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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Supportive use of digital technologies during transition to adult healthcare for young people with long-term conditions, focusing on Type 1 diabetes mellitus: A scoping review

Type 1 diabetes mellitus (T1DM) is the second most common chronic or long-term condition (LTC) affecting young people (YP); when transitioning from paediatric to adult healthcare, young people with LTCs such as T1DM are expected to self-manage medication, diet and clinical appointments. This scoping review aimed to analyse research examining ways digital health technologies were used to support YP with LTCs during transition from paediatric to adult healthcare and to establish YP's needs, experiences and challenges when transitioning. We aimed to identify knowledge gaps and inform development of a novel chatbot with components such as avatars and linked videos to help YP with T1DM gain self-management confidence and competence during transition. Nineteen studies identified through searching five electronic databases were included in this review. A combination of digital health technologies was used to support transition of YP with LTCs to adult healthcare. Barriers to successful transition were reported and YP described the importance of social relationships and transition readiness and expressed the need for individualised interventions that acknowledge social factors such as work and college. No supportive chatbots with components to help YP with T1DM were identified. This contribution will inform future development and evaluation of such a chatbot.

A review of trends in health professions education research at the turn of three decades (2000, 2010, and 2020)

INTRODUCTION

Health professions education research has evolved as a discipline, yet chronological trends in topics and methodologies together have not been comprehensively explored previously. This study aimed to identify the trends in research topics and methodologies used in primary empirical studies published in reputable health professions education research journals at the turn of three decades (2000, 2010, and 2020).

METHODS

Underpinned by relativism and subjectivism, this review of trends included primary empirical studies published in five quartile 1 health professions education research journals, defined by Clarivate (Academic Medicine, Advances in Health Sciences Education, Medical Education, Medical Teacher, and Nurse Education Today) from three sample years at the start of three decades (2000, 2010, and 2020). Each study was coded for demographics (e.g., country of origin), topic area, and methodological approach, including philosophical positioning, study design, and methods. Data were analysed descriptively.

RESULTS

A total of 1126 empirical studies were published across the three time-points, with the majority from North American and European countries. More papers were published in recent years, with publications doubling in 2020 (n = 488) compared with 2000 (n = 223). Effective teaching methods were the most researched topic, whereas teaching and learning of Indigenous health received the least priority consistently across the three time-periods. Over half of the methodologies were quantitative, followed by qualitative, and mixed methods. The use of qualitative methodologies and the reporting of philosophical positioning (mostly in qualitative studies) have gradually increased over the three time-points. Many studies, however, still fail to report key markers of methodological quality.

DISCUSSION

Despite positive trends in health professions education research (more studies, multi-institutional research, and balanced methodological approaches), our review of trends identified notable issues (e.g., limited country diversity, missing criteria for methodological quality, and less-diverse research topics). We therefore encourage greater consideration of the role of journals in shaping the future, quality of output reporting, and gaps in the literature; thereby diversifying what and how we research health professions education.

The Nursing Inter Shift Handover: A Moment of Care for Patients and Their Family Caregivers

Precedents: The transfer between nursing shifts must guarantee the quality of care for patients and their families in the hospital. This study aimed to transform the handover between nursing shifts to strengthen the care capacity of patients and their family caregivers, and improve the care capacity of nursing staff, in a Latin American university hospital. Methods: This is a Nursing Methodology Research developed in the following phases: (a) identification of the best handover practices between nursing shifts to apply them within the institutional culture; (2) diagnosis of the transfer between shifts in the hospital; (3) design and validation of the transformation proposal; (4) measurement of transfer indicators; and (5) definition of a path to improve this transfer. Results: The proposal developed focuses on the patient and their family caregiver. The proposed protocol considered the perspective of the care recipients, the nursing staff, and the best available evidence. The overall transfer rating over 10 months went from 65% to 84%. Conclusions: The adjustment to the transfer process made it possible to strengthen the care capacity of patients and their family caregivers and improve the care capacity of the nursing staff.

Return-to-Play With R2Play: Protocol for Evaluating Cross-Site Feasibility, Face Validity, and Content Validity of a Multidomain Concussion Assessment Tool for Youth

CONTEXT

Clinical concussion assessments do not typically simulate the speed or complexity of sport. Performance changes arising from combined physical, cognitive, and sensory demands of sport may thus remain undetected during rehabilitation. We developed R2Play, a multidomain return-to-play assessment tool for youth with concussions. R2Play involves levels and conditions that vary in physical, cognitive, and sensory load to simulate the multidomain demands of sport.

OBJECTIVES

To explore cross-site feasibility, face validity, and content validity of R2Play by integrating quantitative and qualitative data.

