The role of a cardio-oncology clinical nurse specialist in the United Kingdom

Cardio-oncology is a growing subspeciality of cardiology that involves the prevention and early detection of cancer therapy-related cardiovascular toxicity (CTR-CVT). Cardiovascular complications can occur before, during and after cancer treatment, due to de novo cardiotoxicity or an exacerbation of a previous cardiac condition. Therefore, cancer patients undergoing cancer treatment need to be assessed before, during and after their cancer treatment. This article describes the development and progress of a specialised nursing role, known as a Clinical Nurse Specialist (CNS), at the Royal Brompton Hospital in London, United Kingdom (UK).

Clinical inertia in sexual medicine practice

Clinical inertia (CI) is common in clinical practice. Sexual health issues are common in society, and CI is ubiquitous in sexual medicine practice. CI influences all aspects of healthcare, including prevention, diagnosis, and treatment. In this short review, we briefly describe the various aspects of CI in sexual medicine practice and ways to tackle them

Clinical nurse educators' experience of new graduate nurses' transition into practice following the COVID-19 pandemic. A qualitative study

BACKGROUND

Graduate registered nurses transitioning into clinical practice are known to feel uncertain about their ability to provide high-quality patient care and meet professional expectations. These concerns may have been magnified following the COVID-19 pandemic.

AIM

To explore clinical nurse educators' and new graduate nurses' perspectives on the transition into clinical practice following the COVID-19 pandemic.

DESIGN

An exploratory descriptive qualitative study design was used to allow for flexible interaction with the study participants to collect rich data and themes to develop.

SETTING

The study was conducted at a large not-for-profit healthcare facility in Victoria, Australia.

PARTICIPANTS

There were two (2) groups of study participants: six (6) clinical nurse educators and ten (10) graduate year registered nurses.

METHODS

Individual, semi-structured interviews were conducted via teleconferencing.

RESULTS

Three (3) key themes explored the experiences of new graduate nurses and the support provided by clinical nurse educators during their transition to clinical practice. The professional challenges of clinical nurse educators following the COVID-19 pandemic were also explored. Five (5) subthemes addressed: increased motivation of graduate nurses entering clinical practice, importance of opportunities for kinaesthetic learning, and relationship building in the clinical environment to strengthen integration into the health service. Pre-registration nursing roles contributed to greater confidence and a smoother transition to clinical practice. Clinical nurse educators identified gaps in communication and clinical skills, but also resilience and determination as key attributes of graduate nurses. Structured study days early in the graduate year resulted in rapid improvements in the graduates' kinaesthetic skills and confidence to practice.

CONCLUSIONS

Completing undergraduate education during the COVID-19 pandemic impacted pre registration nursing students' clinical and communication skill development. Opportunities to work in structured and supported clinical roles prior to registration Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation eased the transition into clinical practice. During their graduate year factors mitigating transition stress included: targeted educational support and integration into clinical teams.

Teaching and interconnecting research and evidence-based practice in midwifery and nursing education: A mixed methods systematic review

OBJECTIVE

To examine current approaches in research, teaching, and Evidence Based Practice (EBP) in midwifery and nursing education and how they interconnect.

DESIGN

A mixed-methods systematic review.

DATA SOURCES

Seven databases were used: Academic Search Complete, ASSIA, CINAHL, Cochrane Library, Education Source, Medline, and Scopus. Grey literature was searched from GreyNet International, The Society for Research on Educational Effectiveness, Virginia Henderson Global Nursing e-Repository, The National Institutes for Health Library, and the DART-Europe E-theses Portal.

METHODS

This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. It includes studies conducted in higher and professional practice education in midwifery and nursing between 2013 and 2024. Included studies were published in English, reported the design, development, implementation, and/or evaluation of research or EBP intervention with primary data as part of their research, regardless of study design. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Extracted data were analysed using reflective thematic analysis and descriptive statistics.

RESULTS

A total of 59 studies, and 7214 participants were included. Four themes representing the interconnections between teaching, research and EBP were identified: 1) Pedagogical approaches employed in teaching and learning interventions 2) Theories, models, and frameworks to bridge the theory-practice gap 3) Collaborative approaches and partnerships as a conduit for the acquisition of knowledge and transferable skills 4) Capabilities developed in research and EBP.

CONCLUSIONS

This review is the first to demonstrate how different educational interventions, models and findings relate to teaching research and EBP and their application in midwifery and nursing. Despite numerous educational strategies for integrating research into teaching, there is no conclusive evidence on the best methods for teaching EBP. The field needs clear guidelines, educational toolkits, and comprehensive materials to effectively bridge the gap between knowledge and practice and to address the challenges of EBP education and its clinical application.

Using patient journey mapping and provider workflows to understand process barriers to pediatric mental and behavioral health care in emergency departments

With the rise in mental and behavioral health (MBH) conditions among school-age children in the United States (US), the number of Emergency Department (ED) visits have also increased. However, ED settings struggle to meet the needs of children with MBH conditions safely and efficiently. This study integrated SEIPS (Systems Engineering Initiative for Patient Safety) 3.0 and 2.0 frameworks to explore the temporal and non-linear aspects of pediatric MBH patients' journey and work processes (professional, patient, and collaborative work) to identify process barriers to pediatric MBH care in the ED. This mixed-method, multiple case study used observations, staff interviews, and time stamps of patient visits from electronic medical records at four EDs in the south-eastern US to inform the integrated patient journey and staff workflow process maps. Most barriers identified related to "medical and psychiatric evaluations" and "disposition and treatment plan" segments of the patient journey, suggesting potential points for interventions.

Development and validation of competencies for home-based nursing care: an e-Delphi study

Background

The expected competencies of nurses in home-based care remain unclear. A list of professional competencies that are agreed upon by a panel of content expert are needed to offer some form of standardized expectations among nurses and home-based care stakeholders.

Objectives

To evaluate the content validity of the professional competencies identified for home-based nursing care.

Design

An e-Delphi method was used.

Settings

A purposive sampling of local and international experts in home-based nursing care or community nursing.

Methods

Preliminary competency items were developed inductively from earlier studies and deductively by a steering committee. Sixteen experts performed two rounds of content validation. The Item-Content Validity Index, Scale-Content Validity Index/Average (S-CVI/Ave) and Fleiss' kappa coefficient were evaluated.

Results

In Round One, the list was revised to 49 items. In Round Two, the list was revised to 45 items, categorized into eight domains of practice: (1) client assessment and care planning; (2) nursing care in a home-based setting; (3) management of clients with health conditions, (4) interpersonal relationships and communications; (5) collaboration and teamwork; (6) critical thinking and problem-solving skills; (7) professional development and leadership; and (8) innovation and research. The S-CVI/Ave was 0.95. The overall acceptable clarity was 94.1 %.

Conclusions

This study generated a list of competencies that have reached consensus among a panel of experts. The list offers insights into the expected competencies of home-based care nurses. Further validity and reliability testing is needed to determine the underlying structure of the competencies.

Impact of nutrition-related laboratory tests on mortality of patients who are critically ill using artificial intelligence: A focus on trace elements, vitamins, and cholesterol

BACKGROUND

This study aimed to understand the collective impact of trace elements, vitamins, cholesterol, and prealbumin on patient outcomes in the intensive care unit (ICU) using an advanced artificial intelligence (AI) model for mortality prediction.

METHODS

Data from ICU patients (December 2016 to December 2021), including serum levels of trace elements, vitamins, cholesterol, and prealbumin, were retrospectively analyzed using AI models. Models employed included category boosting (CatBoost), extreme gradient boosting (XGBoost), light gradient boosting machine (LGBM), and multilayer perceptron (MLP). Performance was evaluated using area under the receiver operating characteristic curve (AUROC), accuracy, precision, recall, and F1-score. The performance was evaluated using 10-fold crossvalidation. The SHapley Additive exPlanations (SHAP) method provided interpretability.

RESULTS

CatBoost emerged as the top-performing individual AI model with an AUROC of 0.756, closely followed by LGBM, MLP, and XGBoost. Furthermore, the ensemble model combining these four models achieved the highest AUROC of 0.776 and more balanced metrics, outperforming all models. SHAP analysis indicated significant influences of prealbumin, Acute Physiology and Chronic Health Evaluation II score, and age on predictions. Notably, the ratios of selenium to age and low-density lipoprotein to total cholesterol also had a notable impact on the models' output.

CONCLUSION

The study underscores the critical role of nutrition-related parameters in ICU patient outcomes. Advanced AI models, particularly in an ensemble approach, demonstrated improved predictive accuracy. SHAP analysis offered insights into specific factors influencing patient survival, highlighting the need for broader consideration of these biomarkers in critical care management.

