Patients' Evaluation of the Quality of Emergency Care Services in Jordan: Integration of Patient Centeredness Model

Background and PurposeAccreditation is viewed to enhance the total quality of healthcare. The present study aims at assessing patients' perspectives toward the quality of emergency healthcare services at different hospitals with different characteristics in Jordan. The elements of patients' perception were aligned with the conceptual framework of Patient Centeredness Model.MethodsThis descriptive cross-sectional study was carried out in four emergency departments from different healthcare sectors and accreditation statuses in Jordan. Less urgent/nonurgent, alert, and cooperative patients were identified directly after the completion of emergency treatment. The perspectives of patients about the quality of emergency services were evaluated by 10 domains articulated in a validated accident and emergency questionnaire.ResultsA total of 276 patients were enrolled in the study. Private sector scored higher in all assessment domains in both accredited and nonaccredited hospitals in comparison with the government sector. Accredited government hospitals scored higher in patients' evaluation for “doctor and nurse,” “investigations,” “pain,” and “overall respect of medical staff” domains than nonaccredited government hospitals. The overall experience was significantly different between accredited and nonaccredited government hospitals.Implications for PracticeQuality of emergency care services should be assessed through various dimensions related to patients' perspectives. Patients' perception toward the quality of emergency health services is evidently enhanced by accreditation especially in the government sector.

Probabilistic Thinking: A Principle-Based Concept Analysis in the Context of Uncertainty in Chronic Illness

Background and PurposeThe Reconceptualized Uncertainty in Illness Theory (RUIT) includes the concept of “probabilistic thinking” intending to explain the positive reappraisal of uncertainty in chronic illness. However, the description of the concept is vague, thereby limiting the understanding of the theory. Thus, the aim was to develop a theoretical definition of probabilistic thinking in order to increase the explanatory value of RUIT.MethodsWe conducted a principle-based concept analysis by means of a conceptually driven literature search. Methods consisted of database, dictionary, lexicon, and free web searching as well as citation tracking. We analyzed the concept in terms of (a) epistemology, (b) pragmatics, (c) logic, and (d) linguistics.ResultsThe final data set included 27 publications, 14 of them from nursing. (a) Probabilistic thinking is a coping strategy to handle uncertainty. It involves a focus on either possibilities (in nursing) or probabilities (in other disciplines). (b) There is a lack of operationalization in nursing, though three measurements focusing the handling of probabilities are offered in psychology. (c) Nursing authors interpreting probabilistic thinking as accepted uncertainty lacked logical appropriateness, since probability negotiates uncertainty. (d) Probabilistic thinking is used synonymously with positive thinking and probabilistic reasoning.Implications for PracticeNurses working with chronically ill patients should consider the findings for the application of RUIT. They should recognize whether uncertainty is perceived as a danger and encourage probabilistic thinking. Efforts are necessary to achieve a common language between nursing and other disciplines in order to avoid misunderstandings in clinical practice and research.

Conducting Online Healthcare Research With Open-Ended Questions in the Age of COVID-19: A Critical Review

BackgroundWorldwide, there is a remarkable increase in Internet use, with a current penetration rate of 62%. This widespread Internet use and the global coronavirus disease (COVID-19) preventive measures provide opportunities for data collection using the Internet in healthcare research. No recent studies have been conducted regarding the methodological issues of asynchronous Internet research that employed opened-ended questions to explore providers’ and patients’ experiences.PurposeThis study utilizes prior research to explore methodological issues that affect online research using open-ended questions to obtain health data.MethodsThe electronic databases searched were PubMed, CINAHL, and full-text Ovid. Reference lists and the Journal of Medical Internet Research were manually searched. The search strategy was based on the PRISMA flow diagram. Articles published between January 2003 and May 2020 were searched. Inclusion criteria were asynchronous online researcher-led studies that used open-ended questions to explore healthcare issues. Methodological issues were extracted from the selected studies.ResultsThe evidence suggests that factors such as technical/website study/survey design issues, smartphone study applications, use of reminders, incentives, overrecruiting participants, using a combination of asynchronous and synchronous methods, trustworthiness, ethical and security issues affect the quality of data obtained in online health research.Implications for PracticeAsynchronous online research methods with open-ended questions could be used to collect high-quality data from patients, healthcare providers, and other participants in self-isolation, quarantine, and in diverse locations. However, researchers should be aware of the identified methodological issues. Future research could explore methodological issues and data quality in combined asynchronous and synchronous data collection methods.