METHODS

Convergent mixed-methods feasibility study. Five sites will each recruit 5 clinicians (total nc = 25) and 10 youth sport participants (ages 10-25 y) with a history of concussion in the previous year (total ny = 50). Feasibility will be evaluated using quantitative criteria for acceptability, demand, implementation, practicality, and integration, and qualitative investigated data from content analysis of postassessment interviews with youth and clinician participants. Face validity will be investigated in postassessment interviews. Content validity will be established through (1) changes in performance metrics (time to completion, errors, and heart rate) across R2Play levels, (2) youth-perceived physical and cognitive exertion for each level, and (3) overall clinician perceptions determined through postassessment interviews. Qualitative and quantitative data will be merged through joint display to identify areas of convergence, divergence, and complementarity, and to establish meta-inferences about feasibility, face validity, and content validity.

DISCUSSION

This study aims to demonstrate the face and content validity of R2Play, and its feasibility for cross-site implementation. Findings will guide further iteration of R2Play and establish the foundation for a larger multicenter validation study to establish the psychometric properties of R2Play. This work represents an important first step toward the implementation of an ecologically valid multidomain assessment tool designed to support a safe and efficient return-to-play after concussion, ultimately reducing the risk of recurrent concussion and subsequent injury.

Developing a Competency Assessment Index System for Hematology Nurses in China: Delphi Study Insights

PURPOSE

Patient management, care, and education are influenced by the core competencies of hematology nurses. Nurse specialists enhance patient safety and nursing care quality. However, no study has constructed an index of core competence assessment for hematology nurses.

DESIGN

In this study, a literature review, theoretical analysis, and group discussion were performed to construct the core competency evaluation index system for hematology nurses.

METHODS

Twenty-six experts from 7 provinces and cities across China were selected by purposive sampling for 2 rounds of Delphi expert consultation, and the indicators were selected based on the mean importance score >3.5 and coefficient of variation <0.25. A precedence chart determined the indicator weights at all levels.

RESULTS

The evaluation index included 6 primary, 18 secondary, and 70 tertiary indicators. The positive coefficients of the questionnaire on the 2 rounds were 100% and 92.86%. The Kendall's harmony coefficients for indicators at all levels were 0.176 to 0.461 and 0.197 to 0.220. Experts' familiarity, judgment, and authority coefficients were 0.892, 0.871, and 0.882, respectively.

CONCLUSIONS

The evaluation index system may provide references for the training, curriculum setting, assessment, and qualification certification of hematology nurses.

Nurse-involved early mobilization in the intensive care unit: A systematic review and meta-analysis

BACKGROUND

Early mobilization is one proposed strategy for reducing complications and optimizing patient outcomes. Nurses play an essential role in patient monitoring and co-ordination.

AIMS

To assess the effects of a nurse-involved early mobilization programme on muscle strength and intensive care unit (ICU) length of stay and identify the components of an early mobilization programme.

STUDY DESIGN

A systematic review and meta-analysis were conducted. MEDLINE (PubMed), Embase, Cochrane and CINAHL databases were searched. Eligible studies included randomized controlled trials (RCTs) and non-randomized studies of adult ICU patients undergoing early mobilization. The studies were appraised using RoB 2.0 and ROBINS-I tools, and a meta-analysis was performed using Rstudio 2023.06.2.

RESULTS

Nine studies were selected from 943 studies. Four studies involved only ICU nurses, while five involved multidisciplinary teams. Concerns about bias were raised in four RCTs, and two non-randomized studies had moderate bias risk. Interventions involved progressive exercise steps, but none detailed the specific role of nurses. Early mobilization significantly decreased ICU length of stay (95% CI: -3.22, -0.11; p = .04), although it did not improve muscle strength (95% CI: -0.86, 0.99; p = .80).

CONCLUSIONS

Nurse-involved early mobilization was associated with a reduction in ICU stay, although it did not impact muscle strength. The nurses' roles were not specifically defined.

RELEVANCE TO CLINICAL PRACTICE

An analysis of relevant tasks is necessary to clarify the role of nurses in early mobilization and to provide optimal care. Including these roles is crucial in the development of standardized early mobilization.

Evidence-based control of stress response on intraoperative physiological indexes and recovery of patients undergoing gastrointestinal surgery

BACKGROUND

Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery (ERAS) provide recommendations for ERAS in gastrointestinal surgery, the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the complex factors contributing to patient stress responses. Moreover, stress responses are more severe in older adult patients. Therefore, precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.

AIM

To establish an evidence-based ERAS model based on stress response nursing care and demonstrate nursing benefits through clinical practice.

METHODS

This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response. Next, 392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based (study group) or conventional (control group) ERAS nursing models, respectively. Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.

