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

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.

Exploring Alternate Targets for Respiratory Resuscitation in Patients With Sepsis and Septic Shock

Despite limited evidence to support it, resuscitation in sepsis has primarily targeted aggressive fluid administration and liberal administration of oxygen. In 2024, new thought paradigms emerged to suggest that dysregulation of aerobic metabolism are essential underpinnings of sepsis, and that in fact, aggressive resuscitation with fluids liberal oxygen could potentially aggravate oxidative stress and organ failure in sepsis. As sepsis continues to be shaped and molded by the latest research; therapies targeting sepsis and septic shock management warrant similar scrutiny.

METHODS

We searched literature pertaining to what is known about metabolic dysregulation in sepsis, to consider approaches to identifying new targets for resuscitation and management in sepsis.

RESULTS

Therapeutic hypoxemic targets of 88-92% have been shown to have some benefit in sepsis resuscitation in a limited number of studies. The benefit is believed to result from protection from excessive accumulation of harmful reactive oxygen species.

CONCLUSION

Limited supporting evidence exists in the literature to recommend targeted hypoxemia or hypercapnia in patients with sepsis. Mixed results have been observed in the literature, including minimal benefit to mortality. New research designs with consideration to the dysregulated metabolic sequelae in sepsis could improve the meaningfulness of these therapies in sepsis.

Crisis Management and Problem-Solving Skill Levels of Nurses Caring for Patients With COVID-19 and Affecting Factors: A Cross-Sectional Survey

This study aims to assess the crisis management and problem-solving skills of nurses caring for patients with COVID-19. The participants of this descriptive cross-sectional were 132 nurses who cared for patients with COVID-19 in a public hospital. The crisis management scale (CMS), problem-solving inventory (PSI), and Nurse Introduction Form were used to collect data. In this study, the nurses' CMS total score average was 3.75 ± 0.442, the average PSI total score was 86.32 ± 24.420, and it was determined that their crisis management ability was at a good level and their problem-solving skills were at a medium level. A significant difference was found between the nurses' descriptive characteristics of having children (P = .029), being informed about crisis management (P = .035), and their total average score on the CMS (P < .05). A statistically significant negative relationship was found between the nurses' total CMS and PSI scores (P < .05).This study showed that the problem-solving skill levels of nurses caring for patients with COVID-19 affected their crisis management skills.

An Evidence-Based Practice Mentoring Program: Outcomes and Cost

BACKGROUND

The Evidence-Based Practice Mentoring Program (EBPMP) is a 12-month initiative offered at a large acute care facility in Hawai'i. The EBPMP provided two layers of mentoring, with experienced evidence-based practice (EBP) faculty supporting EBP mentors who, in turn, guide mentees or novice EBP team members.

AIM

The primary aim of this pilot initiative was to promote the Value, Implementation, and Knowledge of EBP.

METHODS

A literature search, appraisal, and synthesis were conducted, and the results informed the development of the EBPMP. The pilot was initiated from July 2022 to June 2023 and consisted of a nurse-led interdisciplinary team. Outcome measurements involved the Quick-EBP-VIK survey, a faculty-developed Self-Confidence in EBP Mentoring Skills Inventory, feasibility measures, and the program cost.

RESULTS

Pre- and post-EBPMP outcome measures demonstrated that the mentors' and mentees' scores increased in the domains of EBP Value (11.14%), Implementation (80.87%), and Knowledge (99.46%). Mentors' self-confidence increased over time (Baseline: 0.06, 6-months: 2.33, 12-months: 3.03). Feasibility measures showed that the majority (80%) of the mentees were able to complete > 75% of assigned modules by the due date, most (80%) spent 1-2 h to complete the didactic modules, and the monthly mentee meeting attendance rate was 88.1%. The program cost was 1.2 FTE per month.

LINKING EVIDENCE TO ACTION

EBP mentoring was an effective strategy for supporting staff's EBP development. Continued leadership support is crucial to the EBPMP's success and sustainability. The EBPMP may be an effective strategy to contribute to the development of an organization's culture of EBP.

Authentic Leadership-A Concept Analysis

AIM

To report an analysis of the concept of authentic leadership.

DESIGN

Concept analysis.

DATA SOURCES

Data sources included core databases: CINAHL, PubMed, Embase, ProQuest, APA PsycINFO, ERIC, ABI/Inform and Tomlinson's Nursing Core Collection (2010).

METHODS

Walker and Avant's method was used to identify descriptions, antecedents, consequences and empirical referents of the concept. Model, related and contrary cases were developed.

RESULTS

Defining attributes were identified as self-awareness, transparency, balanced processing, internalised moral perspective, caring, shared decision making and moral/ethical courage. Antecedents were authenticity, positive psychological capacities, life experiences, leadership development programme, supportive organisational climate and an ethical climate. Consequences are employee well-being and satisfaction, positive work environment and enhanced performance and safety.

CONCLUSION

While authentic leadership is an emerging and popular leadership approach, there are gaps in relation to agreed definitions. Moreover, core textbooks within the subject area also fail to provide these definitions. This concept analysis represents the first comprehensive and robust analysis of the concept of authentic leadership that will serve to reliably inform research, education and practice.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This analysis reveals that authentic leadership can have a positive effect on staff well-being and satisfaction, their work environment, performance and ultimately safety. This has potential for a positive impact on patient care and patient outcomes by fostering an ethical and supportive work environment.

IMPACT

This study revealed a new comprehensive understanding of authentic leadership that provides conceptual clarity that will guide research and practice in the field, which refines the existing understanding, highlighting essential attributes and their relevance in nursing practice.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Exploring Xylazine Awareness, Health Impacts, and Harm Reduction Strategies: Findings From a Multimethods Study in Lowell, Massachusetts

BACKGROUND

Xylazine, an adulterant in local drug supplies, has been detected in approximately 30% of opioid samples submitted for testing in Massachusetts. A better understanding of local risks, harms, and use preferences is needed to combat xylazine-related impacts on local communities.

METHODS

Through the STOP-OD Lowell study, we aimed to assess local xylazine awareness through in-depth interviews with local community stakeholders (n = 15) and local people who use drugs (PWUD; n = 15) and surveys with local PWUD (n = 94). The qualitative interviews focused on the current drug landscape and knowledge of adulterants in Lowell, and the results informed subsequent survey design. Through our survey, we examined whether PWUD were aware of xylazine and their willingness to use xylazine test strips.

RESULTS

Most community stakeholders and PWUD had limited awareness about the presence and impact of xylazine as an adulterant. Forty-seven (50%) survey respondents were aware of xylazine. When provided with more information about xylazine, 65% of all respondents expressed a willingness to use xylazine test strips. PWUD who had received naloxone training, reported using with others, and using tester shots were more willing to use xylazine test strips.

CONCLUSION

Our findings are congruent with existing literature that indicates that there is limited awareness of xylazine among PWUD, and they consider xylazine an unwanted adulterant. We also found that PWUD who use other harm reduction measures are more willing to use xylazine test strips. The increase in xylazine warrants additional community-level interventions such as wound management and local testing infrastructure. Further research is needed to understand better the impacts associated with xylazine use, effective harm reduction techniques, and perceptions of xylazine test strips.

Identification of ChatGPT-Generated Abstracts Within Shoulder and Elbow Surgery Poses a Challenge for Reviewers

PURPOSE

To evaluate the extent to which experienced reviewers can accurately discern between artificial intelligence (AI)-generated and original research abstracts published in the field of shoulder and elbow surgery and compare this with the performance of an AI detection tool.

