Methodological Considerations in Acute-Care Research: Issues in Securing Self-Report Data

Conducting research in the acutely ill and injured is important to broaden the scientific foundation of nursing practice for the specialty. Given the nature of acute illness, challenges to the collection of self-report data are numerous, but they are not insurmountable. Attending to these challenges and planning for strategies to enhance the accuracy of data are important tasks for any investigator considering research in groups of patients with acute illness or injury

Firearm Violence in America: A Growing Health Problem

Firearm injury is a disease that afflicts many individuals in the United States, either directly or indirectly. Trauma and critical care nurses have direct experience with this life-threatening disease and recognize the high lethality and life-altering consequences of these injuries. The magnitude of this health problem requires a focus on primary prevention. We recognize that any focus on firearm injury is often contentious and political; however, nurses bring a ready-made credibility and focus on evidence-based practice to the prevention of this disease

Years of Life Lost Because of Gunshot Injury to the Brain and Spinal Cord

Objective: A recent study (Lemaire) estimated the life expectancy loss attributable to gun deaths at 103.6 days for the overall U.S. population: 150.7 days for white males and 361.5 days for black males. This study estimates the life expectancy loss attributable to the premature death of individuals who initially survived gun-related traumatic brain injury (TBI) and spinal cord injury (SCI) in the United States. Design: Interpersonal TBI data were drawn from a surveillance system, and self-inflicted TBI data were obtained from the Web-based Injury Statistics and Reporting System. SCI data were obtained from a national database. Multiple decrement analysis was used to calculate the days of life lost to gunshot wounds to the brain and spinal cord, by race and gender, in the United States. Results: On average, across age, gender, and race, life expectancy in the United States is reduced by 3.1 days because of the shorter lifespan for individuals who survive an initial gunshot wound to the brain or spinal cord. Black males bear a disproportionate burden, losing 9.5 days, whereas white males lose 4.6 days. Black and white females lose 1.5 and 1.0 days, respectively. Conclusions: We add these findings to the Lemaire study, resulting in a total of 106.7 days of life expectancy loss from gunshot wounds for the U.S. population, with 371.0 days of life lost for black males

Reasons for and Reservations about Research Participation in Acutely Injured Adults

PURPOSE: The purpose of this study was to explore the reasons adult patients seeking emergency department care for minor injuries agree to participate in clinical research and to identify their reservations about participating in a research study. DESIGN AND METHODS: This is a secondary analysis of data from a longitudinal cohort study of 275 adults who sought emergency department care for physical injury and were followed over 12 months. At the final interview, participants were asked open-ended short-answer questions about their perception of participating in the study. Free text responses were analyzed using conventional content analysis. FINDINGS: The final sample of 214 participants was composed equally of males and females, predominantly Black (54%) and White (42%), with a mean age of 41 years. Six themes about reasons for participation emerged from free text responses: being asked, altruism, potential for personal benefit, financial gain, curiosity, and valuing or knowledge of research. Most did not report reservations. Those reservations identified included time constraints, confidentiality, and whether patients felt well suited to fulfill the study requirements. CONCLUSIONS: Although injured patients are identified by the research community as vulnerable, they are willing to participate in research studies for diverse reasons, and their participation is commonly associated with positive experiences. CLINICAL RELEVANCE: Understanding perceptions of participants\u27 experiences of being in a research study after acute injury can guide researchers to improve future study protocols and recruitment strategies in order to optimize participants\u27 experiences. Recruitment and retention into clinical research studies is essential to build nursing science to enhance the recovery of injured individuals

Cultivating Responsive Systems for the Care of Acutely and Critically Ill Older Adults

This article examines the importance of creating acute care systems that are responsive to the needs of acutely and critically ill and injured older adults. Four attributes of the responsive system are examined: elasticity, enabling, ease, and equanimity. An analytic literature review provides the basis for recommended practices by responsive professionals in responsive systems. Implications for practice, research, education, and policy are provided

The Relationship Between Community Violence Exposure and Mental Health Symptoms in Urban Adolescents

Urban adolescents are exposed to a substantial amount of community violence which has the potential to influence psychological functioning. To examine the relationship between community violence exposure and mental health symptoms in urban adolescents, a literature review using MEDLINE, CINAHL, PubMed, PsycINFO, CSA Social Services and CSA Sociological Abstracts was conducted. Search terms included adolescent/adolescence, violence, urban, mental health, well-being, emotional distress, depression, anxiety, posttraumatic stress disorder and aggression. Twenty-six empirical research articles from 1997 to 2007 met inclusion criteria for review. Findings indicate an influence of community violence exposure on mental health symptoms, particularly posttraumatic stress and aggression. Mediators and moderators for community violence exposure and mental health symptoms help explain relationships. Limitations in the literature are the lack of consistency in measurement and analysis of community violence exposure, including assessment of proximity and time frame of exposure, and in analysis of victimization and witnessing of community violence. Knowledge about identification of urban adolescents exposed to chronic community violence and who experience mental health symptoms is critical to mental health nursing practice and research

