UNDERSTANDING THE PATIENT’S RECALLED EXPERIENCE OF AN ACUTE EPISODE OF GUILLAIN-BARRE’ SYNDROME: A QUALITATIVE DESCRIPTIVE STUDY

Guillain-Barre’ syndrome (GBS) is a rare disease that affects the peripheral nervous system. It is autoimmune in nature and generally presents with areflexia and paresthesias that can lead to total paralysis. Guillain-Barre’ syndrome, with the eradication of polio, is now the leading cause of flaccid paralysis in the United States. This condition produces significant mortality and morbidity challenging the entire healthcare team, but particularly nurses. Guillain-Barre’ syndrome is not understood well by nurses. Patients who have experienced a moderate to severe case of Guillain-Barre’ syndrome have reported that nursing care was inconsistent. Patients have disclosed that nurses do not have the knowledge related to the special needs of GBS patients. Because of this lack of knowledge, patients experience unnecessary discomfort and/or stress. Research to better understand the impact of an acute episode of Guillain-Barre’ syndrome and the care required during hospitalization is crucial in order to educate caregivers and enhance the patient’s care experience. The purpose of this study was to gain a richer understanding of the patient’s recalled experience of an acute episode of moderate to severe Guillain-Barre’ syndrome. A qualitative descriptive design was utilized to answer three research questions. Orem’s self care deficit theory of nursing was utilized to inform this research study. Data were collected through semi-structured interviews with 14 participants. The sample included 10 females and four males from 19 to 79 years old from eight different states. Inductive content analysis was utilized to analyze the data to establish themes. Five major themes were identified: physical manifestations of GBS, attitudes and emotions, knowledge and awareness, the value of peer contact, and care concepts. These themes would suggest that healthcare team members, including nurses, do not have an understanding of the special needs of Guillain-Barre’ syndrome patients. Additional work and research is needed to enhance the patient’s experience with moderate to severe Guillain-Barre’ syndrome. Implications are evident in the areas of practice, educational preparation of healthcare staff, health policy and future research

School-Age Children\u27s Perception of Stress in the Hospital: A Draw and Tell Story

The purpose of this study was to explore the perceptions of stress for hospitalized school-age child, seven to nine years of age, through a child-centered draw and tell technique. Over 3 million children are hospitalized every year (NACHRI, 2012). Hospitalization of children is reserved for increasingly complex care. Since the 1960s, it has been well known that hospitalization can be a traumatic experience for children (King & Ziegler, 1981; Thompson, 1986; Vernon, Foley, Simpowicz, & Schulman, 1965; Visintainer & Wolfer, 1975). This experience elicits feelings of fear, uncertainty, pain and discomfort that can affect a child\u27s healing, behavior and health outcomes (Hopia, Tomlinson, Paavilainen, Paivi, 2004). Although the psychosocial impact of hospitalization is evident, it has not been fully explored from a child\u27s perspective. Thirty child participants in a large Midwest children\u27s hospital were interviewed through a child-centered \u27draw and tell\u27 technique (Driessnack, 2006) to elicit their perceptions of stress in the context of hospitalization. Interpretive description approach was applied (Thorne, 2008) .The results of this study revealed 14 themes for building a conceptualized framework. Five important messages from children are communicated to professional caregivers in the hospital: a) stress for children is expressed through their fears, worries, discomforts and sadness; b) children should be listened to, as they have something important to say; c) children want to know what is expected of them and be informed of what they need to do; d) children identify simple things health care providers can do to help them during hospitalization e) the ultimate relief of stress for children in the hospital is going home and children want to know a timeline what they need to do to go home. Discovering the meaning of stress for the hospitalized child launches a research trajectory addressing the remedies for psychosocial trauma for this population

