Yvonne L. Munn Center for Nursing Research

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Research for Review

Monthly Update - 2022

Below is a listing of research articles and abstracts that may be useful as you care for patients, their families and yourself. The abstracts below are printed or adapted from the original articles published. They are to be used by nurses and staff for educational purposes only. They are not to be not to be reproduced or sold without the expressed permission of the Authors.

July 2022

Richard-Lalonde, M., Gélinas, C., Boitor, M., Gosselin, E., Feeley, N., Cossette, S., & Chlan, L. L. (2020). The effect of music on pain in the adult intensive care unit: a systematic review of randomized controlled trials. Journal of pain and symptom management, 59(6), 1304-1319. e1306.

Context: Multimodal analgesic approaches are recommended for intensive care unit (ICU) pain management. Although music is known to reduce pain in acute and chronic care settings, less is known about its effectiveness in the adult ICU. OBJECTIVES Determine the effects of music interventions on pain in the adult ICU, compared with standard care or noise reduction. METHODS This review was registered on PROSPERO (CRD42018106889). Databases were searched for randomized controlled trials of music interventions in the adult ICU, with the search terms [‘‘music*’’ and (‘‘critical care’’ or ‘‘intensive care’’)]. Pain scores (i.e., self-report rating scales or behavioral scores) were the main outcomes of this review. Data were analyzed using a DerSimonian-Laird random-effects method with standardized mean difference (SMD) of pain scores. Statistical heterogeneity was determined as I2 > 50% and explored via subgroup analyses and meta-regression. RESULTS Eighteen randomized controlled trials with a total of 1173 participants (60% males; mean age 60 years) were identified. Ten of these studies were included in the meta-analysis based on risk of bias assessment (n ¼ 706). Music was efficacious in reducing pain (SMD _0.63 [95% CI _1.02, _0.24; n ¼ 10]; I2 ¼ 87%). Music interventions of 20e30 minutes were associated with a larger decrease in pain scores (SMD _0.66 [95% CI _0.94, _0.37; n ¼ 5]; I2 ¼ 30%) compared with interventions of less than 20 minutes (SMD 0.10 [95% CI _0.10, 0.29; n ¼ 4]; I2 ¼ 0%). On a 0e10 scale, 20e30 minutes of music resulted in an average decrease in pain scores of 1.06 points (95% CI _1.56, _0.56).

Conclusion: Music interventions of 20e30 minutes are efficacious to reduce pain in adult ICU patients able to self-report.



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Krau, S. D. (2020). The multiple uses of guided imagery. Nursing Clinics, 55(4), 467-474.

With the United States facing a so-called opioid epidemic, it is important to identify and use therapies that reduce pain but that do not involve pharmacologic interventions. There are a variety of nonpharmacologic interventions that not only have been shown to ameliorate pain, and the perception of pain, but that have been shown to help patients’ mood, decrease anxiety, enhance relaxation, support behavior modification, and improve the immune system. One method that has shown all of these modifications is the use of imagery. It is common to have patients who have engaged in mental imagery for a variety of reasons, because imagery takes on many forms. As such, it is important to know how the patients have used imagery, the reasons they have used imagery, and the expected outcomes. Understanding this intervention improves the care nurses offer their patients, because it allows them to comprehend more about their patients and their patients’ values and beliefs. Imagery is a nonpharmacologic intervention that can be accessed in a variable manner, and usually is inexpensive. There are a variety of methods that incorporate the use of imagery, but, regardless of the form, or name, the method typically involves the mental representation of a future situation, task, or event.1 One of the more common forms of mental imagery is referred to as guided imagery. Guided imagery is sometimes referred to as guided meditation, visualization, mental rehearsal, or guided self-hypnosis. It can be as simple as a ski jumper’s 10-second pause to consider the perfect ski jump and imagining how perfect it would feel to fly through the air and come to a perfect landing and slide. It can be more complicated to help individuals alter behavior, or reduce anxiety and stress, by imagining positive interactions and scenarios to a real or potentially distasteful or anxiety-producing personal interaction.



