Objective. The purpose of this study was to evaluate the effect of Kegel exercises on reducing urinary incontinence symptoms in women with stress urinary incontinence. Methods. Randomized controlled trials (RCTs) were conducted on females with stress urinary incontinence who had done Kegel exercises and met inclusion criteria in articles published between 1966 and 2012. The articles from periodicals indexed in KoreaMed, NDSL, Ovid Medline, Embase, Scopus, and other databases were selected, using key terms such as &#x201c;Kegel&#x201d; or &#x201c;pelvic floor exercise.&#x201d; Cochrane&#x2019;s risk of bias was applied to assess the internal validity of the RCTs. Eleven selected studies were analyzed by meta-analysis using RevMan 5.1. Results. Eleven trials involving 510 women met the inclusion criteria. All trials contributed data to one or more of the main or secondary outcomes. They indicated that Kegel exercises significantly reduced the urinary incontinence symptoms of female stress urinary incontinence. There was no heterogeneity in the selected studies except the standardized bladder volumes of the pad test. Conclusion. There is some evidence that, for women with stress urinary incontinence, Kegel exercises may help manage urinary incontinence. However, while these results are helpful for understanding how to treat or cure stress urinary incontinence, further research is still required.

Seong-Hi Park

Chang-Bum Kang

Effect of Kegel Exercises on the Management of Female Stress Urinary Incontinence: A Systematic Review of Randomized Controlled Trials

Introduction. Pressure ulcers, also known as decubitus ulcers (bed sores), are localized skin injuries that remain a major health problem affecting approximately 3 million adults. Objective. The aim of this study was to assess the prevalence and associated factors of pressure ulcer among hospitalized patients in Felegehiwot referral hospital. Methods. This cross-sectional study used systematic sampling on a sample of 422 patients. The data was collected by trained data collectors through pretested checklist. Bivariate analysis was used principally and variables were then entered into multiple logistic regressions model for controlling the possible effect of confounders and the variables which have significant association were identified on the basis of OR with 95&#x25; CI and P value. Results. The finding of this study revealed that 71 (16.8&#x25;) of them had pressure ulcer. Prolonged length of stay in hospital, slight limit of sensory perception, and friction and shearing forces were significantly associated with the presence of pressure ulcer. Conclusions and Recommendations. The prevalence of pressure ulcer was high among hospitalized patients. Researches of prospective (follow-up) study required investigating the incidence and associated factors of pressure ulcer for hospitalized patients.

Haileyesus Gedamu

Mignote Hailu

Abdella Amano

Prevalence and Associated Factors of Pressure Ulcer among Hospitalized Patients at Felegehiwot Referral Hospital, Bahir Dar, Ethiopia

This study aims to explore the barriers to evidence based practice (EBP) experienced by nurses working in a Maldivian healthcare organisation. A total of 400 questionnaires were distributed to nurses in 5 healthcare facilities and 198 completed questionnaires were returned. The results of this study show that the perceived barriers by the nurses in the Maldives are not significantly different from those reported in developed countries. For healthcare organisations in the Maldives, it is necessary to have a clear understanding of the barriers and facilitators to research practice in order to implement EBP. The study showed that the major barriers to research use were that &#x201c;the relevant literature is not compiled in one place,&#x201d; there is &#x201c;insufficient time on the job to implement new ideas,&#x201d; and &#x201c;administration will not allow implementation.&#x201d; The key facilitating factors for EBP include support, encouragement, and recognition by the management and administration. The findings of this study can be useful for determining strategies that can be introduced in the clinical setting to use EBP. Healthcare organisations must continue their support in order to decrease the barriers and optimise care in healthcare facilities.

