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AnteayerJournal of Nursing Scholarship

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.

Impact of Structured Nurse Leader Rounds on Satisfaction With Nursing Care Among Patients With Cancer

Abstract

Background

The patient satisfaction rate is considered a challenge for nurse leaders, especially among patients with cancer, due to the complexity of the disease, diagnostic procedures, and treatment.

Aim

The purpose of this study was to evaluate the impact of structured nurse leader rounds (NLRs) on satisfaction with nursing care among patients with cancer. Moreover, we assessed the relationship among NLRs, patient satisfaction, and demographical variables.

Methods

A two‐group posttest design was used in four adult inpatient oncology units in a specialized oncology center. A stratified random sampling technique was utilized to select 169 patients for the experimental group (80 patients) and control group (89 patients). Structured leader rounds were conducted by nurse leaders using a scripted nurse leader tool to standardize the rounds in the experimental group, while the unstructured leader round was conducted in the control group. Patient satisfaction was measured using the Patient Satisfaction with Nursing Care Quality Questionnaire.

Results

The findings revealed that there was a significant difference in total score of patients’ satisfaction between study groups (t = −9.213, p > .001). Conversely, the structured leader round has a significant impact on the patient’s experience with nurse concern and caring (t = −2.054, p = .042).

Conclusions

Adoption of a structured NLR has a significant impact on improving patient satisfaction in an oncology setting where patients receive care from many disciplines, such as surgical, medical, radiotherapy, and radiology.

Clinical Relevance

Efficient structured NLRs of nursing professionals are important for enhancing the quality of nursing care and patient satisfaction.

The Relationship Between Depression and Frailty in Community‐Dwelling Older People: A Systematic Review and Meta‐Analysis of 84,351 Older Adults

Abstract

Objectives

In this study we investigated the correlation between depression and frailty in older adults. Additionally, correlations among study designs (prospective vs. cross‐sectional), regions, depression indices, frailty indices, covariance corrections, and sexes were explored to support the analysis.

Methods

A systematic literature review and meta‐analysis were conducted. A total of 84,351 older adults, all 65 years of age or older, were analyzed. Both authors independently extracted and examined retrieved articles. Searched keywords included “depression” or “depressive”; “frailty” or “frail”; and “older people,” “elderly,” “geriatric,” or “senior.” Articles published between January 2000 and December 2016 were searched. A literature quality assessment was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic

Reviews and Meta‐Analyses

Systematic literature searches were conducted on the Embase, PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library databases, and collected studies were analyzed using a random effects model.

Results

Fourteen studies on people 65 years of age or older were collected, and a correlation analysis was conducted for depression and frailty. According to the meta‐analysis, the risk for frailty due to depression was nonsignificant among the subgroups for study design (p for heterogeneity = .149), region (p = .429), depression criteria (p = .934), covariate adjustment (p = .702), and frailty criteria (p = .661). Notably, the risk for frailty due to depression was significantly higher in men than in women (pooled odds ratios for men and women: 4.76 and 2.25, respectively; Qbetween χ2 = 9.93, p = .002).

Conclusion

Older adults with depression are more prone to frailty than are those without depression. Regardless of study design, region, depression index, frailty index, and covariance corrections, no significant differences were observed in the results of studies on depression and frailty in older adults. The only factor that had a significant influence was sex; older men with depression were at a higher risk for frailty than were older women with depression.

Clinical Relevance

Depression and frailty are pertinent health concerns related to geriatric syndromes. Because older adults with depression have a high risk for frailty, nursing personnel should use a depression index as early as possible to screen for depression and further reduce the occurrence of frailty in older adults. Furthermore, based on the aforementioned differences between the sexes, special attention should be paid to older men with depression to reduce their risk for frailty.

Appropriate Nursing Home Nurse Hours per Resident Day in Korea: A Secondary Analysis of Longitudinal Data

Abstract

Purpose

To encourage the enactment of laws about mandatory nurse staffing in nursing homes, researchers should provide evidence of concrete nurse hours per resident day (HPRD). This article estimates optimal nurse staffing HPRD to achieve increased quality‐of‐care outcomes for nursing home residents.

Design

Secondary analysis of longitudinal data.

