Ethical and legal reflections on secondary research using genetic data acquired for criminal investigation purposes

Research with human genetic data or human beings more generally requires valid informed consent. However, several exceptions exist to this universal principle, usually for situations where it is impossible or at least impractical to obtain this consent. Those exceptions are usually bound to requirements of necessity, shared benefit for the concerned community and minimization of harmful impact. Research without consent is normally subject to approval by an ethics review board. However, secondary use for research may also be based on statutory research privileges in the law. We identified several legal provisions in different countries, permitting the secondary use of DNA data that has been collected without consent for law enforcement purposes, which raises ethical questions. Most of the respective laws seem to be connected to privacy rules and permit the use of de-identified data only. However, whether individual DNA profiles in suspect and offender databases can actually be de-identified must be questioned. What appears to be less critical in terms of re-identification risk are the frequently mentioned "statistical indices", most likely referring to aggregated allele frequencies. However, reflections about data anonymity and a narrow purpose limitation to research aiming at the improvement of calculations of weight of evidence seem not to be the sole reasons for permitting research with entries from criminal offender databases. Distinctions between convicted offenders and other people in the database suggest an assumption of forfeiting some level of privacy protection upon conviction underlying some of these provisions. The use of entries on national DNA databases could therefore amount to problematic additional punishment.

Lavender improves sleep through olfactory perception and GABAergic neurons of the central amygdala

ETHNOPHARMACOLOGICAL RELEVANCE

The use of lavender as sleep aid or hypnotic agent can be traced back as early as ancient Romans and Greeks. Yet, objective experimental data on whether and how lavender enhances sleep duration or/and sleep quality remain lacking.

AIM OF THE STUDY

We aimed to characterize the sleep-wake regulating effects of lavender in the mouse and to demonstrate the brain targets and neural circuits involved.

MATERIALS AND METHODS

A self-made precise odor delivery system combined with chronic polysomnographic recordings was employed to assess the sleep-wake effects of inhalation with lavender essential oil (LEO, extracted from lavender) and its different constituents during the light and dark phases in free-moving C57BL/6J mice. Neuroviral labeling, in situ hybridization and pharmacogenetics were combined to identify the neural circuits and targets involved. Finally, an insomniac model of DL-4-Chlorophenylalanine (PCPA)-treated mice was established to examine the sleep-inducing potential of LEO.

RESULTS

We found that inhalation of LEO with a concentration at 25.0% during the light (inactive) phase significantly shortened the latency to non-rapid eye movement (NREM) sleep, increased the total amount of NREM sleep at the expense of wakefulness (W), and enhanced cortical EEG slow wave activities, notably delta power spectra density. We further identified linalool, d-limonene, 1,8-cineole, linalyl acetate and terpinene-4-ol as the major effective sleep-promoting monomer components. Importantly, we found that LEO no longer produced any of the above sleep-promoting effect following either nasal injection of zinc sulfate which interrupts the olfactory pathway, or pharmacogenetics silencing of central amygdala GABAergic neurons. Finally, LEO reestablished NREM sleep with short latency in PCPA-treated insomniac mice, effects comparable with those induced by a potent sedative diazepam.

CONCLUSIONS

We have characterized the quantitative and qualitative sleep-promoting effects of LEO and its effective components via the olfactory pathway and central amygdala GABA neuronal targets. The hypnotic property of LEO is reinforced by its ability to restore sleep in insomnia. Our study thus establishes a neurobiological basis for aromatherapy of sleep disorders using lavender.

A Scoping Review to Contribute to Knowledge About Culturally Adapting Interventions for Latino Family Caregivers of Persons Living With Dementia

INTRODUCTION

Few interventions have focused on Latino family caregivers to persons with dementia, addressing their unique needs. This review aimed to identify best practices in cultural adaptation to make recommendations for adapting interventions for Latino family caregivers of persons living with dementia.

METHOD

This scoping review was conducted following the Joanna Briggs Institute Scoping Review guidelines, with findings extracted and summarized from 17 studies addressing cultural adaptation.

RESULTS

Frameworks guiding the adaptations were comprehensive, addressing cultural values and traditions and the social context faced by Latino family caregivers. Features of the adaptations included diverse teams of researchers and community members, including Latino family caregivers, to inform the integration of cultural values into the content, mode, and place of intervention delivery.

