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AnteayerJournal of Nursing Scholarship

Challenges, Coping, and Resilience Among Immigrant Parents Caring for a Child With a Disability: An Integrative Review

Abstract

Purpose

The aim of this integrative review is to synthesize quantitative and qualitative research evidence on challenges in caring for a child with a disability among immigrant parents and to understand their coping strategies and resiliency factors associated with their coping.

Methods

A comprehensive literature search was conducted to identify relevant studies from the following databases: MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, PsycINFO, Social work abstract, Cochrane library, and EMBASE.

Findings

This review included 25 studies: 1 quantitative, 23 qualitative, and 1 narrative review. The main challenges that parents faced were language barriers, financial hardships, service utilization challenges, poor adaptation to new culture, stigma related to mental illness, discrimination, and social isolation. This review found poor communication and lack of cultural awareness among some healthcare professionals. Immigrant parents used problem‐focused coping, avoidance coping, spiritual coping, and social support to manage their challenges. Parents who received social, emotional, and instrumental support were more resilient. Personality traits and faith were protective factors that enhanced resilience.

Conclusions

When immigration and disability are considered concurrently, the burden of care multiplies. Immigrant parents with children who have disabilities faced extra challenges related to adaptation, finance, service utilization, and stigma. Healthcare providers can play an important role in aiding these parents in service utilization and adaptation.

Significance

This review adds new knowledge on immigrant parents’ challenges in caring for their children with disabilities. Such knowledge could help health professionals to develop supportive interventions to enhance parental coping and resilience.

Clinical Relevance

Culturally appropriate and sensitive communication and care provided by healthcare providers can facilitate service utilization and reduce perceived stigma. Special training provided to healthcare providers regarding the challenges of these families may enhance awareness. Information support and parental support groups may help to enhance parental coping and reduce isolation. An interpreting service should be provided in all aspects of care.

Postdoctoral Nurses’ Experiences With Leadership and Career Development: A Qualitative Study

Abstract

Purpose

The purpose of this study was to explore the experiences and perceptions of Dutch postdoctoral nurses working in research with leadership and career development.

Methods and Design

A generic explorative qualitative design with semistructured in‐depth interviews was used. A criterion sample of 13 postdoctoral nurses working in research in the Netherlands was included. The data were analyzed using thematic analysis.

Findings

Three themes were identified: (a) developing leadership and identity as a PhD nurse, (b) becoming a valuable member in the scientific world of academe, and (c) continuous search for progression while balancing worlds and tasks. Postdoctoral nurses experienced their leadership and professional development as a serious and conscious process. Their vision of nursing, health care, and research was an important motive regarding future career choices. Although the scientific world of academe was perceived as honorable, the nurses experienced it as a complex work environment. All the postdoctoral nurses had to deal with the demands and pressures of the scientific world. Coping with the tension between enjoying work and handling high workloads and academic achievements was described as challenging. Searching for balance was important, especially because of the different part‐time employment or working activities with various commitments.

Conclusions

This study demonstrates that postdoctoral nurses do show considerable progression in their leadership and career development; however, they experience the scientific working environment as challenging. The findings of this study indicate the need for more academic positions, the strengthening of the infrastructure for nursing research, and the development of supportive leadership and mentoring programs for postdoctoral nurses to provide optimal evidence‐based and high‐quality care for patients.

Clinical Relevance

Postdoctoral nurses need to develop strong leadership competencies to strengthen research, education, and evidence‐based practice in clinical care to improve patient and healthcare outcomes.

Role of Coping Styles in the Relationship Between Nurses’ Work Stress and Well‐Being Across Career

Abstract

Objectives

This study examines the mediating role of stress coping styles—problem‐focused coping and emotion‐focused coping—on the relationship between work stress and psychological well‐being in clinical nurses according to career experience.

Methods

A cross‐sectional survey design was used. Data were collected from February to March 2016. The study population was composed of 399 nurses working at two university hospitals with over 500 beds located in Seoul and Gyeonggi‐do in South Korea. Self‐report questionnaires were administered to measure work stress (Work Stress Scale), stress coping styles (Korean version of The Ways of Coping Checklist Scale), and psychological well‐being (Ryff’s Psychological Well‐being Scale). A multiple‐group path analysis was performed using SPSS version 21.0.