Impacts of stigma and discrimination on people with obesity who smoke cigarettes

Stigma is the state of social devaluation due to a trait or group identity; weight and smoking-based self-, felt-, and enacted stigma may have detrimental health effects and pose barriers to smoking cessation. This study examined associations between stigma, discrimination, and health for people with overweight or obesity (body mass index [BMI] ≥ 25) who smoke cigarettes (cigarettes smoked/day ≥ 5) who reported interest in quitting smoking and minimizing weight gain. Participants (N = 63; predominantly women (81.0 %), White (63.5 %) or Black/African American (31.7 %), and heterosexual (85.7 %) with 50 % having a yearly income below $50,000) completed the measures of stigma (i.e., Weight Bias Internalization Scale and Internalized Stigma of Smoking Inventory), discrimination (i.e., Everyday Discrimination Scale), and symptoms of depression, weight, smoking, nicotine dependence, and concerns about gaining weight while quitting smoking were measured. Those who reported more internalization of weight bias and more everyday discrimination reported greater depressive symptomatology and greater concern about gaining weight while quitting smoking, with depressive symptomatology fully mediating both internalization of weight bias and everyday discrimination's relation with concern about gaining weight while quitting smoking. There was also an association of smoking felt-stigma, but not self- or enacted-stigma, with symptoms of depression. Stigma's associations with symptoms of depression and post-cessation weight concern suggest barriers to effective behavior change, and interventions may consider targeting processes for coping with stigma experienced by this population.

Longitudinal psychological well-being in caregivers of young children with cleft lip and/or palate

OBJECTIVE

Caregivers of children with chronic conditions can experience psychological distress and an impact on quality of life (QoL). Cleft lip and/or palate (CL/P) is one of the most common congenital conditions worldwide. Utilizing data extracted from The Cleft Collective cohort studies in the United Kingdom, this study investigated longitudinal psychological well-being in caregivers of young children with CL/P, to inform screening practices and early intervention.

METHODS

Baseline (post-diagnosis) and 5-year questionnaire data were extracted for 525 caregivers (342 biological mothers, 183 fathers/partners). Outcome measures included the PedsQL-Family Impact Module, the Perceived Stress Scale, and the Hospital Anxiety and Depression Scale.

RESULTS

QoL significantly improved from T1 (post-birth) to T2 (5 years) as reported by mothers and fathers/partners. At T2, scores on all measures were aligned with, or more favorable than, norms. A minority continued to report clinically significant levels of distress at 5 years. Predictors of poorer outcomes on all measures included a less positive life orientation, more negative appraisals of CL/P, less favorable baseline scores, lower healthcare satisfaction, and prior mental health conditions. Outcomes were also less favorable for caregivers of children with combined cleft lip and palate compared to other cleft types. Reductions in negative appraisals of CL/P were significantly associated with improved QoL over time.

CONCLUSIONS

QoL and psychological well-being in caregivers is generally positive at 5 years. A minority experienced poorer outcomes and routine assessment by a multidisciplinary team is therefore recommended. Targeting early negative appraisals may help to facilitate long-term caregiver adjustment.

Engaging patients, family caregivers and healthcare providers to develop metrics tailored to a palliative care population: a content validity process

BACKGROUND

Assessment of patient readiness for hospital discharge has been advocated as an important component of discharge preparation. However, no measures focused on hospital-to-home transitions for patients receiving a palliative approach to care, or the associated difficulties in coping at home after hospital discharge, have been developed to date. Using a co-design approach, the purpose of this study was to (1) adapt two scales to a palliative care population, one of which was developed to assess readiness for the hospital-to-home transition and another developed to assess difficulty in coping post-transition and to (2) test the content validity of both scales from the perspectives of patients, family caregivers, and healthcare providers. The scales chosen for adaptation were the Readiness for Hospital Discharge Scale and Post-Discharge Coping Difficulty Scale.

METHODOLOGY

The research team made initial adaptations to scale language prior to developing three parallel versions of each scale to be patient-, family caregiver-, and healthcare provider-facing. We conducted content validity testing of the items on both scales by asking each participant group to rate scale items on their usefulness, and to provide suggestions on ways items could be improved. We calculated the Item Content Validity Index and a modified Kappa statistic for each scale item, and calculated the Scale Content Validity Index for each of the three versions of the scales. Refinements were informed by qualitative feedback provided by participants during the content validity process. Final refinements were informed by members of a Patient and Family Advisory Council, and healthcare provider research team members.

RESULTS

Moderate modifications were required to the three versions of both scales. Modifications included adding items, modifying item language, and adding examples in parentheses to enhance item context. Patients, family caregivers, and healthcare providers deemed the research team's initial modifications to the scales useful, as evidenced by each scale yielding a Scale Content Validity Index of higher than 0.5.

CONCLUSION

The methodology provided can be used as an example of ways to engage and leverage the experiences of healthcare system users and healthcare providers throughout the outcome measures development process. The next steps will be to utilize the adapted scales as intervention outcome measures in a subsequent implementation study.

Personality Traits, Impostor Phenomenon, and Workplace Bullying: A Cross-Sectional Study on Hospital Nurses

BACKGROUND

Although workplace bullying among nurses has long been recognized as a significant problem and solutions have been discussed, it still persists in nursing organizations. To gain a comprehensive understanding of this phenomenon, personal as well as workplace-related factors should be considered, and individual characteristics such as personality traits should be examined as potential factors of influence.

PURPOSE

This study was developed to investigate the influence of personality traits and the impostor phenomenon on workplace bullying among nurses in tertiary hospitals.

METHODS

A cross-sectional research design was employed. Data were collected in December 2022 from 268 nurses working in tertiary hospitals in South Korea using an online survey. Personality traits, the impostor phenomenon, and workplace bullying were respectively assessed using the Big Five Inventory-short version, Clance Impostor Phenomenon Scale, and Negative Acts Questionnaire-Revised. Multiple linear regression analysis was conducted to identify the significant factors of influence on workplace bullying.

RESULTS

A multiple linear regression analysis revealed the neuroticism personality trait and the impostor phenomenon to significantly influence workplace bullying, with higher levels of both factors associated with a more severe experience of workplace bullying.

CONCLUSION/IMPLICATION FOR PRACTICE

Higher levels of neuroticism were found significantly associated with both impostor phenomenon severity and experience of workplace bullying. Preventing workplace bullying and mitigating victimization require awareness of neuroticism in nurses and intervention strategies able to mitigate both the impostor phenomenon and neuroticism. Workplace bullying prevention policies should direct nursing leadership and management to develop and implement educational and intervention programs to help hospital nurses recognize their own personality traits and address their maladaptive impostor phenomenon proactively.

Mediating Role of Evidence-Based Nursing Competence Between Specialist Nurses' Information Literacy and Innovative Behaviour: A Multicentre Cross-Sectional Study

AIM

To investigate the levels of information literacy, evidence-based nursing competence and innovative behaviour in specialist nurses, determine the impact of information literacy and evidence-based nursing competence on the innovative behaviour of specialist nurses and to analyse the mediating role of evidence-based nursing competence between information literacy and innovative behaviour among specialist nurses.

DESIGN

A multicenter cross-sectional design.

METHODS

In March 2024, a survey was conducted on 313 specialist nurses in four tertiary Grade A comprehensive hospitals in China. Data collection involved the utilization of general demographic questionnaire, the Information Literacy Questionnaire, the Evidence-Based Nursing Competence Scale and the Nurse Innovation Behaviour Scale. The data were analysed using IBM SPSS26 and Amos28 software.

RESULTS

Specialist nurses scored above average in information literacy, evidence-based nursing competence and innovative behaviour. Information literacy significantly positively correlated with innovative behaviour. Evidence-based nursing competence also positively affected innovative behaviour and partially mediated the relationship between information literacy and innovative behaviour.

CONCLUSION

This research indicated that specialist nurses exhibited above-average levels of evidence-based nursing competence, information literacy and innovative behaviour. Both information literacy and evidence-based nursing competence positively impacted innovative behaviour, with evidence-based nursing competence playing a significant mediating role between information literacy and innovative behaviour.

IMPACT

The findings suggest that nursing managers should focus on enhancing information literacy and evidence-based nursing competence in specialist nurses. Improving these abilities will support the implementation of innovative practices and advance the nursing field.

REPORTING METHOD

The research findings were presented in strict accordance with the STROBE statement.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY

It provides reference guidance and theoretical basis for global nursing managers to formulate targeted interventions, so as to effectively enhance the innovative behaviour of specialist nurses.

Nurses' Knowledge, Attitude and Practice in Nutrition Management of Hospitalised Adults: A Mixed-Methods Study

AIM(S)

To examine nurses' knowledge, attitude and practice regarding nutrition management in hospitalised adults and explore their views on it.

DESIGN

A mixed-method approach combining cross-sectional and descriptive qualitative methods.

METHODS

379 enrolled/registered nurses working in acute or intensive units of a tertiary hospital were recruited between 24th August 2023 and 3rd December 2023. Participants completed a questionnaire on their sociodemographic profile, knowledge, attitude and practice (KAP) regarding nutrition management. Data analysis was conducted using R software, reporting levels of KAP and its associations with sociodemographic factors. Mann-Whitney U and Kruskal-Wallis tests were used for non-normally distributed knowledge and practice scores (reported as median and interquartile range). Two-sample t-tests and ANOVA were used for normally distributed attitude scores (reported as mean and standard deviation). 21 of the participants from the quantitative study were either purposively sampled or snowballed from the quantitative study to undergo semi-structured interviews (physically or virtually face-to-face), which were transcribed verbatim and analysed using content analysis.