Methods

This study used secondary analysis of longitudinal nursing home survey data. Nurse staffing HPRD and quality‐of‐care survey data accrued from nursing homes operating under long‐term‐care insurance in Korea. The collected data include a total of six quarterly base measurements on nurse staffing HPRD and 15 quality indicators from 2014 to 2017. The proposed optimization model emerged to most appropriately combine nurse staffing HPRD to increase quality‐of‐care outcomes for nursing home residents by 3% to 8%. Optimal outcome measures were fixed as best outcomes and compiled from 15 nursing‐sensitive quality indicators.

Findings

Constrained nonlinear optimization was used for analysis. A 12% increase in registered nurse (RN) HPRD (from 0.168 HPRD [10 min 5 s] to 0.177 [10 min 38 s]) aligned with a 3% improvement in quality‐of‐care outcomes. A 20% RN HPRD increase aligned with a commensurate 5% to 8% increase in compiled quality‐of‐care outcomes (from 0.168 HPRD [10 min 5 s] to 0.202 HPRD [12 min 6 s]) without increasing certified nurse aide HPRD. About a 30% RN HPRD increase aligned with a commensurate 5% to 8% increase in compiled quality‐of‐care outcomes (from 0.168 HPRD [10 min 5 s] to 0.218 HPRD [13 min 6 s]) without increasing certified nurse aide HPRD.

Conclusions

It is urgent to institute mandatory nurse HPRD for nursing homes in Korea by law. This research provides evidence that increasing nursing HPRD improved residents’ outcomes in nursing homes.

Clinical Relevance

Findings from the optimization model implied that stable care by RNs in nursing homes is a key factor in achieving acceptable quality of care for residents.

Effects of Work‐Related Stressors and Mindfulness on Mental and Physical Health Among Australian Nurses and Healthcare Workers

Abstract

Purpose

To examine the relative impact of work‐related stressors and the personal resource of mindfulness on employees’ mental and physical health.

Design

A cross‐sectional survey design with nursing and healthcare workers in Victoria, Australia.

Methods

Data were collected from 702 respondents. Mean scores for work‐related stressors and employee mental and physical health were compared with population norms. We used hierarchical linear regressions to examine the relative impact of demographics, work‐related stressors, and mindfulness on employee mental and physical health.

Findings

Employees in this sample reported higher levels of work‐related stress and poorer mental health compared to available norms, while their levels of physical health were within the normal range. Regression analyses showed that work‐related stressors were important predictors of employee mental health, but mindfulness was the stronger predictor. There was a slightly stronger relationship between employee physical health and work‐related stress compared to mindfulness. Furthermore, being younger and employed in a non‐nursing role were associated with better physical health.

Clinical Relevance

Encouraging mindfulness as a health behavior practice among nurses and other healthcare workers could improve employee well‐being and potentially enable them to more effectively fulfill the requirements of their demanding roles.

Dissemination of PhD Dissertation Research by Dissertation Format: A Retrospective Cohort Study

Abstract

Purpose

The study purpose was to compare dissemination of PhD dissertation research by dissertation format: traditional (five‐chapter document providing a complete and systematic account of the PhD research) versus an alternate (substudy [document containing three smaller studies but not written as stand‐alone manuscripts] or publication [document containing three or more related manuscripts intended for submission or published in a peer‐reviewed journal]) format.

Design

A retrospective study of all PhD dissertations (1999–2019) from one research intensive school of nursing.

Methods

Following identification of graduates via the school's PhD database, we searched ProQuest and PubMed databases for the dissertation and first authored peer‐reviewed publications of each graduate to determine dissertation format, study design, timing and number of dissertation research publications, and inclusion of dissertation sponsor in authorship. Data were analyzed using descriptive statistics and Wilcoxon rank sum tests.

Findings

Of 113 graduates, 80 (70.8%) employed a traditional format, with the remaining graduates structuring dissertations using an alternate (substudy [n = 12], publication [n = 21]) format. Of those using the traditional format, 33 graduates (41.3%) never published dissertation research findings in a peer‐reviewed journal. For those who published their dissertation research in a peer‐reviewed journal, time to first publication was 1.4 ± 2.1 years (median 1.6 years) following degree conferral. In contrast, all graduates who utilized alternate formats published one or more components of their dissertation research with shorter time to first published manuscript (‐0.6 ± 1.1 years; median ‐0.5 years; p < .001). Number of peer‐reviewed publications was higher for those who utilized an alternate format compared to the traditional format (2.9 ± 1.5 [median 3.0] vs. 1.8 ± 1.1 [median 1.0], p = .001). Acknowledgment of the sponsor's contribution via publication authorship was higher for those using an alternate format compared to the traditional format (100% vs. 70.2%).