METHODS

Twenty-five shoulder- and elbow-related articles published in high-impact journals in 2023 were randomly selected. ChatGPT was prompted with only the abstract title to create an AI-generated version of each abstract. The resulting 50 abstracts were randomly distributed to and evaluated by 8 blinded peer reviewers with at least 5 years of experience. Reviewers were tasked with distinguishing between original and AI-generated text. A Likert scale assessed reviewer confidence for each interpretation, and the primary reason guiding assessment of generated text was collected. AI output detector (0%-100%) and plagiarism (0%-100%) scores were evaluated using GPTZero.

RESULTS

Reviewers correctly identified 62% of AI-generated abstracts and misclassified 38% of original abstracts as being AI generated. GPTZero reported a significantly higher probability of AI output among generated abstracts (median, 56%; interquartile range [IQR], 51%-77%) compared with original abstracts (median, 10%; IQR, 4%-37%; P < .01). Generated abstracts scored significantly lower on the plagiarism detector (median, 7%; IQR, 5%-14%) relative to original abstracts (median, 82%; IQR, 72%-92%; P < .01). Correct identification of AI-generated abstracts was predominately attributed to the presence of unrealistic data/values. The primary reason for misidentifying original abstracts as AI was attributed to writing style.

CONCLUSIONS

Experienced reviewers faced difficulties in distinguishing between human and AI-generated research content within shoulder and elbow surgery. The presence of unrealistic data facilitated correct identification of AI abstracts, whereas misidentification of original abstracts was often ascribed to writing style.

CLINICAL RELEVANCE

With rapidly increasing AI advancements, it is paramount that ethical standards of scientific reporting are upheld. It is therefore helpful to understand the ability of reviewers to identify AI-generated content.

Breast cancer survivors' experiences of barriers and facilitators to lymphedema self-management behaviors: a theory-based qualitative study

PURPOSE

Lifelong self-management plays a critical role in the prevention and management of lymphedema among breast cancer survivors. However, adherence to lymphedema self-management behaviors has remained suboptimal. Hence, we adopted a theory-informed method to elucidate the facilitators and barriers of lymphedema self-management for breast cancer survivors.

METHODS

In-depth semi-structured interviews were conducted between August and October 2022 in the lymphedema nursing clinic of a tertiary cancer hospital. The maximum variation sampling technique was used to ensure a diverse sample. The ITHBC (Integrated Theory of Health Behavior Change) framework was used to inform the interview outline and data analysis. Interview transcripts were coded line-by-line and mapped to domains in accordance with the ITHBC, using both deductive and inductive content analysis.

RESULTS

A total of 16 participants were interviewed (aged 35 to 67). Twenty-three themes (12 facilitators and 11 barriers) were mapped onto the three domains (knowledge and belief, social facilitation, and self-regulation skill and ability) of ITHBC as facilitators and barriers to lymphedema self-management. Three additional themes including limited treatment resources for lymphedema, inconvenience of lymphedema management, boredom and tedium of lymphedema self-management were categorized under the domain of other barriers.

CONCLUSIONS

Incorporating these findings into the ITHBC framework allows for a more systematic selection of theory-based strategies that may improve the design of effective lymphedema self-management interventions for breast cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Elucidating impact factors, especially facilitators and barriers, for lymphedema self-management adherence is essential for developing effective intervention programs to enhance breast cancer survivors' lymphedema self-management behaviors.

Dietary self-management behavior and associated factors among breast cancer patients receiving chemotherapy: A latent profile analysis

PURPOSE

Breast cancer patients experience more gastrointestinal symptoms during chemotherapy than during the survival period post-treatment. This can interfere with daily dietary intake and increase the risk of malnutrition. This study aimed to evaluate the level and classification of dietary self-management behavior and the influence of self-care self-efficacy, outcome expectations, treatment self-regulation and perceived social support guided by "Integrated theory of Health Behavior Change".

METHODS

A multicenter cross-sectional study was conducted. The assessment tools included self-designed demographic and clinical instruments, Dietary Management Behavior Questionnaire, Strategies Used by People to Promote Health, Consideration of Future Consequences Scale-Food, the Treatment Self-regulation Questionnaire and Perceived Social Support Scale.

RESULTS

A total of 760 samples were analysed. The best-fitting model of the 4 classes was determined, with the lowest-to-highest scores as follows: Class 1-poor behavior group (17.84%), Class 2-medium behavior group (28.26%), Class 3-good behavior group (22.67%) and Class 4-excellent behavior group (31.23%). In the control group, being underweight (OR = 0.131), having no spouse (OR = 0.235), having a lower educational level (OR = 0.147-0.384), being premenopausal (OR = 0.220-0.255), having immediate consequence considerations (OR = 0.866-0.909) and receiving other support (OR = 0.830) were risk factors (all P < 0.05).

CONCLUSIONS

The performance of dietary self-management behavior needs to be improved. This study may provide a reference for determining key intervention populations that are underweight during premenopause, have no spouse and have lower education. Specific intervention content, including future consequence consideration, positive attitudes, decision-making, autonomous motivation, introjected regulation and friend support, should be added to improve the dietary practices during chemotherapy precisely.

Emergency clinical nurse specialist practice in Victoria and New South Wales: A cross-sectional study

BACKGROUND

Emergency Clinical Nurse Specialists (CNS) are experts in treating patients across the lifespan in the dynamic, unpredictable and busy Emergency Department (ED). The aim of this paper was to create a profile of the Emergency CNS role and practice, and assess work satisfaction.

METHODS

An online cross-sectional survey based on the College of Emergency Nursing Australasia's Practice Standards for the Specialist Emergency Nurse was conducted in the Australian states of Victoria and New South Wales.

RESULTS

There were 59 survey responses. The domains Lawful Practice, Professional Ethics and Communication were rated as practiced with the greatest frequency, and Lawful Practice and Teamwork were rated very important by respondents. 79 % of CNSs planned to continue working in ED, with all CNSs reporting plans to continue working in healthcare. 77 % of CNSs were satisfied in their current role.

CONCLUSION

The Practice Standards for the Specialist Emergency Nurse are used regularly and are relevant to CNS practice. CNSs are largely satisfied with their role, which is versatile and multifaceted. However, CNSs face challenges to perform all elements of their role, and reported protected non-clinical time and collaboration with management as enablers to their role.

The Shizuoka Study of a Population-Based Retrospective Cohort for the Evaluation of Risk of Pressure Injury in the Elderly

Objective: The risk of pressure injuries (PIs) is increasing in Japan, where an aging population imposes substantial health care burdens. Approach: This retrospective cohort study utilizing the Shizuoka Kokuho Database evaluated factors associated with PI development in hospitalized patients. Results: An analysis of over 546,000 patients aged ≥65 years from 2012 to 2022 identified 6,372 PI cases. Cox regression analyses revealed that male sex (hazard ratio [HR] 1.32, 95% confidence interval [CI]: 1.25-1.39), advanced age (HR 8.54, 95% CI: 7.40-9.87 for ≥95 years vs. 65-69 years) and comorbidities such as neurological disorders (HR 1.87, 95% CI: 1.72-2.04), dementia (HR 1.69, 95% CI: 1.59-1.80), and congestive heart failure (HR 1.19, 95% CI: 1.12-1.27) were associated with increased PI risks. Conversely, antihyperlipidemic drugs may be associated with a lower PI risk (HR 0.69, 95% CI: 0.65-0.74). Due to data limitations, factors such as nutritional status, mobility, and caregiver support could not be evaluated. Innovation: This study is the first in Japan to leverage big data to identify high-risk groups for PIs, particularly among elderly individuals with specific comorbidities. This approach offers actionable insights into PI management, potentially enhancing care strategies and preventive guidelines. Conclusion: Male sex, advanced age, and comorbidities, including neurological disorders, dementia, psychosis, and congestive heart failure, were identified as primary PI risk factors. Conversely, antihyperlipidemic drug use may be associated with a lower PI risk. These findings highlight the need for comprehensive, targeted prevention strategies to reduce the risk of PI in elderly hospitalized patients.