Results

In the path model analysis (N = 399), work stress directly influenced psychological well‐being. Both problem‐focused coping and emotion‐focused coping were indirectly influenced in the relationship between work stress and psychological well‐being. In the group of nurses with 3 years or less of career experience (n = 202), work stress was significantly related to psychological well‐being. Only emotion‐focused coping exerted a partial mediating effect on the relationship between work stress and psychological well‐being. On the other hand, in the group of nurses with over 3 years of career experience (n = 197), work stress was not significantly related to psychological well‐being. Both problem‐focused coping and emotion‐focused coping exerted a full mediating effect on the relationship between work stress and psychological well‐being.

Conclusions and Clinical Relevance

This study’s path analysis displayed a distinct pathway in the relationships among work stress, stress coping styles, and psychological well‐being between nurses with 3 years or less and nurses with over 3 years of experience. The intervention with decreasing work stress and emotion‐focused coping could be effective for nurses with less career experience, whereas the intervention with focusing on improving emotion‐ and problem‐focused coping could be effective for nurses with more career experience. The practical implications of the results suggest that nurses need different stress management programs according to their career experience, as the appropriate use of stress coping styles would improve the psychological well‐being of nurses as influenced by their work stress.

Effectiveness of a Social Media–Based, Health Literacy–Sensitive Diabetes Self‐Management Intervention: A Randomized Controlled Trial

Abstract

Aims

The purpose of the study was to evaluate the effects of a social media–based, health literacy–sensitive diabetes management intervention on patient activation, self‐care behaviors, and glucose control compared to telephone‐based, health literacy–sensitive diabetes management intervention and usual care. Additionally, this study aimed to identify how patient health literacy influenced the effectiveness of health literacy–sensitive diabetes management interventions.

Design

3 (treatment condition) × 2 (health literacy level) randomized factorial trial.

Methods

In total, 151 patients diagnosed with type 2 diabetes were randomly assigned to the social media–based or telephone‐based, health literacy–sensitive diabetes management interventions or the usual care control. The health literacy–sensitive diabetes management intervention consisted of an initial face‐to‐face diabetes nurse education using easy‐to‐read educational materials, the teach‐back method, and eight weekly action‐planning sessions guided with the use of social media or phone calls for each group.

Findings

Patients with high health literacy at the 9‐week follow‐up showed higher levels of patient activation than those with low health literacy in the control group, but the effect of health literacy was no longer significant when patients were provided with social media–based or telephone‐based interventions. Patients who received the telephone‐based, health literacy–sensitive diabetes management intervention had a significantly higher score for self‐care behaviors than the usual care control group at 9 weeks’ follow‐up. No other effects for self‐care behaviors or glycated hemoglobin were significant at follow‐up.

Conclusions

The social media–based, health literacy–sensitive diabetes management intervention was effective at mitigating the disadvantages faced by people with low health literacy when attempting to improve self‐care activation.

Clinical Relevance

Social media–based self‐management interventions accommodating low health literacy have the potential to help people overcome their disadvantages associated with low health literacy.

Accuracy of Body Weight Estimation Among Palestinian Refugee Adolescents Living in Jordan: A Cross‐Sectional Study

Abstract

Purpose

We aimed to examine the prevalence of obesity among adolescents living in a refugee camp in Jordan and analyze the factors influencing their weight perceptions.

Design

Cross‐sectional survey.

Methods

We examined the body weight perception, and the influence of psychological, cultural, and social factors, among Palestinian refugee adolescents living in Jordan using a cross‐sectional survey. Univariate, bivariate, and multiple logistic regression analyses were used to investigate the relationships between body weight status, weight perception, satisfaction with weight, screen time, and depression status of these adolescents.