RESULTS

Among 64 domestic and international studies, the stress responses of older adult patients mainly included emotional anxiety, sleep disorders, gastrointestinal discomfort, physical weakness, pain, and swelling. The appropriate nursing interventions included comprehensive psychological counseling, pre- and postoperative nutritional support, temperature control, pain management, and rehabilitation training. Compared with the control group, the study group showed lower heart rate, mean arterial pressure, blood glucose level, and adrenaline level; shorter duration of drainage tube placement, time to first flatus, time to first ambulation, and postoperative hospital stay; lower anxiety scores on postoperative day 3; and lower incidences of postoperative infection, obstruction, poor wound healing, and gastrointestinal reactions were lower in the study group (all P < 0.05).

CONCLUSION

The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery, promoted postoperative recovery, and reduced the incidence of complications.

The impact of nurses' adversity quotient on their work stress: the mediating role of professional identity

PURPOSE

To explore the influence of nurses' adversity quotient on their work stress and to further explore whether professional identity can mediate in this process.

METHODS

From July to September 2023, an online questionnaire survey was conducted among nurses in six public tertiary hospitals in Suzhou and Wuxi, China, including demographic information, Adversity Response Profile (ARP), The Professional Identity Scale for Nurses (PIS) and Stress Overload Scale (SOS). Analyzed the collected data using correlation, multiple linear regression, and structural equation modeling.

RESULTS

1,578 nurses completed the questionnaires, resulting in 1,468 valid questionnaires. The average score of Stress Overload Scale of the surveyed nurses was 65.26 ± 17.93 points (Total score of Stress Overload Scale: 110). The correlation analysis showed a significant positive relationship between nurses' adversity quotient and their professional identity (r = 0.59, P < 0.01); professional identity and work stress were negatively correlated (r=-0.44, P < 0.01); and adversity quotient was also negatively correlated with work stress (r=-0.31, P < 0.01). The structural equation model indicated that professional identity might mediate between stress and adversity quotient.

CONCLUSION

Clinical nurses suffer from heavy work stress, and nurses' adversity quotient could change their work stress level by affecting their professional identity. Strategies and measures to improve professional identity is expected to buffer the impact of adversity quotient on nurses' work stress.

Concept analysis of health research translation nomenclature

INTRODUCTION

Translating health research into clinical practice is a complex process aimed at enhancing healthcare quality and patient outcomes. The terminology surrounding this process is varied and often used interchangeably, leading to minimal consensus on the activities encompassed by each term.

OBJECTIVES

This study aims to examine existing taxonomies and websites for operational definitions related to health research translation, culminating in a comprehensive synopsis of terms specific to this field.

DESIGN

In 2019, a literature search was conducted using databases such as PubMed and CINAHL, along with relevant government and non-governmental organisation (NGO) websites, including grey literature. The search focused on English-language publications defining health research translation from 2000 onward and was updated in 2023. One author conducted the search, employing a mix of free-text and database-specific terms. Two authors independently evaluated the results for inclusion. Relevant data were extracted to aid in sorting and prioritising terminology based on frequency. A concept analysis approach, developed by Foley and Davis and informed by Rodgers' seven phases, was used to map the nomenclature.

RESULTS

A total of 51 papers were analysed, revealing that the most frequently used terms for health research translation were knowledge translation (KT), implementation and translational research. Both evidence-based healthcare and KT describe the process of integrating evidence into practice, positioning them as analogous. Two major domains were identified: practice and science, with practice-related language further categorised into people-focused, process-focused and outcome-focused.

CONCLUSIONS

This paper presents a conceptual nomenclature map that serves as a foundation for developing a consensus-driven ontology for health research translation. The framework highlights how language can be categorised into common domains, fostering meaningful communication across diverse groups and entities.

Prevalence of interprofessional collaboration towards patient care and associated factors among nurses and physician in Ethiopia, 2024: a systematic review and meta-analysis

INTRODUCTION

Enhancing clinical outcomes and patient satisfaction can be achieved through interprofessional collaboration between physicians and nurses. Conversely, a lack of nurse-physician interprofessional collaboration compromises patient safety, care, and improvement, and creates moral discomfort for healthcare professionals. Studies indicate that failures in interprofessional collaboration between nurses and physicians lead to adverse medical events, including hospital-acquired infections, medication administration errors, and unnecessary health-related costs.

OBJECTIVE

This systematic review and meta-analysis aimed to investigate the pooled proportions of the interprofessional collaborations towards patient care and associated factors among nurses and physicians in Ethiopia, 2024.