RESULTS

The mean scores on KAP were 61.6, 19.4 and 22.8, respectively. Knowledge varied significantly by educational level (p < 0.001), while attitudes also differed based on education (p = 0.001) and years of employment (p = 0.019). Practice scores showed differences based on subspeciality (p = 0.032), nursing rank (p < 0.001) and years of employment (p = 0.004). Findings identified barriers to effective nutrition management, including prioritisation issues, varying professional roles, limited autonomy and resource shortages. It also emphasises nurses' roles in nutrition management and strategies such as nurses' autonomy and family members involvement to improve nutrition management.

CONCLUSION

Sociodemographic factors significantly influence nurses' KAP in nutrition management, revealing knowledge deficits, low prioritisation and time constraints. Tailored education and training, increased autonomy, resource expansion and greater family involvement can enhance nurses' KAP in nutrition management.

Parents care needs with epileptic children: a hybrid model concept analysis

BACKGROUND

The care needs of epileptic children are a multidimensional concept that varies based on the experience and understanding of family caregivers. This study aimed to analyze the concept of parental care needs for children with epilepsy.

METHODS

This study was conducted using the hybrid method in three phases. In the theoretical phase, a systematic literature review was performed. In the fieldwork phase with a qualitative approach, 13 parents caring for epileptic children were investigated with individual and semi-structured interviews at the Besat Teaching-Treatment Center (Hamadan, Iran) in 2024. In the final phase, the concept of parental care needs was defined based on the findings of the theoretical and fieldwork phases.

RESULTS

The common antecedents identified in both the theoretical and fieldwork phases included low education levels and poor economic status. Additionally, the fieldwork phase highlighted the role of ineffective support systems. The common consequences were care quality improvement, financial burden reduction, care knowledge acquisition, and psychosocial status improvement, and the consequence of increasing stability in the family structure appeared in the fieldwork phase. The care needs of epileptic children's parents included comprehensive support, therapeutic needs, and psychological needs, while financial constraints and inadequate care knowledge were identified as major challenges. These needs are influenced by factors such as low socioeconomic status and limited education, and their fulfillment leads to an improved quality of life and more effective disease management.

CONCLUSION

Concentration on parental care needs and provision of appropriate support through education, financial resources, and social support can help reduce psychosocial pressures on families.

Strategies to enhance nurses' adherence to central line-associated bloodstream infection prevention bundles in the ICU setting: A systematic review

BACKGROUND

The incidence of central line-associated bloodstream infection (CLABSI) in the ICU continues to rise. Despite existing CLABSI bundles to prevent infections, adherence remains suboptimal.

OBJECTIVE

To identify and synthesize the evidence about strategies used to enhance nurses' adherence to CLABSI prevention bundles.

METHODS

Five databases were searched: CINAHL, MEDLINE, PubMed, Cochrane Library, and SCOPUS. Eligible studies were those published between 2012-2024, and investigated the adherence to central line bundles and strategies to improve adherence in the ICU. Two reviewers independently screened, critically appraised, and extracted data using Joanna Briggs Institute tools. The review protocol was registered on PROSPERO (CRD42024513345).

RESULTS

Seven studies met the inclusion criteria, including four quality improvement projects and three quasi-experimental studies. The studies ranged in quality from moderate to high, with scores between 68.75 %-88.88 %. These studies explored various strategies to enhance nurses' adherence to CLABSI prevention bundles. Strategies included education, leadership, and auditing/feedback mechanisms. Education was the primary strategy utilized and included simulation and online training. Active participation in decision making, transparency in sharing CLABSI outcome data, celebrating achievements, and electronic documentation were essential aspects of leadership support to promote adherence. Implementing these strategies led to significant improvements in nurses' adherence to bundle (<0.01).

CONCLUSION

Education, leadership, and audit mechanisms improve adherence to CLABSI bundles. Yet, the current evidence lacks randomized controlled trails that can establish effectiveness of these strategies. Future research should also investigate the long-term effect of these strategies on adherence, and the influence of organizational culture on CLABSI bundle adherence.

Transition to Practice: Entry-Level Clinical Nurse Specialist Leveraging Practice From a Structured Orientation and Mentorship Program

PURPOSE

The purpose of this article is to describe the experiences of an entry-level clinical nurse specialist (CNS) leveraging practice from a structured orientation and mentorship program developed by advanced practice supervisors.

DESCRIPTION OF PROGRAM

An entry-level CNS may experience feelings of ambiguity, role confusion, social isolation, and inadequacy when transitioning into a CNS role. The author applied key components of a transition-to-practice program from a review of literature that includes a standardized competency-based orientation with mentorship, leadership support, and professional development opportunities.

OUTCOME

An annual portfolio outlined the completion of entry-level CNS outcomes in the 3 spheres of impact: patient care, nursing practice, and health system innovation.

CONCLUSION

A structured CNS onboarding and mentoring program is crucial to support entry-level CNS on transition to practice. Entry-level CNSs are in a position to take action advocating for role clarity, establishing a working relationship with mentors and peers, and maintaining clinical competence through a structured orientation program with mentorship.

Interventions in the Sexuality of Men With Stomas: A Scoping Review

AIMS

To map interventions in the sexuality of men with stomas.

DESIGN

Scoping review, following JBI and PRISMA-ScR guidelines to report results.

METHODS

Databases consulted were PubMed, via National Library of Medicine, Latin American and Caribbean Health Sciences Literature, Web of Science, Scopus, Embase, Scientific Electronic Library Online, Brazilian Electronic Library of Thesis and Dissertations, CAPES Catalogue of Thesis and Dissertations and Open Access Scientific Repository of Portugal. Texts were read by independent reviewers, with no time or language restrictions.

RESULTS

The final sample included 10 studies. Data were synthesised and grouped for its similarity to approach models, preoperative orientations, self-care promotion, collecting pouch hygiene and safety, sexual health discussion and education, construction of bonds and sexual function evaluation.

CONCLUSION

Interventions in the sexuality of men with stomas included adherence to models for approaching sexuality, focusing on the permission and coparticipation of the patient, open conversations on the topic, self-care promotion, collecting pouch hygiene and safety, encouragement to the creation of bonds, sexual function evaluation in pre- and postoperative periods and individual and/or collective sexual health education.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study contributes to the sexuality of men with stomas. It identified recommendations to approach and conduct the topic at hand, addressing the rehabilitation process since the surgery to place the stoma is considered.

IMPACT (ADDRESSING)

This study addressed scientific literature on the sexuality of men with stomas. Most were from Europe and results demonstrated a gap in knowledge. This research will impact the stoma therapy research, affecting teams involved in the care to men with stomas, encouraging reflections on the sexuality of these patients.

REPORTING METHOD

This study complies with the PRISMA-ScR.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

PROTOCOL REGISTRATION

The protocol of this scoping review was registered in the Open Science Framework, registered under DOI 10.17605/OSF.IO/X9DSC. It can be accessed through the following link: https://osf.io/x9dsc/?view_only=a9c62ef6c11f44499f7b2bfe1fe379f9.

Emergency Department Triage Accuracy and Delays in Care for High-Risk Conditions

Importance

Emergency department (ED) triage may impact timeliness of care for high-risk conditions.

Objective

To determine the association of ED undertriage with delays in care for patients with subarachnoid hemorrhage (SAH), aortic dissection (AD), and ST-elevation myocardial infarction (STEMI).

Design, Setting, and Participants

This retrospective cohort study included adult ED patients diagnosed with SAH, AD, or STEMI from January 1, 2016, to December 31, 2020, from a multicenter, community-based health care delivery system. Data analysis were completed in March 2023 to October 2024.

Exposure

Undertriage vs correct triage, defined by operational measures of mistriage.

Main Outcomes and Measures

Using a lognormal distribution, the outcomes of interest for patients with SAH and AD were adjusted median time to noncontrast computed tomography (CT) (head CT for patients with SAH, chest CT for patients with AD), antihypertensive medication orders (SAH), and β-blocker orders (AD), and ED length of stay (LOS). For patients with STEMI, outcomes of interest were adjusted median time to electrocardiogram (ECG) and troponin orders.

Results

A total of 5929 patients (median [IQR] age, 63.0 [54.0 to 73.0] years; 3876 [65.4%] male) were identified, including 915 with SAH, 480 with AD, and 4534 with STEMI. There were 1129 Asian patients (19.0%), 553 Black patients (9.3%), 889 Hispanic patients (15.0%), and 2906 non-Hispanic White patients (49.0%). Overall, 2175 patients (36.7%) were undertriaged. For patients with SAH, the lognormal estimate for delay in time to head CT was 0.2 (95% CI, 0.0-0.3), or a delay of 2.4 minutes, and for antihypertensive orders, the lognormal estimate was 4.8 (95% CI, 3.6-5.9), or a delay of 33.3 minutes; the lognormal estimate for ED LOS was 0.1 (95% CI, 0.0-0.1), or 7.7 minutes longer. For patients with AD, the lognormal estimate for delays were 0.2 (95% CI, 0.0-0.4), or 8.9 minutes, for chest CT and 0.5 (95% CI, 0.2-0.7), or 17.6 minutes, for β-blocker orders, and ED LOS was 0.2 (95% CI, 0.1-0.3), or 64 minutes longer. For patients with STEMI, differences in time to ECG and troponin orders were not statistically significant, at less than 1 minute, comparing correctly and undertriaged patients.

