The Role Of The Nurse Practitioner In Support Of Families Experiencing Chronic Sorrow

Chronic sorrow is the periodic recurrence of permanent, pervasive sadness or other grief-related feelings associated with ongoing disparity resulting from a loss experience (Eakes, 2004). As a concept, chronic sorrow speaks to the emotional strain in the lived experiences of caregivers of the chronically ill and disabled. The term chronic sorrow was first used by Olshansky (1962) to describe the grief and sadness that parents felt when their child was first diagnosed as being mentally retarded. Research on chronic sorrow has proven its presence not only in parents, but in other family members, caregivers, and those with an illness or disability. Furthermore, chronic sorrow as a phenomenon has also been recorded in caregivers of the physically ill, mentally ill, and those disabled. Healthcare providers across all disciplines are in constant contact with individuals who are dealing with hopeless situations and many of them are experiencing chronic sorrow. It is inconceivable that with modem medicine and technological advancements, the majority of healthcare providers are at a loss in dealing with those caregivers who suffer. Therefore, this author has chosen to look at the progress made since the original usage by Olshansky. To this end, a systematic integrated review of the literature using computer searches of CINAHN, MEDLINE, the Cochrane Library, and electronic media was done in an effort to identify the current level of healthcare knowledge regarding the role of the nurse practitioner in providing support to families experiencing chronic sorrow. These searches produced a limited number of articles regarding support by any healthcare professional and none that referenced nurse practitioners. However, the literature was rich with progressive information and noted enormous gains in understanding of this phenomenon over the past two decades. Of particular importance was information about the instigation of the Nursing Consortium for Chronic Sorrow, the development of the Chronic Sorrow Questionnaire, and the ongoing work to further develop the middle range nursing theory of chronic sorrow. The Uncertainty in Chronic Illness Model developed by Merle Mishel was used as the theoretical foundation for this review. This model is used to describe and to establish an understanding of the uncertainty or unpredictability and lack of consistency that is ever present in chronic illness (Mishel, 1990). Within this review the theoretical and operational definitions of chronic sorrow, nurse practitioner, healthcare provider, and family support were explored. From this review, it is evident that there is a need for further considerations regarding the role o f the nurse practitioner in support of families experiencing chronic sorrow. Further evidenced is the need to fill the void in education of advanced practice nurses as it relates to this phenomenon. Within this review, implications for nursing theory, nursing research, advanced nursing practice, nurse practitioner education, and health policy are provided as they emerge from the concepts explored

Online tutorial – meeting students’ needs

Pretendemos dar a conhecer um estudo piloto que foi desenvolvido com alunos do ensino superior e cujo objectivo passou pelo ensejo de potenciar o trabalho colaborativo entre os mesmos, bem como as suas capacidades de pesquisa. Os recursos informáticos utilizados foram espaços virtuais de colaboração, uma vez que são espaços com grandes potencialidades ao nível da colaboração e da interacção. O grupo-alvo foi constituído por estudantes de primeiro ano do ensino superior politécnico. Os estudantes estavam divididos em turmas: um grupo a tempo inteiro e outro em pós aboral, ambos frequentando o mesmo curso e a mesma unidade curricular. A estratégia de tutória adoptada iniciou-se com a apresentação de um desafio por parte da docente. Após o desafio lançado os estudantes pesquisaram acerca da temática e partilharam, no Diigo, os links/documentos que encontraram e consideraram serem pertinentes para o desenvolvimento do tema. No final, os estudantes tinham que escrever um artigo acerca do tema, tendo em conta as pesquisas desenvolvidas, as leituras efectuadas e as discussões colaborativas realizadas. Para facilitar o desenvolvimento de uma compreensão partilhada, os estudantes, além de disponibilizarem e comentarem a informação no Diigo, também participaram em sessões virtuais de discussão na plataforma Second Life®. O estudo piloto conduzido, e descrito neste documento, permitiu reunir indicadores sobre as mais valias das ferramentas online utilizadas, nomeadamente no que se refere ao grau e qualidade da participação, colaboração e interacção dos estudantes, aliados à inexistência de constrangimentos de ordem temporal e/ou física.This article will present a pilot study that was developed with students from higher education on approaches to increase the collaborative work between students, and to enhance their research skills. The methodology we are evaluating is designed around collaborative virtual spaces which offer some benefits for deeper collaboration and interaction. The target group was students from the 1st year of a Higher Level Course. One group of students was in full-time education and a second group was mature students in part-time education. Both groups are engaged on an identical course. The tutorial strategy adopted began with the teacher setting the class a challenge. Students were then invited to research the question and post whatever links/documents they consider relevant using a Diigo group, and comment on what they found (using the share and comment capabilities). The task for students was to write an article about the topic based on their research, readings and collaborative discussions. To facilitate the development of a shared understanding the students posted information and participated in virtual on-line meetings (Second Life®). The pilot study implemented, and described in this article, demonstrated some gains from the use of online tools, in particular related with the level and quality of participation, collaboration and interaction among students. The use of virtual environments allows students to participate in richer interactions at times that are more convenient to their work/study patterns, with no physical restrictionsinfo:eu-repo/semantics/publishedVersio

Advancing Scientific Discourse in the Controversy Surrounding the Comprehensive System for the Rorschach: A Rejoinder to Meyer (2000)