METHODS

A comprehensive search was conducted to find articles on interprofessional collaboration towards patient care and associated factors among nurses and physicians in Ethiopia. The study included cross-sectional studies conducted in Ethiopia and published in English from inception up to August 20, 2024. Excluded were conference proceedings, qualitative research, commentaries, editorial letters, case reports, case series, and monthly and annual police reports. The search encompassed full-text publications written in English and databases such as PubMed/MEDLINE, African Journals Online (AJOL), Semantic Scholar, Google Scholar, and Google. A checklist from the Joanna Briggs Institute (JBI) was used to evaluate the quality of the studies. Two independent reviewers performed data extraction, critical appraisal, and article screening. Statistical analysis was performed using STATA-17 software. A random-effects model was employed to estimate pooled proportions, and effect sizes with 95% confidence intervals were used to analyze determinants of interprofessional collaboration in patient care among nurses and physicians. Funnel plots and Egger's test were used to examine the possibility of publication bias (p-value < 0.10), and the trim-and-fill method by Duval and Tweedie was applied to adjust for publication bias.

RESULTS

Five studies with a total of 1686 study participants that are conducted in three Ethiopian regions and meet the inclusion criteria were reviewed and pooled for this evaluation. The pooled proportions of the interprofessional collaboration towards patient care in Ethiopia is 52.73% (95% CI = 44.66, 60.79%, I2 = 91.5%). Factors such as attitude (favorable attitude towards collaboration) (OR = 1.13, 95% CI: 0.13, 9.89, I2 = 97.7%) and organizational support (satisfaction towards organizational support) (OR = 0.38, 95% CI: 0.07, 2.10, I2 = 97.5%) were not significantly associated with interprofessional collaboration towards patient care.

CONCLUSION

In summary, this systematic review and meta-analysis reveal that interprofessional collaboration between nurses and physicians in Ethiopia is moderately common, with a pooled proportion of 52.73%. This finding underscores the need for ongoing efforts to enhance collaborative practices to further improve patient care outcomes. Additionally, the review identified two potential contributors to interprofessional collaboration: satisfaction with organizational support and favorable attitudes towards collaboration. However, the pooled effects of these factors did not show a significant association with interprofessional collaboration. This highlights the necessity for further primary research to identify additional factors that may influence interprofessional collaboration and enhance patient care outcomes. Notable limitations of this study include significant variation among studies, a small number of studies, a focus solely on public hospitals, restriction to English-language publications, only observational studies, and limited access to databases such as EMBASE, CINAHL, and Web of Science.

REGISTRATION

This systematic review and meta-analysis was registered in Prospero with the registration ID and link as follows: CRD42024579370; https://www.crd.york.ac.uk/prospero/#recordDetails .

Identifying unmet palliative care needs of nursing home residents: A scoping review

INTRODUCTION

Many nursing home residents do not receive timely palliative care despite their need and eligibility for such care. Screening tools as well as other methods and guidelines can facilitate early identification of nursing home residents unmet palliative care needs.

AIM

To map and summarise the evidence on identifying unmet palliative care needs of nursing home residents.

METHODS

Any paper reporting on nursing home residents' unmet palliative care needs were eligible for inclusion. CINAHL, MEDLINE, Embase, Web of Science, APA PsycINFO, and APA PsycArticles and grey literature were systematically searched over two months, February and March 2024. Data were extracted using data extraction forms. Data were synthesised using descriptive analysis and basic content analysis.

RESULTS

Forty six records were included in this review. Nineteen methods, five screening tools, and four guidelines related to identifying residents unmet palliative care needs were identified. Most methods such as the Minimum Data Set and Palliative Care Needs Rounds were implemented as part of an intervention. Limited evidence was identified on what methods healthcare professionals use in daily practice. In total, 117 non-disease specific indicators for identifying residents unmet palliative care needs were identified, with physical indicators such as pain and weight loss being the most represented.

CONCLUSION

While developments have been made related to the concept of 'unmet palliative care needs', a clear definition is required. Evidence-based standardisation of methods for identifying unmet palliative care needs would ensure timely and equitable access to palliative care for nursing home residents worldwide. Achieving this goal requires incorporating screening for unmet palliative care needs into routine care.

Daylighting and Patients' Access to View Assessment in the Palestinian Hospitals' ICUs

Daylight and access to a view out are vital factors in improving patients' wellness, side by side healthcare providers' satisfaction and productivity in intensive care units (ICUs). Unfortunately, insufficient attention was paid to this issue in Palestine resulting in many ICU designs lacking the required daylight and access to view, which, in turn, negatively affects patients' wellness, increasing delirium incidence and sleep disorders. This study aims to assess the Palestinian hospitals' ICUs in terms of daylight and patients' access to view by conducting daylight measurements and field observations. The results show that the available ICU designs in Palestine do not provide adequate daylight and access to view for patients.

