Peer group clinical supervision for community health nurses: Perspectives from an interpretive hermeneutic study

AIM

To explore the lived experience of utilizing peer group supervision in practice for community health nurses.

BACKGROUND

Community health nursing is an autonomous and challenging role where quality clinical supervision has benefits for the registered nurse. The structured New Zealand Coaching and Mentoring model of peer group supervision provides the foundation for this research.

METHOD

An interpretative hermeneutic study explored the experience of peer group supervision in a regional health service in Australia. Qualitative in-depth interviews were conducted with all levels of nursing staff to gain an understanding of their experience of peer group supervision.

RESULTS

Data interpretation through hermeneutic analysis revealed the value and professional sustenance gained by participants. Identified game changers include adherence to rules and the influence of group dynamics. These areas were found to impact the quality of supervision.

CONCLUSIONS

This research provides different perspectives of peer group supervision that shares the experience of staff immersed in the process. Peer group supervision yields benefits for community health nurses; however, the research has implications for practice.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers require information when making key decisions regarding workplace implementation. Effective supervision is only possible when balance between benefits and game changers are achieved.

Applicant perception of virtual interviews in cardiothoracic surgery: A Thoracic Education Cooperative Group Study

OBJECTIVES

Cardiothoracic programs used virtual interviews exclusively this year. As programs consider using virtual interviews permanently, our goal was to evaluate the experience of applicants with virtual interviews.

METHODS

All 2020-2021 traditional cardiothoracic fellowship applicants received an anonymous electronic survey after the Match process ended. The survey assessed the number of interviews, strengths, and inadequacies of virtual interviews and factors that affected rank decision.

RESULTS

Forty-three percent of applicants responded (60/139). The average number of interviews was 16.0. Eighty percent (48/60) of respondents successfully matched. Eighty-seven percent (52/60) of respondents had a favorable experience with virtual interviews, and 97% (58/60) found them to be convenient. However, only 50% (30/60) were able to evaluate a program fully. Respondents who matched were more likely to have a favorable experience (P = .02), but not more likely to be able to evaluate a program fully (P = .35). The most valued aspect was the informal meet and greet session with fellows (4.2 of 5). The least valued aspect was the program's social media site (2.0 of 5). The factors most frequently used to decide ranking were case numbers by 92% (55/60) and culture/personality by 82% (49/60).

CONCLUSIONS

Virtual interviews were perceived more favorably compared with last year, but half of applicants were still unable to evaluate a program fully. Fellow interactions were the most popular aspect of virtual interviews. As programs consider using virtual interviews permanently, more exposure to current trainees and a more robust social media/online presence will improve favorability.

Systematic review: Acculturation strategies and their impact on the mental health of migrant populations

Objectives

This study aims to examine the correlation between the different types of migrant acculturation strategies according to Berry’s model of acculturation (integration, assimilation, separation, and marginalisation) and their effects on mental health conditions, such as depression, anxiety and PTSD.

Study design

Systematic Review.

Methods

Three databases (PubMed, Ovid and Ebsco) were searched using different combinations of search terms to identify relevant articles to be included. The search terms were pre-identified using relevant synonyms for “migrants”, “mental health” and “integration”. The list of article titles from these searches were then filtered using predefined inclusion and exclusion criteria. The mental health consequences included a range of common conditions including suicide/self-harm, depressive disorders, psychosis, as well as substance misuse.

Results

21 primary studies were included in the review, which assessed 61,885 migrants in total (Fig. 1 and Supplemental File 1). Of these, seven were cohort studies and fourteen were cross-sectional studies.

Most studies showed that marginalisation was associated with worse depression symptoms, compared to integration, assimilation and separation, while integration was associated with the least depressive symptoms.

Marginalisation more than triples the likelihood of anxiety-related symptoms compared to integration. Similarly, separation increased the likelihood of anxiety-related symptoms nearly six-fold.

Conclusions

Our review found out that marginalisation had the worst effects on mental health of the migrant populations while integration had the most positive effects. The study also identified three key sources which may contribute to acculturation stress and worse mental health: low education or skill set, proficiency of the host country’s language, and financial hardships.