Results

A total of 620 adolescents participated in the study, of which 24% were either overweight or obese. Overweight or obese adolescents were more likely to underestimate their weight (p < .001), while those with depressive symptoms (Patient Health Questionnaire for Adolescents score > 14), were more likely to overestimate their body weight (p = .021). Having symptoms indicative of depression (adjusted odds ratio [AOR] = 1.70; 95% confidence interval [CI] = 1.16–2.50) and having a body mass index in the overweight/obese range (AOR = 4.16; 95% CI = 2.73–6.35) were predictors of discordant weight perception.

Conclusions

This study showed that excess body weight is a significant issue among Palestinian refugee adolescents living in a refugee camp in Jordan. Underlying depression is an important factor in excess weight and distorted weight perceptions especially among this vulnerable group.

Clinical Relevance

The study highlights the importance of addressing discordant body weight perception and depression in weight management in nursing interventions for vulnerable adolescent groups.

The Regenerative Horizon: Opportunities for Nursing Research and Practice

Abstract

Background

Regenerative technologies aim to restore organ form and function. Technological advances in regenerative treatments have led to patients increasingly seeking these therapies. The readiness of nursing to fully contribute to this emerging healthcare field is uncertain.

Purpose

The goal of this discipline‐oriented overview is to enhance awareness in the nursing community regarding regenerative science, and to provide suggestions for nursing research contributions and practice implications.

Methods

Evolving and applied cutting‐edge therapies, such as regenerative immunotherapies with chimeric antigen receptor expressing T lymphocytes, are highlighted in the context of emerging opportunities for nurses in practice and research.

Discussion

Next generation nurses will increasingly be at the forefront of new therapies poised to make chronic illnesses curable, thus restoring health and function to diverse groups of individuals.

Clinical Relevance

The regenerative care model imposes on the nursing community the imperative to (a) increase research awareness; (a) educate, develop, and deploy a skilled nursing workforce; (c) integrate regenerative technologies into nursing practice; and (d) embrace the regenerative technologies horizon as a future in health care.

The Use of Technology to Support Precision Health in Nursing Science

Abstract

Purpose

This article outlines how current nursing research can utilize technology to advance symptom and self‐management science for precision health and provides a roadmap for the development and use of technologies designed for this purpose.

Approach

At the 2018 annual conference of the National Institute of Nursing Research (NINR) Research Centers, nursing and interdisciplinary scientists discussed the use of technology to support precision health in nursing research projects and programs of study. Key themes derived from the presentations and discussion were summarized to create a proposed roadmap for advancement of technologies to support health and well‐being.

Conclusions

Technology to support precision health must be centered on the user and designed to be desirable, feasible, and viable. The proposed roadmap is composed of five iterative steps for the development, testing, and implementation of technology‐based/enhanced self‐management interventions. These steps are (a) contextual inquiry, focused on the relationships among humans, and the tools and equipment used in day‐to‐day life; (b) value specification, translating end‐user values into end‐user requirements; (c) design, verifying that the technology/device can be created and developing the prototype(s); (d) operationalization, testing the intervention in a real‐world setting; and (e) summative evaluation, collecting and analyzing viability metrics, including process data, to evaluate whether the technology and the intervention have the desired effect.

Clinical Relevance

Interventions using technology are increasingly popular in precision health. Use of a standard multistep process for the development and testing of technology is essential.

Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care

Abstract

Purpose

To analyze the literature on advance care planning (ACP) in primary care through the lens of implementation science, with a focus on implications for rural settings.

Design

Scoping review of the literature.

Methods

The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PsycINFO, and the Psychology and Behavioral Sciences Collection databases were searched for studies related to ACP adoption and implementation in primary care. The Theoretical Domains Framework was used to map the literature to 14 determinants that serve as barriers or facilitators to ACP. The Conceptual Model of Evidence‐Based Practice Implementation in Public Service Sectors was used to analyze the stage of implementation for each of the included studies.

Findings

Four steps to ACP were specified: identification, conversation, documentation, and follow‐up. Determinants were identified for each step, but studies largely focused on the conversation step. Professional role and identity, environmental context and resources, and emotion were the most frequently cited determinants in initiating conversations. The identification step was largely determined by behavioral regulation. For documenting ACP, environmental context and resource determinants were most prevalent. In the few studies that addressed follow‐up, providers expressed a desire for electronic reminders as a behavioral regulator to follow‐up.