Can a Short-Term Intervention Promote Growth Among Parents of Children with ASD?

The present study investigated the effects of a short-term synergic growth mindset intervention towards abilities and towards stress on reducing parental stress and promoting stress-related growth (SRG) among Arab parents of children diagnosed with Autistic Spectrum Disorder (ASD). One hundred and seven parents (70 mothers, 37 fathers) of male children with ASD, completed several questionnaires, including a demographic questionnaire; the Childhood Autism Rating Scale, the Parenting Stress Index-Short Form, the revised Stress- Related Growth Scale, The Implicit Self-Theories Scale, and the Stress Mindset Scale. Seventy- two parents were randomly assigned to an "intervention group", and 35 to a comparison group. Members of the intervention group participated in a short synergic growth mindset intervention, created especially for this research. Six months after the intervention, all participants re-completed the same questionnaires. The intervention significantly increased growth mindset and SRG and decreased parental stress. This study demonstrates the effectiveness of a short-term intervention in promoting growth mindsets, reducing parental stress, and fostering SRG among parents of children with a chronic disorder. These findings are particularly important since many parents of children with chronic disorders often exhibit fixed mindset patterns due to their children's slow progress in various developmental domains.

Perceptions and experiences of young adults and their healthcare team of the D1 Now type 1 diabetes intervention

BACKGROUND

Young adults (18-25 years) with type 1 diabetes can have high blood glucose levels, increasing their risk of complications. The D1 Now intervention aimed to improve outcomes, using a young adult-centred approach, comprising three components: an interactive messaging system, agenda setting tool, and support worker. A pilot randomised controlled trial was conducted to assess acceptability and feasibility of this novel intervention.

AIM

To explore perceptions and experiences of young adults and healthcare staff participating in the intervention arms of the D1 Now pilot randomised controlled trial.

METHODS

A descriptive qualitative approach using semi structured interviews was used to collect data between May 2020, and January 2021 from sixteen young adults and ten healthcare staff Interviews were conducted online using MS Teams. Thematic analysis was used to analyse the data. A patient and public involvement approach was used with the D1 Now Young Adult Panel deployed from the outset to design and contribute to the study. Both written consent in advance and verbal consent was given by all participants for the online interviews that were video and audio recorded according to individual participant preference.

RESULTS

Themes were developed separately for young adult and healthcare staff participants. Two themes were developed from the young adult data, 1) 'empowerment' and 2) 'perceptions and experiences of the intervention'. One theme was developed from the healthcare staff data, 'perceptions and experiences of delivering the intervention'. All participants highlighted that the agenda setting tool and the support worker empowered the young adults as they could focus the consultation process on what mattered most to them. However, the interactive messaging system was perceived as unsuitable by many mainly because the technology was outdated. Overall, the perceived impact of participating in the study was positive.

CONCLUSIONS

Understanding participants perceptions and experiences of taking part in the D1 Now intervention is crucial. The lessons learnt can be used to further refine and develop the intervention with a view to measuring its effectiveness, in a future definitive trial.

PURPOSE-T: validity, reliability and implementation

Pressure ulcer risk assessment is an essential part of pressure ulcer prevention. This article explores the Pressure Ulcer Risk Primary Or Secondary Evaluation Tool (PURPOSE-T), the use of which is advocated by the NHS England National Wound Care Strategy Programme. The article aims to increase awareness of the PURPOSE-T risk assessment tool and address the need, expressed by Wound Care Alliance UK members, for an overview of it. Consideration is given to reliability and validity. Further testing of the tool is needed in some healthcare settings. A recommendation is made regarding its implementation, which should be fully supported by guidance, resources and inform the development of an appropriate, patient-focused individualised care plan, wherever possible agreed with the patient.

Development of lifestyle assessment: A Delphi survey of multi-faceted health experts

OBJECTIVE

In the field of health promotion, there's a growing focus on adopting an academic approach to assess and evaluate the intricate and ever-evolving nature of lifestyles. This approach is crucial for shaping and improving a healthy way of life. Systematic measurement of lifestyles is essential for enhancing overall health and well-being, encompassing physical, mental, and social dimensions. This study's goal is to create an assessment tool that measures the diversity and intensity of lifestyle behaviors linked to human health. Our efforts involved developing quantitative measurement items that encompass the holistic concepts of health and lifestyle and validating them.

METHODS

Between March and April 2023, we gathered insights from 14 experts in lifestyle and health. Building on previous research, we conducted a Delphi survey twice. In the initial survey, we collected expert opinions through open and closed-ended questions about lifestyle evaluation items. After the first survey, we corrected several items that didn't meet the Content Validity Ratio (CVR) standard before proceeding. We presented the first survey's findings to an expert panel, leading to a consensus.