Prenatal Motivation for Caregiving Issues: A Pilot Study of Mothers Expecting Healthy Infants and Infants With Complex Congenital Heart Disease

Background and PurposeThe prenatal preparing women do for infant caregiving is understudied. In this pilot, multimethods study, we examined motivation for preparing for infant caregiving of women in their third trimester of pregnancy expecting either a healthy infant or an infant with complex congenital heart disease (CCHD).MethodsEleven women expecting a healthy infant and four expecting an infant with CCHD completed a questionnaire and were interviewed. Preparing was reported in context of expectations, intentions, and goals and in personal, family, and infant conditions. Motivation for preparing was expressed through an interview about caregiving issues women were working on. Intensity of motivation was estimated by self-report of the time infant caregiving issues were in thought or action. Effect sizes were calculated for between group differences in motivation intensity. Interview data were examined with directed content analysis.ResultsIntensity of motivation was higher for women expecting an infant with CCHD for issues of Knowing What and How to prepare. Women expecting an infant with CCHD reported uncertainty about how they would feed their babies given their health condition. Interviews yielded new motivations encompassing issues of family and working with the parent partner.ImplicationsAssessment of issues women are working on prenatally, indicating motivations for preparing for infant caregiving, and of the intensity of motivations advances culturally-attuned and family-centered preparation. Knowledge of these issues and motivation intensity could orient clinical care to supporting women in developing well-informed expectations, intentions, and goals culturally suited to postnatal learning and infant needs.

Factors Affecting Cancer Prevention Behaviors and Cancer Screening in First-Degree Relatives of Breast and Colorectal Cancer Patients in Korea: A Cross-Sectional Study

BackgroundFirst-degree relatives (FDRs) of cancer patients have a high risk of cancer due to a similar lifestyle and genetic predisposition. However, previous studies rarely examined the level of cancer prevention behaviors and screening and affecting factors in cancer patients’ FDRs.PurposeThis study aimed to describe the levels of cancer knowledge, attitudes toward cancer, cancer worry, perceived cancer risk, and cancer prevention behaviors and cancer screening in FDRs of breast and colorectal cancer patients. Moreover, it sought to identify factors affecting cancer prevention behavior and cancer screening.MethodsA cross-sectional, descriptive correlational design was used. The study enrolled 138 FDRs of breast and colorectal cancer patients. Participants completed self-administered questionnaires at a tertiary hospital in Seoul, Korea. Descriptive statistics, frequencies, chi-square test, independent t test, one-way analysis of variance (ANOVA), Pearson’s correlation, multiple regression, and logistic regression were performed for data analysis.ResultsThe levels of perceived cancer risk, cancer knowledge, attitude toward cancer, and cancer prevention behaviors were moderate, while the level of cancer worry was high. Ninety-two participants reported having undergone cancer screenings, but the types of screening were not associated with their family history. Age, gender, and attitude toward cancer affected cancer prevention behaviors. The cancer screening rate was higher in older participants, in women, and in patients’ FDRs with a longer cancer diagnosis.Implications for PracticeAttitude was the modifiable factor for cancer prevention behaviors. Nurse-led educational and counseling interventions should be developed to improve attitude toward cancer among FDRs of cancer patients.

Part 2: New Graduate Nurse Transition Into the Intensive Care Unit: Summative Insights From a Longitudinal Mixed-Methods Study

Background and PurposeTo address the nursing shortage, it is increasingly common for hospitals to hire new graduate nurses into intensive care units (ICU). New graduates in intensive care likely experience needs beyond those of their peers outside of critical care contexts. Yet, relatively little is known about the experiences of this unique population. The purpose of this study was to explore the transition experience of a cohort of new graduate nurses in the ICU over a 2-year period.MethodsA longitudinal mixed-methods convergent design using a purposive and convenience sample of new graduate nurses working in an ICU. Surveys were administered and in-depth qualitative interviews were conducted at four points in time over a 2-year period.ResultsParticipants identified a number of skills that remained difficult, as well as less comfort in performing a number of nursing interventions, over the four time points. In addition, they highlighted a decline in their perception of receiving encouragement and feedback from their manager. Participants identified that a lack of confidence was a barrier to transition and that improved orientation and work environment could further support them in their journey. Certain aspects of their work environment, such as peer support, were identified as most satisfying, whereas the environment and system were least satisfying.Implications for PracticeThe results provide a greater understanding of the transition experienced by new graduate nurses in the ICU. In addition, the results may provide the ICU leadership team with potential areas to further support the transition of new graduates within this critical care environment.