Conclusions

While ACP has been shown to have patient, family, and societal benefits, its uptake in primary care has been minimal. Because ACP is a complex process that is highly context dependent, implementation science is critical to inform its successful adoption and implementation. Smaller healthcare networks, adaptable professional roles, trusted relationships, and tight‐knit community might be important facilitators of ACP in rural primary care.

Clinical Relevance

Findings from this study can be used to accelerate ACP implementation in rural primary care.

Power Distance and Physician–Nurse Collegial Relations Across 14 European Countries: National Culture is Not Merely a Nuisance Factor in International Comparative Research

Abstract

Purpose

This study illustrates the huge untapped potential of quantifying the impact of culture in making meaningful comparisons across groups. Our focus is on cross‐national differences in nurses' reports of their relations with physicians, and how the measurement of this complex construct and the evaluation of true differences are related to dimensions of national culture.

Design

We examine across 14 European countries the association between indices of national culture from the seminal work of Hofstede and 39,435 nurses' ratings of their relations with physicians. Multilevel confirmatory factor analysis was used to evaluate strong factorial invariance across countries and to examine the influence of power distance and masculinity.

Findings

There was wide variation across countries in nurses' reports of their relations with physicians. Strong factorial invariance was shown for a one‐factor model, which confirmed that across countries the seven survey items measure a common factor of physician‐nurse relations. This model showed no country bias for any of the seven survey items, which suggests that differences across countries reflect true differences. These true differences were significantly associated with variation in country values of power distance, which showed a significant negative correlation with physician–nurse relations.

Conclusions

Continuously pursuing a better understanding of characteristics that impact the studied indicators, such as national culture, is elementary to better understand the construct under study. In this application, country values of power distance negatively impacted nurse‐reported relations with physicians, which strongly varied across countries.

Clinical Relevance

Better nurse‐reported relations between nurses and physicians link to higher nurse job satisfaction, lower emotional exhaustion, better nurse‐perceived quality of care, and lower patient mortality. The Practice Environment Scale of the Nursing Work Index is an excellent instrument to characterize variation in working relations between nurses and physicians as well as physicians' professional posture towards nurses.

Update on Research and Practices in Major Sleep Disorders: Part II—Insomnia, Willis‐Ekbom Disease (Restless Leg Syndrome), and Narcolepsy

Abstract

Purpose

This review (Part II of a series on sleep disorders) presents an update of the characteristics, epidemiology, assessment, and latest management of insomnia, restless legs syndrome (Willis‐Ekbom disease; RLS/WED), and narcolepsy. Insomnia, the most common sleep disorder and most prevalent of all psychological health disorders, is a problem of difficulty initiating and maintaining sleep and early morning awakenings. RLS/WED is characterized by a crawling sensation or urge to move the legs in the evening and nighttime. Narcolepsy is a sleep disorder that commonly results in chronic daytime sleepiness and cataplexy. Nonpharmacological management, which includes education, cognitive behavioral therapy, and complementary therapy, is used as primary or adjunctive to pharmacotherapy for the treatment of these disorders.

Methods

This narrative review utilized medical databases such as PubMed to identify relevant English‐language original and systematic review articles predominantly from peer‐reviewed journals from 2012 to 2019. However, as background, findings from classic articles prior to 2012 were also included.

Clinical Relevance

Assessment of sleep problems, excessive sleepiness, and difficulty performing activities or being productive should be routine in the care of all patients. Utilization of behavioral interventions, including cognitive behavioral therapy, in addition to education and sleep hygiene, can promote sleep quality. Management of insomnia, RLS/WED, and narcolepsy should include helping patients adjust to treatment, managing cataplexy triggers in narcolepsy, and initiating strategies to live with chronic illness to improve quality of life.

Relational‐Level Factors Influencing Suicidal Behaviors Among Korean Adolescents

Por: Dabok Noh

Abstract

Purpose

To identify relational‐level risk and protective factors for suicidal ideation, suicide plan, and suicide attempt in a nationally representative sample of Korean adolescents.