Electronic Health Record Strategies for Improving Nurse Documentation in the Hospital Setting: A Scoping Review

Electronic health record support nurses' work in many ways; however, nursing documentation within the system has also been associated with burden and noncompliance with organizational and regulatory requirements. An increasing number of studies have analyzed nursing documentation burden and noncompliance, but no scoping review has been conducted that focuses on electronic health record-based strategies for improving nursing documentation. This scoping review aimed to identify electronic health record-based strategies for improving nursing documentation in hospital settings. The Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews guidelines were used, and databases MEDLINE, Web of Science, and CINAHL were searched on April 1, 2024. A total of 652 studies were retrieved, of which 25 were included at the full-text level. Six documentation issues emerged across the studies, with 44% identifying documentation compliance as the main issue. Three electronic health record-based strategies, such as organizational change, end-user reminder system, and financial incentives, regulation, and policy, were identified. Six documentation improvement outcomes with findings were identified, with 52% of the studies' outcome demonstrating improved documentation compliance. This review identified electronic health record-based and supplemental strategies that concentrate on improving nursing documentation. More research is needed to identify how these strategies may affect other measures, such as patient care outcomes, accuracy and quality of nursing documentation, and costs associated with nursing time spent on documentation activities.

What is Disaster Readiness Among Health Care Professionals? A Systematic Integrative Review Study

OBJECTIVE

This study aimed to explore the meaning of disaster readiness among health care professionals.

METHODS

A systematic, integrative literature review was conducted on PubMed, Chinal plus with full text, Web of Science, PsychInfo, and Scopus. Quality appraisal was conducted using the CASP checklists.

RESULTS

A total of 22 scientific articles were included. Disaster readiness, from the perspectives of health care professionals, was defined as having sufficient skills and confidence to respond, having access to the necessary equipment, being able to adapt to the changing environment and organizational structure, and being willing to serve in a disaster.

CONCLUSIONS

Disaster readiness is more than being prepared. Disaster readiness means moving beyond technical skills and knowledges to include personal mental preparedness and a willingness to confront the risks and take necessary precautions to stay safe and resilient in the efforts to help others. To enhance disaster readiness, preparations should include introducing elements that touch the soul, providing moral and personal motivation to serve in a disaster, and initiating thoughts on what such deployments or situations could be like for those affected as well as for health care professionals. How to enhance such trainings and develop effective training methods must be a focus for future studies.

Developing practice-level quality indicators to assist in evaluating the application of the Australasian Triage Scale: A modified e-Delphi process

BACKGROUND

Triage quality is central to patient safety and the efficient distribution of emergency department resources. Currently, there are no identified quality indicators for application of the Australasian Triage Scale.

AIM

To address a gap in quality indicators specific to triage.

DESIGN

A literature review and modified Delphi technique.

METHOD

A review of the literature published between 2001 and 2024 was conducted to identify potential indicators and metrics of triage quality, and were categorised across six quality of care domains (patient-centeredness, timeliness, effectiveness, equity, efficiency and safety). Three consecutive online surveys where panellists rated these indicators for perceived appropriateness, validity and feasibility were completed between August and December 2023.

RESULTS

From the review, 17 initial quality indicators across six quality of care domains were developed. Following round 1, 3 indicators were modified and 8 indicators were added. After two further survey rounds, 18 (72 %) indicators met consensus.

CONCLUSION

An expert panel validated a set of triage quality indicators for measuring Australian triage practice. A continuous quality improvement approach is required to optimise triage practice, develop processes for detecting and reducing patient harm and minimising variation. Further research is needed to test applicability of the indicators.

Challenges and Considerations in Naming True and Quasi-Experimental Research Designs: A Methodological Discussion

Background: Novice researchers may face challenges in choosing names for true and quasi-experimental designs due to complexity in terminology and variety of experimental designs used in nursing. Addressing these issues is crucial for ensuring clarity and accuracy in experimental nursing research. Aim: To discuss the complexities, challenges, and considerations involved in naming true and quasi-experimental research designs and propose a decision tree for researchers to guide them in accurately and consistently naming these designs. Design: A methodological discussion. Methods: Research texts, the Public Health Agency of Canada Critical Appraisal Tool Kit, and articles from various scientific journals were chosen to illustrate the challenges and characteristics of different experimental and quasi-experimental study designs. Discussion: Key characteristics of true and quasi-experimental designs such as nature of experimental and control groups and process of random allocation are outlined and illustrated with examples. Conclusion: A decision tree is offered to help researchers and reviewers in the precise and consistent labeling of true and quasi-experimental designs. By providing a structured way for decision-making, it enhances the accuracy and reliability of classification processes.

Preventive effects of early mobilisation on delirium incidence in critically ill patients: systematic review and meta-analysis

OBJECTIVE

To evaluate whether early mobilisation can reduce the incidence of delirium in critically ill patients and to assess the methodological quality of published studies.

METHODS

Three electronic databases, PubMed, Embase and the Cochrane Library, were searched for relevant studies published up to 2 March 2024. Articles were screened independently by two reviewers, based on inclusion and exclusion criteria, and a meta-analysis was performed using RevMan 5.3 software with a random-effects model.

RESULTS

A total of 18 studies (intervention group: 1794 participants, control group: 2129 participants) were included in the systematic review, with 18 studies included in the meta-analysis. Early mobilisation was found to reduce the risk of delirium in critically ill populations, with a pooled odds ratio of 0.65 (95% confidence interval [CI] 0.49-0.86; P = 0.003; I2 = 59%). Additionally, two studies found that early mobilisation did not change the duration of delirium in critically ill populations, with a pooled mean difference of -1.53 (95% CI -3.48 to 0.41; P = 0.12; I2 = 37%). Subgroup analysis revealed that early mobilisation maintained its preventive effect on delirium in the before/after intervention studies, studies published before 2018 and studies with a moderate methodological rating.

CONCLUSION

As a nonpharmacological intervention, early mobilisation may help reduce the risk of delirium and shorten its duration in critically ill patients compared with standard treatment and may potentially become a novel strategy for delirium prevention in future intensive care unit settings.

Efficacy of an educational website on headaches in schoolchildren: A cluster-randomized controlled trial

OBJECTIVE

In this cluster-randomized controlled trial, we developed an educational website on tension-type headache and migraine for children and adolescents and evaluated its effectiveness in a school setting.

BACKGROUND

Primary headaches are a widespread issue in children and adolescents, often persisting into adulthood and associated with considerable disabilities, costs, and reduced quality of life. Effective management of primary headaches may prevent chronicity and its associated consequences.

DESIGN

Guided by a workbook, N = 814 fifth and sixth grade students explored the website during class. Data were collected before the headache education and at three further assessments, each 4 weeks apart, between November 2021 and April 2022. Participants were randomly assigned by class to either the intervention group, which received the website-based educational intervention after the first data collection, or a control group, which accessed the website after the last data collection.

RESULTS

The intervention significantly increased children's headache-related knowledge (time × group interaction: β = 0.35, 95% confidence interval [CI] = [0.30; 0.41], p ≤ 0.001) and resulted in fewer passive pain coping strategies (time × group interaction: β = -0.06, 95% CI = [-0.12; 0.00], p = 0.044). However, the intervention did not significantly reduce the number of days with headaches, use of headache medication, or school absences due to headaches.

CONCLUSION

While the website is an effective educational tool for imparting knowledge about headaches, even initiating small behavioral changes, it does not lead to substantial changes in behavior or headache characteristics. Educating children via this website may lay a solid foundation of knowledge, but the intervention should be expanded and supplemented with closer supervision to achieve more significant behavior changes and improved outcomes.