Fathimath Shifaza

David Evans

Helen Bradley

Nurses&#x2019; Perceptions of Barriers and Facilitators to Implement  EBP in the Maldives

Aim. To describe the features and examine effects of community based HIV prevention interventions implemented in developing countries on HIV-related knowledge and self-reported risk behavior. Background. The HIV epidemic has a significant impact on developing countries, increasing the prevalence of HIV among young persons. Community-based HIV prevention interventions have been designed to improve HIV-related knowledge and decrease engagement in risk behavior. Variations in the design and implementation of these interventions have been reported, which may influence their effectiveness. Design. Systematic review. Method. Data were extracted on the characteristics of the study and interventions and effects of the interventions on knowledge and self-report of risk behavior. Results. In total, 10 studies were included in the review. Overall, the results showed variability in theoretical underpinning, dose, and mode of delivery of the interventions. Multicomponent interventions that used mixed teaching methods produced beneficial effects on knowledge and self-reported risk behavior. Conclusion. Examining the characteristics of HIV-prevention interventions provides direction for researchers in developing efficient interventions to improve knowledge and 	reduce engagement in self-reported risk behavior and, in turn, decrease transmission of HIV.

Sarah Ibrahim

Souraya Sidani

Community Based HIV Prevention Intervention in Developing Countries: A Systematic Review

This paper is a report of an integrative review conducted to assess the methodological and ethical strategies used to protect participants and researchers in conducting violence against women (VAW) studies in Pakistan. The measurement of the prevalence of violence against women in Pakistan is challenging for researchers given the cultural norms and the traditional role of women. Lack of methodological rigor in addressing the concerns can result in underreporting of violence, create physical and emotional risk for the participants, interviewers, and researchers, and impose threats to internal and external validity of VAW studies. Using Whittemore and Knafl&#x2019;s process for conducting an integrative review, 11 studies published between 1999 and 2012, reporting on prevalence, experiences, and factors associated with violence in a marital relationship were analyzed. Overall, studies reveal an underreporting of exposure to violence and threats to women and interviewers&#x2019; safety in the conduct of such studies, both of which present threats to study rigor. The utilization of WHO ethical and safety recommendations to guide VAW studies in this context should be considered.

Farhana Irfan Madhani

Catherine Tompkins

Susan M. Jack

Anita Fisher

An Integrative Review of the Methods Used to Research the Prevalence of Violence against Women in Pakistan

Background. A programme of postgraduate study was developed in partnership between a health board and a university in New Zealand, having identified critical thinking and practice change as key determinants of good care delivery. Aim. To explore the impact after 12 months of a postgraduate programme for registered nurses on patient assessment and clinical reasoning, and the status of implementation plans for improved patient care. Design. Outcome evaluation using a survey and focus groups. Setting. On location at a hospital in a small city in New Zealand that provides healthcare services for 102,000 people across rural and urban areas. Participants. Registered nurses who had completed the programme (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.1625795pt" id="M1" height="8.9689pt" version="1.1" viewBox="0 -8.80632 39.8993 8.9689" width="39.8993pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-79" d="M822 650H589L583 622C660 617 677 607 674 561C672 534 664 481 647 390L600 137H596L273 650H126L120 622C176 620 194 615 207 594C221 571 225 557 214 504L161 257C141 166 129 112 121 85C108 42 83 30 29 28L23 0H260L266 28C193 33 173 42 176 89C178 122 186 172 202 255L256 527H259L583 -8H612L690 390C708 481 720 535 728 558C744 603 756 619 816 622L822 650Z"></path></g><g transform="matrix(.0135,0,0,-0.0135,15.155,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"></path></g><g transform="matrix(.0135,0,0,-0.0135,26.893,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"></path></g><g transform="matrix(.0135,0,0,-0.0135,33.396,0)"><path id="g113-57" d="M249 635C141 635 70 555 70 471C70 401 114 353 179 316C143 294 106 267 90 252C68 231 45 202 45 157C45 50 130 -12 237 -12C322 -12 435 52 435 169C435 256 372 304 303 343C349 374 375 398 383 407C401 429 411 458 411 487C411 569 344 635 249 635ZM238 603C285 603 337 567 337 482C337 422 310 385 276 358C205 393 145 426 145 500C145 552 179 603 238 603ZM248 20C183 20 125 70 125 163C125 218 158 268 206 300C284 261 355 217 355 143C355 66 308 20 248 20Z"></path></g></svg>) and seven clinical mentors. Methods. A survey, focus groups, and follow-up data about quality improvement projects were used to explore how the programme was experienced and its impact. Results. The survey revealed perceptions of improved knowledge and skills but a lack of confidence in communicating with medical staff. Of 28 quality improvement projects planned, all but three had been implemented and were still in use. Two themes were generated from focus group data: “new ways of thinking” and “doing things differently.” Conclusions. This academic/clinical partnership positively influenced nurses’ knowledge and skills, encouraged critical thinking and self-efficacy, and resulted in the sustained implementation of nurse-initiated projects intended to improve patient care.