RESULTS

The initial Delphi round produced 76 items, and the second round resulted in 72 items after adjusting those with CVR scores of 0.51 or less. The final Content Validity Ratio was 0.83, signifying a robust validation process, with a convergence of 0.50 and a consensus level of 0.75.

CONCLUSION

In summary, this study successfully developed a comprehensive lifestyle assessment tool using a modified Delphi technique. The 72 items are categorized into eight subcategories and four overarching themes. This tool provides a systematic approach to evaluate lifestyles, promoting health and well-being across physical, mental, and social dimensions. It also assists in identifying specific lifestyle elements that require more in-depth intervention strategies, all while preserving the academic integrity of the content.

Interventions to develop clinical judgment among nurses: A systematic review with narrative synthesis

AIM

To explore interventions developed to improve nurses' clinical judgment.

BACKGROUND

Clinical judgment can assist nurses in assessing clinical situations, identifying and preventing problems, and making effective decisions about patient care. Studies on developing clinical judgment among nurses thus far been limited and heterogeneous.

DESIGN

A systematic review with narrative synthesis.

METHODS

Eight databases (PubMed, CINAHL, PsycInfo, Scopus, Web of Science, Cochrane Library and ProQuest Dissertations and Theses databases) were systematically searched for studies published until May 2024. A total of 13 studies satisfied the inclusion criteria. Joanna Briggs Institute's critical appraisal tools were used to assess the quality of the selected studies, whereas the Mixed Methods Appraisal Tool was used for mixed methods studies.

RESULTS

Overall, 13 studies were included for analysis. Simulation was the most used type of intervention, whereas Tanner clinical judgment model was the most used framework, and Lasater Clinical Judgment Rubric was the most used tool for exploring the development of nurses' clinical judgment skills. Among the 13 interventions analyzed, 11 were found to be effective.

CONCLUSIONS

Simulation teaching strategies using Tanner's clinical judgment model and Lasater Clinical Judgment Rubric satisfactorily develop clinical judgment among nurses. The findings of this systematic review underscore the dearth of nursing research exploring the efficacy of interventions designed to enhance clinical judgment among general registered nurses.

REPORTING METHOD

The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The Efficacy of Music Intervention in Patients with Cancer Receiving Radiation Therapy: A Systematic Review and Meta-Analysis

Background: Music intervention (MI) is a promising complementary therapy for alleviating psychological distress in patients with cancer undergoing radiotherapy. This systematic review and meta-analysis assessed the efficacy of MI in reducing anxiety, depression, and fatigue in these patients. Methods: A comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and the International Clinical Trials Registry Platform from inception to 9 January 2025. We included randomized controlled trials (RCTs) and cohort studies investigating MI's impact on psychological outcomes in patients with cancer receiving radiotherapy in this review. The study quality was appraised using the Cochrane Risk of Bias 2.0 for RCTs and the ROBINS-I tool for cohort studies. A meta-analysis was performed using a random-effects model in Review Manager 5.4. Results: A total of 13 studies (11 RCTs and 2 cohort studies) with 1073 participants were included. The pooled analysis revealed a significant reduction in anxiety (mean difference [MD]: -3.53, 95% confidence interval [CI]: -5.98 to -1.07, p = 0.003), a non-significant effect on depression (MD: -1.12, 95% CI: -3.25 to 1.01, p = 0.29), and a significant improvement in fatigue (MD: -15.88, 95% CI: -28.19 to -3.57, p = 0.01). A subgroup analysis based on intervention type indicated that music medicine (MM) was more effective in reducing anxiety compared to music therapy (MT). Conclusions: The findings of this study suggest that MI, particularly MM, may be beneficial in alleviating anxiety and fatigue in patients with cancer undergoing radiotherapy, but its impact on depression remains inconclusive. Future studies should employ standardized methodologies and rigorous RCT designs to validate these findings.

The effect of ambidextrous leadership on knowledge sharing behavior among nurse specialists: a chain mediation role of perceived organizational support and organizational commitment

BACKGROUND

Knowledge sharing behavior of nurse specialists can cultivate nurses' core abilities, improve the quality of healthcare system services, and enhance people's well-being. Ambidextrous leadership can increase the level of knowledge sharing behavior, but the exact mechanism in nurse specialists remain unclear. This study investigated the relationship between ambidextrous leadership and knowledge sharing behavior among nurse specialists, with a specific focus on the mediation roles played by perceived organizational support and organizational commitment.