The effectiveness of nursing interventions to improve self-care for patients with heart failure at home: a systematic review and meta-analysis

BACKGROUND

Self-care plays an important role in the treatment of patients with heart failure (HF) and adequately performed self-care at home can contribute to fewer hospitalizations, lower mortality risk and require less emergency care. The aim of this systematic review and meta-analysis was to synthesise evidence on the effectiveness of nursing interventions on HF-related self-care at home.

METHODS

Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane database, Web of Science, PsycInfo, and trial registers were searched up to 31st December 2022. We aimed to include experimental and observational studies with a control group investigating nursing interventions including transitional care, home care programs, phone calls, digital interventions, or a combination thereof on self-care of patients with HF. Outcomes were self-care maintenance, self-care management, and self-care behaviours, measured with various instruments. The screening and data extraction were performed independently by two reviewers, and disagreements were solved by a third reviewer. Cochrane risk of bias tool for randomised trials and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach were used.

RESULTS

Twenty-seven studies were included (2176 participants), of which 24 were randomised controlled trials. Three categories of interventions emerged, called "transitional care", "home care", and "remote interventions". Transitional care aimed at caring for patients at their homes after discharge through phone calls, digital interventions, and home visits may result in little to no difference in self-care maintenance (MD 7.26, 95% CI 5.20, 9.33) and self-care management (MD 5.02, 95% CI 1.34, 8.69) while contrasting results emerged in self-care behaviours since two out of six studies reported no improvements in self-care. Home care combined with phone calls or digital interventions likely increase self-management and self-care behaviours (MD -7.91, 95% CI -9.29, -6.54). Remote care could improve self-care behaviours when delivered as phone call programs, but they are ineffective on all outcomes when delivered as digital interventions alone.

CONCLUSION

Transitional care and home care combined with phone calls and digital interventions, and phone calls caring for patients at their home could slightly improve self-care in patients with HF. However, more research is needed to study the effects across different domains of self-care and of interventions delivered through digital interventions alone.

Mobility matters: a protocol to improve mobility and reduce length of stay in hospitalised older adults

Functional decline in hospitalised older adults aged 65 and above is a significant clinical problem. Despite its adverse outcomes, the problem of not mobilising older adult patients in clinical settings remains. Existing evidence suggests that a mobility protocol can be effective in addressing this concern. The aims of this quality improvement project were to determine whether a nurse-driven, multidisciplinary collaborative mobility protocol would increase the daily out-of-bed episodes, improve mobility level and reduce hospital length of stay (LOS). A nurse-driven mobility protocol was implemented in three phases. This five-component protocol included mobility assessment using the Johns Hopkins Highest Level of Mobility (JH-HLM) scale, documentation of mobility score, implementation of out-of-bed activities three times per day, communication of mobility score and goal at daily huddle, and indication of mobility score and goal on the board at patient's bed. Data were collected before and after the implementation. 142 patients were recruited from an acute geriatric unit. There were 72 patients from the pre-implementation group and 70 patients from the post implementation group. Comparing the pre-implementation and post implementation groups, the mean out-of-bed episodes per patient day increased from 0.80 to 3.59 (p<0.001). JH-HLM scores at discharge with ambulation status increased from 51.4% to 71.4% (p<0.001). Patients had improved JH-HLM scores with a median 2.00 (B 2.00, 95% CI 1.35 to 2.65, p<0.001) higher at discharge in the post implementation group after adjusting for score at admission. Increased mobility did not lead to any fall incidents. The mean hospital LOS was reduced from 15.67 (SD 11.30) days to 13.07 (SD 7.18) days (p=0.069). In conclusion, the implementation of a nurse-driven mobility protocol resulted in increased frequency of out-of-bed episodes and improved mobility, and reduction in LOS.

How many is enough? Justifying sample size in descriptive quantitative research

BACKGROUND

Descriptive quantitative researchers often use surveys to collect data about a group or phenomenon. Determining the required sample size in descriptive surveys can pose a challenge as there is no simple 'formula' by which to calculate an appropriate sample. However, when a sample is too small the study may fail to answer the research question and too many responses can create resource implications.

AIM

To explore considerations regarding the justification of adequate sample size in descriptive quantitative research.

DISCUSSION

Several considerations may assist quantitative descriptive researchers in examining the appropriateness and justification of sample size. Response rates can guide decision-making around the proportion of the target population who respond. Additionally, consideration of any validated tools, the spread or responses and types of analysis can guide sampling decisions.

CONCLUSION

The strategies in this article provide a considered approach to justifying sample size in descriptive quantitative research. Factors such as response rates and analytical considerations provide a transparent means of justifying an adequate sample.

IMPLICATIONS FOR PRACTICE

Providing clear justification for the sample size within descriptive quantitative research demonstrates a robust research approach and optimises resource use.

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.

Major trauma coordinators in the UK: A survey of demographics and role functions

BACKGROUND

Trauma coordinators (TCs) play a key role in managing patients with complex injuries, coordinating care across multiple specialties. This study aimed to investigate the current role functions of TCs in the UK, compare them to findings from 2015, and explore differences between TCs in Major Trauma Centres (MTCs) and Trauma Units (TUs).

METHODS

A UK-wide cross-sectional survey was conducted using an online questionnaire. Participants included trauma coordinators from MTCs and TUs. Data on role functions, clinical activities, and professional background were analyzed using descriptive statistics.

RESULTS

There were 153 responses from TCs from 22 of the 27 trauma networks in the UK. Respondents reported 54 different role titles. Nurses comprised 65 % of the respondents, with 45 % holding a master's qualification. Clinical activities accounted for 51 % of the role, an increase from 39 % in 2015. Data entry and research responsibilities decreased. Advanced or autonomous practice was reported by 19 % of respondents, with more TCs from TUs engaging in independent prescribing.

CONCLUSION

The role of TCs has evolved since 2015, with increasing clinical responsibilities and more professionals working at advanced practice levels. However, there remains considerable variation in role titles and functions, reflecting the need for standardization and further research on the impact of TC roles on patient outcomes.

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.

Assessing delirium knowledge among health care professionals: findings from a scoping review

BACKGROUND

Delirium is highly prevalent among older adults in various healthcare settings. Healthcare professionals' knowledge is crucial for preventing, recognizing, and managing delirium and delirium-related adverse outcomes. Despite its importance, little is known about how delirium knowledge is assessed.

OBJECTIVES

To map instruments and items used to assess delirium knowledge among healthcare professionals.

DESIGN

A scoping review based on the methodological framework of Arksey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005).

MATERIALS AND METHODS

A systematic literature search was performed in Medline, Embase, CINAHL, Scopus, and PsycINFO to include studies that assessed delirium knowledge among healthcare professionals.

RESULTS

After removing duplicates, 760 studies were assessed for eligibility and 98 studies were included. Delirium knowledge was mainly assessed among nurses (57/98, 58.8%) and physicians (12/98, 12.4%) with a focus on critical care (32/98, 33.0%) over long-term care settings (4/98, 4.1%). Most studies used self-developed instruments (50/93, 53%), followed by original or modified versions of the Delirium Knowledge Questionnaire (14/93, 15%). Among the 32 identified instruments, limited evidence of validity and reliability was reported for six (18.8%). Analysis at the item level (n = 392 items) revealed five domains: (a) definition, signs and symptoms (81 items); (b) risk factors, incidence, and prevention (139 items); (c) detection and tools (89 items); (d) management and therapy (64 items); and (e) outcomes, prognosis and consequences (19 items).

