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Biomedical subjects

Lynn McCleary

Publications and source records attributed to Lynn McCleary.

15 recordsLinked to original sources
PubMed2006

A pilot study of adjunctive family psychoeducation in adolescent major depression: feasibility and treatment effect.

OBJECTIVE: To obtain preliminary evidence of the feasibility and effectiveness of adjunctive family psychoeducation in adolescent major depressive disorder. METHOD: Participants were from outpatient clinics in Hamilton and London, Ontario. Over 24 months, 41 adolescents ages 13 through 18 years meeting major depressive disorder criteria were recruited (31 in Hamilton, 10 in London). Participants were randomized to usual treatment or usual treatment plus family psychoeducation. Outcome measures were readministered at 2 weeks, mid-treatment, posttreatment, and 3-month follow-up. Intent-to-treat analyses used chi2 and t tests and growth curve analysis. Standardized effects based on growth curve estimates were calculated for continuous outcomes. RESULTS: The London site was withdrawn because of poor participant retention. In Hamilton, no participant missed more than one assessment and there was good family psychoeducation adherence. Compared to controls, participants in the experimental group showed greater improvement in social functioning and adolescent-parent relationships (with medium standardized effect size > 0.5), and parents reported greater satisfaction with treatment. CONCLUSIONS: There were positive treatment effects on family and social functioning processes postulated to mediate the clinical course of major depressive disorder. The study provides support for further evaluation of family psychoeducation in this clinical population.

Adolescent↗
PubMed2005

A systematic review of practice standards and research ethics in technology-based home health care intervention programs for older adults.

OBJECTIVE: The purpose of the review is to assess frequencies of reporting adherence to professional practice standards and research ethics in studies of technology-based home health care programs. METHODS: Key databases were searched to yield 2,866 abstracts that were independently rated by two reviewers using inclusion-exclusion criteria, resulting in 107 articles that were then reviewed for reports of practice standards and research ethics. RESULTS: Issues related to professional practice standards and research ethics were not well reported. When reported, adherence to practice standards included preintervention training, use of intervention protocols, supervision, and mechanisms for risk management. Research ethics most commonly reported were informed consent, REB/IRB approval, and protection of privacy. DISCUSSION: The results raise questions as to whether practice standards and research ethics are addressed sufficiently when health service delivery occurs in technology-based environments. Guidelines for professional accountability in e-health service delivery are needed.

Aged↗
PubMed2004

Evaluation of the pain resource nurse role: a resource for improving pediatric pain management.

Pain resource nurses (PRNs), who act as pain management coaches or mentors for their colleagues, can contribute to effective pain management. The PRN's role has not been well evaluated in the context of pediatric nursing. Therefore, the objective of this study was to examine the PRN's role in a pediatric setting and, more specifically, to describe the role in terms of the activities PRNs engage in, the challenges they face, and the supports that help them fulfill their role. This research was part of an evaluation of the implementation of a comprehensive pain management program in a pediatric hospital. Focus groups were conducted with 18 PRNs six months after implementation of the PRN role. The essence of the role is to provide support for best-practice pain management to nurses and the multidisciplinary team. The PRNs described seven components of their role and specific strategies to operationalize their role. In addition, the PRNs faced challenges, including feeling disappointed when their expectations for better pain management were not met, experiencing difficulty fitting the activities into their busy workdays, facilitating their colleagues' improved pain management without also alienating them, and maintaining their enthusiasm and energy for the role. Pediatric nursing staff can effectively fill the role of the PRN. The role is multifaceted, and maintaining the role required commitment and enthusiasm on the part of the nurses, as well as commitment by their related institutions.

Attitude of Health Personnel↗
PubMed2003

Association between nurses' education about research and their research use.

Knowledge about research methods, skills for critical appraisal of research reports, and a positive attitude towards research have been identified as means to potentially overcome barriers to individual nurses' research utilization, and ultimately improve nursing practice. The objective of this study was to examine independent relationships between nurses' education about research and research use and their attitudes towards research, knowledge about research and research utilization. Research utilization and attitude towards research were measured using the Edmonton Research Orientation Scale. One hundred and seventy-five nurses working in a pediatric hospital responded to the survey. Higher levels of education were associated with both (1) positive attitudes towards research and (2) higher levels of self-reported research utilization. Whether or not nurses had university education, completing a course about research design or a course about how to read and use research was associated with positive attitudes towards research. Having completed a course about how to read and use research was not associated with self-reported research utilization. The association between having completed a course about research design and self-reported research utilization was not independent of the association between level of education and research utilization. The findings indicate that education about research may be one way to overcome negative attitudes towards research as a barrier to research utilization.