METHODS

An anonymous cross-sectional survey with a convenience sampling among nurse specialists was conducted in Anhui Province, east China from July to September 2024. Sociodemographic information questionnaire, Multifactor Leadership Questionnaire, Perceived Organizational Support Scale, Chinese Employees Organizational Commitment Scale and Knowledge Sharing Behavior Scale were used to collect data. SPSS23.0 and AMOS 26.0 were used for statistical analysis.

RESULTS

A total of 298 nurse specialists participated in this study. The average score of nurse specialists' knowledge sharing behavior was 55.00(10.65). Knowledge sharing behavior was positively correlated with ambidextrous leadership (r = 0.562, p<0.01), perceived organizational support (r = 0.575, p<0.01), and organizational commitment (r = 0.413, p<0.01). The total effect (β = 0.635) of ambidextrous leadership on knowledge sharing behavior consisted of a direct effect (β = 0.320) as well as an indirect effect (β = 0.315) mediated through perceived organizational support and organizational commitment. Perceived organizational support and organizational commitment have a chain-mediated effect (β = 0.056) between ambidextrous leadership and knowledge sharing behavior among nurse specialists, bootstrap 95% confidence interval (0.018,0.131), which represented 8.8% of the total effect.

CONCLUSIONS

This study confirms that ambidextrous leadership has a significant positive predictive effect on knowledge sharing behavior. Ambidextrous leadership was first associated with an increase in perceived organizational support, followed by a sequential ascend of organizational commitment, which associated with an improvement in knowledge sharing behavior among nurse specialists at last. Hospital managers can increase the levels of knowledge sharing behavior among nurse specialists by improving ambidextrous leadership, perceived organizational support and organizational commitment.

Sleep-wake stages classification based on single channel ECG signals by using a dynamic connection convolutional neural network

In the field of sleep medicine, identifying sleep-wake stages is crucial for evaluate of sleep quality. Until now, numerous methods have been proposed for sleep-wake classification. These methods predominantly utilize electroencephalogram (EEG) signals, achieving competitive performance in sleep-wake stage classification. However, acquiring EEG signals is both cumbersome and inconvenient. At the same time, EEG signals are very weak and are easily disturbed. In contrast EEG signal, collecting electrocardiogram (ECG) signals is relatively simple and convenient. Therefore, based on the ECG signals, we propose a simple and effective sleep-wake stages model that can be used for wearable devices. In order to extract multi-scale features of ECG signals, convolutional kernels of different sizes are designed. Then, a novel dynamic connection convolutional neural network (DCCNN) is proposed to classify sleep-wake stages. First, the DCCNN calculates the goodness of feature maps from each layer. Second, according to the goodness of different layers, select the optimal layer to form a residual module with the current layer. The proposed method was tested on sleep data from a publicly accessible databases, namely the MIT-BIH Polysomnographic Database, resulting in an best accuracy of 92.21%. The findings are similar and higher performance to those models trained with EEG signals. Moreover, when compared to state-of-the-art methods, the proposed approach's effectiveness is further demonstrated. In conclusion, this research offers a novel approach for sleep monitoring.

Use and de-implementation of fecal occult blood tests in the acute care setting: a systematic review and meta-analysis

BACKGROUND

To determine methods of FOBT de-implementation in acute care practice while summarizing the reasons and contraindications for inappropriate FOBT in acute care settings. Fecal occult blood testing is valuable for colorectal cancer screening in ambulatory settings but is not valuable for diagnostics in acute care with consistent indications for discontinuation as a tradition-based practice.

METHODS

We included all English language prospective and retrospective evaluation studies of FOBT use in acute care settings with or without de-implementation interventions and published as original research articles in peer-reviewed journals. A meta-analysis of FOBT positivity was conducted using a random effects model. Quality was assessed using Critical Appraisals Skills Programme criteria.

RESULTS

Of 2471 abstract/titles screened, 157 full-text articles were reviewed, and 22 articles met inclusion criteria of measuring prevalence or de-implementation of FOBT use in acute care settings. All 22 studies evaluated either FOBT use or de-implementation. Twenty articles reported FOBT positivity, with some illustrating that FOBT results were inconsequential to subsequent endoscopy decisions (n = 7, 32%). The included studies represent a publication date range spanning 32 years, with limited documentation of de-implementation strategies. Four published studies described system-level disinvestment to administratively eliminate access to inpatient FOBT orders.

CONCLUSION

Overall, all studies endorse that the use of FOBTs in acute care settings results in increased workload and/or cost without diagnostic benefit. Critical appraisal of low-value tradition-based practices such as FOBT use in acute care settings are essential for deploying deliberate and effective de-implementation strategies.