DISCUSSION

Culturally adapting evidence-based interventions will increase the number of available interventions for Latino family caregivers to persons living with dementia, thus reducing inequities in caregiver support.

Optimizing triage education for emergency room nurses: A scoping review

AIMS

Accurate triage decisions by emergency room nurses are pivotal for patient prognosis and efficient utilization of resources. This study aimed to identify teaching methods, contents, intervention characteristics, and initial consideration of educational design for the development of triage education, targeting triage nurses.

DESIGN

A scoping review.

DATA SOURCES

PubMed, CINAHL, Web of Science, Embase, and RISS were searched for studies in either English or Korean, regardless of publication year.

REVIEW METHODS

The review was conducted according to the Joanna Briggs Institute guidelines. Studies published before November 15, 2023 were selected, based on the following index terms in each database: nurses, triage, education, and emergency services, hospital.

RESULTS

Of the 20 studies included in this review, five focused on severity classification of patients with cardiovascular diseases, one addressed infectious diseases, two examined pediatric patients, one explored patients with trauma, and the remaining eleven were not limited to specific diseases. Eleven studies (55 %) employed face-to-face (offline) education, whereas six (30 %) used non-face-to-face (online) education. The teaching methods were classified as teacher-centered learning and student-centered learning. The educational strategies included in-person lectures, online classes, demonstrations, simulations, mobile technology or web-based programs, group discussions, role-plays, and flipped learning. Outcome variables, such as triage accuracy, knowledge, performance ability, self-efficacy, satisfaction, wait time, and competency were measured as intervention effects.

CONCLUSIONS

This review demonstrates the key characteristics and contents of triage education interventions, along with key considerations in the initial design stages. Triage education covers a wide range of contents and diverse teaching methods pertinent to severity classification in triage practice. Effective educational programs hinge on the meticulous planning of objectives, optimal selection of the target population, needs assessment, and suitable teaching methods and materials. Future triage education for emergency room nurses should be tailored to specific participants while anticipating and planning all potential circumstances of implementation.

Emotional safety in maternity care: An evolutionary concept analysis

BACKGROUND

Safety in maternity care is a priority, and a broadened view of safety (e.g., emotional, psychological, cultural) is evident in scientific literature and in lay discourse. 'Emotional safety' is being referred to with increasing frequency in this context; however, there is a lack of clarity in its use and meaning.

AIM

The aim of this concept analysis was to examine the concept of emotional safety in maternity care.

METHODS

The evolutionary approach was used for this concept analysis.

DATA SOURCES

This concept analysis was literature-based, with a systematic search conducted of CINAHL, MIDIRS, and MEDLINE databases. Ten articles published between 2006 and 2024 met our criteria for inclusion.

RESULTS

Identified attributes of emotional safety in maternity care included 'feeling secure', 'feeling heard and well taken care of', experiencing 'supportive and respectful care', and being in a 'calm care environment'. Antecedents to emotional safety in maternity care were 'having care needs met', enacting 'personal agency', and engaging in 'trusting relationships'. The consequences of emotional safety for maternity care recipients were 'positive impact on experience', 'feeling empowered', and 'improved outcomes'. A conceptual definition and model resulted that clarify and illustrate the concept of emotional safety in the context of receiving maternity care.

CONCLUSION

This concept analysis contributes to the current body of knowledge of care recipients' views and experiences of safe maternity care and provides a foundation for future concept use in research, education, policy, and clinical practice.

Post-Intensive Care Syndrome Family

Family members of patients admitted to intensive care units often experience psychological distress, including depression, anxiety, and trauma symptoms, known as post-intensive care syndrome-family (PICS-F), due to the stress from having a critically ill loved one and resultant caregiver burden. Awareness of this syndrome is needed, as are prevention and management strategies, to improve outcomes.

