Translation to practice: a randomised controlled study of an evidenced based booklet targeted at breast care nurses in the United Kingdom

BACKGROUND: In the United Kingdom (UK), it was documented that a problem of knowledge transfer existed within the speciality of breast-cancer care, thus depriving patients of receiving optimal care. Despite increasingly robust research evidence indicating recommendation of whole body exercise for people affected by breast cancer, commensurate changes to practice were not noted amongst breast-care nurses (BCNs). AIM: To evaluate the effect of a targeted booklet, Exercise and Breast Cancer: A Booklet for Breast-Care Nurses, on changes in knowledge, reported practice, and attitudes of BCNs in the UK. METHOD: A prospective, experimental approach was used for designing a pre- and post-test randomised controlled study. Comparisons of knowledge, reported practice, and attitudes based on responses to a questionnaire were made at two time-points in two groups of BCNs (control and experimental). The unit of randomisation and analysis was hospital clusters of BCNs. The sample comprised 92 nurses from 62 hospitals. Analysis consisted of descriptive statistics and clustered regression techniques: clustered logistic regression for knowledge items, clustered linear regression for knowledge scores, ologit for attitude and reported practice items, and clustered multiple regression for paired and multiple variable analysis. RESULTS: A statistically significant increase in knowledge and changes in reported practice and attitudes were found. Robust variables affecting knowledge acquisition were: promotion of health, promotion of exercise, and understanding how exercise can reduce cancer-related fatigue. DISCUSSION: The study has shown that evidence-based printed material, such as an information booklet, can be used as an effective research dissemination method when developed for needs, values, and context of a target audience. CONCLUSIONS: This practical approach to research dissemination could be replicated and applied to other groups of nurses.</p

The variability of refractivity in the atmospheric boundary layer of a tropical island volcano measured by ground-based interferometric radar

For 24 h we measured continuously the variability of atmospheric refractivity over a volcano on the tropical island of Montserrat using a ground-based radar interferometer. We observed variations in phase that we interpret as due to changing water vapour on the propagation path between the radar and the volcano and we present them here in the context of the behaviour of the atmospheric boundary layer over the island. The water vapour behaviour was forced by diurnal processes, the passage of a synoptic-scale system and the presence of a plume of volcanic gas. The interferometer collected images of amplitude and phase every minute. From pairs of phase images, interferograms were calculated and analyzed every minute and averaged hourly, together with contemporaneous measurements of zenith delays estimated from a network of 14 GPS receivers. The standard deviation of phase at two sites on the volcano surface spanned a range of about 1–5 radians, the lowest values occurring at night on the lower slopes and the highest values during the day on the upper slopes. This was also reflected in spatial patterns of variability. Two-dimensional profiles of radar-measured delays were modelled using an atmosphere with water vapour content decreasing upwards and water vapour variability increasing upwards. Estimates of the effect of changing water vapour flux from the volcanic plume indicate that it should contribute only a few percent to this atmospheric variability. A diurnal cycle within the lower boundary layer producing a turbulence-dominated mixed layer during the day and stable layers at night is consistent with the observed refractivity

The BARRIERS scale -- the barriers to research utilization scale: A systematic review

<p>Abstract</p> <p>Background</p> <p>A commonly recommended strategy for increasing research use in clinical practice is to identify barriers to change and then tailor interventions to overcome the identified barriers. In nursing, the BARRIERS scale has been used extensively to identify barriers to research utilization.</p> <p>Aim and objectives</p> <p>The aim of this systematic review was to examine the state of knowledge resulting from use of the BARRIERS scale and to make recommendations about future use of the scale. The following objectives were addressed: To examine how the scale has been modified, to examine its psychometric properties, to determine the main barriers (and whether they varied over time and geographic locations), and to identify associations between nurses' reported barriers and reported research use.</p> <p>Methods</p> <p>Medline (1991 to September 2009) and CINHAL (1991 to September 2009) were searched for published research, and ProQuest^®digital dissertations were searched for unpublished dissertations using the BARRIERS scale. Inclusion criteria were: studies using the BARRIERS scale in its entirety and where the sample was nurses. Two authors independently assessed the study quality and extracted the data. Descriptive and inferential statistics were used.</p> <p>Results</p> <p>Sixty-three studies were included, with most using a cross-sectional design. Not one study used the scale for tailoring interventions to overcome identified barriers. The main barriers reported were related to the setting, and the presentation of research findings. Overall, identified barriers were consistent over time and across geographic locations, despite varying sample size, response rate, study setting, and assessment of study quality. Few studies reported associations between reported research use and perceptions of barriers to research utilization.</p> <p>Conclusions</p> <p>The BARRIERS scale is a nonspecific tool for identifying general barriers to research utilization. The scale is reliable as reflected in assessments of internal consistency. The validity of the scale, however, is doubtful. There is no evidence that it is a useful tool for planning implementation interventions. We recommend that no further descriptive studies using the BARRIERS scale be undertaken. Barriers need to be measured specific to the particular context of implementation and the intended evidence to be implemented.</p