Conclusions

Number and timeliness of peer‐reviewed publications stemming from dissertation research was higher for PhD graduates who utilized an alternate dissertation format. Alternate dissertation formats should be encouraged by PhD programs as one means to improve dissemination of PhD nursing research.

Clinical Relevance

Dissemination of PhD research through peer‐reviewed publications promotes the continued development of nursing science to inform nursing practice and advances the career trajectory of PhD graduates.

Socioeconomic Status and Health Services Utilization for Children With Complex Chronic Conditions Liable to Receive Nurse‐Led Services: A Cross‐Sectional Study

Abstract

Aim

To analyze the use of health services for children with severe chronic diseases, seeking to identify patterns of use according to sociodemographic and clinical conditions, and to identify unmet needs of care coordination that could benefit from nursing case management services.

Design

Cross‐sectional study.

Methods

Children treated in ambulatory and hospital care in Granada, Spain, with complex chronic diseases in 2016 were analyzed to determine their use of healthcare resources. Socioeconomic variables were evaluated, along with clinical status and duration of their conditions.

Results

In total, 265 children were analyzed (mean age 7.3 years, SD 4.63; 56.6% male). The average duration of the disease was 63.26 months (SD 54.09). The most common types of disease were neurological (35.80%), congenital (23.90%), and oncological (18.90%). Multivariate analysis showed that children in need of advanced care (β = 0.71), with a relatively recent diagnosis (β = ‐0.11), with criteria for palliative care 1 (β = ‐0.26), and whose mothers were older (β = 0.36) and had a higher educational level (β = 0.19) made greater use of healthcare resources during the preceding 12 months, whether urgent or scheduled (r 2 = 78.0%, p < .001).

Conclusions

Children with higher needs for advanced care have a heterogeneous use of healthcare resources depending on certain clinical and sociodemographic determinants. This finding highlights the importance of the identification of profiles of children and families for care coordination. The presence of sociodemographic determinants may need individualized approaches to assure a timely health care utilization.

Clinical Relevance

A significant proportion of the children used multiple health services, being treated at several centers simultaneously, and producing up to 139 total yearly contacts with the health system. Policymakers, healthcare providers, and patients’ families should engage in a redesign of healthcare services for these children, providing comprehensive and coordinated systems of care for this population.

Nursing Research Literature Production in Terms of the Scope of Country and Health Determinants: A Bibliometric Study

Abstract

Purpose

The aim of this paper was to present the results of the first study in which nursing research literature production was studied in the relation to country and health determinants.

Design

Bibliometric analysis was used.

Methods

The corpus of nursing publications was harvested from the Scopus indexing and abstracting database. Using research articles' metadata (funding acknowledgments, publication years, and author affiliations), we analyzed global trends in the nursing research literature production of funded and nonfunded publications. Next, we performed a regression analysis and correlation analysis relating nursing research productivity to health and country determinants.

Findings

The search resulted in 118,870 papers, among which 22.0% were funded (24.7% for G8 countries). Nursing literature production is exhibiting a positive trend. The United States is by far the most productive country in terms of funded and nonfunded literature production, although it is ranked only ninth in per capita production, for which Sweden is the most productive country regarding funded papers. The study also revealed that gross domestic product, human development factor, and gross national income were related to nursing research literature productivity.

Conclusions

The positive trend in nursing research literature production (both funded and nonfunded) reveals a growth in nursing research funding. Regionally centered research literature production shows that the more developed and “rich” countries produce the majority of publications. A positive correlation is evident between country determinants and research literature production, as is a positive correlation between per capita literature research production and well‐being and health determinants.

Clinical Relevance

Substantial growth in terms of nursing research literature production and research funding has been identified. While a limited amount of research in this area exists, this study revealed some interesting relations between nursing literature production and country and health determinants, which might motivate nursing researchers to pursue more intensive research and funders to support further growth of nursing research funding.

Impact of an Online Training Program in Smoking Cessation Interventions in Hospitals

Abstract

Purpose

To assess changes in the self‐reported performance of smoking cessation interventions according to the 5A's model (Ask; Advise; Assess; Assist; and Arrange follow‐up) among clinicians; and to identify the main barriers and facilitators in smoking cessation implementation before and after an online smoking cessation training program.

Design

Pre‐post evaluation.