An implementation facilitation intervention to improve the musculoskeletal X-ray reporting by radiographers across London

BACKGROUND

The National Healthcare Service (NHS) radiology service delivery in London is representative of the current pressures and challenges faced in England of Musculoskeletal (MSK) X-ray reporting workforce shortages, and national turnaround time (TATs) targets. The implementation project evaluated facilitation as a strategy to achieve the NHS England 50% target for all MSK X-rays to be reported by radiographers.

METHODS

The project was an eight-month multi-centre (n = 5 London NHS Trusts) study applying the Promoting Action on Research Implementation in Health Services (PARIHS) framework with embedded mixed-methods evaluation. Initial observational data using the Context Assessment Index (CAI) tool and the Workplace Culture Critical Analysis Tool (WCCAT) set the implementation interventions which comprised external facilitation, to support internal facilitators action learning activities. Evaluation data comprised monthly reporting performance, systems mapping, interviews.

RESULTS

System mapping allowed a perspective beyond the characteristics of the NHS Trusts involved (small single site hospitals to large multi-sites hospitals) of mixed clinical duties, scope of practice, reporting session allocation, and equipment used. CAI scores for workplace culture demonstrated x ¯ = 73.7% (SD 6.8; 95%CI 8.49), leadership scored x ¯ = 69.3% (SD 7.3; 95% CI 9.17), and evaluation scored x ¯ = 75.5% (SD 6.9; 95% CI 98.63). WCCAT observations provided themes for facilitation focusing on remote reporting, insourcing backlogs, prioritising worklists to reduce breaching TATs, reporting metrics, and reducing auto reporting. The combined reporting of MSK X-rays by London radiographers during this study achieved x ¯ = 53.7%.

CONCLUSION

This study had an innovative approach using an implementation facilitation framework to improve service delivery. The clinical workplace context in which MSK X-ray reporting by radiographers occurs was key to implementing change. The complexities of sustaining and upscaling MSK X-ray reporting by radiographers to meet the NHS England target of 50% are varied and require local champions to facilitate and drive change at organisational levels. It is recommended that there are dedicated 'resources' to sustain implementations with a community of practice for support. Workplace leadership and stakeholder networks are needed to sustain improved working practices and embrace regular evaluation and monitoring of service delivery performance.

Empowering Future Physicians: Enhancing Naloxone Competency Through Early Harm Reduction Training in Medical Education

Introduction

With increasing rates of fatal opioid overdoses and substance use disorders, discussing harm reduction strategies in undergraduate medical education is imperative. Medical students learn opioid pharmacology but often lack adequate training in recognizing and responding to opioid overdoses. Incorporating naloxone training into preclinical undergraduate medical education can be lifesaving.

Methods

This educational activity trained second-year medical students in opioid overdose recognition and response. The 2-hour interactive session included an informative presentation on opioid use statistics, harm reduction, and opioid overdose; a case-based learning session; and hands-on practice on task trainers using an OSCE-style checklist. Student confidence in four areas was assessed through pre- and posttraining surveys on 5-point Likert scales. Data analysis was conducted using R (programming language), with exploratory analyses for sample size, normality, and variable selection. The Wilcoxon signed rank test evaluated changes in attitudes from pre- to posttest.

Results

Eighty-six students participated, with 60 completing pre- and posttest surveys. Significant improvements were observed in confidence across all areas: assessing an opioid overdose (p < .001), administering naloxone (p < .001), continuing management after naloxone (p < .001), and training others on naloxone administration (p < .001).

Discussion

Early training in opioid overdose management increased second-year medical students' confidence in key areas, potentially enabling them to better combat the crisis during their clinical years and educate at-risk patients. Future activities should incorporate objective skill assessments to evaluate competency and explore long-term knowledge retention during clinical rotations.

Healthcare's empathy in elderly care: How anxiety, depression, and professional quality of life influence empathic abilities

The objective of this descriptive cross-sectional study was to determine the relationship between empathy, anxiety, depression, compassion satisfaction, and fatigue in healthcare professionals working in elderly care centers. A sample of 104 healthcare professionals from nursing homes in Spain completed questionnaires assessing empathic skills, anxiety, depression, and quality of life. The results showed high levels of empathy and compassion satisfaction among participants and significant relationships between empathic skills, anxiety, depression, and quality of life measures. The regression analysis identified interpersonal reactivity, depression, compassion satisfaction, fatigue, and years of experience as significant predictors of empathy in the clinical context. Empathy is of paramount importance in the field of geriatric care, with enhanced empathic abilities exerting a beneficial influence on professional practice. However, the presence of depressive symptoms may hinder empathic abilities and affect the quality of care. Compassion satisfaction emerged as a significant predictor of empathy, highlighting the importance of emotional support and communication skills training in healthcare settings.