Acne and rosacea in skin of colour

Acne and rosacea are common inflammatory skin conditions present in numerous racial and ethnic groups. There are distinct differences in clinical presentation, exacerbating factors, potential triggers and consequences of both conditions in individuals with skin of colour (SOC), classified as Fitzpatrick skin types III-VI. For example, acne can be complicated by the development of postinflammatory hyperpigmentation and keloid scarring in SOC, and this can influence treatment choice. Although rosacea is reported less frequently in SOC, this may be the result of delayed diagnosis or late presentation due to the difficulty in discerning the classic features of erythema in darker skin tones. In such cases, additional clues in the medical history and clinical examination may assist in making the diagnosis. This review aims to summarize nuances in both the diagnosis and management of these two common skin conditions in patients with SOC to support clinicians in providing an individualized treatment approach.

Acculturation strategies and their impact on the mental health of migrant populations

Objectives

This systematic review examined the correlation between the different types of migrant acculturation strategies according to Berry's model of acculturation (integration, assimilation, separation, marginalisation) and their effects on mental health.

Methods

Three databases (PubMed, Ovid and Ebsco) were searched using different combinations of terms to identify relevant articles. Search terms included relevant synonyms for “migrants”, “mental health” and “integration”. The list of article titles from these searches were filtered using inclusion and exclusion criteria. Common mental health conditions including suicide/self-harm, depressive disorders, psychosis, as well as substance misuse were analysed.

Results

21 primary studies were examined, which assessed 61,885 migrants in total. Of these, 7 were cohort studies and 14 were cross-sectional studies. Most studies showed that marginalisation was associated with worse depression symptoms, compared to integration, assimilation and separation, while integration was associated with the least depressive symptoms. Marginalisation triples the likelihood of anxiety-related symptoms compared to integration. Similarly, separation increased the likelihood of anxiety-related symptoms nearly six-fold. Our study has also identified 16 factors that negatively impact level of migrant acculturation, 19 factors that adversely impact general mental health of migrants, and 22 factors that increases risks of depressive symptoms in migrants.

Conclusions

Our review found out that marginalisation had the worst effects on migrant mental health while integration had the most positive effects. The study also established multiple factors associated with low levels of acculturation and poor mental health in migrants. Given the problem of limited public resources, governments can identify at-risk individuals using factors highlighted and channel these scarce resources to develop targeted mental health interventions for them.

Key messages

Our review found out that marginalisation had the worst effects on migrant mental health while integration had the most positive effects. The study identified factors associated with low levels of acculturation and poor mental health in migrants. Governments can develop targeted mental health interventions for these at-risk individuals.

How to use remote patient monitoring successfully in cardiac and pulmonary patients: a realist review

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Queensland Health

Background

Remote patient monitoring (RPM) is an underutilised telehealth intervention that can enhance self-management of cardiovascular and pulmonary disease and reduce acute care use. However, studies of effectiveness of RPM interventions vary widely. This study aimed to explain the variation in outcomes related to RPM interventions within cardiac and pulmonary populations. Specifically, we aimed to answer why some RPM interventions are more successful than others in reducing demand on acute care services.

Methods

In brief, search terms for remote monitoring and acute care utilisation were used across three electronic databases: PubMed, EMBASE and CINAHL. The search, conducted in October 2020, included articles published in the last five years (2015-2020). Articles were included if they used RPM to monitor an individual’s biometrics (e.g. heart rate, blood pressure) from a distance while they are not in hospital. Realist review methodology was used to enable exploration of how, why and for whom interventions do and do not work.  Outcomes were evaluated to determine contextual factors and potential mechanisms that led to variation in cardiac and pulmonary intervention outcomes.

Results

After screening, 91 articles met the eligibility criteria and were included. We found that across a broad range of RPM interventions 31 factors emerged that are likely to impact the effectiveness of cardiac and pulmonary RPM innovations. These were synthesised into six theories of intervention success: 1) targeting populations at high risk; 2) accurately detecting a decline in health; 3) providing responsive and timely care; 4) personalising care; 5) enhancing self-management and, 6) ensuring collaborative and coordinated care.

Conclusion

 While RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and with the key variables identified within this review  incorporated, it is more likely that they will be effective at reducing acute hospital events.

