assessment tool when nurses prepare families for patient transfer from an ICU to a ward setting, and may also provide useful information to those developing an intervention programme for family relocation stress management.

Wärdig, Rikard; Bachrach‐Lindström, Margareta; Hultsjö, Sally; Lindström, Torbjörn; Foldemo, Anniqa

doi: 10.1111/jocn.12782pmid: 25664402

Aims and objectives To describe how persons with psychosis perceive participation in a lifestyle intervention, and use these perceptions to present factors to for consideration in future interventions. Background Metabolic syndrome is common in persons with psychosis. A healthy lifestyle is the primary option for preventing and treating metabolic syndrome, which is why the importance of lifestyle interventions has come into focus among health care professionals. Identifying perceptions of participation in a lifestyle intervention can increase the understanding of how to design future interventions. Design A qualitative, phenomenographic approach was selected, using semi‐structured interviews. Methods The sample consisted of 40 participants with a psychotic disorder, who had undergone a lifestyle intervention focusing on theoretical education in healthy eating and physical activities. The interviews were conducted in 2011 and 2012, six to seven months after the intervention had been completed. Results The findings comprise three categories that emphasise the need for a moderate intervention level that facilitates participation and thereby social interactions among group members. The experience of success in the intervention supported the perception of oneself as a capable individual. However, it could also be the opposite, another experience of failure. Conclusion Content in moderation can facilitate participation, and participants can thereby achieve health benefits and find social contacts. In addition to physical activity and lifestyle habits, interventions should have a social focus and be continuous. Professional support is a prerequisite and should facilitate the participants' ability to mirror themselves against healthy people in society by introducing activities that ordinary people do. Relevance for clinical practice Identifying perceptions of participation in a lifestyle intervention can increase the understanding of how to design and manage future interventions. This is also an aspect that is important to consider in everyday clinical practice.

Forsberg, Angelica; Vikman, Irene; Wälivaara, Britt‐Marie; Engström, Åsa

doi: 10.1111/jocn.12793pmid: 25737070

Aims and objectives To explore orthopaedic and general surgery patients' perceptions of their postoperative recovery for one month. Background In general, nursing research in the postoperative context has been directed towards a single symptom or area, which is valuable. However, there is a lack of studies of orthopaedic and general surgery patients' perceptions of postoperative recovery from a short‐term perspective. Design A quantitative approach with a longitudinal design was used. Methods A total of 180 patients participated in the study. Data were collected using a standardised questionnaire, the Postoperative Recovery Profile, for self‐assessment of recovery. Descriptive statistics reported as proportions were used for the categorical variables. Analytic statistics were used to identify statistically significant differences. Mean values and t‐tests were used for quantity variables, and Mann–Whitney U‐tests and Chi‐squared tests were used for nonparametric variables. Results Overall, the orthopaedic patients were substantially less recovered than the general surgery patients. Two‐thirds of the orthopaedic patients and half of the general surgery patients perceived severe or moderate pain in the acute recovery phase. Within the general surgery group, there were significant differences in the recovery between the Gastric Bypass patients and colon/ileum surgery patients. The gastric bypass patients were overall more recovered than the other groups of patients. The Gastric Bypass patients reported that they had improved after one month compared to their own status prior to surgery. Conclusions and relevance to clinical practice Nursing support for orthopaedic patients must be improved, especially after they are discharged from the hospital. To structure and monitor individual recovery, a top‐five priority profile of the most important problems should be used during follow‐up calls after the patient is discharged from the hospital. Postoperative pain continues to represent a clinical problem that requires attention. Heterogeneity in the perceptions of recovery within the general surgery group was indicated, which may depend on the surgical procedure as well as the patients' expectations and comparisons with their lives before surgery. Rather than return to their preoperative levels, certain patients tend to continue towards a new or different life postoperatively.

Law, Bernice Yee‐Shui; Chan, Engle Angela

doi: 10.1111/jocn.12805pmid: 25753769

Aims and objectives To explore the process of learning to speak up in practice among newly graduated registered nurses. Background Speaking up is an important aspect of communication to ensure patient safety within a healthcare team. However, nurses have reported being hesitant about speaking up or being unable to be heard, despite adopting various safety tools. A power differential could be a factor in their hesitation to speak up. While a large number of new graduates are employed in the lower rungs of the hospital hierarchy to resolve local and global nursing shortages, the process of their learning to speak up remains under‐explored. Design The narrative concept of experience is addressed through the three‐dimensional space of a narrative inquiry. Methods Eighteen new graduates were recruited. Stories of experiences of speaking up emerged naturally during repeated unstructured interviews and ongoing email conversations with three participants. Results The complex process of learning to speak up is schematically represented. Three interrelated narrative threads were identified: (1) learning to speak up requires more than one‐off training and safety tools, (2) mentoring speaking up in the midst of educative and miseducative experiences and (3) making public spaces safe for telling secret stories. Conclusions Speaking up requires ongoing mentoring to see new possibilities for sustaining professional identities in the midst of miseducative experiences under the potential shaping of the Chinese culture and generational differences. Appreciative inquiry might be a new approach that can be used to promote positive cultural changes to encourage newly graduated registered nurses to learn to speak up to ensure patient safety. Relevance to clinical practice Cultivating a safe and open culture of communication and mentoring new graduates to speak up will benefit patient safety now and in the future by helping to retain committed patient advocates who could mentor future generations.

Su, Mei‐Chen; Lin, Hung‐Ru; Chu, Nain‐Feng; Huang, Chih‐Hsung; Tsao, Lee‐Ing

doi: 10.1111/jocn.12806pmid: 25753923

Aims and objectives To develop a descriptive theory for the weight loss experiences of obese perimenopausal women with metabolic syndrome. Background Obesity and metabolic syndrome both pose a threat to the health of perimenopausal women; therefore, understanding perimenopausal women's subjective feelings and experiences is beneficial to establishing effective prevention strategies. However, studies have rarely explored these relevant experiences. Design A qualitative study using the grounded theory method to establish a descriptive theory. Methods Eighteen obese perimenopausal women with metabolic syndrome aged 45–60 years participated in comprehensive interviews. Results ‘Crossing the gaps to making life modifications’ was the core category, and ‘the awareness of weight gain and health alarm’ was the antecedent condition. In the weight loss experience, the following three interaction categories were identified: (1) ‘experiencing bad feelings,’ (2) ‘encountering obstacles’ and (3) ‘making efforts to transition to a new life.’ Some women adhered to new life habits through perceiving social support and by using self‐incentives. Finally, women enjoyed and mastered self‐monitoring of their health in their new life, and practiced new changes as part of their life. However, some participants felt that making changes to their life was too time‐consuming. Therefore, these women chose to live with their abnormal health without making changes. Conclusions Obese perimenopausal women with metabolic syndrome experienced various gaps in their weight loss process. Although they struggled with many obstacles, these women were able to learn from their experiences and face their health challenges. Relevance to clinical practice These findings can guide healthcare professionals to provide appropriate interventions to understand the hidden health problems of this particular group of women. Healthcare professionals should develop a set of plans by which women receive a complete weight loss program and support from professionals and family.