Study Design

This study is a secondary data analysis of cross‐sectional national data on Youth Health Behavior collected in June 2017. The final sample (n = 62,276), collected from 2,400 classes in 800 schools, reflects stratification, clustering, and weight. It is representative of the population (n = 3,027,488).

Methods

This study used relational factor variables, including experiences of assault, living with family or not, and adolescents’ confidants. Dependent variables included suicidal ideation, suicide plan, and suicide attempt. This study used logistic regression analyses on the complex sample to examine relational‐level risk and protective factors for suicidal ideation, plan, and attempt.

Findings

The adjusted logistic regression models found that experiences of assault, living with family or not, and adolescents’ confidants were all significantly associated with suicidal ideation, plan, and attempt. In particular, 35.3% of victims had thought about suicide seriously, and victims of assault were approximately eight times more likely to attempt suicide compared to nonvictims.

Conclusions

The experience of assault by others was found to be a strongly associated risk factor for suicidal behaviors in adolescents. Living with family and the presence of confidants to talk with were found to be protective factors against suicidal behaviors. To be specific, talking with parents about personal worries and troubles was more protective against suicidal behaviors than talking with a sibling, friend, or teacher.

Clinical Relevance

Nurses should provide crisis intervention for symptoms of trauma and suicidal behaviors among assault victims. Suicide prevention efforts should focus more on adolescents not living with family. They should also aim to enhance adolescents’ family interactions. Encouraging adolescents to talk with their parents may mitigate the effects of risk factors on suicidal behaviors.

Journal of Nursing Scholarship: How Are We Doing?

Journal of Nursing Scholarship, Volume 51, Issue 5, Page 499-499, September 2019.

Update on Research and Practices in Major Sleep Disorders: Part I. Obstructive Sleep Apnea Syndrome

Abstract

Purpose

The purpose of this first of two review articles providing an update on sleep disorders was to examine the pathophysiology, epidemiology, and treatment of obstructive sleep apnea (OSA). OSA is a common sleep disorder whose prevalence is similar to asthma. As with other sleep disorders, OSA has a broad impact on individuals, affecting their daily behaviors, cognitive abilities, and performance, and putting them at increased risk for accidents, mood disorders, cancer, cardiovascular disease, and hypertension. Thus, early recognition and management, much of which can be implemented by nurses, can reduce health and accident risks and improve daily functioning.

Methods

This narrative review utilized medical databases such as PubMed to identify relevant English language original and systematic review articles predominantly from peer‐reviewed journals from 2012 to 2018. However, as background, findings from classic articles prior to 2012 were also included.

Clinical Relevance

OSA is a common condition with considerable impact on daily functioning and potential for accidents and serious comorbidities such as hypertension, cardiovascular disease, diabetes, and depressed mood. The impairments and comorbidities associated with OSA can be reduced through early detection, encouraging treatment, providing education about sleep and OSA, and, importantly, promoting adherence to the predominant therapy, positive airway pressure.

Issue Information

Journal of Nursing Scholarship, Volume 51, Issue 5, Page 497-498, September 2019.

Nurses’ Role in Implementing and Sustaining Acute Telemedicine: A Mixed‐Methods, Pre‐Post Design Using an Extended Technology Acceptance Model

Abstract

Purpose

Technology‐based systems like telemedicine are frequently being implemented into healthcare settings, impacting clinician practices. Little is known about factors influencing acute telemedicine uptake, if factors differ across time, or between nurses and non‐nurses.

Design

A mixed‐methods, pre‐post design with implementation of a new acute stroke telemedicine service.

Methods

A survey based on an extended Technology Acceptance Model (TAM) was administered to clinicians involved in acute stroke care at 16 regional hospitals (2014–2017). Open‐ended questions postimplementation (at 6 months) included strengths of the program and areas to improve. Subsequently, a secondary analysis of nurses’ semistructured interviews at the first telemedicine site (2010–2011) was completed to provide greater explanatory detail.