CONCLUSIONS

Delirium poses a significant burden on patients and on the healthcare system. This scoping review provides a comprehensive overview on how healthcare professionals' delirium knowledge has been assessed. Further research in this field is needed to provide stronger evidence of instruments' validity and reliability and to explore delirium knowledge among healthcare professionals in long-term care settings.

Mental health nursing consultations in Brazilian primary care: analysis of proposed competencies for advanced practice nurses

BACKGROUND

Primary Health Care (PHC) is a key strategy to identify, manage, and coordinate mental health cases. Considering that nurses are essential to integrating mental health care into PHC, initiatives to broaden the discussion and incorporate the role of Advanced Practice Nurses in this setting can help reduce disparities in mental health care. Thus, this study aimed to analyze mental health nursing consultations in PHC and investigate whether nurses have the care management skills proposed for Advanced Practice Nurses.

METHODS

A multicenter study, with a quantitative and qualitative approach, was conducted in 17 Primary Care Health Units distributed in three regions of Brazil from May to July 2022. Data collection was carried out twice during the nurse's professional practice: nursing consultation (recorded using film, with direct and non-participatory observation) and nursing record. From a quantitative perspective and during the first research stage, consultations that had ≥ 50% compliance with the nursing process were selected so that, in the second qualitative stage, the competencies proposed for Advanced Practice Nurses in PHC were identified through content analysis.

RESULTS

A total of 49 mental health nursing consultations were performed by 21 nurses. Of these, seven were selected with a score greater than 50% compliance with the nursing process, carried out by three nurses. The consultations presented few competencies in the care management dimension proposed for the Advanced Practice Nurses; nevertheless, nursing consultation presented 39.68% in the care focus, 38.78% in evaluation and diagnosis, and 47.62% in the provision of care.

CONCLUSIONS

Nurses who conduct mental health nursing consultations in PHC present, in a scarce and partial way, the competencies proposed for the Advanced Practice Nurses for the care management domain. Hence, the results of this study highlight the need for specific training and policy initiatives to enhance the integration of Advanced Practice Nurses in mental health care within PHC, address existing gaps in care management competencies, and improve the quality of mental health services provided to the population.

Food Insecurity and Clinical Outcomes in Surgical Trauma Patients

Importance

Food insecurity, which is the lack of consistent access to sufficient and nutritious food, impacts over 1.3 billion individuals worldwide. The impact of food insecurity on primary care and medical subspecialties is recognized, but its influence on surgical outcomes remains underexplored.

Objective

To investigate the association between food insecurity and postoperative clinical outcomes in adult surgical trauma patients.

Design, Setting, and Participants

This prospective longitudinal cohort study was conducted from October 2021 to June 2023 and surveyed patients at admission and at 1 and 3 months postoperatively. This multicenter study was conducted across 3 public and private tertiary care centers in India. Adult patients who underwent inpatient operative intervention for traumatic injury were included through consecutive sampling.

Exposures

Food insecurity, which was identified using the validated Hunger Vital Sign tool. This was determined at admission as preoperative food insecurity. Also assessed was a subset of participants who were food secure at admission but then became food insecure during the follow-up period.

Main Outcomes and Measures

Postoperative complications and length of stay. These outcomes were tracked during hospitalization and also at 1 month and 3 months after discharge to compare between time points.

Results

A total of 848 patients (median [IQR] age, 32 [24-45] years; 692 male [82%]) were included in this analysis. Of the total cohort, 174 participants (21%) reported experiencing food insecurity in the year before admission. Patients with food insecurity had significantly higher rates of postoperative complications compared with those without food insecurity (41.4% [72 of 174] vs 12.5% [84 of 671]; odds ratio [OR], 3.68; 95% CI, 2.24-6.05). Additionally, patients with food insecurity had a longer median (IQR) length of stay (13 [6-28] days vs 5 [3-9] days; incidence rate ratio, 1.51; 95% CI, 1.31-1.74). Furthermore, new-onset food insecurity at 1 month postoperatively was associated with an increased risk of new complications at 3 months postoperatively (OR, 5.06; 95% CI, 2.21-11.13).

Conclusions and Relevance

Results demonstrate that food insecurity was significantly associated with increased postoperative complications and longer hospital stays in surgical trauma patients. Routine screening for food insecurity and targeted interventions like medically tailored meals, food prescription programs, and philanthropic food resources may mitigate the detrimental impact of food insecurity on surgical outcomes.

Peer-led digital health lifestyle intervention for a low-income community at risk for cardiovascular diseases (MYCardio-PEER): a quasi-experimental study protocol

BACKGROUND

Cardiovascular disease (CVD) poses a substantial global health burden, necessitating effective and scalable interventions for primary prevention. Despite the increasing recognition of peer-based interventions in managing chronic diseases, their application in CVD prevention still needs to be explored.

AIMS

We describe the protocol of a quasi-experiment to evaluate the effectiveness of a peer-led digital health lifestyle intervention, MYCardio-PEER, for a low-income community at risk for CVD. This study aims to assess the effectiveness of MYCardio-PEER in improving the participants' knowledge, lifestyle behaviours and biomarkers related to CVD. Secondarily, we aim to assess the adherence and satisfaction of participants towards MYCardio-PEER.

METHODS

A minimum total sample of 68 low-income community members at risk for CVD will be recruited and allocated either to the control group or the intervention group. Participants in the control group will receive standard lifestyle advice and printed materials for CVD prevention, while the intervention group will participate in the 8-week MYCardio-PEER intervention program. The participants will be assessed at Week 0 (baseline), Week 8 (post-intervention) and Week 20 (post-follow-up).

DISCUSSION

We anticipate a net improvement in CVD risk score, besides investigating the effectiveness of the intervention program on CVD-related knowledge, biomarkers, and diet and lifestyle behaviours. The successful outcome of this study is essential for various healthcare professionals and stakeholders to implement population-based, cost-effective, and accessible interventions in reducing CVD prevalence in the country.Trial registration: ClinicalTrials.gov (NCT06408493).

A Systematic Review of Needleless Connector Function and Occlusion Outcomes: Evidence Leading the Way

Vascular access devices (VADs) are essential to intravenous (IV) therapy in acute care. The Centers for Disease Control and Prevention recommends using needleless connectors (NCs) to provide IV access and eliminate the need for needles. Approximately 17 NCs are currently available in the United States, with 3 basic designs. The Infusion Nurses Society Standards of Practice established NC classifications of negative, positive, and anti-reflux NCs. Evidence indicates a relationship between NC fluid displacement, blood reflux, and occlusion. A systematic review of the literature was performed to ascertain whether the functional design of anti-reflux NCs results in reduced catheter occlusion. A literature search of design types, function, and incidence of occlusion complications with peripheral and central venous access devices yielded 24 334 publications, with 61 studies meeting inclusion criteria. Results from available in vitro and in vivo evidence suggest using anti-reflux NCs with the lowest levels of fluid displacement may result in fewer complications of occlusion and longer catheter dwell times. This review correlates current research to update scientific knowledge of NC displacement performance and outcomes of NCs.

Digital Motherhood in the Postpartum Period: A Descriptive Study

BACKGROUND

During the first 6 weeks after birth, women often encounter problems and seek answers to their questions. This period is also crucial in terms of technology use.

AIM

The aim of this study was to examine the digital motherhood approach to self-care and infant care in the 6-week postpartum period, and its association with different variables.

METHODS

This descriptive study recruited 278 women in the postpartum period. Data were collected from the Digital Motherhood Survey. Descriptive statistics and chi-squared analysis were performed.