Conclusions and Relevance

In this cohort study of patients diagnosed with SAH, AD, or STEMI, ED undertriage was associated with small but significant delays in key diagnostic and therapeutic orders for patients with SAH and AD but not for patients with STEMI.

Cultivating excellence: Development and validation of a bilingual competency self-assessment tool for infection prevention and control practitioners

BACKGROUND

The study aimed at developing and validating a bilingual competency self-assessment tool for infection prevention and control practitioners based on the core competencies proposed by the World Health Organization.

METHODS

The study was conducted from December 2021 to June 2023. The bilingual tool (Brazilian Portuguese and English versions) was developed according to 4 stages: (1) conceptual framework establishment and item generation; (2) content validity; (3) response process validity; and (4) internal structure validity.

RESULTS

The Brazilian Portuguese version of the tool was organized into 5 areas, 36 items, and a Cronbach's alpha coefficient between 0.89 and 0.97; the English version of the tool was organized into 5 areas, 37 items, and a Cronbach's alpha coefficient between 0.91 and 0.98.

DISCUSSION

The bilingual tool gathers evidence of content validity and internal structure validity.

CONCLUSIONS

The current evidence suggests that these are the first self-assessment tools that have utilized the core competencies proposed by the World Health Organization as a conceptual basis. Such tools can be applied in countries of all income classifications, which makes it possible to design educational initiatives and enhance core competencies.

From policy to practice: Rolling out the clinical nurse specialist role in Portugal

The specialization of Health Human Resources (HHR) is increasingly recognized as essential for addressing evolving healthcare demands. This paper presents a comprehensive policy framework for assisting with the implementation of Clinical Nurse Specialist (CNS) roles at the national or regional level, integrating key dimensions including barriers and enablers, regulation and governance, education and training requirements, career development, workforce planning, and economic analysis. The framework was applied to the implementation of CNS roles in Portugal, resulting in the issuance of a decree-law by the government. Our findings demonstrate that the economic analysis step was critical in addressing concerns from government authorities and health system funders regarding the potential budgetary impact of CNS implementation. By providing evidence-based projections of costs and benefits, the economic analysis facilitated smoother negotiations and consensus-building among stakeholders, including nursing unions. Furthermore, the integration of workforce planning ensured the alignment of educational capacity with workforce needs, thus avoiding potential implementation bottlenecks. The application of the framework also revealed important feedback relationships between its dimensions, highlighting the interdependent nature of the implementation process. This dynamic approach, which adapts to real-time feedback and stakeholder input, underscores the necessity of a holistic and iterative strategy for successful CNS role integration. The insights gained from the Portuguese case underscore the utility of this policy framework in guiding the implementation of advanced nursing roles in diverse healthcare contexts.

Co-design of a group-based programme to facilitate adherence to pelvic floor muscle training in pregnant women in China: Describing the process of developing an intervention underpinned by the behaviour change wheel

PROBLEM

The effectiveness of pelvic floor muscle training is limited by insufficient human resource and low adherence to the exercise.

BACKGROUND

Group-based pelvic floor muscle training provides a possible way to implement pelvic floor muscle training for more women. However, the feasibility and effectiveness of group-based pelvic floor muscle training still needs to be evaluated.

AIM

This study aimed to co-design a group-based programme to facilitate adherence to pelvic floor muscle training in pregnant women.

METHODS

The study involved a systematic review, a survey, behaviour change theory identification and stakeholder engagement to co-design the programme.

FINDINGS

The stakeholders discussed the barriers and mapped them to the capability, opportunity, motivation and behaviour model. The main barriers are increased cost and time for receiving the pelvic floor muscle training supervision and lack of knowledge about the importance of doing pelvic floor muscle training. Six intervention functions were identified to facilitate behaviour change in pregnant women. Then, 18 behaviour change techniques were identified and used to develop a facilitated group-based pelvic floor muscle training programme for pregnant women.

DISCUSSION

This study has shown the importance of addressing barriers to adhere to the resulting programme. However, how to ensure the pregnant women to attend the sessions still need to be discussed.

CONCLUSIONS

Through the use of the behaviour change wheel approach, this paper describes a transparent process of translating current evidence and theoretical understanding to the co-design of a complex intervention to improve adherence to a group-based pelvic floor muscle training programme.

REGISTRATION

This study has been registered with ClinicalTrials.gov under NCT05242809.

Utilizing Federal Data Sources to Support Nursing Workforce Analysis

Effective health workforce analysis requires robust data and information. Quality data facilitate monitoring workforce trends, identifying shortages, forecasting employment needs, and planning educational programs. A wide range of federal agencies collect various forms of data, including administrative data, surveys, and censuses, which can be used for health workforce analysis. However, identifying the most appropriate data sources to address a specific nursing workforce issue can be challenging, particularly for newcomers to the field or those researching unfamiliar topics. In this article, we introduce and review 18 federal data sources pertinent to nursing workforce analysis. We categorize the datasets by their associated federal agency, describe each source, discuss their applicability to nursing workforce studies, present examples of past studies that employed these datasets, and highlight their limitations. Our aim is to help researchers, policymakers, and healthcare administrators efficiently locate and leverage relevant data for their analysis.

Recruitment and retention of intensive care unit survivors in follow-up studies: A systematic review

BACKGROUND

Engaging intensive care unit survivors in research is challenging. Studies have reported recruitment and attrition rates; details are lacking on retention strategies and attrition.

OBJECTIVE

The aim of this study was to explore barriers and enablers to recruitment and retention in research of people post intensive care discharge.

METHODS

A convergent mixed-method review using the Joanna Briggs Institute (JBI) methodology considered studies that reported on recruitment, retention, and attrition rates of adult post-intensive care survivors in longitudinal studies. CINAHL Ultimate (CINAHL+), PubMed, Excerpta Medica Database (EMBASE), PsycINFO, Scopus, Proquest Health, and Medical Collection were searched in March 2024 using Medical Subject Headings terms and keywords related to post-intensive care survivors, patient selection, and research in peer-reviewed journals or theses published in English. Risk of bias was assessed with JBI's critical appraisal tools. Qualitative data were extracted and themed, and quantitative data were extracted using predefined data fields and qualitised. Synthesis was guided by the JBI mixed-method convergent integrated approach.

RESULTS

A total of 1608 records were identified; 12 high-quality articles were included, with a total of 2551 participants. Studies focussed on outcome measures following hospital discharge to the community. Three superordinate and eight subordinate themes emerged: factors influencing participation/nonengagement, retention strategies, and researcher insights. Attrition was predominantly due to mortality or ill health. Non-health-related themes included transport difficulties, expense, and inconvenience. Challenges included symptoms triggered by participation, being unaware of appointments, and not understanding study requirements. Enabling strategies included reminder calls, letters, cards, and home visits. Researcher insights included the impact of critical illness on survivors' wellbeing, finances, and communication challenges.

DISCUSSION

Recruitment and retention strategies were under-reported. Person-centred approaches considering survivors' challenges may increase recruitment and retention. Retention strategies should be evaluated to determine the impact on engagement or withdrawal from studies. The strong likelihood of attrition should be factored into sample size calculations to reduce risk of bias in longitudinal studies.

REGISTRATION

This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO [CRD42022315688]).

The expository phase of debriefing in clinical simulation: a qualitative study

BACKGROUND

Clinical simulation fosters reflective, experiential learning in a safe environment, allowing participants to learn from mistakes without patient risk. Debriefing, essential for reflection, is typically facilitator driven. The MAES© methodology (Self-Learning Methodology in Simulated Environments) shifts the focus to students, guiding them through six sequential phases: group identity creation, topic selection, objective setting, competency establishment, scenario design, simulation, and debriefing. MAES© introduces an expository phase in debriefing, where students present theoretical and practical content. The facilitator assumes a significant, yet secondary role, fostering increased student-led learning opportunities and, at times, enabling even trained real patients to co-facilitate the debriefing.

OBJECTIVE

To explore participants' experiences and perceptions regarding the expository phase of debriefing within the MAES© methodology framework, with specific focus on the student-led debriefing component.

METHOD

A descriptive qualitative inductive approach with thematic content analysis was used. Open-ended questionnaires from 151 undergraduate final year and post-graduate nursing students, captured their experiences with the MAES© expository phase. Open-ended questionnaires allow participants to freely and anonymously express their perspectives and experiences. Responses were transcribed, independently coded, and analyzed using MaxQDA® v18. Data were coded and analyzed based on absolute and relative frequencies of emerging categories. The study adhered to the SRQR (Standards for Reporting Qualitative Research) guidelines.