Ann McKillop

Cheryl Atherfold

Gary Lees

The Power of Synergy: An Academic/Clinical Partnership for Transformational Change

Nursing is a discipline in transition. As the complexity and acuity of patients increase, nurses are taking on a more comprehensive role in health care leadership and patient outcomes. As the discipline has evolved so has the curricular framework of nursing educational programs, moving from being based on a specific nursing theory, to a general metaparadigm, to the current focus on meeting curricular content standards developed by national accrediting agencies. When considering the skills needed to fully engage in critical thinking and patient advocacy there may be room for an additional curricular focus: that of metacognitive development based on critical theory and constructivism. The empowerment of students via metacognitive and self-evaluative practices also supports the critical theory pedagogy. If graduating nurses are presented with a cohesive and comprehensive curriculum that meets the need for competent and critically reflexive nurses the discipline of nursing can continue to expand in function and voice. The use of metacognition, constructivism, competency, and critical pedagogies in a unified and broad curricular framework allows for the development of these essential skills in contemporary nursing practice. This paper presents this innovative curricular framework that embodies these various teaching and learning perspectives.

Jayne Josephsen

Critically Reflexive Theory: A Proposal for Nursing Education

Objective. To identify the impact of an educational intervention on compliance of health professionals with hand hygiene. Method. The survey involved nurses, doctors, and physiotherapists who work in pediatric intensive care unit of a pediatric hospital. A multifaceted hand hygiene educational program was introduced with compliance assessed during successive observational surveys. Results. The total healthcare professionals&#x2019; compliance increased from 31.8&#x25; in the baseline period to 51.5&#x25; immediately after the first educational intervention, and it remained at improved levels (45.9&#x25;) six months later, while after the completion of the second educational intervention it increased to 67.7&#x25;. The nurses&#x2019; and doctors&#x2019; compliance increased from 30.4&#x25; and 28.3&#x25; at baseline period to 71.5&#x25; and 60.2&#x25;, respectively, during the study phases. Finally, physiotherapists&#x2019; compliance increased from 37.5&#x25; at baseline period to 73.9&#x25; after the completion of the second educational intervention. Conclusion. The degree of the staff&#x2019;s compliance with hand hygiene in the pediatric intensive care unit after the educational program increased substantially. The continuing education and training of health professionals contribute to increasing the degree of compliance with the international recommendations for hand hygiene.

Charalampia Nteli

Petros Galanis

Despoina Koumpagioti

Georgios Poursanidis

Eleni Panagiotopoulou

Vasiliki Matziou

Assessing the Effectiveness of an Educational Program on Compliance with Hand Hygiene in a Pediatric Intensive Care Unit

Background. Advances in genetic science and biotechnology accumulated huge knowledge of genes and various genetic tests and diagnostic tools for healthcare providers including nurses. Genetic counseling became important to assist patients making decisions about obtaining genetic testing or preventive measures. Method. This review was conducted to describe the counseling topics, various interventions adopted in genetic counseling, and their effectiveness. Experimental studies (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.27588pt;width:50.724998px;" id="M1" height="11.425" version="1.1" viewBox="0 0 50.724998 11.425" width="50.724998">
	
		
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</svg>) published between 1999 and 2012 were synthesized. Results. The most frequently covered topic was benefits and limitations of genetic testing on breast cancer ovarian and colorectal cancers. Most of researchers focused on evaluating cognitive aspect and psychological well-being. Conclusion. No single intervention was consistently reported to be effective. Decision aids enhanced with information technologies have potential to improve the outcomes of genetic counseling by providing tailored information and facilitating active engagement of patients in information uptake. Clinical Implication. When nurses are familiar with topics and interventions of genetic counseling, they are well positioned to provide genetic/genomic information to the patient and families.