RESULTS

The mean age of the women was 28.9 ± 5.14 years; 50.4% had a high school education or less, and 49.6% had a university education or higher. The types of digital media consulted included institutional sites, blogs, and commercial sites. The three topics most frequently researched by women in the postpartum period using digital media were breastfeeding, infant nutrition, and general infant care. The top three reasons given by participants for preferring digital media were faster access to information, access to information from their own setting, and benefiting from the experiences of others. The following factors were significantly associated with digital media being a participant's first-choice information source: the woman and her partner having a university education or above, having a male infant, having received information about infant care, and having a postpartum hospital stay duration of 0-2 days.

CONCLUSION

This study defined postpartum digital motherhood. The preference of women for digital media is influenced by their educational status and that of their partners, the sex of the infant, their prior knowledge of infant care, and the early discharge of their infants after birth. Healthcare professionals, especially nurses, must be aware of the digital media used by postpartum women to supervise them and provide guidance.

Recommender systems use in weight management mHealth interventions: A scoping review

The use of recommender systems in mobile health apps for weight control has grown, but user app uptake and engagement remain limited. The objective of our scoping review was to explore the influence of recommender systems on mHealth app user engagement, identify the theoretical frameworks that have been applied on digital health interventions designed for weight management, and examine the key aspects that support tailoring user engagement through recommender systems. Based on existing literature, we identified 13 articles on recommender systems for weight management. Themes emerged, including theoretical underpinnings, authors' domain knowledge, user motivation, and design. Most studies used constructs from the social cognitive theory. We found inconsistencies between authors' domain knowledge and the intervention's content, with few professionals from the health and psychology fields. Only 46% of articles measured user engagement, whereas gamification and tailored messages were common app features. Despite some positive weight change results, more attention is needed toward implementing behavior theory and other strategies to promote app user engagement. Future studies should more accurately measure user motivation and identify the best features and behavioral constructs to increase app user interaction. Larger studies with a more diverse population are needed to generalize findings and evaluate weight loss maintenance and physical activity habits among users of recommender system.

Paediatric-to-adult transition in type 1 diabetes: A two-centre experience of a structured program, 2014 to 2022

BACKGROUND

Transition from paediatric to adult healthcare is a turning point for patients with Type 1 diabetes (T1D). A gradual coordinated process connecting paediatric and adult healthcare providers may improve adherence to adult follow-up.

AIMS

To describe a transition process developed jointly by paediatric and adult diabetology units and compare patients progressing or not to follow-up in adult care setting.

MATERIEL AND METHODS

Retrospective study in one paediatric and one adult diabetology department. Patients following from 2014 to 2021 in the paediatric department were eligible.

RESULTS

At transition, the 183 patients included had a median age of 19 [18.5-19.5] years, T1D duration of 10.5 [7.0-14.0] years, and HbA1c of 8.4% [7.5-9.2%]; 30.6% were treated by continuous subcutaneous insulin infusion. Two years after exiting paediatric care, the subgroup transitioning to adult care at the planned site (n = 137) had a median HbA1c of 7.8% [7.0-8.7]; 13.1% had retinopathy (non-significant change), and 10.8% had changed their insulin treatment. Of the remaining 46/183 (25.1%) patients, 33/46 (71.7%) had no adult care visits at any site reported. Independent predictors of non-adherence to adult follow-up were younger age at TID diagnosis (adjusted odds ratio, 0.91 [0.83-0.99]) and higher pre-transition HbA1c (+1.39 [1.11-1.80]). Among the 52 (28.4%) patients who completed a questionnaire on perceptions, 88.5% reported being well prepared and 90.5% a neutral or positive impact on their diabetes.

CONCLUSION

With a gradual coordinated transition process, most T1D patients attended adult care follow-up visits. Younger age at diagnosis and worse glycaemic control were associated with lack of adherence to planned adult care follow-up.

Nurses communication competencies in social media: A bibliometric review

OBJECTIVE

To analyse the characteristics of articles published on the competencies, abilities, knowledge and education that nurses should have to be able to communicate, inform, disseminate and/or be an informative source in mass media and social media.

DESIGN

This bibliometric study involved a comprehensive search of two databases, PubMed and Scopus. The search terms included 'nursing', 'communication', and 'mass media', along with their synonyms. Article selection was performed through screening titles and abstracts, with any uncertainties resolved through discussions among the researchers.

DATA SOURCES

The data were sourced from PubMed and Scopus, selected for their extensive coverage of academic literature related to nursing and communication.

METHODS

A total of 1,290 articles were initially identified. After screening, 463 articles were analysed. The study employed bibliometric analysis to evaluate publication trends, authorship patterns, and thematic focus. Key metrics such as annual publication growth rate, co-authorship, and thematic prevalence were assessed.

RESULTS AND DISCUSSION

The analysis revealed that the articles were published from 1,971 onwards, with an annual production growth rate of 6.83%. The total number of authors was 1,645, with an average co-authorship of 3 to 4 researchers per article. The most frequently discussed themes included Social Media, COVID-19, and Nurses. Notable authors included Booth R. (5 articles), Borycki E. (4 articles), and Jackson D. (4 articles). The most prominent journal was Nurse Education Today (20 articles), with the highest publication output from the United States (695 articles), followed by Australia (436 articles). Leading institutions included King Saud University (47 articles) and the University of Tripoli (37 articles).

CONCLUSION

This bibliometric review provides valuable insights for researchers, educators, and managers interested in the evolving role of nursing in traditional and social media. It highlights key researchers, influential journals, significant authors, and prominent countries in this field, offering a foundational understanding for further research and development in nursing communication competencies.

Determining the Psychometric Properties of the Turkish Version of the Positive Caregiving Experience Scale in Dementia

BACKGROUND

Caring for individuals with dementia presents significant challenges for caregivers. However, positive experiences such as personal growth and emotional satisfaction play a vital role in fostering resilience and improving caregiving outcomes. This study highlights the need for a culturally relevant tool to assess these positive feelings, focusing on the adaptation and validation of the Dementia Caregiver Positive Feeling Scale for Turkish caregivers.

OBJECTIVES

This study aimed to carry out the Turkish validity and reliability study of the 21-item Dementia Caregiver Positive Feeling Scale.

METHODS

This methodological study was conducted between February and December 2023 with 200 caregivers of dementia patients receiving treatment at the education and research hospital in Samsun, Türkiye. Data were collected using an individual information form and the 21-item Dementia Caregiver Positive Feeling Scale. Data analysis was performed using SPSS 22.0 and Amos 22.0 software. Cronbach's alpha reliability coefficient was calculated, and exploratory factor analysis and confirmatory factor analysis were conducted to test the construct validity of the scale.

RESULTS

The average age of caregivers was 45.18 ± 12.02 (min = 18, max = 78), and 78.0% were female. The average caregiving duration was 4.07 ± 3.00 (1-18) years. The total Cronbach's alpha value of the scale is 0.80. Exploratory factor analysis revealed a KMO coefficient of 0.756 and a Bartlett's test result of χ2 = 960.382, p < 0.001. Factor loadings ranged from 0.32 to 0.61 and the total variance explained was 47.232. Confirmatory factor analysis supported the scale's 20-item, four-factor structure, with fit indices indicating an acceptable model fit: RMSEA 0.07, GFI 0.85, AGFI 0.80, CFI 0.77 and χ2/sd 2.15 (p < 0.001).

CONCLUSIONS

The Dementia Caregiver Positive Feeling Scale has been determined to be a valid and reliable instrument for the Turkish community. It serves as a valuable tool that can be used in research evaluating the positive experiences of caregivers of dementia patients.

Implementing the Clinical Nurse Specialist Role in Hospital Settings: A Scoping Review

PURPOSE/AIMS

To understand, based on the literature, how to implement the role of a clinical nurse specialist (CNS) in the hospital setting.

DESIGN

A scoping review was conducted following the methodological framework of Arksey and O'Malley and the Joanna Briggs Institute.