Findings

Surveys were completed by nurses (preimplementation n = 77, postimplementation n = 92) and non‐nurses (pre n = 90, post n = 44). Preimplementation, perceived usefulness was the only significant predictor of intending to use telemedicine for nurses, while perceived ease of use and social influence were significant for non‐nurses. Postimplementation, perceived usefulness was significant for both groups, as was facilitating conditions for nurses. Specific examples aligned to TAM categories from our detailed interviews (n = 11 nurses) included perceived usefulness (improved clinical support and patient care), perceived ease of use (technical, clinical aspects), facilitating conditions (setting, education, confidence), and social influence (working relationships).

Conclusions

Important factors for acute stroke telemedicine varied between nurses and non‐nurses, and changed after implementation. The benefits of telemedicine should be emphasized to nurses. Preimplementation, more non‐nurses wanted systems to be easy. Support in clinical, technical, and relationship aspects of telemedicine consultations is required.

Clinical Relevance

Nurses are influential in implementing acute telemedicine, which is complex, with clinical and technical aspects entwined. Evidence‐based implementation strategies must be tailored over time, and between nurses and non‐nurses, to ensure initial uptake and ongoing use.

Implementation Science Training and Resources for Nurses and Nurse Scientists

Abstract

Purpose

The purpose of this article is to describe the differences between quality improvement and implementation science, the urgency for nurses and nurse scientists to engage in implementation science, and international educational opportunities and resources for implementation science.

Organizing Construct

There is a push for providing safe, effective, patient‐centered, timely, efficient, and equitable health care. Implementation science plays a key role in adoption and integration of evidence‐based practices to improve quality of care.

Methods

We reviewed implementation science programs, organizations, and literature to analyze the roles of nurses and nurse scientists in translating evidence into routine practice.

Findings

Implementation‐trained nurses and nurse scientists are needed as part of multidisciplinary teams to advance implementation science because of their unique understanding of contextual barriers within nursing practice. Likewise, nurses are uniquely qualified for recognizing what implementation strategies are needed to improve nursing care across practice settings.

Conclusions

Many international clinical and training resources exist and are supplied to aid interested readers in learning more about implementation science.

Clinical Relevance

Half of research evidence never reaches the clinical setting, and the other half takes 20 years to translate into clinical practice. Implementation science‐trained nurses are in a position to be excellent improvers for meaningful change in practice.

Adaptation and Implementation of a Family Caregiver Skills Training Program: From Single Site RCT to Multisite Pragmatic Intervention

Abstract

Purpose

We describe an approach to rapidly adapt and implement an education and skills improvement intervention to address the needs of family caregivers of functionally impaired veterans—Helping Invested Families Improve Veterans’ Experience Study (HI‐FIVES).

Design

Prior to implementation in eight sites, a multidisciplinary study team made systematic adaptations to the curriculum content and delivery process using input from the original randomized controlled trial (RCT); a stakeholder advisory board comprised of national experts in caregiver education, nursing, and implementation; and a veteran/caregiver engagement panel. To address site‐specific implementation barriers in diverse settings, we applied the Replicating Effective Programs implementation framework.

Findings

Adaptations to HI‐FIVES content and delivery included identifying core/noncore curriculum components, reducing instruction time, and simplifying caregiver recruitment for clinical settings. To enhance curriculum flexibility and potential uptake, site personnel were able to choose which staff would deliver the intervention and whether to offer class sessions in person or remotely. Curriculum materials were standardized and packaged to reduce the time required for implementation and to promote fidelity to the intervention.

Conclusions

The emphasis on flexible intervention delivery and standardized materials has been identified as strengths of the adaptation process. Two key challenges have been identifying feasible impact measures and reaching eligible caregivers for intervention recruitment.

Clinical Relevance

This systematic implementation process can be used to rapidly adapt an intervention to diverse clinical sites and contexts. Nursing professionals play a significant role in educating and supporting caregivers and care recipients and can take a leading role to implement interventions that address skills and unmet needs for caregivers.