Adult↗
PubMed2003

Barriers to paediatric nurses' research utilization.

BACKGROUND: A number of studies have investigated barriers to research utilization among nurses in various countries, and standardized scales have been validated to study this. Reported barriers have been categorized as individual, organizational and environmental, with organizational characteristics generally accounting for more variance. However, information about research utilization among paediatric nurses is lacking. AIM: The objective of the research reported here was to investigate barriers to research utilization and relationships between those barriers and participation in research, self-reported research utilization and education among paediatric nurses. DESIGN: A survey of all nurses in a paediatric teaching hospital; 176 nurses (33.3%) responded. Two standardized measures were used, the Barriers Scale and the Edmonton Research Orientation Scale. RESULTS: Lack of time to read research was the most frequently cited barrier to using research and administrators not allowing implementation was the least frequently cited. Characteristics of the communication and of the setting were more likely to be cited as barriers to research use than were characteristics of the nurse. Nurses who reported higher levels of actual research use were slightly less likely to see characteristics within themselves as barriers. Those who had taken a course about reading or using research were more likely to see the organization as a barrier. Barriers to research use were not associated with self-reported understanding of research. CONCLUSIONS: These results are congruent with previous findings that implementing research in practice is a complex process. They indicate that individual nurses' knowledge about research may not be as important as the process by which organizations implement research. However, the Barriers Scale measures general perceptions about barriers to research utilization and not nurses' specific experiences with barriers to implementing particular research.

Adult↗
PubMed2002

Research utilization among pediatric health professionals.

The present study investigated research use and attitudes toward research among pediatric health professionals. All nurses and allied health professionals in a pediatric teaching hospital were surveyed using previously tested and published measures. Over half of the participants had some formal education in research but, for some participants, that education was many years ago. Most participants reported poor or very poor understanding of research design. Two variables were independently associated with a positive attitude towards research: (i) better understanding of how to conduct a literature search; and (ii) higher level of education. Five variables were independently associated with research use: better understanding of research design; having presented at a conference in the past two years; sense of calling to the profession; better understanding of how to conduct a literature search; and attending rounds. A small proportion of variance in both research use and a positive attitude towards research was explained by the independent predicator variables. Further research is required to identify characteristics of the workplace environment that support research use.

Attitude of Health Personnel↗
PubMed2002

Parenting adolescents with attention deficit hyperactivity disorder: analysis of the literature for social work practice.

Parenting an adolescent with ADHD presents a number of unique challenges and stressors. Social workers can play an important role in providing psychosocial therapies for clients with ADHD and their families. However, practice with this population has not been well-addressed in the social work literature. This article analyzes theories of parenting stress; stress, appraisal, and coping theory; and the research literature about parenting and ADHD, with a focus on relevance for social work practice.

Adaptation, Psychological↗
PubMed2002

Parental expressed emotion in depressed adolescents: prediction of clinical course and relationship to comorbid disorders and social functioning.

BACKGROUND: High expressed emotion (EE) predicts worse clinical course for a number of disorders. High EE is more frequent in parents of disordered children than normal controls. It is uncertain whether EE and its components are disorder-specific, whether EE is more closely related to parent characteristics or child characteristics, and whether EE predicts clinical course independently of clinical variables that reflect severity of disorder. EE has not been investigated in adolescent depression. METHOD: The 57 participants in this study were a sub-sample of a longitudinal study of the clinical course of depression. Adolescents and parents were recruited from consecutive referrals to all psychiatric outpatient clinics and inpatient units in a geographic catchment area. The association between EE and one-year clinical outcome of major depressive disorder was tested and associations between EE and characteristics of the adolescent, the parent, and the family were examined. RESULTS: EE was independent of socio-demographic characteristics, comorbid diagnoses, and parental depression. High EE was associated with worse adolescent social functioning according to either adolescent or parent report. High EE was associated with the presence of more depression symptoms. Low EE predicted major depression remission in participants without comorbid attention-deficit/hyperactivity disorder (ADHD), but this association was not independent of the association between social functioning and depression remission. CONCLUSIONS: The findings indicate a need to examine possible protective effects of low EE. Relationships between EE, social functioning, and depression persistence and remission require further examination.

Adolescent↗
PubMed2002

A toolkit to facilitate the implementation of clinical practice guidelines in healthcare settings.

In the early stages of development and pilot implementation of the guidelines, it became apparent that organizations were struggling to identify ways to introduce and implement the guidelines. The majority of the pilot sites were providing education sessions to facilitate CPG utilization with little attention to other implementation strategies. Those charged with introducing the CPG into the clinical setting were soon faced with a myriad of implementation challenges for which they needed a solution. It became clear that a planned systematic approach to facilitate implementation of CPGs was needed.