Methods

We assessed self‐reported smoking cessation interventions in the implementation of the 5A's model among clinicians working in Catalan hospitals (Spain). In addition, we assessed individual‐, behavioral‐, and organizational‐level factors that act as barriers and facilitators in the implementation of the 5A's model. We used a questionnaire of 63 items reflecting each of the 5A's performance (scored from 0 = none to 10 = most possible). The questionnaire was completed both immediately before and 6 months after the training. We analyzed the data of those participants who had a clinical role and answered pre‐ and post‐questionnaires. We used the nonparametric test for paired data (Wilcoxon) to examine changes in scores.

Findings

A total of 127 clinicians completed the pre‐post questionnaire; 63.0% were registered nurses, 17.3% were nursing assistants, 7.9% were physicians, and 11.8% were other professionals (p < .001). Overall, there were significant increases in the implementation of the assist component (from a score of 4.5 to 5.2; p < .003) and arrange a follow‐up component (from 3.6 to 4.5; p < .001) of the intervention. Scores in the perception of the level of overall preparation, preparedness in using smoking cessation drugs, level of competence, and organizational recognition improved (p < .001) at the follow‐up; however, the score in the perception that implementing smoking cessation is part of their job decreased (from 6.3 to 4.4; p < .001).

Conclusions

The online training had a positive impact on the implementation of assist and arrange follow‐up components. Although self‐preparedness in the management of smokers increased, the motivation and involvement of key professionals decreased. Organizational factors related to the incorporation of resources (such as protocols, records, etc.) should be improved for the correct progression of smoking cessation interventions within the institutions.

Clinical Relevance

Smoking cessation training programs should incorporate some motivational content to increase the engagement of health professionals in smoking cessation interventions in their clinical practice.

Lived Experience of Grieving of Thai Buddhist Husbands Who Had Lost Their Wives From Critical Illness

Abstract

Purpose

To describe the meanings of the lived experiences of grieving of Thai Buddhist husbands who had lost their wives from critical illnesses.

Design

Hermeneutic phenomenological approach using van Manen's concepts. Seven husbands from southern Thailand who met the inclusion criteria participated in the study.

Methods

Individual in‐depth interviews were conducted and recorded on tape, while the interview data were transcribed and analyzed following van Manen's phenomenological approach. Trustworthiness was established using Lincoln and Guba's criteria.

Findings

Five thematic categories described the meanings of the experiences, which were reflective of the four lived worlds of body, relation, space, and time. The lived world of body was “loss of thoughtful focus and energy,” the lived world of relation was characterized by “surrendering attachment with the deceased” and “attachment to the children,” the lived space reflected “social connection,” and lived time was “healing time.”

Conclusions

The grief experience did not seem to be complicated, and the hoped‐for experience was being healed through surrendering attachment with the deceased while maintaining attachment with children and social connection. The model of grieving may contribute to the knowledge of nursing care processes, specifically in palliative and end‐of‐life care, and other care processes for healthcare professionals.

Clinical Relevance

Hospital administrators can clearly support a bereavement service to provide a continuum of after‐death care for Buddhist males. Nurses and healthcare providers can develop a bereavement care process by valuing the religious principles integrating social interaction for male bereaved husbands.

Developing a Universal Nursing Competencies Framework for Registered Nurses: A Mixed‐Methods Approach

Abstract

Purpose

To develop a methodology for identifying the universal nursing competencies required for registered nurses (RNs).

Design

A mixed‐methods approach was used.

Methods

The research in this article entails a combination of different methodological approaches, namely the Delphi technique and an empirical quantitative nonexperimental study. A total of 14 experts with credentials in the nursing field participated in the former. Consensus was defined as at least 80% agreement. Subsequently, a purposive sample of 321 RNs participated in the empirical quantitative nonexperimental study. The data were collected during 2014.

Findings

In the study's first stage, 39 professional nursing competencies were identified using the Delphi technique. In the second stage, factor analysis resulted in seven factors: professional nursing clinical practice; professional communication and quality in nursing; determinants of health and safety in nursing; critical thinking and self‐planning of professional work; new knowledge and knowledge transfer in nursing; management and coordination in nursing; and nursing research. Together they explain 74.9% of the variance.

Conclusions and Clinical Relevance

In the future, the identification of the national nursing competencies should be considered. The study has some limitations; however, the proposed methodology revealed in this study may be the first step in overcoming them.

Identification of Binge Eating Disorder Criteria: Results of a National Survey of Healthcare Providers

Abstract

Purpose

To determine whether general healthcare providers and adult psychiatrists recognized binge eating disorder (BED) symptoms and features. The aims were to examine how they delineated the core criteria of BED—eating a large amount of food and sense of loss of control over eating—and how their evaluations compared to ratings by BED experts.