Facilitators and Barriers to Adoption of a Healthy Diet in Survivors of Colorectal Cancer

Abstract

Purpose

Adherence to dietary guidelines and consumption of a high‐quality diet are essential to rebuild strength and to decrease tumor recurrence and mortality in patients with colorectal cancer. We examined the associations of the diet quality of patients who have colorectal cancer with the characteristics of the patients and their families, the patient's perceived barriers to following the diet, and the family's attempts to change the diet.

Design

A cross‐sectional study design was employed. Patients with colorectal cancer were recruited from National University Hospitals in South Korea. Enrolled patients were over 19 years old. Enrolled relatives served as the primary caregivers of the patients.

Methods

A total of 216 patients who had colorectal cancer and their family caregivers were enrolled. We assessed patients’ diet quality, their perceived barriers to following the dietary plan, and family caregivers’ attempts to improve diet quality.

Findings

Patients with colorectal cancer were less likely to have healthy eating habits if they perceived barriers to the recommended dietary plan, and more likely to have healthy eating habits if they had family caregivers who attempted to change their own dietary habits.

Conclusions

Strategies that target patients’ perceived barriers to following a healthy diet and that encourage family members to facilitate the adoption of a healthy diet can be integrated into the treatment plan of patients with colorectal cancer.

Clinical Relevance

The results can be used as evidence for promoting the notion that diet interventions for patients with colorectal cancer focus on the patient–family dyad, which support overall quality of care in oncology care hospitals.

Difficult Peripheral Venous Access in Children: An International Survey and Critical Appraisal of Assessment Tools and Escalation Pathways

Abstract

Background

Peripheral venous cannulation is considered a routine procedure, yet 50% of first attempt insertions fail, necessitating repeat insertion attempts. Identification of children with difficult intravenous access (DIVA) can help promote prompt escalation to an appropriately skilled clinician.

Objective

To describe current international practice regarding the identification and management of children with DIVA, and to systematically review clinical tools and clinical pathways for children with DIVA.

Methods

A cross‐sectional, international survey; followed by a systematic review and critical appraisal of clinical pathways using the Appraisal of Guidelines for Research Evaluation (AGREE) II checklist.

Results

A total of 148 clinicians from eight countries completed the survey. The majority were nurses (n = 92; 62%), practicing as vascular access specialists (n = 27; 18%). Twenty‐three respondents (16%) reported using a DIVA tool, of which the DIVA Score was most common (n = 5; 22%). Five clinical pathways were identified from the survey and review. Based on the AGREE II domains, pathways generally scored well for scope and purpose, and for clarity of presentation areas. Information on the rigor of development and editorial independence was infrequently detailed. Based on AGREE II findings, one pathway was recommended for clinical practice, and four were recommended for use with modification.

Conclusions

Resources for the identification and escalation of children with DIVA are not standardized or consistently used. Further work is needed to streamline processes for DIVA identification and escalation to the appropriate clinician, with technology‐assisted insertion capability. This will enhance patient experiences and reduce harm from multiple insertion attempts.

Clinical Relevance

Multiple failed insertion attempts come at great cost to the child, family, and healthcare service. Early identification and management of the child with DIVA can ensure prompt escalation and management, improving the patient and family experience.

The Nurse–Family Partnership in Colorado: Supporting High‐Quality Programming With Implementation Science

Abstract

Purpose

The purpose of this article is to describe how the Nurse–Family Partnership (NFP) has been scaled up and supported in Colorado. As an intermediary, Invest in Kids (IIK) provides implementation support for the NFP in Colorado using a generalizable implementation framework, the Active Implementation Frameworks (AIF).

Organizing Construct

An overlay of the AIF and the clinical nursing‐informed implementation support that IIK offers to NFP providers across Colorado is explored, and relevant examples are highlighted.

Conclusions

Without the use of the AIF in combination with clinical nursing expertise to support high fidelity use of the NFP throughout Colorado, promised NFP program outcomes may likely not be realized and sustained.

Clinical Relevance

Further understanding of how to utilize implementation frameworks to support evidence‐based clinical nursing programs and interventions may allow for results found in research studies to be more widely attained and maintained across practice settings.

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