METHOD

The search was conducted during March and April 2023 and was updated in November 2023. Electronic searches were conducted in the following major databases: PubMed, CINAHL, Web of Science, Scopus, PsycINFO, and Cochrane Library. Additionally, a "snowballing" strategy was used. A critical reading was conducted using the Joanna Briggs Institute methodological quality criteria. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for the Scoping Review guidelines were used.

RESULTS

Eleven relevant studies were included in this review. The primary results are presented in 4 sections related to the framework, process, components, and evaluation of the implementation of the CNS role. The findings of the reviewed studies suggest that the implementation process of the CNS is cyclical, variable, context-dependent, and multifactorial and can be assessed using the indicators of structure, process, and outcome.

CONCLUSIONS

This scoping review provides relevant information to support the design of implementation and evaluation strategies for the role of the CNS in the hospital context. Based on the findings of the reviewed studies, a comprehensive strategy is suggested for implementing the role of the CNS in a hospital setting.

Characteristics of Quality Improvement Projects in Health Services: A Systematic Scoping Review

OBJECTIVE

Current QI reports within the literature frequently fail to provide enough information regarding interventions, and a significant number of publications do not mention the utilization of a guiding model or framework. The objective of this scoping review was to synthesize the characteristics of hospital-based QI interventions and assess their alignment with recommended quality goals.

METHODS

This scoping review followed the JBI methodology for scoping reviews to synthesize existing literature on hospital-based QI interventions and reporting using the PRISMA Extension for scoping reviews. Included studies involved a hospital-based QI intervention that was evaluated through the Development of the Quality Improvement Minimum Quality Criteria Set (QI-MQCS) framework, reporting on hospital users' (i.e., practitioners and patients) data. We searched Medline, CINAHL, Embase and PubMed databases for primary research published between 2015 and 2024. Grey literature was also examined. A narrative synthesis guided the integration of findings.

RESULTS

From 1398 identified records, 70 relevant records were included. Results indicate a wide variation in QI frameworks and methods used by the included studies. The QI interventions most frequently assessed were organizational-focused (n = 59), followed by professional-related interventions (n = 41) and patient-care interventions (n = 24). There were multiple facilitators and barriers across organizational, professional, and patient care levels found in the included studies. Examples of facilitators were instrumental in driving successful QI initiatives included education, training, active leadership, and stakeholder engagement. Conversely, barriers such as time constraints, resource limitations, and resistance were highlighted.

CONCLUSION

Existing QI publications lack sufficient detail to replicate interventions. Using a model or framework to guide the conduct of a QI-activity may support a more robustly designed and well-conducted project. The variation of reporting characteristics suggests that future research should focus on the development of a pragmatic tool for use by front-line clinicians to support consistent and rigorous conduct of QI projects.

Sudden cardiac arrest prediction via deep learning electrocardiogram analysis

Aims

Sudden cardiac arrest (SCA) is a commonly fatal event that often occurs without prior indications. To improve outcomes and enable preventative strategies, the electrocardiogram (ECG) in conjunction with deep learning was explored as a potential screening tool.

Methods and results

A publicly available data set containing 10 s of 12-lead ECGs from individuals who did and did not have an SCA, information about time from ECG to arrest, and age and sex was utilized for analysis to individually predict SCA or not using deep convolution neural network models. The base model that included age and sex, ECGs within 1 day prior to arrest, and data sampled from windows of 720 ms around the R-waves from 221 individuals with SCA and 1046 controls had an area under the receiver operating characteristic curve of 0.77. With sensitivity set at 95%, base model specificity was 31%, which is not clinically applicable. Gradient-weighted class activation mapping showed that the model mostly relied on the QRS complex to make predictions. However, models with ECGs recorded between 1 day to 1 month and 1 month to 1 year prior to arrest demonstrated predictive capabilities.

Conclusion

Deep learning models processing ECG data are a promising means of screening for SCA, and this method explains differences in SCAs due to age and sex. Model performance improved when ECGs were nearer in time to SCAs, although ECG data up to a year prior had predictive value. Sudden cardiac arrest prediction was more dependent upon QRS complex data compared to other ECG segments.

Development and psychometric evaluation of a self-management ability assessment scale for individuals with spinal cord injury

OBJECTIVE

The objective of this study was to develop a scale to assess the self-management capability of patients with spinal cord injuries and provide an evaluation tool for implementing targeted interventions.

METHODS

Drawing upon the Integrated Theory of Health Behavior Change (ITHBC) and the International Classification of Functioning, Disability, and Health (ICF) framework, an initial version of the Spinal Cord Injury Patient Self-Management Capability Assessment Scale was developed through literature analysis, semi-structured interviews, and expert inquiry using the Delphi method. Subsequently, two rounds of inquiries were conducted with a panel of 20 experts to refine items in the scale based on the feedback obtained.

RESULTS

The two rounds of expert inquiry questionnaires yielded an effective recovery rate of 100%, with expert authority coefficients for the two rounds of inquiries being 0.925 and 0.940, respectively. Kendall's coefficient of concordance for the two rounds was 0.200 and 0.317, respectively. The finalized 54-item Spinal Cord Injury Patient Self-Management Capability Assessment Scale developed in this study comprises five dimensions: disease knowledge management, daily behavior management, social-psychological management, information and resource management, and rehabilitation exercise.

CONCLUSION

A Spinal Cord Injury Patient Self-Management Capability Assessment Scale was developed based on the Delphi method. It may be used to evaluate the level of self-management capability of patients with spinal cord injuries but warrants further empirical verification.

Critical factors influencing Generation Z registered nurses' professional socialization process: A grounded theory study

BACKGROUND

Professional socialization in nursing describes a continuous interactive and personal process that characterizes the valued behavior of the profession. The process becomes complex when dealing with Generation Z nurses (Gen Z), the youngest and most diverse of the generational cohorts, who have a unique set of characteristics that is reframing the healthcare landscape. Their lived experiences and priorities may be incongruent with the real expectations of the nursing workforce; ultimately impacting their ability to engage and thrive in the workplace. It is significant to address the social process that influenced how Gen Zs learn and continues to develop in the profession.

AIM

To understand the factors influencing the Generation Z professional socialization process in the nursing workforce and co-create a substantive theory.

DESIGN

Charmaz's constructivist grounded theory (CGT) methodology was used for the study.

PARTICIPANTS

Twenty-two Gen Z nurses and five generational expert participants were recruited from various healthcare systems in an ethnically diverse metropolitan area in North America.

METHODS

Phase I participants in individual interviews responded to semi-structured open-ended questions. Phase II participants during a focus group interview, authenticated the data and fit of an emerging theory.

RESULTS

Four major categories encompassing the process of how Generation Z nurses became professionally socialized in the workforce were derived: developing a sense of belongingness, enhancing communication, overcoming self-doubt, and advancing learning in the depths of adversities. These concepts interacted with each other and converged to create the substantive theory, thriving toward professional socialization in the nursing workforce.

CONCLUSIONS

Gen Z interactions and relationships in the nursing workforce are foundational for professional socialization. This study contributed meaningful information integral for guiding practices, promoting positive outcomes, and creating collaborative relationships that are critical for Gen Zs' advancement of the nursing profession.

TeamSTEPPS® in Home Health

TeamSTEPPS is a patient safety model that uses a collection of tools and best practices to optimize team performance. It has been widely adopted in the inpatient setting but clinician autonomy has been a barrier in its use. A home healthcare agency began using TeamSTEPPS® and found that it has a positive impact on nurse retention through the use of situational awareness and mutual support tools. Small improvements were made in OASIS outcomes and 30-day hospital readmissions through the use of handoffs and huddles.