Design

This is a cross‐sectional study of a nationwide U.S. sample of healthcare providers and a convenience sample of BED experts.

Methods

Providers were mailed surveys that asked respondents about their perceptions of a large amount of food and whether they thought case vignettes met thresholds for loss of control. Participants were also asked to select BED diagnostic criteria from a symptom list. Results were analyzed using one‐way analyses of variance with post‐hoc comparisons and chi‐squared tests.

Findings

The survey was completed by 405 healthcare providers (response rate of 28.4%). Ratings of a large amount of food did not differ between BED experts and general healthcare providers (p = .10) or psychiatrists (p = .90). Provider groups did not differ significantly on whether five of the six vignettes met thresholds for loss of control (p > .05). Of the respondents, 93.0% of general healthcare providers and 88.6% of psychiatrists could not correctly identify the diagnostic criteria for BED.

Conclusions

Across provider groups, demarcation of a large amount of food and loss of control over eating were relatively consistent. However, general healthcare providers and psychiatrists were not able to correctly identify BED symptoms.

Clinical Relevance

Training and education are greatly needed to improve knowledge of the diagnostic criteria for BED.

HIV Testing Among Heterosexual Hispanic Women in South Florida

Abstract

Purpose

The purpose of this study was to examine the influence of selected facilitators, barriers, beliefs, and knowledge suggested by the literature to be associated with human immunodeficiency virus (HIV) testing among heterosexual Hispanic women.

Design

This study utilizes a cross‐sectional design to analyze secondary data from SEPA III: The Effectiveness Trial. SEPA stands for Salud, Educacion, Prevencion y Autocuidado, which translates to Health, Education, Prevention, and Self‐Care. The Social Cognitive Model (SCM) guided this study.

Methods

Three hundred twenty heterosexual Hispanic women 18 to 50 years of age participated in this study. Data were analyzed using descriptive statistics and logistic regression.

Findings

The most common facilitators for HIV testing were receiving recommendations from a healthcare provider (HCP) and the test is offered by an HCP rather than women asking for it. The most common barrier to testing was having no reason to believe they were infected. Most women believed a positive test result would encourage them to take better care of themselves. However, as much as 15% of women reported desires to kill or hurt themselves if they test positive. On the other hand, a negative result would make them assume their partners are negative and thus do not need to be tested. Significantly, explanatory variables related to HIV testing were knowledge and the HIV test is offered by an HCP instead of women asking for it.

Conclusions

Strengthening HIV knowledge and offering HIV tests are significant contributions that nurses make to the health of Hispanic women. The SCM can be used to design programs to increase HIV testing among Hispanic women.

Clinical Relevance

Nurses are encouraged to offer testing and provide culturally competent HIV prevention education to increase HIV testing among Hispanic women.

Challenges to Studying Illicit Drug Users

Abstract

Purpose

Throughout the world, illicit drug use continues to pose a significant risk to public health. The opioid crisis in North America, the diversion of the prescription drug tramadol throughout Africa, and the increasing supply of methamphetamines in East and South Asia all contribute to increasing risks to individual and societal health. Furthermore, the violation of human rights in efforts to enforce prohibitionist values poses significant threats to many individuals worldwide. With these evolving situations, it is imperative that researchers direct their attention to the various populations of illicit drug users. However, the inclusion of illicit drug users, often considered a vulnerable population, as participants in research studies presents several increased risks that must be addressed in study protocols. Researchers are required to provide “additional safeguards” to all study protocols involving illicit drug users, but there is often substantial variability and inconsistency in how these safeguards are applied. Additional safeguards can be timely, costly, and unduly burdensome for researchers, ethical review boards, and research participants.

Approach

Through synthesis of the current literature, this article addresses the barriers to studying illicit drug users and the methods researchers can utilize to minimize risk. A case study is provided to illustrate the high level of scrutiny of study protocols involving the participation of illicit drug users and the effect of such scrutiny on recruitment of participants. The article concludes with a discussion of the effects of the current political climate on the recruitment of illicit drug users in research.

Conclusions

Individuals who participate in criminal or illegal behaviors such as illicit drug use, prostitution, illegal entry into a country, and human trafficking are susceptible to multiple physical, mental, and social health risks, as well as criminal prosecution. The importance of research on the health of marginalized populations cannot be overstated. This work must continue, and at the same time, we must continue to protect these individuals to the best of our ability through diligent attention to sound research methods.