RESULTS

The analysis revealed several key themes in student evaluations. Satisfaction with the methodology emerged strongly, with over one-third of participants expressing no desired changes. The reflective nature of the approach was prominently valued, along with its effectiveness for concept clarification and fostering collaborative learning. Participants particularly noted developmental outcomes in communication competencies and technical skills, while appreciating the motivational learning environment and evidence-based focus. The suggested improvements focused on three main aspects: increased session dynamism, a greater use of visual and interactive elements, and reduced dependence on slide-based presentations.

CONCLUSION

The study highlights the value of the expository phase in the MAES© methodology, emphasizing its effectiveness in clarifying concepts, fostering collaboration, and developing technical and communication skills. It also promotes student autonomy through active engagement. However, participants suggested improvements, such as greater dynamism, personalization, and varied presentation methods using videos, skill stations or patient's-oriented debriefing. Overall, the expository phase proves to be a valuable pedagogical tool with potential for broader application in simulation-based learning and other debriefing models.

CLINICAL TRIAL NUMBER

Not applicable.

Implementation of a Naloxone Vending Machine in the Public Space of an Emergency Department: A Feasibility and Acceptability Study

INTRODUCTION

Naloxone is a lifesaving medication to prevent opioid overdose deaths. Emergency departments can provide important access points for individuals to receive naloxone. Vending machines are 1 low-barrier method of distributing naloxone. We describe the implementation of an emergency department-based naloxone vending machine and demonstrate its feasibility and acceptability among participants.

METHODS

A naloxone vending machine, supplying free naloxone and educational resources via a Quick Response code affixed to the box in addition to brochures, was installed in a public hallway next to other vending machines in the emergency department. A 12-item paper survey attached to the machine queried reasons for obtaining naloxone, acceptability of emergency department-based naloxone vending machines, and an open-ended question about their experiences with the machine.

RESULTS

From October 2023 to May 2024, 1470 boxes of naloxone were dispensed. Survey results (N = 54) indicated that nearly half of respondents (46.2%) would not have otherwise had access to naloxone. Also, 75.9% obtained naloxone to be prepared for an overdose emergency, 42.6% because it was free, and 35.2% out of concern for a family or friend. High acceptability was reported for all survey items. Qualitative themes were predominantly positive, including gratitude, desire to help others, need for increased distribution, and the personal impact of naloxone in their lives.

DISCUSSION

Emergency department-based naloxone vending machines are an impactful, low-barrier strategy that is acceptable to the public. They provide continuous access to a life-saving medication and should be replicated widely.

Association between adverse childhood experiences and masculinity with well-being: moderating role of behavioural emotional regulation among men of three nations

The psychosocial aspects of men's health and well-being have gained attention in the literature in recent years. However, evidence from developing countries is limited. Therefore, the present study attempted to understand the determining role of Adverse Childhood Experiences (ACEs) and masculinity on well-being factors, namely self-care and self-compassion among men, along with the moderating role of behavioral emotional regulation (BER) between masculinity and self-care. We adopted a cross-sectional study design. The data were collected from three countries, which are patriarchal societies, namely Ethiopia, India, and Oman, with a total sample size of 823 men between 18 and 45 years. Self-reported measures of the key variables were administered among the participants. We performed descriptive statistical analyses and path analysis. The ACEs were positively associated with masculinity (b = 1.544; 99% CI = 1.227-1.853), while it reduced the likelihood of self-compassion. Further, the increase in masculinity increased self-care (b = 0.195; 99% CI = 0.097- 0.295). However, the use of negative BER strategies reduced the likelihood of involvement in self-care (b=-1.185; 95% CI= -2.280- - 0.125) and changed the direction between masculinity and self-care (b=-0.644; 95% CI = - 0.988- - 0.279) acting as a moderator (b = 0.027; 95% CI = 0.003-0.051). The results suggest the importance of BER in effectively promoting self-care among men. Future self-care programs and interventions in the three nations should consider training men in BER. BER-focused interventions can facilitate positive coping among men and further enhance self-care and self-compassion.

The role of community pharmacists in natural disasters: Experiences from the 2023 Türkiye earthquakes

OBJECTIVE

On 6 February 2023, a series of earthquakes struck the south-eastern region of Türkiye. The aim of this research is to identify the challenges and experiences of community pharmacists who were first-degree victims of the earthquake during and after the earthquake in providing health services.

METHODS

Phenomenological design, one of the qualitative research methods, was used in the study. In-depth interviews were conducted with 15 individuals who were both first-degree earthquake victims and community pharmacists.

RESULTS

Qualitative data were analyzed with the MAXQDA 2020 program and three main themes were created. It was determined that community pharmacists did not prepare despite knowing about seismic hazards. Following the disaster, a number of difficulties arose, such as drug safety issues, risky behaviors, and the physical destruction of pharmacies. It was noted that some community pharmacists could not return to normal processes on the date of the research.

CONCLUSIONS

Continuing pharmacy services without interruption during disasters is of global importance. Before the disaster, training should be organized for community pharmacists on their roles in disasters, medication management, and providing health care. Community pharmacists should take part in crisis management committees and contribute to drug supply chain planning. The roles of community pharmacists in risk reduction, preparedness, response, and recovery phases should be determined, and strategic actions should be developed for pre- and post-disaster periods.

Simulation as a foundation for experiential learning among ambulance nursing students: A qualitative observation study

Simulation-based education is commonly used in undergraduate training but has gained increased utilization in postgraduate education. Ambulance nursing programs struggle to provide suitable simulations, as ambulance care can involve any possible situation. Simulation-based education in ambulance nursing programs commonly includes basic assessment and treatment of various conditions. However, there seems to be a lack of knowledge regarding students' experience of simulating pediatric emergency care in an ambulance care setting. Thus, the aim of this study was to explore specialist nursing students' experiences of simulating pediatric emergency care in an ambulance care setting. A qualitative design was deployed, utilizing field notes, individual and group interviews to capture the students' experiences. The results show that students immerse themselves in the simulations when the environment and facilitators support this. The simulation can elicit both emotional and physical responses among the students. Students gain insights into their knowledge deficit regarding certain topics, such as pediatric emergency care, as well as the rules and regulations governing what they are allowed to do for a child's safety and well-being. During simulation, students understand the importance of using adequate communication and recognize that there might be several aspects influencing this. Finally, the students gain insight into their emotional and behavioral responses when encountering patients and relatives in situations that conflict with their own views. In conclusion, simulation-based education can be a useful pedagogical tool if barriers to immersion are reduced. It can provide students with insights into their emotional and behavioral responses when encountering unexpected events. If properly discussed in debriefing sessions, these matters lead to increased learning that students can carry with them into their future careers. However, more research is needed on the feasibility of this kind of simulation in the ambulance nurse education setting.

Call to action to reduce the occupational hazard associated with patient handling for workforce preservation

BACKGROUND

Nursing injuries from overexertion decreased in recent years, but 2020 saw an increase. Reducing work-related injuries (WRI) through safe patient handling (SPH) can preserve the nursing workforce. Policies focused on workforce preservation are needed.

PURPOSE

We investigate an evidence-based SPH program initiated in 2002, in reducing injuries among nurses compared with national patterns, and offer a blueprint for replication.

METHODS

A three-step iterative, mixed-methods approach compares national data on WRI and lost workdays from overexertion with a case example.

FINDINGS

The case example outperforms national trends. Data demonstrate benefits from a comprehensive, evidence-based SPH program with steady reductions in Occupational Safety and Health Administration recordable WRI and median workdays lost. Fifty-eight implementation strategies promoted sustainability of SPH practices.

DISCUSSION AND CONCLUSION

SPH can reduce injuries and lost workdays but requires funding for SPH equipment across settings. Implications for organizations, research and technology development, policy, and workforce preservation are provided.

Toward Solving the Menopause Data Gap: An Evidence-Based Standardized Mapping Study Using the Omaha System

Menopause is a significant health event that affects a large portion of the global female population, necessitating greater awareness and research to enhance women's health and quality of life during this stage. The purpose of this study was to identify validated menopause symptom checklists and map those to the Omaha System signs/symptoms terms. The authors used a consensus approach to identify menopause symptoms from six evidence-based checklists and map them to Omaha System signs and symptoms. The team mapped each symptom if it matched exactly (full match) with the Omaha System term or had a similar, although not identical, meaning (partial match). The mapping included more than 293 source text menopause symptoms to the Omaha System problems and signs/symptoms resulting in a standardized list of 72 signs/symptoms for 21 problems. Of these 72, 70 (97.2%) signs/symptoms were a full match at the problem level, and 67 (93.1%) signs/symptoms were a full or partial match at the signs/symptoms level. This study lays the groundwork for creating a more standardized, data-driven approach, for tracking menopause symptoms. Clinicians and researchers can use this checklist to assess, track, and evaluate symptoms, enabling the development of personalized treatment approaches for menopause.