Creating a Healing Environment: Strategies Christian Nurses Use

Nursing metaparadigm concepts of nurse, person, environment, and health are the conceptual building blocks which provide direction to nursing research and knowledge development (Fawcett & Desnato-Madeya, 2013). Interaction of person, nurse and environment facilitate optimal outcomes yet, there remains a need for research on the paradigm concept of environment and creation of a healing environment in particular. (Meleis, 2010). The purpose of this study was to explore the strategies Christian nurses used to create a healing environment and enhance well-being for non-end-of-life, hospitalized patients from admission forward. Specific aims included identifying nurses’ perspectives on (1) the strategies Christian nurses used to create a healing environment and enhance well-being, (2) the outcomes they perceived resulting from these strategies, and (3) the factors they regarded as either enhancing or inhibiting the creation of the healing environments. An additional aim was description of characteristics of nurses who created healing environments and enhanced well-being. In this qualitative, Glaserian grounded theory (GGT) study, interview data were collected via a demographic “Information about You” sheet (see Appendix D) and semi- structured interviews (see Appendix C for interview guide) of nurses (N = 15) until data saturation was reached. A criterion-based, purposive sample was recruited, and tape-recorded face-to-face interviews were transcribed verbatim, coded, and analyzed using constant comparative methods in consultation with a grounded theory expert. “Charting the healing path” is the core category and consists of four phases: helping patients get better, fostering the healing environment, charting a healing path, and observing outcomes. Within this model are ten substantive categories of baseline assessment, being available, knowing as a unique individual, hearing immediate concerns, seeing from the patient and the nurse points of view, partnering with the patient, setting realistic goals, realizing best potential, and outcomes. See Figure 1 for a conceptual model. The “charting the healing path” model informs development of the environment domain of nursing knowledge. Knowing the patient, the juncture of nurse and patient points of view, and the resultant nurse-patient partnership seek best potential outcomes to be realized incrementally during, and after, hospitalization

8th Annual Research Week- Event Proceedings

8th Annual Research Wee

Pediatric Nurses\u27 Experiences of Identifying and Managing Constipation in Hospitalized Children

Pediatric nurses care for hospitalized children with constipation daily. Pediatric nurses’ timely identification and management of constipation in hospitalized patients can be key to preventing long-term problems with chronic constipation and promoting child well-being. The purpose of the study was to investigate the experiences of pediatric nurses regarding their identification and management of constipation in hospitalized children. The Theory of Planned Behavior (TBP) informed this qualitative study. Participants for this phenomenological investigation were 21 pediatric nurses. Nurses provided care in the inpatient setting in a freestanding 292 bed magnet-designated pediatric hospital. In depth interviews were conducted to explore participants’ perspectives of their experiences caring for hospitalized children with constipation. Six themes emerged from the results: 1) Looking for clues of constipation with subthemes of a) typical bowel patterns, b) walking kind of funny, and c) different reasons why they’re constipated; 2) Multiple, multiple interventions with subthemes of a) go and sit on the toilet, b) a wide variety of constipation management, and c) it just took educating; 3) Getting everybody on the same page with subthemes of a) the parents are a huge resource, b) they trust our judgment, and c) just kind of negotiate; 4) Down there with subthemes of a) I would not automatically do a rectal check, b) an infant is totally different from a 5 or 6-year old, c) I just try and build a trustful rapport, d) comfort and privacy, and e) we kind of do a dress rehearsal at the desk; 5) Just a very basic overview of constipation with the subthemes of a) you need time, experience, and certain patient situations and b) the unit I work on; and 6) Experiences whether good or bad with subthemes of a) it’s exhausting, b) people missed it, and c) I know it will help the child. Participants described their ability to recognize constipation in children across all ages. Pediatric nurses were creative in promoting bowel elimination through non-pharmacologic interventions, yet found pharmacologic constipation management challenging. Oral medications were easier for nurses to administer, which can influence the timely resolution of constipation. Participants didn’t like to give enemas or suppositories and were uncertain about performing rectal checks and disimpactions. Pediatric nurses reported that child and parent negotiation was required to influence outcomes in the care of hospitalized children with constipation. Nurses in this study found that years of experience, especially on their work unit, enhanced their knowledge of constipation. According to the participants, constipation identification and management in hospitalized children can be exhausting but rewarding. Nurses needed to negotiate to promote successful outcomes. Implications for nursing practice, education, policy and future research are discussed