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Hui, D., Bohlke, K., Bao, T., Campbell, T. C., Coyne, P. J., Currow, D. C., . . . Nava, S. (2021). Management of dyspnea in advanced cancer: ASCO guideline. Journal of Clinical Oncology(12), 1389-1411.

Purpose: To provide guidance on the clinical management of dyspnea in adult patients with advanced cancer.

Methods: ASCO convened an Expert Panel to review the evidence and formulate recommendations. An Agency for Healthcare Research and Quality (AHRQ) systematic review provided the evidence base for nonpharmacologic and pharmacologic interventions to alleviate dyspnea. The review included randomized controlled trials (RCTs) and observational studies with a concurrent comparison group published through early May 2020. The ASCO Expert Panel also wished to address dyspnea assessment, management of underlying conditions, and palliative care referrals, and for these questions, an additional systematic review identified RCTs, systematic reviews, and guidelines published through July 2020.

Results: The AHRQ systematic review included 48 RCTs and two retrospective cohort studies. Lung cancer and mesothelioma were the most commonly addressed types of cancer. Nonpharmacologic interventions such as fans provided some relief from breathlessness. Support for pharmacologic interventions was limited. A metaanalysis of specialty breathlessness services reported improvements in distress because of dyspnea.

Recommendations: A hierarchical approach to dyspnea management is recommended, beginning with dyspnea assessment, ascertainment and management of potentially reversible causes, and referral to an interdisciplinary palliative care team. Nonpharmacologic interventions that may be offered to relieve dyspnea include airflow interventions (eg, a fan directed at the cheek), standard supplemental oxygen for patients with hypoxemia, and other psychoeducational, self-management, or complementary approaches. For patients who derive inadequate relief from nonpharmacologic interventions, systemic opioids should be offered. Other pharmacologic interventions, such as corticosteroids and benzodiazepines, are also discussed.



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June 2022

Breman, R. B., & Neerland, C. (2020). Nursing Support During Latent Phase Labor: A Scoping Review. MCN: The American Journal of Maternal/Child Nursing, 45(4), 197-207

Purpose: The purpose of this scoping review was to synthesize the literature on nursing support during the latent phase of the first stage of labor. In 2014, the definition of the beginning of active labor changed from 4 centimeters (cm) to 6 cm cervical dilation. More women may have an induction of labor based on results of recent research showing no causal increase in risk of cesarean birth with elective induction of labor for low-risk nulliparous women. Therefore, in-hospital latent phase labor may be longer, increasing the need for nursing support.

Design: Scoping review of the literature from 2009 to present. Methods: We conducted the review using key words in PubMed, CINAHL, and Scopus. Search terms included different combinations of “latent or early labor,” “birth,” “support,” “nursing support,” “obstetrics,” and “onset of labor.” Peer-reviewed research and quality improvement articles from 2009 to present were included if they had specific implications for nursing care during the latent phase of labor. Articles were excluded if they were not specific to nursing, focused exclusively on tool development, or were from the perspective of pregnant women or providers only.

Results: Ten articles were included. Results were synthesized into six categories; support of physiologic labor and birth, the nurse’s own personal view of labor, birth environment, techniques and tools, decision-making, and importance of latent labor discussion during the prenatal period.

Clinical Implications: Support for physiologic labor and birth is an important consideration for use of nonpharmacological methods during latent labor. The nurse’s own personal view on labor support can influence the support that laboring women receive. Nurses may need additional education on labor support methods.