Jeeyae Choi

Hyeoneui Kim

Effectiveness of the Interventions Utilized in Genetic Counseling

Nursing schools want to choose candidates most likely to successfully finish the program and many include interview as part of the admission process. Research on interviews as a component of admission has yet to address the students&#x2019; experience. The purpose of this study was to examine students&#x2019; lived experience of being interviewed for admission into a BSN program, with application of findings to more holistically examine the interview process. Three themes resulted from grounded theory analysis of 25 transcribed-verbatim interviews of nursing students. Seeing Me describes how the interview was a positive way of showing a side that was not represented on paper. Participants shared an awareness that qualities needed in a nurse (The Right Stuff) are better assessed with interview. The interview marked when the Beginning of the Nursing Journey felt real. This paper considers the student&#x2019;s experience and helps us more holistically examine effective processes for admission to a nursing program.

Michelle L. Finch

Debra Rose Wilson

Kelly Symonds

Kim Floyd-Tune

Being Interviewed for Admission to a BSN Program: A Qualitative Inquiry

Background and Objectives. Awareness about the patients&#x2019; needs and expectations is quite important in improving the quality of the services they are provided with. Since meeting the needs and expectations of the patients is one of the basic issues in patient care, the present study aimed to investigate the patients&#x2019; expectations from nurses and nursing care. Methods. In this qualitative study, 20 hospitalized patients were interviewed. The data were gathered through deep, semistructured interviews. Then, all the recorded interviews were transcribed, reviewed for several times, and analyzed using qualitative content analysis approach. Results. By analyzing of data, three main categories were extracted. The main categories of the patients&#x2019; expectations from nurses and nursing care were comprehensive care, ethical performance, and having proper individual characteristics. Discussion and Conclusion. The study results revealed that the patients expected comprehensive care from the nurses. In addition, the nurses were required to apply the ethical principles in what they do as their duties. The findings of the study can be helpful in improving the patient care.

Majid Najafi Kalyani

Raziyeh Illon Kashkooli

Zahra Molazem

Nahid Jamshidi

Qualitative Inquiry into the Patients' Expectations regarding Nurses and Nursing Care

Background. McMaster University first introduced Problem Based Learning (PBL) in the mid 1960s. However, measuring the relationship between PBL for undergraduate nursing programs and students test performance has not yet been assessed in the USA. Purpose. The main purpose of this paper is to describe the effectiveness of PBL on senior student test performance on content related to PBL in a BSN program. Diabetes mellitus and renal insufficiency were taught by traditional lecture format in the previous years. This was the first year we taught this content by the problem based learning method. Method. Historical control group was used to compare the test performances between the PBL groups and the traditional group using Student&#x2019;s t-test. Result. The mean of diabetes mellitus related questions missed by the PBL group was less than the traditional group (<svg style="vertical-align:-0.17555pt;width:65.025002px;" id="M1" height="11.125" version="1.1" viewBox="0 0 65.025002 11.125" width="65.025002" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>, and <svg style="vertical-align:-0.17555pt;width:50.549999px;" id="M2" height="11.375" version="1.1" viewBox="0 0 50.549999 11.375" width="50.549999" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>). The mean of renal insufficiency related questions missed by the PBL group was more than the traditional group (<svg style="vertical-align:-0.17555pt;width:63.674999px;" id="M3" height="11.225" version="1.1" viewBox="0 0 63.674999 11.225" width="63.674999" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>, and <svg style="vertical-align:-0.17555pt;width:50.549999px;" id="M4" height="11.375" version="1.1" viewBox="0 0 50.549999 11.375" width="50.549999" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"/></g>

		
	
</svg>). Discussion. This study produced inconclusive findings. Factors that could be attributed to their performance will be discussed.

Weihua Zhang

Problem Based Learning in Nursing Education

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Advances in Nursing