Clinical Relevance

The use of illicit drugs continues to pose a substantial threat to global health. Individuals who use illicit drugs are susceptible to multiple physical, mental, and social health risks, as well as criminal prosecution. It is imperative that researchers study these vulnerable populations in order to develop interventions to minimize individual and societal harm. There are several barriers to the study of illicit drug users that must be addressed through rigorous methodology and the addition of safeguards.

The Perfect Author

Journal of Nursing Scholarship, Volume 51, Issue 4, Page 367-367, July 2019.

Issue Information

Journal of Nursing Scholarship, Volume 51, Issue 4, Page 365-366, July 2019.

Ward‐Based Nurses’ Knowledge and Attitudes Toward Clinical Trials: A Survey Study in Taiwan

Abstract

Purposes

Clinical trial education has not been extensively integrated into nursing education systems. Acute care nurses may lack sufficient knowledge when caring for admitted trial patients, which may negatively influence their attitudes toward clinical trials. The aim of this study was to explore ward‐based nurses’ knowledge and attitudes toward clinical trials.

Design and Methods

Ward‐based nurses working in medical, surgical, and intensive care units in a medical center in Taiwan were approached to complete a questionnaire. The questionnaire was developed by the research team and included four parts: demographics, experience with clinical trials, clinical trial knowledge, and attitudes toward clinical trials.

Findings

A total of 161 nurses responded. Nearly 90% of the nurses accessed trial information in their workplace. Nearly 80% of the respondents had experience with caring for trial patients, but the mean score of clinical trial knowledge was 4.5 out of a possible score of 10. For attitudes toward clinical trials, the mean score for positive beliefs was 39.7, and the mean score for negative expectations was 42.5, both out of a possible score of 55. The results indicated that respondents typically tended to hold a negative attitude toward clinical trials, especially in regard to the side effects of study drugs and communication with investigators.

Conclusions

Knowledge deficits of ward‐based nurses concerning trial participation is apparent. Continuing education for ward‐based nurses is necessary to promote implementation of clinical trials and reduce negative expectations related to clinical trials.

Clinical Relevance

One way to improve nurses’ knowledge is to integrate clinical trial education into nursing education systems, which will provide more channels through which nurses can understand how a trial works, including the risks, benefits, and participant protection. Through such educational initiatives, ward‐based nurses may develop more positive beliefs regarding clinical trials and provide higher quality clinical trial care to participants.

Predictors of Postnatal Care Services Utilization Among Women in Nigeria: A Facility‐Based Study

Abstract

Purpose

Adequate utilization of postnatal care (PNC) services is a major contributing factor to reducing maternal mortality among women. Hence, this study was designed to assess the level of utilization of PNC services and its predictors among postpartum women in Ekiti State, Nigeria.

Design

The study adopted a cross‐sectional descriptive design.

Methods

A total of 405 postpartum women from primary healthcare centers in five selected local government areas in Ekiti State participated in this study. A self‐structured questionnaire was used to collect data, which were analyzed using IBM SPSS Statistics version 20 (IBM Corp., Armonk, NY, USA). Data were presented using descriptive (means, frequencies, and percentages) and inferential (Pearson's chi square and binary logistic regression) statistics.

Findings

The mean age of the women was 27 ± 8 years. A preponderance of the respondents (98.8%) were aware of PNC services, of which only 22% utilized PNC services after their last delivery. Those who did not utilize PNC services identified some of the barriers to their utilization, which included poor attitude of the healthcare providers and insufficient financial resources. The rate of utilization was found to be significantly higher among those who were 25 to 34 years of age (p = .03), who had formal education (p = .04), who were employed (p = .01), who had made use of an antenatal care (ANC) clinic (p = .02), and who had a good level of knowledge about PNC (p = .02). Furthermore, a prior experience with PNC services reduced by almost 90% the odds of a mother's subsequent utilization after her last delivery (odds ratio 0.10; confidence interval 0.05–0.24).

Conclusions

The majority of respondents in this study were aware of PNC services, but this did not translate to utilization of the services. Also, the rate of utilization of PNC services was significantly associated with certain sociodemographic factors such as age, educational status, employment status, use of an ANC clinic, and level of knowledge about PNC.

Clinical Relevance

This study provides pertinent knowledge for healthcare providers, especially nurses, who provide PNC services.

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