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Howard, E. D. (2018). Promoting Maternal Confidence, Coping, and Comfort in Latent Labor: Evidence-Based Strategies and Resources. The Journal of Perinatal & Neonatal Nursing, 32(4), 291-294

A national quality goal is reduction of cesarean births in low-risk women. One of the most common reasons for cesarean birth in low-risk women is labor dystocia. Encouraging a woman’s confidence to employ comfort measures in her own home, armed with evidence-based strategies and resources, is key to delaying admission until active labor. Obstetric nurse interaction and communication with women during the evaluation time are vital components in relaying the appropriate information and techniques for a safe and positive latent labor experience that occurs outside of the inpatient setting. Women may turn to the hospital setting seeking information, reassurance, and advice. Provision of support, reassurance, and nonpharmacological coping strategies for comfort is crucial to facilitating a physiologic labor process and minimizing intervention. A process of shared decision-making, coupled with detailed, specific guidance that includes comfort measures at home or in the support of an early labor lounge (ELL), contributes to a satisfying labor and birth experience.



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Faucher, M. A., & Kennedy, H. P. (2020). Women's perceptions on the use of video technology in early labor: Being able to see. Journal of Midwifery & Women's Health, 65(3), 342-348.

Introduction: Delaying admission to the birth setting until active labor has commenced has known benefits. However, women and their partners often struggle to stay home in early labor. Research on telephone triage during early labor at home has illuminated significant disadvantages with this model of care, contributing to women feeling dissatisfied with the early birth experience. Research conducted with midwives on the potential benefits of using video technology suggests it might be a helpful strategy for early labor support. This study examined women’s perspectives on the potential use of this technology.

Methods: Focus groups and individual interviews were conducted with 23 English-speaking women who experienced spontaneous labor within the last year. The recordings were transcribed verbatim. Content analysis was used to interpret women’s perceptions.

Results: The women identified potential advantages of video technology in early labor connected to the major theme of being able to see, which could enable closer human connections between the intrapartum care provider, the woman, and her partner, as well as better assessments of labor. This human connection was integral to enhancing empathy and building confidence. Concerns about using video calls during early labor at home focused on privacy issues and the need to practice beforehand. Concerns about privacy depended upon having a prior relationship with the intrapartum care provider and women being able to decide if they wanted to use the technology.

Discussion: One way of optimizing the experience of staying home in early labor and overall satisfaction with the birth experience may be with video technology, which could offer enhancements over traditional telephone triage.



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May 2022
Inciarte, A., Leal, L., Masfarre, L., Gonzalez, E., Diaz-Brito, V., Lucero, C., Garcia-Pindado, J., León, A., García, F., & Sexual Assault Victims Study Group. (2020, January). Post-exposure prophylaxis for HIV infection in sexual assault victims. HIV Medicine (2020), 21, 43-52

Objectives: Sexual assault (SA) is recognized as a public health problem of epidemic proportions. Guidelines recommend the administration of post-exposure prophylaxis (PEP) after an SA. However, few data are available about the feasibility of this strategy, and this study was conducted to assess this. Methods: We conducted a retrospective, longitudinal, observational study in SA victims attending the Hospital Clinic in Barcelona from 2006 to 2015. A total of 1695 SA victims attended the emergency room (ER), of whom 883 met the PEP criteria. Five follow-up visits were scheduled at days 1, 10, 28, 90 and 180 in the out-patient clinic. The primary endpoint was PEP completion rate at day 28. Secondary endpoints were loss to follow-up, treatment discontinuation, occurrence of adverse events (AEs) and rate of seroconversion. Results: The median age of participants was 25 years [interquartile range (IQR) 21–33 years] and 93% were female. The median interval between exposure and presentation at the ER was 13 h (IQR 6–24 h). The level of risk was appreciable in 47% (n = 466) of individuals. Of 883 patients receiving PEP, 631 lived in Catalonia. In this group, the PEP completion rate at day 28 was 29% (n = 183). The follow-up rate was 63% (n = 400) and 38% (n = 241) at days 1 and 28, respectively. Treatment discontinuation was present in 58 (15%) of 400 patients who attended at least the day 1 visit, the main reason being AEs (n = 35; 60%). AEs were reported in 226 (56%) patients, and were mainly gastrointestinal (n = 196; 49%). Only 211 (33%) patients returned for HIV testing at day 90. A single seroconversion was observed in men who have sex with men (MSM) patient at day 120. Conclusions: Follow-up and compliance rates in SA victims were poor. In addition, > 50% of the patients experienced AEs, which were the main reason for PEP interruption. Strategies to increase follow up testing and new better tolerated drug regimens must be investigated to address these issues.