Exploring Working Relationships Between Clinical Nurse Specialists and Clinical Nurse Leaders to Better Understand Opportunities for Improvement: A Phenomenological Qualitative Study

OBJECTIVE

The aim of this descriptive qualitative study was to describe the experiences between clinical nurse specialists (CNS) and clinical nurse leaders (CNLs) at a Midwestern hospital.

BACKGROUND

Clinical nurse specialists and CNLs are both nurses with advanced degrees yet differing specialties and responsibilities. Both focus on improving nursing and patient care but face challenges such as role definition and resource constraints.

METHODS

A sample of 8 CNSs and 9 CNLs from a Midwestern hospital were recruited to participate in focus groups to explore their experiences working together within the same organization.

RESULTS

Six themes were identified from the interviews: 1) organizational factors; 2) role identity and function; 3) communication practices and challenges; 4) value and visibility; 5) challenges and barriers; and 6) strategies and solutions.

CONCLUSIONS

It is important for administrative leadership to have a clear understanding of the scopes and unique significant contributions that the CNS and CNL each bring to healthcare.

Intensive care nurses' impostor phenomenon: Associations with narcissistic personality, shame-proneness, and guilt-proneness

BACKGROUND

Intensive care unit nurses commonly experience impostor phenomenon owing to constant exposure to urgent situations, high work pressure, and the demands of their professional roles. Impostor phenomenon may induce anxiety and self-doubt and adversely affect personal growth and career development. Therefore, identifying the severity of impostor phenomenon among intensive care unit nurses and its associated factors is important.

OBJECTIVES

The aim of this study was to investigate the associations between narcissistic personality, shame-proneness, guilt-proneness, and impostor phenomenon among intensive care unit nurses in tertiary hospitals.

METHODS

This cross-sectional study collected data from 251 nurses in tertiary hospitals in Korea, in July 2022, using an online questionnaire. Narcissistic personality was assessed using the Pathological Narcissism Inventory, and shame-proneness and guilt-proneness were measured using the Test of Self-Conscious Affect. Impostor phenomenon was assessed using the Clance Impostor Phenomenon Scale.

RESULTS

Multiple linear regression analysis showed that the most potent factors affecting impostor phenomenon in intensive care unit nurses was shame-proneness, followed by narcissistic vulnerability and guilt-proneness. The regression model explained 65.0% of the variance.

CONCLUSION

Nurse leaders can address impostor phenomenon among newly hired intensive care unit nurses with the goal of minimising adverse psychological outcomes. Shame-proneness, narcissistic vulnerability, and guilt-proneness require attention because of their relationship to impostor phenomenon. Additionally, it is necessary to plan and implement measures to promote awareness of self-conscious emotions, psychoeducation, and mental health intervention programs that focus on these factors.

Economic Model of Uridine Triacetate Versus Supportive Care for the Treatment of Patients with Life-Threatening Early-Onset Severe Toxicity

BACKGROUND

Early-onset severe toxicity following the administration of 5-fluorouracil (5-FU) or capecitabine occurs in approximately 10-30% of patients receiving fluoropyrimidine therapy in the USA and is fatal to at least 0.5% of patients treated. Supportive care measures used to manage symptoms of toxicity are associated with extended hospital length of stay, high cost of care, and poor survival. Uridine triacetate is indicated as an emergency treatment for patients who exhibit early-onset, severe or life-threatening toxicity, and has been shown to significantly improve clinical outcomes. Despite its life-saving capability to reverse early-onset severe toxicity, uridine triacetate may be underutilized.

PURPOSE

This study aims to evaluate the economic impact of uridine triacetate as a rescue therapy for adult patients from the US hospital payer perspective for early-onset severe toxicity, who are expected to die without treatment.

METHODS

A decision tree model was developed to compare inpatient survival, hospital length of stay, and inpatient healthcare resource utilization for patients treated with and without uridine triacetate. Costs associated with hospitalization, including supportive care measures and monitoring were evaluated, considering medications and procedures commonly used to manage various severe toxicities experienced (e.g., gastrointestinal, hematological, etc.). The model compared the hypothetical current practice, in which approximately half of patients expected to die from early-onset severe toxicity receive uridine triacetate in addition to supportive care, with the proposed future practice in which all eligible patients receive uridine triacetate during their hospital stay. Hypothetical practical scenarios for US institutions were also considered.

RESULTS

For each adult patient hospitalized for early-onset severe or life-threatening toxicity who would be expected to die without treatment, adoption of uridine triacetate as a rescue treatment was associated with clinical benefits, including increased inpatient survival (48.5%) and a 7.3-day reduction in total hospital length of stay per patient. Treatment of each additional patient with uridine triacetate was associated with an incremental cost of US$25,247 per patient. Seventy percent of the drug cost was offset by reduction in inpatient healthcare resources utilization. This cost offset is likely underestimated as it does not include additional savings from potential reimbursements associated with changes in hospital length of stay, readmissions and discounting. Hypothetical scenarios demonstrated that model outputs were most sensitive to changes in length of stay and hospitalization costs.

CONCLUSION

Optimal treatment with uridine triacetate for all hospitalized patients in the USA expected to die from early-onset severe toxicity has the potential to improve inpatient survival at a minimal inpatient budget increase. The majority of the drug cost is offset by a reduction in the length of hospital stay and associated costs.

Longitudinal Trends in the Incidence of Hyperactive Delirium and Its Causes of Change After Surgery for Degenerative Lumbar Disease: A Population-Based Study of 7250 Surgical Patients Over 11 Years

OBJECTIVES

Delirium is one of the common complications in elderly patients after spinal surgery. Severe delirium can lead to a series of adverse consequences such as drainage tube removal, wound rupture, patient falls, and severe adverse effects. The current research on POD is mostly small sample studies. This study aimed to investigate longitudinal changes in the incidence of hyper-postoperative delirium in patients with lumbar degenerative disease at our institution over the past 11 years and to identify the potential causes of these changes.

METHODS

This is a retrospective cohort study included 7250 patients who underwent surgical treatment for lumbar degenerative diseases at a single center from 2011 to 2021. These patients were diagnosed with delirium through the Confusion Assessment Method and then diagnosed with high activity delirium through the Richmond Agitation-Sedation Scale, totaling 130 cases. According to the incidence rate of hyper-postoperative delirium within 11 years, the trend test is divided into three groups: S1 upward trend (2011-2014), S2 downward trend (2015-2016) and S3 upward trend (2016-2021). The study collected variables from patients before, during, and after surgery, including gender, age, laboratory tests, anesthesia risk score, New York Heart Association cardiac function grading, number of surgical segments, surgical time, estimated intraoperative blood loss, anesthesia medication, and supplementary analgesic medication in the ward within 3 days after surgery. Kruskal Wallis one-way ANOVA test, Kruskal-Wallis H test, or chi-square test are used to evaluate inter group differences. p < 0.05 is considered statistically significant.

RESULTS

The pooled incidence of hyper-postoperative delirium over the past 11 years was 1.79% (130/7250). The average age of 7250 patients was 54.5 ± 13 years, with a male/female ratio close to 1:1. We statistically analyzed the relevant influencing factors before, during, and after surgery of S1 and S3 in the incidence rate increase group and found no statistical difference between the two groups. Our research results show that the incidence of high activity delirium is correlated with age, number of surgical segments, surgical duration, use of dexmedetomidine, remifentanil, and benzodiazepines, with p < 0.05.

CONCLUSIONS

The reduced use of dexmedetomidine, increased use of benzodiazepines, and prolonged surgical time are the reasons for the increased incidence of hyper-postoperative delirium. The joint management of orthopedic surgeons and anesthesiologists during the perioperative period is of great significance in reducing the incidence of hyper-postoperative delirium in patients undergoing lumbar spine surgery.