Chronic organ injuries in children with sickle cell disease

Median life expectancy of patients with sickle cell disease has increased to up to 55 years but there are still frequent cases of premature death, mostly in patients with pre-existing organ failure such as pulmonary hypertension, kidney injury, and cerebral vasculopathy. Most organ injuries remain asymptomatic for a long time and can only be detected through early systematic screening. Protocols combining assessment of velocities on transcranial Doppler and regular transfusions in patients with abnormal velocities have been demonstrated to dramatically reduce the risk of stroke. In contrast, no consensus has been reached on systematic screening or therapy for silent cerebral infarcts. The prognostic significance of increased tricuspid regurgitant jet velocity on echocardiography has not yet been identified in children, whereas increased albuminuria is a good predictor of kidney injury. Finally, screening for hip and eye disorder is recommended; however, different countries adopt different screening strategies. Hydroxyurea is probably of potential benefit in preventing chronic organ damage but this requires further study in order to be fully demonstrated. Efficacy and safety of the other new drugs available are also under investigation.

High-repetition rate solid target delivery system for PW-class laser-matter interaction at ELI Beamlines

L3-HAPLS (High-repetition-rate Advanced Petawatt Laser System) at ELI (Extreme Light Infrastructure) Beamlines currently delivers 0.45 PW pulses (12 J in 27 fs) at 3.3 Hz repetition rate. A fresh target surface for every shot was placed at the laser focus using an in-house tape target system designed to withstand large laser intensities and energies. It has been tested for different material thicknesses (25 and 7.6 µm), while L3-HAPLS delivered laser shots for energies ranging from 1 to 12 J. A technical description of the tape target system is given. The device can be used in diverse geometries needed for laser-matter interaction studies by providing an ≈300° free angle of view on the target in the equatorial plane. We show experimental data demonstrating the shot-to-shot stability of the device. An x-ray crystal spherical spectrometer was set up to measure the Kα yield stability, while a GHz H-field probe was used to check the shot-to-shot electromagnetic pulse generation. Finally, we discuss short and mid-term future improvements of the tape target system for efficient user operation.

The Relationship Between Behavioral Inhibition and Approach Motivation Systems (BIS/BAS) and Intrinsic Brain Network Connectivity in Adult Cannabis Users

Dampened behavioral inhibition and overactive behavioral approach motivation systems (i.e. BIS/BAS) are associated with cannabis use disorder (CUD), although the underlying neural mechanisms of these alterations have not yet been examined. The brain’s executive control network (ECN) plays a role in decision-making and is associated with BIS/BAS. In this study, we tested the hypothesis that altered ECN resting-state functional connectivity (rsFC) underlies dysfunctional behavioral inhibition and approach motivation in cannabis users. To that end, we collected resting-state functional magnetic resonance imaging scans in 86 cannabis using adults and 59 non-using adults to examine group differences in the relationship between ECN rsFC and BIS/BAS. Our results showed that BIS was positively correlated with left ECN rsFC in cannabis users, while it was positively correlated with right ECN rsFC in non-users. There was a trend-level moderation effect of group on the association between BIS/BAS and ECN rsFC, showing a weaker association in BIS/BAS and ECN rsFC in cannabis users compared to non-users. An exploratory mediation analysis found that the severity of CUD mediated the relationship between users’ BIS scores and left ECN rsFC. These findings suggest that cannabis use may lead to dysregulation in typical ECN functional organization related to BIS/BAS.

Determinants of gender disparities in scaling up the first 90 towards the UNAIDS 90-90-90 targets in South Africa: findings from the 2017 household-based national cross-sectional survey

BACKGROUND

The first 90 of UNAIDS 90-90-90 targets to have 90% of the people living with HIV know their status is an important entry point to the HIV treatment cascade and care continuum, but evidence shows that there is a large gap between males and females in this regard. It is therefore important to understand barriers and facilitators of achieving the first 90 target. This study examined determinants of the first 90 target among females and males in order to inform strategies aimed at improving the HIV cascade in South Africa.

METHODS

The data used in the analysis were obtained from a 2017 household-based cross-sectional nationally representative survey conducted using a multi-stage stratified cluster random sampling design. A series of hierarchical multiple logistic regression models were fitted to identify the determinants of the first 90 target by gender.