A Neonatal Nurse-Controlled Model of Analgesia to Manage Post-Operative Pain in the Surgical Neonate: A Pilot Randomised Controlled Trial

AIM

To test the feasibility and acceptability of a newly developed model of neonatal nurse-controlled analgesia to manage pain in the post-operative infant.

DESIGN

The study utilised a single-centre two-arm parallel, unblinded randomised controlled external pilot trial design.

METHODS

The pilot trial was conducted in a surgical neonatal tertiary intensive care unit in Brisbane, Australia. Eligible infants were randomised to receive either post-operative pain management care via a model of neonatal nurse-controlled analgesia or standard care. Feasibility and acceptability were the primary outcomes. Seven feasibility outcomes were assessed by a traffic light system to delineate progression to a larger trial. Acceptability and clinical utility of the model of care by staff were assessed by feedback from an anonymous questionnaire that was administered at the completion of the trial period. Secondary outcomes included parental attitudes and perceptions of post-operative pain management to help establish primary outcomes for a larger randomised controlled trial.

RESULTS

Overall staff found the formalised model beneficial for managing post-operative pain but found the complexity of the model and ability to titrate analgesia based only on documented pain scores barriers requiring further consideration. Three of the seven feasibility outcomes failed to reach 'greenlight' targets to progress to a larger trial with adherence to the model, and the proportion of eligible infants not recruited was allocated a 'redlight'. Secondary outcomes were comparable and support future study.

CONCLUSION

This pilot feasibility study has shown that a model of neonatal nurse-controlled analgesia can be safely implemented and utilised in the post-operative care of the surgical neonate. Further exploration of the barriers to model adherence and recruitment is warranted before a future larger trial is undertaken.

IMPACT

Though not all primary outcomes reached an acceptable range for further progression, this pilot feasibility study provided invaluable learning and has provided direction for future research into the provision of a family integrated and responsive model of analgesia.

REPORTING METHOD

This study is reported in line with the Consolidated Standards of Reporting Trials (CONSORT): Extension to randomised pilot and feasibility trial and the TIDieR Checklist (Template for Intervention, Description and Replication).

PUBLIC OR PATIENT CONTRIBUTION

No patient or public contribution was utilised for this study.

TRIAL REGISTRATION

ACTRN12623000643673-the trial was prospectively registered.

Barriers and facilitators to optimal sepsis care - a systematized review of healthcare professionals' perspectives

BACKGROUND

Despite therapeutic advances, sepsis remains a global burden. Shortcomings within the healthcare system that inflate morbidity and mortality rates are instructive in this regard. This review aims to provide a qualitative synthesis of literature related to healthcare providers' perspectives on sepsis care, emphasizing perceived factors that impact the adequate care of septic patients and sepsis survivors.

METHODS

In February 2023, we conducted a systematized search approach using the PubMed database.

RESULTS

Of 114 articles found in the PubMed database, 37 were included. A further 13 articles were identified by manual search. Healthcare providers highlighted a variety of dysfunctional and functional processes with an impact on sepsis care. Six domains were identified, related to the underlying disease, the patient, the provider, the guidelines, the healthcare system, and the collaboration among providers. Of note, providers' level of knowledge and a lack of communication between disciplines and/or sectors were reported as shortcomings in each phase of the care pathway (prevention, recognition, treatment, transitions of care, and aftercare).

CONCLUSIONS

This review suggests that, without limitation, interventions that provide continuous provider education as well as standard communication channels between interdisciplinary and intersectoral providers have great potential to improve structural deficiencies in sepsis care.

The science behind the lifesum app: an intervention design analysis

Wellness is an increasingly important part of public health and can prevent both disease and death. Diet and nutrition are important factors that contribute to wellness and predict health outcomes. Adhering to healthy diets is notoriously difficult for many, and some support is often required. Increasingly, that support may be found in the shape of an app in a smartphone. One such app is Lifesum, with some 65 million users worldwide. Lifesum adopts a more holistic approach to nutrition and well-being, and adopted an evidence-based approach to its development. The aim of this study was to describe the scientific, theoretical basis for the Lifesum app and contribute to advancing science in the field of wellness app development. This was an intervention design analysis, designed to describe the theoretical model and intervention theory used to create the Lifesum app in its current embodiment. A pragmatic theoretical model describing behaviour change in the context of healthy eating was devised based on findings in literature. Factors that drive unhealthy eating behaviours, but that were malleable and whose mechanisms of change were feasible to implement, were identified and used to form an intervention theory. The theoretical model and the intervention theory could then guide the implementation of the Lifesum app, illustrated by a logic model. The theoretical model emphasizes personal goal-attainment and motivation as keys to establishing and maintaining healthy eating behaviours, with proximal outcomes being nutrition knowledge, mindfulness about eating and macro-nutrient balance. Nutrition knowledge is achieved through the provision of nutrition information from a vast database on food items, easily available. Continuous feedback on food choices made will enhance this knowledge and a greater awareness of the impact of nutrition on health remains desirable. A more mindful disposition regarding foods is achieved through support in terms of tracking food intake continuously, as well as recommending meals or recipes. After collecting user preferences on health status, biometrics and goals, these meal plans and recipes can be made to offer the optimal macro-nutrient distribution for each individual user. A theoretical model for diet-related behavior change was developed and key dietary issues were identified, outlining mechanisms for positive impact. These insights informed a mechanistic description of the Lifesum app, providing a foundation for future research on intervention outcomes.

Mobile app-based intervention for paternal perinatal depression, anxiety, and stress: A randomised controlled trial

BACKGROUND

Paternal perinatal mental health significantly impacts family outcomes, yet fathers are often overlooked and underserved in mental health services. This study evaluates the efficacy of a mindfulness-based cognitive behaviour therapy intervention delivered via mobile app to address paternal perinatal depression, anxiety, and stress symptoms.

METHOD

A randomised controlled trial was conducted with perinatal fathers experiencing moderate depression, anxiety, or stress symptoms. Participants were assigned to either the Rover app mindfulness-based CBT intervention (n = 81) or an active control app, moodmonitor (n = 75). Primary outcomes were depression (EPDS), anxiety, and stress (DASS21); secondary outcomes included social support, parenting self-efficacy, and couple relationship quality. Post-test analysis occurred at four weeks, with an additional eight-week follow-up for the intervention group.

RESULTS

Contrary to hypotheses, no differences were found between groups for depression, anxiety, and stress symptoms. Both groups showed significant reductions in anxiety (intervention d = -1.7, control d = -1.94) and stress (intervention d = -2.9, control d = -2.8) and improved couple relationship quality. Rover users maintained improvements at 8-week follow-up. Fathers with severe baseline depression experienced greater reductions in depression using the Rover app (b = 5.36, p < 0.01).

LIMITATIONS

Low adherence to the intervention and moderate attrition over the study duration.

CONCLUSIONS

Although the intervention was acceptable to fathers, treatment adherence was low, highlighting the need for more engaging content. App-based interventions show potential benefits for paternal mental health, but user engagement must be improved. This study contributes to the growing literature on digital interventions for fathers' mental health and emphasizes the importance of including fathers in perinatal mental health research.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry: ACTRN12621000275864.

Analysis of facilitators and barriers to early urinary catheter removal in postoperative patients by spine surgery nurses: a qualitative study based on the COM-B model in China

BACKGROUND

The high utilization rate of indwelling urinary catheters in patients after spine surgery poses an increased risk for a range of associated complications. Evidence-based recommendations suggest that urinary catheters should be removed early, yet spine surgery nurses are not positive about the behavior of removing catheters early after the surgery.

OBJECTIVES

The aim of this study was to explore the facilitators and barriers to early catheter removal by spine surgery nurses in postoperative patients, guided by the COM-B model.

METHODS

This study employed a qualitative study with a descriptive research design. In-depth and semi-structured interviews were carried out to explore facilitators and barriers to early catheter removal in postoperative patients by 18 spine surgery nurses in China. Data were analyzed using traditional content analysis methods.

RESULTS

We identified 10 barriers and facilitators from capability, opportunity, and motivation based on the COM-B model. (1) capability: lack of knowledge, Lack of standardized protocols, Changes in workload; (2) opportunity: Increase in the demand for human and material resources, Lack of effective communication, Lack of prioritization of early catheter removal; and (3) motivation: Promote patients' early recovery, Conflicting emotions.

CONCLUSIONS

Nurses encountered barriers from capability, opportunity, and motivation, which were not isolated but interrelated. Future interventions need to incorporate facilitators and barriers to address the issue of early indwelling urinary catheter removal in patients after spine surgery by taking a holistic approach at multiple levels, including nurses, doctors, patients, and health systems.