Ethical Issues of Recruitment and Enrollment of Critically Ill and Injured Patients for Research

The ethical issues of recruitment and enrollment of critically ill and injured patients into research studies is central to the conduct of nursing research in critical care settings. Nurse scientists can anticipate and plan for the challenges that arise during the recruitment and enrollment of these vulnerable patients into research studies

The Effect of Early Psychological Symptom Severity on Long-term Functional Recovery: A Secondary Analysis of Data from a Cohort Study of Minor Injury Patients

Background: The mental health consequences of injuries can interfere with recovery to pre-injury levels of function and long term wellbeing. Objectives: The purpose of this study was to explore the relationship between psychological symptoms after minor injury and long-term functional recovery and disability. Design: This exploratory study uses secondary data derived from a longitudinal cohort study of psychological outcomes after minor injury. Setting: Participants were recruited from the Emergency Department of an urban hospital in the United States. Participants: A cohort of 275 patients was randomly selected from 1100 consecutive emergency department admissions for minor injury. Potential participants were identified as having sustained minor injury by the combination of three standard criteria including: presentation to the emergency department for medical care within 24 h of a physical injury, evidence of anatomical injury defined as minor by an injury severity score between 2 and 8 and normal physiology as defined by a triage-Revised Trauma Score of 12. Patients with central nervous system injuries, injury requiring medical care in the past 2 years and/or resulting from domestic violence, and those diagnosed with major depression or psychotic disorders were excluded. Methods: Psychological symptom severity was assessed within 2 weeks of injury, and outcome measures for functional limitations and disability were collected at 3, 6 and 12 months. A quasi-least squares approach was used to examine the relationship between psychological symptom scores at intake and work performance and requirement for bed rest in the year after injury. Results: Adjusting for demographic and injury covariates, depression symptoms at the time of injury predicted (p ≤ 0.05) both poorer work performance and increased number of days in bed due to health in the year after injury. Anxiety symptoms predicted (p ≤ 0.05) bed days at 3, 6, and 12 months and work performance at 3 months. Conclusions: Depression and anxiety soon after minor injury may help predict important markers of long-term recovery. With further research, simple assessment tools for psychological symptoms may be useful to screen for patients who are at higher risk for poor long-term recoveries and who may benefit from targeted interventions

Neighborhoods, Daily Activities, and Measuring Health Risks Experienced in Urban Environments.

Studies of place and health often classify a subject\u27s exposure status according to that which is present in their neighborhood of residence. One\u27s neighborhood is often proxied by designating it to be an administratively defined unit such as census tract, to make analysis feasible. Although it is understood that residential space and actual lived space may not correspond and therefore exposure misclassification may result, few studies have the opportunity to investigate the implications of this issue concretely. A population-based case-control study that is currently underway provides one such opportunity. Adolescent victims of assault in Philadelphia, Pennsylvania, USA, and a control sample of adolescents drawn randomly from the community are being enrolled to study how alcohol consumption and time spent nearby alcohol outlets - individual-level and environmental-level risk factors for violence, respectively - over the course of daily activities relate to the likelihood of being assaulted. Data from a rapport-building exercise consist of hand-drawn sketches that subjects drew on street maps when asked to indicate the area considered their neighborhood. The main data consist of self-reported, detailed paths of the routes adolescents traveled from one location to the next over the course of one full day. Having noticed interesting patterns as the data collection phase proceeds, we present here an analysis conducted with the data of 55 control subjects between 15 and 19 years old. We found that hand-drawn neighborhoods and activity paths did not correspond to census tract boundaries, and time subjects spent in close proximity to alcohol outlets during their daily activities was not correlated with the prevalence of alcohol outlets in the census tract of their residence. This served as a useful example demonstrating how classifying subjects as exposed based solely on the prevalence of the exposure in the geographic area of their residence may misrepresent the exposure that is etiologically meaningful

Trauma Center-Community Partnerships to Address Firearm Injury: It can be Done

Firearm violence is often framed as a problem of the inner cities and of the criminal justice system. However, this focus may direct attention away from smaller communities that also face firearm violence, including suicide. Ten years ago, the Firearm and Injury Center at Penn (FICAP) developed and implemented a model program in three smaller cities, using trauma centers to spearhead community partnerships. This Issue Brief describes the development and implementation of these partnerships, and highlights one community’s ongoing activities to reduce firearm injury