RESULTS

Overall, 84.8% of HIV-positive individuals aged 15 years and older were aware of their HIV status. Females were significantly more aware of their HIV status compared to males (88.7% vs 78.2%, p < 0.001). Both females aged 25 to 49 years [aOR = 3.20 (95% CI 1.35-7.57), p = 0.008], and 50 years and older [aOR = 3.19 (95% CI 1.04-9.76), p = 0.042] and males aged 25 to 49 years [aOR = 3.00 (95% CI 1.13-7.97), p = 0.028], and 50 years and older [aOR = 7.25 (95% CI 2.07-25.36), p = 0.002] were significantly more likely to know their HIV status compared to those aged 15 to 19 years. Males with tertiary education level were significantly more likely to be aware of their HIV positive status [aOR = 75.24 (95% CI 9.07-624.26), p < 0.001] compared to those with no education or with primary level education. Females with secondary [aOR = 3.28 (95% CI 1.20-8.99), p = 0.021] and matric [aOR = 4.35 (95% CI 1.54-12.37), p = 0.006] educational levels were significantly more likely to be aware of their HIV positive status, compared to those with no education or with primary level education.

CONCLUSION

Significant progress has been made with regards to reaching the UNAIDS first 90 target. In this context achieving the first 90 target is feasible but there is a need for additional interventions to reach the males especially youth including those with no education or low levels of education.

Tracheostomy decannulation to noninvasive positive pressure ventilation in congenital central hypoventilation syndrome

PURPOSE

Noninvasive positive pressure ventilation (NPPV) may permit tracheostomy decannulation (TD) in patients with congenital central hypoventilation syndrome (CCHS) requiring nocturnal positive pressure ventilation via tracheostomy (PPV-T). There is limited evidence on optimal strategies for transitioning patients from PPV-T to NPPV. This study aimed to describe the clinical course and outcome of children with CCHS who underwent TD and transitioned from PPV-T to NPPV.

METHODS

Retrospective review was conducted on patients with CCHS using nocturnal PPV-T who underwent TD to NPPV. The results of clinical evaluations, airway endoscopy, polysomnography, and clinical course leading to TD were analyzed.

RESULTS

We identified 3 patients with CCHS aged 8-17 years who required PPV-T only during sleep. Patients underwent systematic multidisciplinary evaluations with a pediatric psychologist, pulmonologist, sleep physician, and otolaryngologist utilizing a TD algorithm. These included evaluation in the sleep clinic, NPPV mask fitting and desensitization, endoscopic airway evaluation, daytime tracheostomy capping, acclimatization to low-pressure NPPV, polysomnography with capped tracheostomy and NPPV titration, and if successful, TD. All patients underwent successful TD following optimal titration of NPPV during polysomnography. The duration to TD from decision to pursue NPPV was between 2.4 and 10.6 months, and the duration of hospitalization for TD was between 4 and 5 days. There were no NPPV-related complications; however, all patients required surgical closure of tracheocutaneous fistula.

CONCLUSION

NPPV may be an effective and feasible option for patients with CCHS requiring PPV-T during sleep and permits TD. In patients with CCHS, a systematic multidisciplinary algorithm may optimize successful transition to NPPV and TD.

Exploring Factors Contributing to Chronic Obstructive Pulmonary Disease (COPD) Guideline Non-Adherence and Potential Solutions in the Emergency Department: Interdisciplinary Staff Perspective

Purpose

Acute exacerbations of chronic obstructive pulmonary disease (COPD) have a significant and prolonged impact on health-related quality of life, patient outcomes, and escalation of pulmonary function decline. COPD-X guidelines published in 2003 subsist to facilitate a shift from the emphasis on pharmacological treatment to a more holistic multi-disciplinary interventions approach. Despite the existing comprehensive recommendations, readmission rates have increased in the last decade. Evidence to date has reported sub-optimal COPD guidelines adherence in emergency departments. This qualitative study explored contributing factors to interdisciplinary staff non-adherence and utilisation of COPD-X guidelines in a major Southern Queensland Emergency Department.