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Djelaj, V., Patterson, D., & Romero, C. M. (2017). A Qualitative Exploration of Sexual Assault Patients’ Barriers to Accessing and Completing HIV Prophylaxis. Journal of Forensic Nursing, 13(2), 45–51.

Sexual assault patients may encounter barriers when accessing, accepting, and completing nonoccupational postexposure prophylaxis (nPEP), such as lacking insurance or an understanding of nPEP. However, less is known about how sexual assault forensic examiner (SAFE) programs’ protocols, approaches to discussing nPEP, and community resources may influence nPEP completion. Utilizing a qualitative case study framework, we conducted semistructured interviews with 10 SAFEs from an urban SAFE program in which emergency department physicians write prescriptions for nPEP before sending patients to the SAFE program. The participants identified barriers encountered by their patients, ranging from emergency department providers inconsistently offering prescriptions for the correct medication, to difficulty locating a local pharmacy stocking nPEP. The SAFEs also expressed concern that uninsured patients had to complete additional steps to access nPEP, while feeling overwhelmed by the immediacy of their assaults. Several participants raised concern that patients’ emotional distress and fear of acquiring HIV may impede their ability to comprehend information and access nPEP. Participants also noted that the 28-day nPEP regimen might be a daily reminder for patients of the sexual assault. The SAFEs identified multiple strategies for discussing HIV and nPEP with these patients. Implications of the SAFE’s role in reducing barriers are discussed.

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Reynolds, R., Scannell, M., Collins, S., & Colavita, J. (2022). Readability and health literacy level of post-exposure prophylaxis patient education materials offered after sexual assault. International Emergency Nursing, 61(6), 101104. doi: 10.1016/j.ienj.2021.101104

Background: The link between readability of patient education materials and patient outcomes has been well established. Patients who experience sexual assault often present to the emergency department in an acute trauma response state. Stress interferes with memory and learning. Patients routinely receive medication to prevent sexually transmitted infections after sexual assault. HIV post-exposure prophylaxis (PEP) success is dependent on completing a 28-day course. Only 24% of sexually assaulted patients complete HIV PEP. Methods: This descriptive study used three validated tools to assess readability and evaluate the understandability of HIV PEP patient education materials following sexual assault. Patient education materials (n = 21) were collected through a variety of databases, government sources, and secondary reference review. Each researcher independently scored all materials. Inter-rater reliability was assured after robust. Discussion: Final scores were used to determine readability and health literacy levels. Results: All educational materials far exceeded the recommended readability level (Range = 7th grade to college). Those with the highest readability included visual cues. The Patient Education Materials Assessment Tool (PEMAT) understandability scores ranged from 38 to 94%, and actionability scores ranged from 40 to 100%. Using a cut score of 80%, approximately 57% of the educational materials were understandable, while only 14% were actionable. Conclusions: Expert agencies recommend a sixth-grade or below reading level for patient education reading materials. Our data show that post-exposure patient education materials following sexual assault are difficult to understand. This mismatch between the patient education material’s readability and health literacy levels and the recommended standards will likely limit the success of post-exposure prophylaxis course of treatment following sexual assault

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April 2022
Hill, R.R., Hines, M., Martens, A., Pados, B.F., & Zimmerman, E. (2021). A pilot study of non-nutritive suck measures immediately pre- and post- frenotomy in full term infants with problematic feeding. Journal of Neonatal Nursing. https://doi.org/10.1016/j.jnn.2021.10.009

