Nursing intervention studies: issues related to change and timing in children and families. 1995.
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Chronic Disease↗
Biomedical subjects
N Feeley
Publications and source records attributed to N Feeley.
Classification systems for health concerns, nursing strategies, and client outcomes: nursing practice with families who have a child with a chronic illness.
This paper describes 3 classification systems developed from a study of the effectiveness of a nursing intervention in improving the psychosocial adjustment of children with a chronic illness. The study nurses' documentation of the nursing care provided to the 163 participating families was content analyzed. Systems were developed to classify the types of: (a) health concerns or issues that were the focus of the nursing, (b) actions the nurses used to help families achieve their goals, and (c) outcomes observed by the nurses. These classification systems have furthered our understanding of the McGill Model of Nursing, and they describe the scope of nursing practice based on this nursing perspective with a particular population (families who have a child with a chronic illness). These systems could be used to describe and measure nursing practice with this and other groups of clients.
Adaptation, Psychological↗
The McGill model of nursing and children with a chronic-condition: "who benefits, and why?".
This study sought to understand why and how the psychosocial adjustment of children between the ages of four and 16 with a chronic illness was improved by a year-long nursing trial (1990-1991), guided by the McGill Model of Nursing. We examined the characteristics of children whose adjustment improved (improvers), who remained within the normal range (adjusted), and who deteriorated (clinical rangers). Improvers and clinical rangers presented with similar characteristics, and a profile analysis was conducted to understand why one group improved while the other did not. Four pathways leading to improvement were identified. The effectiveness of the nursing appeared to be related to engagement with the nurse and to features of the nursing.
Adaptation, Psychological↗
Nursing intervention studies: issues related to change and timing.
A variety of challenges confront clinicians and researchers involved in developing and testing nursing interventions or programs for children and their families. Many of these challenges relate to the issues of change and timing. This paper discusses some of the critical questions that must be considered when designing and evaluating interventions with this particular population. Issues are illustrated with examples from a study that tested the effectiveness of a nursing intervention (based on the McGill Model of Nursing) in improving the psychosocial adjustment of chronically ill children. The authors propose that careful consideration of these questions will improve the design of intervention studies, the evaluation of their outcomes, as well as contribute to the development of our knowledge in this domain.
Adaptation, Psychological↗
A randomized trial of a nursing intervention to promote the adjustment of children with chronic physical disorders.
OBJECTIVE: This study was conducted to determine whether a specialized form of nursing could help prevent or reduce psychosocial maladjustment among children, aged 4 to 16 years, with chronic physical disorders. In contrast to other studies, nurses were chosen to provide the intervention based on their central role in health care and the appropriateness of their training for this task. METHODOLOGY: A clinical trial was conducted in which 332 children and their families were randomly assigned either to receive this specialized nursing for a 1-year period, or to remain in the control condition. The children were all active outpatients in nine clinics at the Montreal Children's Hospital. Three measures of psychosocial functioning administered before and after the intervention were the basis for assessing its efficacy. The measures included the behavior problems profile of the Achenbach Child Behavior Checklist, the Personal Adjustment and Role Skills, completed by the parents, and two versions of the Self-Perception Profile (Harter) for children aged 4 to 7 years and 8 to 16 years. RESULTS: Differences between groups were examined both categorically and quantitatively. In the former, the percent of children with clinical scores (those above or below a cut-off indicative of maladjustment) at baseline and postintervention were compared. In the latter, the mean scores at the end of the trial were analyzed using analysis of covariance with the baseline scores as covariates. Statistically significant positive differences were found in the domain of anxiety/depression on the Personal Adjustment and Role Skills, and in the areas of scholastic competence, behavior, and global self-worth on the Harter. CONCLUSION: The results indicate that this intervention helps children with chronic disorders by preventing or reducing maladjustment. Most university-prepared nurses already have the basic skills required to achieve these results; only a modest investment in reorientation may be needed. Thus, other pediatric centers should be able to replicate these findings and thereby take a major step toward improving the lives of children with chronic disorders.
Adjustment Disorders↗
Development of professional practice based on the McGill model of nursing in an ambulatory care setting.
This paper describes the efforts of nurses to explore, develop and implement professional nursing practice, based on the McGill model of nursing, within an existing ambulatory paediatric setting. The model facilitated the development of a unique role for nurses in a multidisciplinary team, as it served as the framework for the conceptualization of the nursing role, assessment of families' needs, and the development of a nursing knowledge base. Strategies utilized to develop a 'complemental role' and its inherent professional practice are described. The issues and obstacles which arose as nurses developed their practice are discussed and the outcomes of this development for clients, nurses and the profession are highlighted.
Adaptation, Psychological↗
Screening for dialysis access graft malfunction: comparison of physical examination with US.
PURPOSE: To test the reliability and performance of two physical diagnosis algorithms for use in physical examination of vascular access grafts. MATERIALS AND METHODS: Grafts were assessed in 39 patients by means of physical examination performed by four observers. Grafts were characterized as having a thrill, pulse, or indeterminate examination at three locations (arterial, midpoint, venous). Findings with this algorithm were compared with those from ultrasound (US) with volume flow measurements. RESULTS: Patients with a thrill at all three locations of the graft all had volume flows greater than 450 mL/min (negative predictive value = 100%). Of patients with a pulse at any of three locations, only 28% (positive predictive value) had a volume flow of 450 mL/min or less. CONCLUSION: Physical examination is a good screening test for ruling out the low flows associated with impending access graft failure, thereby eliminating the need for routine US for many patients.
Adult↗
Guide wire directed manipulation of malfunctioning peritoneal dialysis catheters: a critical analysis.
PURPOSE: To evaluate patency rates after guide wire directed manipulation of malfunctioning continuous ambulatory peritoneal dialysis (CAPD) catheters. MATERIALS AND METHODS: During a 58-month period, 23 patients underwent 34 outpatient guide wire directed manipulations of their CAPD catheter to improve function (n = 30) or reduce pain and improve function (n = 4) during dialysis. Catheter patency rates were subsequently determined by review of departmental, hospital, and dialysis center charts; procedural reports; and patient telephone interviews. RESULTS: Among 12 patients who underwent a single guide wire directed manipulation, long-term (> 30 days) catheter patency was achieved in seven (58%). With use of the Kaplan-Meier survival method, the 3-, 6-, and 12-month probability of patency after a single guide wire manipulation was 0.61, 0.54, and 0.11, respectively. The mean duration of patency achieved in this group was 131 days (range, 2-421 days). In those patients (n = 8) who underwent multiple catheter manipulations (n = 19), 11 (58%) procedures resulted in long-term patency, with each patient (100%) achieving at least one such period. The Kaplan-Meier survival method determined the probability of patency in this group at 3, 6, and 12 months to be 0.75, 0.69, and 0.54, respectively. The mean secondary catheter patency was 235 days (range, 2-646 days). Overall, 75% of patients followed up achieved at least one period of long-term catheter patency during the time of this study. One (3%) episode of postprocedure peritonitis occurred. CONCLUSION: Guide wire directed CAPD catheter manipulation is a relatively simple outpatient procedure that restores long-term catheter function for most patients with minimal risk for a major complication. Patients with nonfunctioning CAPD catheters who do not have peritonitis or sepsis will most likely benefit from at least one attempt at radiologic manipulation of their catheter.
Adolescent↗