It is original history that holds lessons for nurses today.What is it that we learn from the women, whose stories are within this book?
I think it’s mainly this: “Do not let your personal limitations stop you from doing the good that you see to do in the world.”
This book contains the previously untold story of how a remarkable set of lay and professional nurses shaped Church of Christ (COC) missions in southeastern Nigeria. No archive of their work existed, and I enjoyed the privilege of compiling the story from the memories, bags, basements, and boxes of the women who lived this story and those who knew them. The book was 10 years in the making.
These women’s decisions and actions occurred within a broader shift of COC perspectives away from missionary healthcare as incidental volunteer women’s work, and toward healthcare missions as a Christian duty. For each being a missionary nurse meant delivering healthcare as part of Christian evangelism. To that end they executed multiple roles: healer, educator, revolutionary, advocate, good-will ambassador, protector, administrator, evangelist, role model, fund-raiser, friend, and colleague. We did “everything that needed to be done that there was nobody to do,” reflected missionary Nancy Petty RN.
Enjoy the read, and pursue the good that you can do in this world.
[Featured image: August 23, 1965. The Nigerian Christ Hospital Outpatient Clinic opens. Photographer JR Morgan. Used with permission from JRM private collection]
“History provides current nurses with the same intellectual and political tools that determined nursing pioneers applied to shape nursing values and beliefs to the social context of their times. Nursing history is not an ornament to be displayed on anniversary days, nor does it consist of only happy stories to be recalled and retold on special occasions. Nursing history is a vivid testimony, meant to incite, instruct, and inspire today’s nurses as they bravely tread the winding path of a reinvented health care system.” (American Association for History of Nursing)
What’s the difference between statistical and clinical significance? Here’s a quick, non-exhaustive intro.
In short, statistical significance is when the difference in outcomes between an experimental and a control group is greater than would happen by chance alone. For example, in a trial of whether gum chewing promoted return of bowel activity among post-op patients, one post-op group would chew gum and the other group would not. Then researchers would statistically compare timing of return of bowel activity between the two groups to see if the difference was greater than would occur by chance (p<.05 or p<.01). If the probability (p) level of the statistical test is less than .05 then we have very strong evidence that gum chewing made the difference. [See example of gum chewing trial in free full text Ledari, Barat, & Delavar (2012).]
All well and good.
However, the effect of an intervention may be statistically significant, but not clinically meaningful to practitioners. Or the intervention’s effects may not be statistically significant, and yet still be clinically important enough to be worth the time, cost, and effort it takes to implement.
What is clinical significance, and how can we tell if something is clinically significant? Two overlapping views:
“Clinical relevance (also known as clinical significance) indicates whether the results of a study are meaningful or not for several stakeholders.7 A clinically relevant intervention is the one whose effects are large enough to make the associated costs, inconveniences, and harms worthwhile.8” (Armiji-Oliva, 2018).
Clinical significance is “the practical importance of research results in terms of whether they have genuine, palpable effects on the daily lives of patients or on the health care decisions made on their behalf” (p. 449, Polit & Beck 2012).
Let me illustrate. Researchers recently examined the effects of a 1300-1500 quiet time on a post-partum unit. Outcome measures showed that women’s exclusive breastfeeding rates increased 14%. However, this change was not statistically significant (p = .39)—a probability value well above p < .05. Nonetheless, researchers concluded that the findings were clinically significant because a higher percent of women exclusively breastfed their infants after quiet time, and arguably for those couplets the difference was “genuine” and “palpable” (p. 449, Polit & Beck). The time, cost, and effort of implementing a low risk quiet time was reasonably associated with producing valuable outcomes for some.
Always remember that the higher the risk of the intervention, the more cautious should be your translation of findings into a particular practice setting. Don’t overestimate, but don’t overlook, clinical significance in your search to improve patient care.
Critical thinking: How might issues of statistical versus clinical significance inform the dialogue on mask wearing during the pandemic?
I recommend this event. I have no conflict of interest.
New virtual EBP Institute – Advanced Practice Institute: Promoting Adoption of Evidence-Based Practice is going virtual this October.
This Institute is a unique advanced program designed to build skills in the most challenging steps of the evidence-based practice process and in creating an organizational infrastructure to support evidence-based health care. Participants will learn how to implement, evaluate, and sustain EBP changes in complex health care systems.
Each participant also receives Evidence-Based Practice in Action: Comprehensive Strategies, Tools, and Tips From the University of Iowa Hospitals and Clinics. This book is an application-oriented EBP resource organized based on the latest Iowa Model and can be used with any practice change. The Institute will include tools and strategies directly from the book.
3-Day Virtual Institute
Wednesday, October 7
Wednesday, October 14
Wednesday, October 21
(participation is required for all 3 days)
Special pricing for this virtual institute: 5 participants from the same institution for the price of 4
Learn more and register for the October 2020 Advanced Practice Institute: Promoting Adoption of Evidence-Based Practice.
Administrative Services Specialist | Nursing Research & Evidence-Based Practice
University of Iowa Health Care | Department of Nursing Services and Patient Care
200 Hawkins Dr, T155 GH, Iowa City, IA 52242 | 319-384-6737
So I’ve been pretty skeptical about people sewing protective face masks at home. And, as with a lot of things we don’t have all the data that we wish we had. So…I’m putting this scientific evidence out there and encouraging you to contribute to this blog by adding other scientific data.
Nevertheless, the expert opinion at CDC is that they are in the “Better Than Nothing” category and gives this additional advice. “In settings where N95 respirators are so limited that routinely practiced standards of care for wearing N95 respirators and equivalent or higher level of protection respirators are no longer possible, and surgical masks are not available, as a last resort, it may be necessary for HCP to use masks that have never been evaluated or approved by NIOSH or homemade masks. It
may be considered to use these masks for care of patients with COVID-19, tuberculosis, measles, and varicella. However, caution should be exercised when considering this option.1,2“
Anecdotally, providers are using them to extend the life of other masks or N95s. Women are also making some with little pockets for other filters, and a material called HANIBON that can be purchased online is used often on the outer layer of disposable masks and works to block out dust and fluids from entering.
“Sew” there you have it. Expert opinion is that as a last resort you may use inadequately tested cloth masks if it is all you have. I am grateful for all those sewists out there responding to medical center calls to supply them with cotton and elastic homemade masks, and sending out the patterns to do so. Field medicine.