Introduction: The purpose of this study was to describe symptoms of problematic feeding in infants with tongue- tie, evaluate changes in non-nutritive suck measures before and after frenotomy, and examine tongue-tie severity with changes in non-nutritive suck patterning. Method: Parents completed the Neonatal Eating Assessment Tool about infant feeding before frenotomy. Non- nutritive suck data were collected for 5 min before and after frenotomy. We used paired t-tests to compare non-nutritive suck measures pre- and post-frenotomy and linear regression evaluated the effect of tongue-tie severity and infant behavioral state on change in non-nutritive suck mechanics. Results: Twenty-one infants had scores that met criteria for problematic feeding. The infant’s non-nutritive suck amplitude (cmH2O) (p .02) and non-nutritive burst duration (sec) (p .03) decreased post-frenotomy. Discussion: This study supports the need for additional research to =better understand feeding problems and changes in non-nutritive suck amplitude and duration in infants with tongue-tie.

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Hill, R.R., Lyons, K.S., Kelly-Weeder, S., & Pados, B.F. (2022). Effect of frenotomy on maternal breastfeeding symptoms and the relationship between maternal symptoms and problematic infant feeding. Global Pediatric Health. doi: 10.1177/2333794X211072835

The relationship between maternal symptoms and problematic infant feeding in the context of tongue-tie is unknown. In a sample of infants with tongue-tie undergoing frenotomy and their mothers, the aims of this study were to: (1) describe changes in maternal symptoms pre- and post-frenotomy, and (2) evaluate the relationships between maternal symptoms and symptoms of problematic feeding pre- and post-frenotomy. Mother-infant dyads were recruited from 1 pediatric dental office between July and November 2020. The sample included 102 mother-infant dyads; 84 completed the follow-up survey. Maternal symptoms of painful and difficult latch, creased/cracked nipples, bleeding, or abraded nipples, chewing of the nipple, and feelings of depression were significantly less common after tongue-tie revision. Poor latch onto the breast was associated with feeding difficulties at both time points. Frenotomy resulted in a decrease of symptoms in breastfeeding mothers. Maternal symptoms and feeding problems persisting post-frenotomy warrant further evaluation.

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Hill, R.R., & Pados, B.F. (2020). Symptoms of problematic feeding in infants under 1 year of age undergoing frenotomy: A review article. Acta Paediatrica, 109(12), 2502-2514. doi: 10.1111/apa.15473

Aim: The aims of this systematic review were to first identify and summarise original research that compared symptoms of problematic feeding in infants with tongue tie before and after frenotomy and then evaluate the quality of measures used to assess problematic feeding. Methods: CINAHL and PubMed were searched for ((tongue-tie) or (ankyloglossia)) and ((feeding) or (breastfeeding) or (bottle-feeding)) and ((frenotomy) or (frenectomy) or (frenulectomy) or (frenulotomy)). Original research reporting on feeding before and after frenotomy in infants under 1 year old was included. Results: Maternal nipple pain, breastfeeding self-efficacy and LATCH scores im-proved after frenotomy. Few data are available on the effect of frenotomy on infant feeding. The measures used to assess infant feeding were not comprehensive and did not possess strong psychometric properties. Conclusion: Literature suggests that maternal nipple pain, self-efficacy and LATCH scores improve in breastfeeding mother-infant dyads after frenotomy. However, cur-rent literature does not provide adequate data regarding the effect of frenotomy on the infant's ability to feed or which infants benefit from the procedure. Future research should utilise comprehensive, psychometrically sound measures to assess infants for tongue tie and to evaluate infant feeding to provide stronger evidence for the effect of frenotomy on feeding in infants with tongue tie.

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March 2022
Nicholas, P., Gona, C., Evans, L., & Reid, E. P. (2021). The Intersection of Climate Change and Health: An Explication of the Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity: Future of Nursing, Health Equity, and Climate Change. Witness: The Canadian Journal of Critical Nursing Discourse, 3(2), 10-17.