Ten Years Follow-Up of a Community-Nurse Managed Intervention to Improve Diabetes Control

Background and PurposeDiabetes control measures were shown to improve, following multidisciplinary intervention managed by a nurse in short-term follow-ups. However, there is a lack of data regarding the long-term effects of such interventions. We assessed long-term diabetes management and control measures in a central multidisciplinary primary care clinic, following a brief intervention conducted by a community nurse.MethodsA cross-sectional study in a central, multidisciplinary, primary care clinic. A previous study cohort of randomly selected 100 people with diabetes was followed-up for over 10 years, following a brief intervention managed by a community nurse. Data of diabetes control measures (e.g., hemoglobin A1c [HbA1c], low-density lipoprotein [LDL], and blood pressure) and clinical use of medical services (e.g., nurse, physician, dietician, and hospitalizations) were extracted from the medical records and compared from before the intervention to short and long-term follow-ups (median of 25 months, 10.56 years respectively).ResultsDuring the follow-up period, 18 participants (median age at intervention time 73 years) died. HbA1c dropped significantly (p < .001) from before to after the intervention, and remained low. LDL and Systolic Blood pressure decreased and continued to decrease during the long-term follow-up. While the number of nurse visits per year increased, physician and dietician visits decreased. Annual foot examinations and ophthalmologist visits, which increased following the intervention, remained high. Diabetes-related hospitalizations also decreased from the point of intervention.Implications for PracticeMultidisciplinary, brief intervention managed by a community nurse, improve, and even continue to improve, most diabetes management and control measures, for more than 10 years following the intervention.

Exploring the Application of Interpretive Description in Chronic Illness: A Scoping Review

Background and PurposeChronic illness is a complex condition that affects over one billion people. To develop a deeper insight of the needs of this patient population, interpretive description uses disciplinary knowledge as the source of understanding. This methodology is a pragmatic approach to research without focusing on a strict methodological directive. The aims of this scoping review are twofold, (a) to describe the findings of studies that have used Thorne's interpretive description to research chronic illness and (b) to discuss the application of interpretive description in clinical research. Thereby, showing interpretive description as a valuable tool to advance nursing knowledge and patient care.MethodsThe methodological framework for this review was based on the Johanna Briggs Institute guidelines for scoping reviews.ResultsTo develop an understanding of interpretive description, it is essential to examine the results of studies which have applied the methodology. Our scoping review showed that researchers utilizing interpretive description identified four common challenges experienced by individuals living with chronic illness: symptom management, education and knowledge, supportive care, and cultural disadvantages. By demonstrating how interpretive description is applied, it shows how it can be used to understand and interpret clinical phenomena to improve practice.Implication for PracticeThis scoping review demonstrates how interpretive description was used to develop knowledge about chronic illness. The premise of interpretive description is that disciplinary knowledge offers a sufficient foundation to develop meaningful research to support health practices. By approaching research from a disciplinary perspective, new knowledge can be discovered to complex health problems.

Attitudes, Knowledge, and Skills Toward Adopting Evidence-Based Practice in Clinical Decision-Making of Registered Nurses in Saudi Arabia

Background and PurposeEvidence-based practice (EBP) is generally recognized as a fundamental tenet of cost-effective and high-quality patient care. Nurses must be engaged with the appropriate attitude and educated with essential competencies to implement EBP systematically into their daily practice. This study assessed the attitudes, knowledge, and skills of registered nurses toward the adoption of EBP in making clinical decisions in their practice.MethodsThis quantitative, crosssectional study surveyed a convenience sample of 312 nurses from five regions in Saudi Arabia from October 2019 to December 2019.ResultsThe majority of nurses were unknowledgeable about the acceptable definition of EBP. The highest overall mean score was reported in the motivation subscale, followed by the skill and barrier subscales. The attitude subscale received the lowest overall mean score, which denotes a positive attitude. The nationality, level of nursing education, and years of experience had significant multivariate effects on nurses' EBP skills. Consequently, designation and EBP training had significant multivariate effects on nurses' perceived barriers to EBP adoption.Implications for PracticeNurses lack EBP knowledge. Nonetheless, they are motivated with positive attitudes to implement EBP in their professional practice if they are given adequate training and resources, sufficient time and managerial support, and mentoring from nurses with adequate EBP experience. Heightening the understanding and utilization of the best available scientific resources about EBP into nurses' daily clinical decision and practice is essential.

Self-Regulation in Pediatric Nursing Literature: An Evolutionary Concept Exploration

The concept of self-regulation appears frequently in nursing literature. Although the concept is well developed in nonnursing theories, its application in nursing has not been explored adequately. Most nursing authors address self-regulation in one of two ways. Some publish findings without a strong theoretical understanding of self-regulation. Others publish studies using a conglomeration of theorists' self-regulatory explanations without properly contextualizing the theoretical elements for nursing practice. For this concept exploration, the authors used Rodgers, B. L. (2005). Developing nursing knowledge: Philosophical traditions and influences. Lippincott, Williams & Wilkins, evolutionary concept analysis method to determine the current use of self-regulation in pediatric nursing literature and trace the concept's recent development, changes, and expansion. This work provides a representation of self-regulation based on existing healthcare studies and suggests steps for concept clarification that could promote accurate use of the concept in future research.