Methods

Semi-structured qualitative interviews with interdisciplinary staff were conducted in an emergency department. A purposive sample of doctors, nurses, physiotherapists, pharmacist and a social worker were recruited. Interviews were digitally recorded, de-identified and transcribed verbatim. Data analysis followed a coding process against the Theoretical Domains Framework (TDF) to examine implementation barriers and potential solutions. Identified factors affecting non-adherence and underutilisation of guidelines were then mapped to the capability, opportunity, motivation, behaviour model (COM-B) and behaviour change wheel (BCW) to inform future implementation recommendations.

Results

Prominent barriers influencing the clinical uptake of COPD guidelines were identified using TDF analysis and included knowledge, professional role clarity, clinical behaviour regulation, memory, attention, and decision process, beliefs about departmental capabilities, environmental context and resources. Potential interventions included education, training, staffing, funding and time-efficient digitalised referrals and systems management reminders to prevent COPD readmissions, remissions and improve patient health-related quality of life.

Conclusion

Implementation strategies such as electronic interdisciplinary COPD proforma that facilitates a multimodal approach with appropriate patient/staff resources and referrals prior to discharge from an ED require further exploration. Greater clarity around which components of the COPD X guidelines must be applied in ED settings needs to stem from future research.

Add-on bone scintigraphy after negative radiological skeletal survey for the diagnosis of skeletal injury in children suspected of physical abuse: a systematic review and meta-analysis

OBJECTIVES

To systematically assess the extent to which bone scintigraphy (BS) could improve the detection rate of skeletal injury in children suspected of physical abuse with an initial negative radiological skeletal survey (RSS).

STUDY DESIGN

We searched MEDLINE and Web of Science for series of ≥20 children suspected of physical abuse who underwent RSS and add-on BS. We assessed the risk of bias and the heterogeneity and performed random-effects meta-analyses.

RESULTS

After screening 1140 unique search results, we reviewed 51 full-text articles, and included 7 studies (783 children, mostly ≤3 years old). All studies were of either high or unclear risk of bias. Substantial heterogeneity was observed in meta-analyses. The summary detection rate of skeletal injury with RSS alone was 52% (95% CI 37 to 68). The summary absolute increase in detection rate with add-on BS was 10 percentage points (95% CI 6 to 15); the summary relative detection rate was 1.19 (95% CI 1.13 to 1.25); the summary number of children with a negative RSS who needed to undergo a BS to detect one additional child with skeletal injury (number needed to test) was 3 (95% CI 2 to 7).

CONCLUSIONS

From the available evidence, add-on BS in young children suspected of physical abuse with a negative RSS might allow for a clinically significant improvement of the detection rate of children with skeletal injury, for a limited number of BS procedures required. The quality of the reviewed evidence was low, pointing to the need for high-quality studies in this field.

COVID-19 pandemic and physical health screening in an assertive community treatment service

Introduction

Patients with severe mental illness experience physical health inequities. They are less likely to receive preventative care and adequate treatment for physical illnesses. Physical health screening of patients receiving antipsychotics is usually carried out every six months. This comprises screening bloodwork and ECGs, and the sharing of results with family physicians.

Objectives

We sought to investigate whether the pandemic affected the receipt of routine physical health screening in patients managed by an Assertive Community Treatment (ACT) Service.

Methods

A comprehensive chart review was performed on 62 ACT patients. We compared the receipt of screening bloodwork and ECGs from March—December 2020 to the same period in 2019. Results were analyzed using McNemar’s Chi square test with Yates’ correction.

Results

Patients were less likely to have received an ECG during the pandemic period. 69% received an ECG from March—December 2019 versus 42% from March—December 2020 (χ²= 7.76, p<0.01). Similarly, patients were less likely to have received screening bloodwork during the pandemic period (69% vs. 50%, Χ²= 4.32, p<0.05). Qualitative discussion with ACT staff regarding the 39 patients who had not received an ECG and/or bloodwork during the pandemic period revealed system-related (8%), patient-related (23%), and Covid-related (69%) barriers to screening. Covid-related barriers included transport concerns and lab closures.

Conclusions

ACT patients were less likely to have received routine health screening during the Covid-19 pandemic. Thus, the pandemic may have exacerbated physical health inequities for patients with severe mental illness. Covid-related barriers to screening represent an important target for intervention.

Disclosure

No significant relationships.