Phytochemical profiling, antioxidant capacity, acute toxicity, and gastroprotective potential of Angelica glauca root: A promising high-altitude medicinal herb

Angelica glauca, a therapeutic and aromatic herb native to the Himalayas, has been traditionally used for culinary purposes and to treat various ailments including rheumatism, asthma, bronchitis, reproductive, and gastrointestinal disorders. This study provides the first comprehensive analysis of phytochemical profiling of the root extract of A. glauca, its antioxidant potential, acute oral toxicity, and gastroprotective effects. Phytochemical quantification of A. glauca revealed significant levels of phenols, flavonoids, and tannins in the hydroalcoholic extract, with major bioactive compounds such as ligustilide, butylidenephthalides, β-bisabolene, and p-hydroxyphenethyl trans-ferulate identified via LC-TOF-MS. Extract exhibited potent antioxidant activity (68 μg/mL) and was non-toxic in acute oral toxicity tests in rats. In ethanol-induced gastric ulcer models, the extract (500 mg/kg) significantly reduced the ulcer-index, enhanced gastric pH, and reduced pepsin levels. Histological analysis confirmed protection against mucosal lesions and necrosis. SOD, CAT, GSH and LPO levels were 173 U/g, 78 U/g, 195 μM GSH/g and 194 nM MDA/g of tissue, respectively at 500 mg/kg dose. This treatment restored the antioxidant systems and reduced the MDA level, indicating its ability to counter oxidative stress. The IL-6 and TNF-α were significantly reduced. Level of IL-6 was reduced by 31.2 % and 57.1 % at 500 mg/Kg and 250 mg/Kg dose, respectively while TNF-α concentration was reduced by 32 % and 60 %, respectively. These findings highlight the gastroprotective efficacy of root extract due to its antioxidant and anti-inflammatory properties. This study establishes the herb's potential as source of bioactive compounds for developing novel therapy against gastric ulcers and other gastrointestinal disorders.

Effects of psychological intervention combined with education on psychological resilience and healthy behavior of patients with pulp disease

BACKGROUND

The two-way, three-stage psychological intervention for patients with dental pulp disease offers a reference for nursing interventions in such cases.

AIM

To examine the effects of a three-stage psychological intervention on psychological resilience and health behaviors.

METHODS

A total of 114 patients with dental pulp disease treated between December 2022 and December 2023 were allocated into two groups according to the random lottery method, with 57 patients in each group. The control group adopted the teaching method, while the observation group used a three-stage psychological intervention combined with the teaching method. We compared psychological resilience, coping strategies, dental fear, health behavior habits, and stigma between the two groups.

RESULTS

The intervention group showed significantly improved scores on the psychological resilience scale (Connor-Davidson Resilience Scale) (P < 0.05); positive and negative response scores also improved after the intervention (P < 0.05); significant differences were observed between the observation and control groups in the Chinese version of the Stouthard Dental Fear Scale (Dental Anxiety Inventory), the Social Impact Scale, and health behavior score (P < 0.05).

CONCLUSION

Combining a three-stage psychological intervention with the back-teaching method effectively reduces dental fear and stigma in patients with dental pulp disease. It also improves psychological resilience, coping strategies, and health behavior habits, achieving significant results.

Incidence and Associated Risk Factors for Falls in Adults Following Critical Illness: An Observational Study

OBJECTIVE

To explore the incidence of falls and associated risk factors in the first year after hospital discharge in survivors of critical illness.

DESIGN

Prospective single-site observational study.

SETTING

University-affiliated mixed ICU.

PATIENTS

One hundred ICU adults who required invasive ventilation for 48 hours and in an ICU for at least 4 days.

INTERVENTIONS

Not applicable.

MEASUREMENTS AND MAIN RESULTS

Falls were monitored prospectively for 1 year with completion of monthly falls calendars. Falls data included the number of people who had falls/no falls/recurrent falls, falls rate per person per year, and time to first fall. Fall severity was classified according to the Schwenck classification scheme to examine injurious falls requiring medical intervention. Other outcomes considered included assessments of balance, strength, function, cognition, psychologic health, and health-related quality of life. One hundred participants (31% female) were recruited with a mean age of 58.3 ± 16.2 years, and a median ventilation duration of 6.3 days [4.0-9.1]. Sixty-one percent fell at least once in the first year with the majority sustaining two or more falls (81.4%) and one in four sustained an injurious fall requiring medical attention. The falls incidence rate was 4.4 falls per person-year (95% CI, 3.2-5.9), with the highest incidence occurring less than 3 months after hospital discharge (5.9 falls/person-year [95% CI, 4.4-7.8]). Time to first fall or injurious fall was 36 [11-66] and 95 (95% CI, 40-155) days, respectively. Key risk factors for falls at the time of hospital discharge include comorbidities, higher discharge medications, balance, and muscle strength.

CONCLUSIONS

There was a high falls incidence in ICU survivors. The study findings suggest a critical window may exist within the first 3 months after hospital discharge and the need for screening, pharmacological optimization, and exercise training in this patient group.

Refresher training for emergency department triage nurses - A scoping review

BACKGROUND

Triage nurses have under five minutes to assess patients; prioritise urgency and assign wait times. Triage accuracy is vital for patient safety and Emergency Department (ED) efficiency. Guidelines for triage nurse refresher training are unclear. This review aimed to describe the evidence on ED triage nurse refresher training.

METHODS

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), searching Medline, Embase and CINAHL databases from 2007 to 2024.

RESULTS

Eighteen studies were included. Problem-based learning, lectures, simulation, and project learning were identified as effective education strategies, with multiple teaching methods frequently used. Cost and delivery mode affected refresher training. Tiredness, patient context, and nurses' forming personal rules over time negatively impacted accuracy, while clear guidelines and flowcharts helped maintain it.

CONCLUSIONS

Triage refresher training enhances nurses' accuracy. Clear guidance on minimum standards along with visible resources, guidelines and flowcharts further improve triage accuracy. Further research is needed to understand the long-term effects on patient safety and ED patient flow.

Role of the clinical nurse specialist in impacting quality of care: a qualitative exploratory interview study utilising complexity theory

BACKGROUND

Clinical nurse specialists (CNSs) work in advanced practice and aim to enhance patients' experiences through expert consultation and providing evidence-based nursing care. They also have a role in educating colleagues about new research and practice innovations.

AIM

To understand the perceptions of nurse leaders and staff nurses regarding the effect of the CNS role on quality improvement and to identify the unique features of the CNS role that can drive change within an organisation.

METHOD

This qualitative study used interviews with nurse leaders and staff nurses in the US to explore their perceptions of the CNS role. It was hoped that understanding these perceptions would enable nurse leaders to realise the full potential of the CNS role in developing meaningful professional relationships and shaping organisational culture.

FINDINGS

A total of 24 participants completed the interviews. Five themes were extrapolated from the interview data: a hospital and unit with cultural rules of quality and evidence-based practice; interdependence among roles; diversity and innovation; attributes; and associative capacity.

CONCLUSION

The CNS role is essential, providing clinical and financial value to healthcare organisations through the professional development of novice nurses, the enhancement of practice environments and improved patient outcomes.

Impact of early multidisciplinary team interventions on dietary management behavior in breast cancer patients: a pilot randomized controlled trial

BACKGROUND

Chemotherapy side effects can easily contribute to malnutrition and disrupt the normal diet of breast cancer patients. Offering early multidisciplinary team interventions during chemotherapy can establish a solid groundwork for dietary management and enhance the quality of life throughout the survival period. This study aims to assess the impact of early multidisciplinary team interventions on dietary management behavior, self-care self-efficacy, quality of life, and body mass index in breast cancer patients undergoing chemotherapy.

METHODS

A prospective, two-arm, single-blind, single-center randomized controlled trial was conducted between November 2023 and July 2024 from a tertiary-level general hospital in Shaanxi, China. A total of 88 participants who were either preparing for or undergoing early or middle stage chemotherapy were enrolled for this intervention. The intervention group received diet-related early multidisciplinary team interventions, in addition to the usual dietary education. The control group only received the usual dietary education. The intervention program included 8 themes, which were covered each week. The data on dietary management behavior, self-care self-efficacy, quality of life, and body mass index were measured at baseline (T0), immediately after the intervention (T1), 1 month after (T2), and 3 months after (T3) the intervention.

RESULTS

Seventy-nine participants, divided into an intervention group of 40 and a control group of 39, completed all the measures. There were statistically significant intergroup effects between the two groups and time effects on dietary management behavior, self-care self-efficacy, and quality of life. Additionally, there was an interaction effect (P < 0.05). However, there was no statistically significant intergroup effect on body mass index before and after the intervention (P > 0.05).

CONCLUSION

The early multidisciplinary team interventions are an effective method for improving dietary management behavior and confidence among breast cancer patients undergoing chemotherapy. Nurses should be attentive to the dietary issues faced by female patients during chemotherapy and should work to train and organize a multidisciplinary team to provide this intervention. This may lay a theoretical and capable foundation for managing a healthy lifestyle for future survival period.

TRIAL REGISTRATION

This intervention was registered with the Chinese Clinical Trials Registry (ChiCTR2300076503, October 10, 2023).

