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6. Strategies to Increase Research-based Practice

Author

PEPLER, CAROLYN J., primary, EDGAR, LINDA, additional, FRISCH, SARA, additional, RENNICK, JANET, additional, SWIDZINSKI, MARIKA, additional, WHITE, CAROLE, additional, BROWN, THOMAS, additional, and GROSS, JULIE, additional

Published
2006
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14. Ambulatory Surgery

Author

Frisch, Sara R., primary, Groom, Linda E., additional, Seguin, Ellen, additional, Edgar, Linda J., additional, and Pepler, Carolyn J., additional

Published
1990
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17. Congruence in Relational Messages Communicated to Nursing Home Residents Through Nurse Aide Touch Behaviors (Gerontology, Nonverbal, Nurse/Patient Interaction).

Author

Pepler, Carolyn Joan

Abstract

Nursing home residents' intepersonal interactions and relationships are largely with nurse aides. When physical care is being given, incongruent relational messages may be sent through the aide's touch and her other nonverbal behaviors. Congruence, or the match between the meaning of touch and concurrent other-than-touch nonverbal messages, was analyzed in relation to characteristics of the interactants, the environment, and the touch itself. The relationship between congruence and the participants' mutual underst and ing of the touch was also examined. Forty-one interactions were collected on videotape as aides helped nursing home residents with a daily procedure. Nurse judges rated 202 r and omly selected touches and concurrent nonverbal behavior using the Touch Message Scale, a 5-point Likert-like instrument with 12 items relating to dominance-submission and association-dissociation. Touches were described using a modified Tactile Interaction Indicator (Weiss, 1976) to quantify characteristics including extent, threshold, centrapetality, intensity, intensity variation, action, duration, and sensation. The mean number of touches per interaction was 12.5, 82% were instrumental, and 62% lasted 5 seconds or less. Verbal comment accompanied 50% of the touches overall, but 80% when the interpersonal relationships were mutually excellent. Congruence was significantly higher when the touch involved grooming or was more intense. It was also higher when the resident moved with discomfort. It was positively correlated with the aide's years of schooling, but negatively related to communication skills in her training. Congruence was lower when the aide was talking to someone else, and when she had known the resident a longer time. Contrary to the theory, congruence and mutual underst and ing did not correlate. Long-st and ing relationships and validity in interpretive schemes were discussed as possible contributory factors. Residents, aides and judges saw the majority of touches as associative and dominant, but the interactants often interpreted the same touch as both dominant and submissive. They showed the least mutual underst and ing on these items, suggesting the relevance of interdependence between aides and residents. The amount of touching and the variability in meaning of touches indicate the need to heighten awareness of these findings among nursing home staff.

Published
1984

18. Pain in the Emergency Department with One-Week Follow-Up of Pain Resolution

Author

Celeste Johnston, C, J Gagnon, Anita, J Pepler, Carolyn, and Bourgault, Patricia

Abstract

OBJECTIVES: To determine the intensity of pain in the emergency department (ED), the use of analgesics in relation to pain intensity, which patients are at risk for unresolved pain at one week post-discharge, and the postdischarge treatment of pain.METHODS: Patients (n=871) admitted to two urban, university-affiliated EDs who were experiencing any pain were recruited on different shifts over the summer months of 1997. Pain intensity was self-reported, and chart reviews of the assessment, immediate treatment and follow-up prescriptions were conducted. Patients (n=699) were contacted one week later, and reports of pain intensity, activity, resuming normal functions and patient attitudes toward pain were documented. Descriptive and regression analyses were performed on the results of patients with complete data (n=585).RESULTS: Mean pain intensity on admission was 6.0 (SD=2.5) on a zero to 10 visual analogue scale, and 5.0 (SD=2.9) at discharge (n=871). One-quarter (23%) of patients were given analgesics while in the ED; their mean pain intensity was 7.0 (95% CI 6.7 to 7.3) versus 5.7 (95% CI 5.5 to 5.9) for those who were not given analgesics (P<0.001). At one week, the mean intensity for worst pain in the past 24 h was 5.2 (SD=2.9) and the usual pain intensity was 3.7 (SD=2.6). Using a cutoff point of pain greater than three on the zero to 10 visual analogue scale as residual pain at one week, 35% (n=207) remained in pain, with musculoskeletal pain accounting for half (n=102) of those cases. Logistic regression showed that the following patients were most likely to have pain at one week: women; those with pain present longer than 48 h before ED visit; those with a high discharge pain rating; those who were taking analgesics; and those who had pain of musculoskeletal origin. Both the attitudes and beliefs about pain and the treatment of pain while in the ED or on discharge were unrelated to the presence of residual pain at one week. An examination of the same factors in relation to the return to normal activities found that they were similar, with the exception that admission and not discharge pain intensity was predictive of not returning to normal activities.CONCLUSIONS: More than one-third of patients presenting to the ED with pain do not experience resolution of their pain. Women presenting with severe musculoskeletal pain of more than a week in duration are less likely to have resolution of their pain and to return to normal activities within a week of the ED visit.