The beneficial attributes of visual art-making in cancer care: an integrative review

We seek to understand what is known about the use of visual art-making for people who have a cancer diagnosis, and to explore how art-making may help address fatigue in the cancer care context. Art-making involves creating art or craft alone or in a group and does not require an art-therapist as the emphasis is on creativity rather than an overt therapeutic intention. An integrative review was undertaken of qualitative, quantitative and mixed-method studies on art-making for people who have cancer, at any stage of treatment or recovery. An adapted version of Kaplan's Attention Restoration Theory (ART) was used to interpret the themes found in the literature. Fifteen studies were reviewed. Nine concerned art-making programmes and six were focused on individual, non-facilitated art-making. Review results suggested that programme-based art-making may provide participants with opportunities for learning about self, support, enjoyment and distraction. Individual art-making can provides learning about self, diversion and pleasure, self-management of pain, a sense of control, and enhanced social relationships. When viewed through the lens of ART, art-making can be understood as an energy-restoring activity that has the potential to enhance the lives of people with a diagnosis of cancer

Are we ready for the Electronic Patient Record? Attitudes and perceptions of staff from two NHS trust hospitals

In light of plans to implement an electronic patient record (EPR), preparations for radical organizational change were recognized as being critical to success. The aim of the study was to determine hospital staff’s experience of and attitudes toward computer use and the EPR. A cross-sectional design using the Computer and EPR Attitude Survey was administered to 878 health service employees in two acute hospitals; 479 completed questionnaires were returned, representing a 54 per cent response rate. The majority of respondents demonstrated positive attitudes toward the use of computers and the EPR, although only 298 (62%) wrote that they knew what ‘EPR’ actually stood for. Nurses consistently recorded the greatest agreement with negative statements: ‘I avoid using computers whenever I can,’ ‘Using a computer is more trouble than it is worth,’ and ‘I sometimes feel intimidated by the thought of using a computer.’ Recommendations centre on responsive and prompt actions, e.g. informative workshops and targeted skills training

Comparing the meanings of fatigue in individuals with cancer in Thailand and Canada

BACKGROUND: Illness is experienced in social contexts; its meaning is rooted in local beliefs and values as well as one's personal and family situation. Health professionals are steeped in knowledge of disease but know much less about illness. OBJECTIVES: The objective of the study was to learn more about the social construction of illness by comparing the meanings of fatigue in Thai and Canadian individuals with cancer. METHODS: Using an ethnoscience design, 10 Thai adults receiving chemotherapy for advanced lung cancer or colorectal cancer were interviewed twice. They were asked to sort words and phrases about fatigue from their first interview using Q-sort, triadic, and dyadic approaches; to name each pile; and to describe the similarities and differences between the piles. The card sorts were used to understand the relationships among key ideas in each interview. A table summarizing the card sorts was constructed, and patterns in the data were identified. RESULTS: Two segregates in the Thai data were identified: essential/constant and intermittent, with essential/constant including 2 segregates (feeble and altered cognition), and intermittent including 2 segregates (loss of mental strength and difficulty sleeping). The primary meanings of fatigue in the Thai data were related to temporality, whereas the primary meanings of fatigue in the Canadian data were related to the location of the fatigue (mind/body). CONCLUSION: These findings help us understand the social construction of fatigue, a common symptom in cancer. IMPLICATIONS FOR PRACTICE: Further research in relation to links between fatigue and other related-symptoms is needed with the goal of developing cross-cultural interventions for managing fatigue in the future