The US National Academy of Medicine released its consensus study for the next decade entitled The Future of Nursing 2020-2030: Charting a Path to Achieve Health. This paper examines the report, its implications for nursing, globally; its focus on systemic, structural, and institutional racism; and the intersection with climate change and deleterious health consequences. The National Academies of Sciences, Engineering, and Medicine (NASEM) has led in addressing the critical role of the nursing profession in achieving optimal population health outcomes in the US. Yet, there is relevance for nursing in other global areas. The most recent US report focuses on social determinants of health and explicitly addresses climate change as a looming public health threat. An analysis of the key foci of nursing’s role in climate change amidst the critical role of health equity globally is explicated.

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Nicholas, P. K., & Breakey, S. (2017). Climate change, climate justice, and environmental health: Implications for the nursing profession. Journal of Nursing Scholarship, 49(6), 606-616.

Purpose: Climate change is an emerging challenge linked to negative outcomes for the environment and human health. Since the 1960s, there has been a growing recognition of the need to address climate change and the impact of greenhouse gas emissions implicated in the warming of our planet. There are also deleterious health outcomes linked to complex climate changes that are emerging in the 21st century. This article addresses the social justice issues associated with climate change and human health and discussion of climate justice. Methods: A literature search of electronic databases was conducted for articles, texts, and documents related to climate change, climate justice, and human health. Findings: The literature suggests that those who contribute least to global warming are those who will disproportionately be affected by the negative health outcomes of climate change. The concept of climate justice and the role of the Mary Robinson Foundation—Climate Justice are discussed within a framework of nursing’s professional responsibility and the importance of social justice for the world’s people. The nursing profession must take a leadership role in engaging in policy and advocacy discussions in addressing the looming problems associated with climate change. Conclusions: Nursing organizations have adopted resolutions and engaged in leadership roles to address climate change at the local, regional, national, and global level. It is essential that nurses embrace concepts related to social justice and engage in the policy debate regarding the deleterious effects on human health related to global warming and climate change. Nursing’s commitment to social justice offers an opportunity to offer significant global leadership in addressing the health implications related to climate change.

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Bekkar, B., Pacheco, S., Basu, R., & DeNicola, N. (2020). Association of air pollution and heat exposure with preterm birth, low birth weight, and stillbirth in the US: a systematic review. JAMA network open, 3(6), e208243-e208243.

Importance: Knowledge of whether serious adverse pregnancy outcomes are associated with increasingly widespread effects of climate change in the US would be crucial for the obstetrical medical community and for women and families across the country. Objective: To investigate prenatal exposure to fine particulate matter (PM2.5), ozone, and heat, and the association of these factors with preterm birth, low birth weight, and stillbirth. Evidence Review: This systematic review involved a comprehensive search for primary literature in Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, PubMed, ClinicalTrials.gov website, and MEDLINE. Qualifying primary research studies included human participants in US populations that were published in English between January 1, 2007, and April 30, 2019. Included articles analyzed the associations between air pollutants or heat and obstetrical outcomes. Comparative observational cohort studies and cross-sectional studies with comparators were included, without minimum sample size. Additional articles found through reference review were also considered. Articles analyzing other obstetrical outcomes, non-US populations, and reviews were excluded. Two reviewers independently determined study eligibility. The Arskey and O’Malley scoping review framework was used. Data extraction was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Findings: Of the 1851 articles identified, 68 met the inclusion criteria. Overall, 32 798 152 births were analyzed, with a mean (SD) of 565 485 (783 278) births per study. A total of 57 studies (48 of 58 [84%] on air pollutants; 9 of 10 [90%] on heat) showed a significant association of air pollutant and heat exposure with birth outcomes. Positive associations were found across all US geographic regions. Exposure to PM2.5 or ozone was associated with increased risk of preterm birth in 19 of 24 studies (79%) and low birth weight in 25 of 29 studies (86%). The subpopulations at highest risk were persons with asthma and minority groups, especially black mothers. Accurate comparisons of risk were limited by differences in study design, exposure measurement, population demographics, and seasonality. Conclusions and Relevance: This review suggests that increasingly common environmental exposures exacerbated by climate change are significantly associated with serious adverse pregnancy outcomes across the US.

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