Canada↗
PubMed2002

Use of the Edmonton Research Orientation Scale with nurses.

Improved understanding of the determinants of research utilization is fundamental to developing and testing strategies to increase research utilization. Inconsistent findings in this field of research about research utilization may be attributable, in part, to lack of development of measures. This research tested the internal consistency and construct validity of the Edmonton Research Orientation Scale (EROS) and its four subscales (Valuing Research, Research Involvement, Being on the Leading Edge, and Evidence-Based Practice), which are promising measures of research utilization and attitudes towards research. One hundred eighty-five registered nurses in a pediatric teaching hospital completed the EROS. Nurses who reported higher levels of education, better understanding of research topics or participation in quality management or research projects also reported higher levels on the EROS and EROS subscales. The Valuing Research and Evidence-Based Practice subscales were associated with having taken courses in research design and statistics. The findings suggest that the EROS and the Valuing Research and Evidence-Based Practice subscales may be used to measure nurses' attitudes towards research and research utilization.

Adult↗
PubMed2002

Equipoise in clinical nursing research.

Equipoise, a state of uncertainty about the relative merits of 2 or more treatments or therapeutic approaches, is fundamental to the ethical conduct of clinical research. The degree of uncertainty necessary for ethical conduct of a clinical trial is the subject of ongoing debate. The concept of equipoise has not received sufficient attention from nurse authors. This paper examines the concept of equipoise by drawing on the author's experience with 3 trials of psychosocial interventions in mental health. Arguments for and against using equipoise in the evaluation of ethics of clinical research are summarized. Equipoise may be impossible to achieve in trials of psychosocial treatments with multiple outcomes for patients and relatives. In addition, the need to achieve equipoise may put nurses who provide psychosocial treatments in clinical trials in conflict. In order to provide the best treatment possible, they must believe that what they are doing is in the best interests of their client. Yet, in order to accept randomization, they must, to some extent, relinquish that belief. Case examples are used to examine how discrepancies with respect to the "equipoise status" of researchers, clinicians, and research participants may be problematic in achieving methodologically sound, ethical clinical nursing research.

Ethics, Research↗
PubMedDate not supplied

Using multiple imputation for analysis of incomplete data in clinical research.

BACKGROUND: Sample loss and missing data are inevitable in multivariate and longitudinal research. Ad hoc approaches such as analysis of incomplete data or substituting the group mean for missing data, while common, may unnecessarily reduce statistical power and threaten study validity. Multiple imputation for missing data is a newly accessible, methodologically rigorous approach to dealing with the problem of missing data. APPROACH: To (a) discuss the problem of missing data in clinical research, and (b) describe the technique of multiple imputation. A case of analysis of multivariate psychosocial data is presented to illustrate the practice of multiple imputation. RESULTS: The advantages of multiple imputation are it (a) results in unbiased estimates, providing more validity than ad hoc approaches to missing data; (b) uses all available data, preserving sample size and statistical power; (c) may be used with standard statistical software; and, (d) results are readily interpreted. DISCUSSION: Accessible, user-friendly computer programs are available to perform multiple imputation for missing data making ad hoc approaches to missing data obsolete.

Data Interpretation, Statistical↗
PubMedDate not supplied

The relationship between vulnerability factors and breastfeeding outcome.

OBJECTIVE: To determine whether vulnerability factors (confidence with breastfeeding, postpartum depression, supplementation, and perceived adequacy of support) are associated with breastfeeding outcome at 6 weeks postpartum after controlling for age and education. DESIGN: Secondary analysis of a cross-sectional telephone survey at 6 weeks postpartum. SETTING: Ottawa-Carleton, Ontario, Canada. PARTICIPANTS: A proportionate, consecutive sample of breastfeeding women from each of four hospitals in the region (526/554, 95% response rate). METHODS: Stratified bivariate analyses were used to examine the relationship between each factor and breastfeeding outcome. Multivariate logistic regression analyses examined relationships between all factors and breastfeeding outcome. RESULTS: In the logistic regression analyses, confidence with breastfeeding (odds ratio: 1.85, 95% confidence interval: 1.50-2.27, p < .001) and postpartum depression (odds ratio: 0.28, 95% confidence interval: 0.11-0.71, p= .007) were related to breastfeeding after controlling for age and education. CONCLUSIONS: Support for breastfeeding should include assessment of maternal confidence with breastfeeding and postpartum depression. Evaluation of intervention strategies to address these vulnerability factors is a priority.

Adult↗