A recent commentary by Meyer (2000) in the Journal of Personality Assessment alleged that Rorschach critic Wood and his colleagues had intentionally published information that they knew to be in error. To substantiate this contention, Meyer’s commentary published information that was part of the peer review process at another journal. In this rejoinder, we present factual information that shows we have consistently acted in good faith. This rejoinder suggests that the scientific debate regarding the Comprehensive System for the Rorschach is unlikely to be advanced by speculating about the intentions of Rorschach critics, or by publishing information from the peer review process that is usually kept confidential

Effective Community Engagement Strategies: The Voices of Injection Drug Users

Academic and community interactions are often conducted with good intentions. However, there is exploitation risk for populations engaging in illegal activities. Collaborations with injection drug users (IDUs) can highlight their expertise and support progressive research. The objective of our research was to use community-based participatory research principles to give voice to IDUs, define community, and recommend authentic engagement strategies. In Phase 1, 10 focus groups (n=33, ages 25–64) helped define community and collaborative partnerships. In Phase 2, community forums with 13 additional IDUs provided feedback on focus group themes. Results: (1) primary themes defining community— geography and social networks; (2) community qualities—respectful, accepting, outcasts, and welcoming; (3) engagement recommendations—incentives, recognizing potential for contributions, treating IDUs respectfully, using research results for positive benefit. Conclusions: Providing voice to marginalized communities allows for self-definition, description of needs, and authentic engagement recommendations. This information is crucial for developing effective programs and creating sustainable collaborations between IDUs and academics

Association between hypertensive disorders of pregnancy and later risk of cardiovascular outcomes

Funder: Homerton College, University of Cambridge (GB)BACKGROUND: Hypertensive disorders of pregnancy are common pregnancy complications that are associated with greater cardiovascular disease risk for mothers. However, risk of cardiovascular disease subtypes associated with gestational hypertension or pre-eclampsia is unclear. The present study aims to compare the risk of cardiovascular disease outcomes for women with and without a history of gestational hypertension and pre-eclampsia using national hospital admissions data. METHODS: This was a retrospective cohort study of national medical records from all national health service hospitals in England. Women who had one or more singleton live births in England between 1997 and 2015 were included in the analysis. Risk of total cardiovascular disease and 19 pre-specified cardiovascular disease subtypes, including stroke, coronary heart disease, cardiomyopathy and peripheral arterial disease was calculated separately for women with a history of gestational hypertension and pre-eclampsia compared to normotensive pregnancies. RESULTS: Amongst 2,359,386 first live births there were 85,277 and 74,542 hospital admissions with a diagnosis of gestational hypertension and pre-eclampsia, respectively. During 18 years (16,309,386 person-years) of follow-up, the number and incidence of total CVD for normotensive women, women with prior gestational hypertension and women with prior pre-eclampsia were: n=8668, 57.1 (95% CI:55.9-58.3) per 100,000 person-years; n=521, 85.8 (78.6-93.5) per 100,000 person-years and n=518, 99.3 (90.9-108.2) per 100,000 person-years, respectively. Adjusted HRs (aHR) for total CVD were: aHR (95% CI) = 1.45 (1.33-1.59) for women with prior gestational hypertension and, aHR=1.62 (1.48-1.78) for women with prior pre-eclampsia. Gestational hypertension was strongly associated with dilated cardiomyopathy, aHR=2.85 (1.67-4.86), and unstable angina, aHR=1.92 (1.33-2.77). Pre-eclampsia was strongly associated with hypertrophic cardiomyopathy, aHR=3.27 (1.49-7.19), and acute myocardial infarction, aHR=2.46 (1.72-3.53). Associations were broadly homogenous across cardiovascular disease subtypes and increased with a greater number of affected pregnancies. CONCLUSIONS: Women with either previous gestational hypertension or pre-eclampsia are at greater risk of a range of cardiovascular outcomes. These women may benefit from clinical risk assessment or early interventions to mitigate their greater risk of various cardiovascular outcomes.Cambridge BHF Centre of Research Excellence (RE/13/6/30180

The MAGEC System for Spinal Lengthening in Children with Scoliosis: A NICE Medical Technology Guidance

Scoliosis—structural lateral curvature of the spine—affects around four children per 1,000. The MAGEC system comprises a magnetically distractible spinal rod implant and an external remote controller, which lengthens the rod; this system avoids repeated surgical lengthening. Rod implants brace the spine internally and are lengthened as the child grows, preventing worsening of scoliosis and delaying the need for spinal fusion. The Medical Technologies Advisory Committee at the National Institute for Health and Care Excellence (NICE) selected the MAGEC system for evaluation in a NICE medical technologies guidance. Six studies were identified by the sponsor (Ellipse Technologies Inc.) as being relevant to the decision problem. Meta-analysis was used to compare the clinical evidence results with those of one conventional growth rod study, and equal efficacy of the two devices was concluded. The key weakness was selection of a single comparator study. The External Assessment Centre (EAC) identified 16 conventional growth rod studies and undertook meta-analyses of relevant outcomes. Its critique highlighted limitations around study heterogeneity and variations in baseline characteristics and follow-up duration, precluding the ability to draw firm conclusions. The sponsor constructed a de novo costing model showing that MAGEC rods generated cost savings of £9,946 per patient after 6 years, compared with conventional rods. The EAC critiqued and updated the model structure and inputs, calculating robust cost savings of £12,077 per patient with MAGEC rods compared with conventional rods over 6 years. The year of valuation was 2012. NICE issued a positive recommendation as supported by the evidence (Medical Technologies Guidance 18)

Infection of Kissing Bugs with Trypanosoma cruzi, Tucson, Arizona, USA

A survey of triatomine insects found that 41.5% were infected with the causative agent of Chagas disease