Published
2005
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19. [Journey of the combatants. Interview by Veronique Robert].

Author

Pepler C, Ducharme F, and Dubuc N

Subjects
Education, Nursing, Graduate, Humans, Nursing Research education, Publishing organization & administration, Quebec, Research Personnel education, Research Personnel organization & administration, Attitude of Health Personnel, Faculty, Nursing organization & administration, Nursing Research organization & administration, Research Personnel psychology
Published
2008

20. Unit culture and research-based nursing practice in acute care.

Author

Pepler CJ, Edgar L, Frisch S, Rennick J, Swidzinski M, White C, Brown TG, and Gross J

Subjects
Evidence-Based Medicine, Humans, Motivation, Acute Disease nursing, Clinical Nursing Research trends
Abstract

The purpose of this multiple-case study of research utilization (RU) was to examine whether and how nursing practices in acute-care units are built on research and to identify potential explanations for the observed patterns. Open-ended data were collected from staff nurses and nursing leaders on 8 acute-care units through interviews and observation. RU varied within and across units, but unit culture emerged as the principal factor linked to patterns of RU. Unit-culture themes that formed the links were harmony of research perspective, motivation to learn, goal orientation, creativity, critical inquiry, mutual respect, and maximization of resources. The findings provide a rich description that could serve as a basis for self-assessment of unit culture in inpatient and outpatient acute-care units.

Published
2005

21. A randomized trial of a cognitive coping intervention for acutely ill HIV-positive men.

Author

Côté JK and Pepler C

Subjects
Adult, Analysis of Variance, Emotions, HIV Infections nursing, Hospitalization, Humans, Male, Treatment Outcome, Adaptation, Psychological, HIV Infections psychology
Abstract

Background: People who are HIV-positive now live longer when they have contracted AIDS, and nursing interventions can help improve their quality of life., Objectives: To test the effects of an intervention based on developing cognitive coping skills as compared to one focused on facilitating the expression of emotions. Both interventions were intended to help regulate emotional response to an exacerbation of HIV-related symptoms., Method: In a randomized, controlled trial, 90 hospitalized HIV-positive men were randomly assigned to one of three groups: cognitive, expression, or control. The intervention was administered on three consecutive days in 20-30 minute sessions. Preintervention and postintervention data were gathered on mood, distress, and anxiety., Results: Both interventions produced a beneficial effect on negative affect (cognitive group p =.002, expression group p =.011), and immediately following the first daily session (p =.001). No change in positive affect was produced by either intervention. Paired t tests indicated a decrease in distress (p =.039), specifically, of intrusive ideation (p =.03), for the cognitive group, which also experienced a decrease in anxiety from immediately before to immediately after each session. Conversely, the expression group experienced an increase in anxiety (p =.018)., Discussion: The cognitive coping skills nursing intervention was effective in helping to regulate HIV-positive persons' emotional responses to advanced disease. This nursing intervention is feasible for use by skilled practitioners providing daily care.

Published
2002
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