Optimizing an Electronic Health Record System Used to Help Health Care Professionals Comply With a Standardized Care Pathway for Heart Failure During the Transition From Hospital To Chronic Care: Qualitative Semistructured Interview Study

BACKGROUND

In Spain, the prevalence of heart failure is twice the European average, partly due to inadequate patient management. To address this issue, a standardized care model, the Care Model for Patients with Heart Failure (Modelos Asistenciales de Atención al Paciente con Insuficiencia Cardíaca), was developed. This model emphasizes the importance of sequential visits from hospital discharge until the patient transitions to chronic care to prevent rehospitalization. The standardized care pathway has been implemented in certain areas of the Andalusia Health Service. However, there is uncertainty about whether the region's electronic health record system, Diraya, can effectively support this model. If not properly integrated, it could lead to data inaccuracies and noncompliance with the standardized care pathway.

OBJECTIVE

This study aimed to explore how to improve Diraya to better support health care professionals in adhering to the transition standardized care model for patients with heart failure as they move from hospital care to chronic care.

METHODS

In total, 16 semistructured interviews were conducted with nurses and physicians from both hospital and primary care settings. Thematic analysis was used to analyze the data and recommendations for improvements that were developed based on the findings. These recommendations were further supported by existing literature and validated through additional interviews.

RESULTS

In total, 65 codes, 23 subthemes, and 8 themes were identified. The main themes included optimizing medical data management for enhanced clinical workflow, agreement on standardization and enhancement of the discharge report, enhancing clinical decision support through updated guidelines and automated tools, optimizing interoperability as a solution for better management of patients with heart failure, and encouraging communication based on digital tools and personal connection. In total, 15 improvements were proposed, such as standardizing technology across Andalusia Health Service facilities and offering targeted training programs. These measures aim to enhance interoperability, streamline communication between different health care settings, and reduce the administrative burden for health care professionals.

CONCLUSIONS

Diraya currently does not adequately support the transition standardized care model, placing a significant administrative burden on health care professionals, often with ethically concerning implications. To ensure effective implementation of the standardized care model, major updates are necessary for Diraya's clinical information management, system functionality, and organizational structure within the Andalusia Health Service.

Effects of a nurse-led individualized mHealth nutrition intervention for post-discharged gastric cancer patients following gastrectomy: A randomized controlled trial

OBJECTIVE

To evaluate the effects of a nurse-led individualized mHealth nutrition intervention on nutritional status, nutritional intake, cognitive beliefs related to nutritional behavior, weight loss, blood parameters, gastrointestinal symptoms, and quality of life in post-discharged gastric cancer patients following gastrectomy.

DESIGN

This was an assessor-blinded parallel-arm randomized controlled trial with a repeated-measures design.

SETTING(S)

The participants were recruited from inpatient gastric surgery units of two tertiary hospitals in Guangzhou, China.

PARTICIPANTS

A total of 108 patients with gastric cancer who underwent gastrectomy and were scheduled to be discharged to their homes were included.

METHOD

Participants were randomly allocated to either the intervention or the control group (n = 54 per group). The intervention group received the nurse-led individualized mHealth nutrition intervention in addition to the usual care, whereas the control group received only usual care. The intervention included face-to-face education before discharge, the use of an applet and phone consultations. Baseline data were collected on the day of discharge from the hospital (T0). The patients' nutritional status, cognitive beliefs related to nutritional behavior, nutritional intake, weight loss, blood parameters, gastrointestinal symptoms and quality of life were repeatedly measured at 4-week (T1) and 12-week (T2) after discharge.

RESULTS

Compared with the control group, the intervention group showed significant improvement in nutritional status (ꞵ₄ weeks = -1.08, 95 % CI -2.12 to 0.04, p = 0.042; ꞵ₁₂ weeks = -1.52, 95 % CI -2.57 to -0.47, p = 0.005). Improvements were also observed in energy and protein intake, weight loss, and cognitive beliefs related to nutritional behavior, including risk perception, outcome expectancy, self-efficacy, intention, and action plan (p < 0.05). However, no statistically significant differences were observed in coping plan, gastrointestinal symptoms, blood parameters, and quality of life (p > 0.05).

CONCLUSIONS

The nurse-led individualized mHealth nutrition intervention was effective for improving the cognitive beliefs related to nutritional behavior, energy and protein intake, and nutritional status, as well as reducing weight loss among post-discharged gastric cancer patients following gastrectomy.

REGISTRATION NUMBER

ChiCTR2200064808.

Thematic Analysis of Barriers to Completion of a Healthcare Proxy at a Comprehensive Cancer Center

Advance care planning is an important component of comprehensive oncology care. Advance directives serve to extend patient autonomy and empower patients to have their preferences and values honored when they cannot speak for themselves. This is a critical component when patients are facing cancer treatment that may challenge their ability to fully participate in their care. A review of institutional practices and procedures identified an opportunity to improve the process for obtaining healthcare proxy documentation, a critical but approachable component of advance care planning. A multi-level assessment was performed utilizing focus groups consisting of patients and community members, medical professionals, and hospital administrators. Areas of concern, misconceptions, and process weaknesses were identified by qualitative thematic analysis. This analysis was utilized to identify institution-specific barriers to completion of a health care proxy. They can then be tailored to develop staff specific education to overcome these barriers, in cooperation with ongoing patient education efforts. The analysis also identified process and workflow barriers to completion, implementation, and access; the result is the identification of multiple opportunities for quality improvement within the cancer care setting. Ultimately, multi-level intervention to improve knowledge and comfort with health care proxies and advance care planning will enhance patient care.

Reimbursement opportunities for caregiver training in rehabilitation: Using new CMS Training Caregiver Codes

Family caregivers of patients with rehabilitation and chronic care needs are often instrumental in helping to minimize patient risks for safety and other adverse health events and to avoid unnecessary healthcare utilization. In the United States, outside of the inpatient rehabilitation unit, they often undertake complex care tasks with minimal training. Heretofore, caregiver training in outpatient, home health, or other care settings has not been a priority, due to lack of reimbursement by insurance payors. In this special communication, we describe novel new codes and reimbursement policies approved by the Centers for Medicare and Medicaid Services (CMS) for caregiver training, discuss their advantages over previous policies, and present potential practice improvements and research opportunities to assess the impact of these codes on patient and caregiver outcomes.

A framework for patient access management: consensus from a Delphi panel of US health system leaders

BACKGROUND

Patient access management in the ambulatory setting is important for health systems as waits and delays lead to reduced health outcomes, inequity, and poor patient experience. Health systems may benefit from a framework that catalogs the determinants of access management in the ambulatory setting to deliver timely care to all patients.

METHODS

The aim of this research is to define patient access and document the determinants of patient access management through a consensus from a two-stage Delphi panel of access leaders in US academic health systems and children's hospitals.

RESULTS

The study demonstrates a patient-centered definition of patient access management focusing on the delivery of timely, simple, connected access to care. Twelve major determinants were identified for patient access management: executive leadership support, dedicated access leadership, system strategy prioritization, data collection and analysis, contact center management, capacity management, appointment availability, appointment accuracy, measurable and defined goals, simplification of system for patients, timely offering of care, and patient-clinician connection. The determinants were applied to a framework using the Donabedian model. Frameworks may improve validity and reliability in performance improvement activities.

CONCLUSIONS

Health systems may benefit from prescriptive strategies to identify, diagnose, resource, and address the determinants that constitute patient access management. Additional research is warranted to understand each determinant.

Impact of tele-nursing on maternal self-efficacy and anxiety in post-discharge epilepsy care: an quasi-experimental study

Epilepsy is one of the most common neurological disorders and one of the chronic childhood diseases that affects many children every year. Therefore, the present study was conducted with the aim of determining the effect of tele-nursing after discharge on the self-efficacy and anxiety of mothers with children with epilepsy. In this quasi-experimental study, 90 mothers of children with epilepsy were selected by available sampling method and then randomly divided into two control and intervention groups. Demographic information questionnaire, Spielberger anxiety questionnaire and caregiver self-efficacy questionnaire were used to collect data. The intervention group was trained by telephone in the form of 10 telephone calls at regular intervals during two months. Data collected was analyzed using SPSS version 16 using descriptive and inferential statistics (independent t-test and paired t-test). The results showed that the two control and intervention groups were similar in terms of mother's age, gender, mother's occupation, and parents' education. In addition, the anxiety scores of the two groups were similar before the intervention, and after the intervention the two groups had a statistically significant difference (P < 0.001). In terms of the self-efficacy score, the two groups had a statistically significant difference after the intervention (P < 0.001), so in the intervention group, a decrease in anxiety and an increase in mothers' self-efficacy were observed.

CONCLUSION

Tele-nursing after discharge caused a significant decrease in anxiety and increased self-efficacy of mothers in taking care of their children; therefore, it is recommended to use a comprehensive program in the form of tele-nursing according to parents' educational needs and wishes.

WHAT IS KNOWN

• Tele-nursing and follow-up by nurses via telephone can reduce anxiety in mothers facing their child's epilepsy diagnosis. • Tele-nursing, focusing on both internal and external capacities, can enhance mothers' self-efficacy in caring for a child with epilepsy.

WHAT IS NEW

• Mobile tele-nursing is an innovative and effective method for increasing community awareness and educating patients, which should be considered by health policymakers. • By addressing parents' questions and educational needs through tele-nursing, we can take steps to control anxiety and increase parents' self-efficacy.