Metabolic Profiles of Critical Care Patients to Confirm Sepsis and Further Understand the Metabolic Phenotype of Sepsis

Sepsis remains a major concern in health care globally. Despite decades of research, incidence is on the rise, and mortality remains high. Costs are staggering. Additionally, the outdated sepsis bundle established based on SIRS, remains the standard by which providers are held accountable. It is now accepted that organ dysfunction in sepsis is secondary to cellular metabolic dysregulation. Technology for metabolic monitoring should be explored for improved, early recognition of sepsis. We sought to investigate the underlying metabolic profile of patients with sepsis, to determine the value of continuous metabolic monitoring technology. The investigators partnered with industry, to trial noninvasive monitoring of the cellular metabolite carbon dioxide, under a prospective, observational design. During the 6-month trial, the investigators collected data from the electronic medical record of patients using the technology, to determine the specific metabolic differences between patients with and without sepsis. The investigators found serum carbon dioxide (paCO2) was significantly lower in patients with sepsis, and, low paCO2 had a significant inverse relationship to serum lactate. This finding supports the notion that paCO2 is low in sepsis secondary to metabolic dysregulation and not hyperventilation, which had historically explained low paCO2 under the SIRS model. Metabolic monitoring is available, easy to apply and manage, and contributes valuable information in the detection of sepsis. Further research should be done to understand trends in serum CO2 and its relationship to the development of sepsis. This study also provides important further support for the emerging understanding of the dysregulated host response in sepsis.

Effects of Auricular Acupressure on Nurses' Perceived Stress, Sleep Quality, and Presenteeism: A Single-Blind, Randomized Controlled Trial

The physical and psychological health management of nurses is very important not only for individual nurses but also for organizations and patients. However, nurses are exposed to high stress, sleep problems, and high presenteeism. Therefore, this study aimed to examine the effects of auricular acupressure (AA) on nurses' stress, sleep problems, and presenteeism. This randomized controlled trial encompassed 60 nurses divided into an experimental group (n = 30) and a control group (n = 30). Auricular acupressure using AA stickers with small magnets attached was performed in the experimental group, and a placebo AA using simple AA stickers (without the small magnets) was performed in the control group. The treatment lasted 7 weeks. To confirm the results, stress, sleep quality, and presenteeism were measured at pre- and posttest. There was a statistically significant difference in scores for sleep quality ( t = -1.98, P = .047), health problems ( z = -2.38, P = .017), and work impairment ( t = -4.46, P < .001) between the experimental and control groups at posttest. Auricular acupressure increased sleep quality scores and decreased presenteeism. Auricular acupressure using AA stickers with small magnets attached was effective in improving sleep quality and reducing presenteeism in nurses.

Effectiveness of non-instrumental early mobilization to reduce the incidence of deep vein thrombosis in hospitalized patients: A systematic review and meta-analysis

BACKGROUND

Deep vein thrombosis (DVT) poses a significant health risk, particularly in hospitalized patients with multiple risk factors (cigarette smoking, hypertension, diabetes and obesity). Despite advances in treatment, DVT remains a prevalent complication of hospitalization.

OBJECTIVE

To assess the effectiveness of non-instrumental mobilization in hospitalized patients at high risk of DVT, exploring the challenges and variations in intervention protocols.

DESIGN

Systematic review and meta-analysis.

SETTING(S)

Not applicable.

PARTICIPANTS

Hospitalized patients at risk of deep vein thrombosis.

METHODS

A systematic search of three databases was conducted from interception to September 2023 for randomized controlled trials. This study was registered in PROSPERO (CRD42023460485). This study was conducted according to PRISMA 2020 statement. Two authors independently screened the studies and extracted the data. The quality of the studies was evaluated using the Downs and Black checklist and GRADE system. The amount of evidence certainty was assessed using the Cochrane Risk of Bias Assessment tool. Meta-analysis was performed addressing the incidence of deep vein thrombosis during hospitalization.

RESULTS

7 studies were eligible for inclusion which included a total of 1774 participants. Interventions ranged from active and passive ankle exercises to walking. Meta-analysis demonstrated a significant overall effect in favor of non-instrumental early mobilization compared to usual care (RR = 0.55; 95 % CI = 0.41, 0.73; p < 0.0001). Subgroup analysis comparing type of mobilization revealed significant effects for global (RR = 0.54; 95 % CI = 0.38, 0.78; p = 0.001) and remote mobilization (RR = 0.25; 95 % CI = 0.07, 0.86; p = 0.03).

CONCLUSIONS

Non-instrumental early mobilization is beneficial in reducing the incidence of deep vein thrombosis in hospitalized patients.

REGISTRATION

PROSPERO, registration number: CRD42023460485.

The effect of WhatsApp-based training on nurses' genetic knowledge levels and awareness in Turkey: A quasi-experimental study

BACKGROUND

Genetics plays an important role in healthcare, and it is crucial for nurses to have a good understanding of this field. However, studies have shown that nurses often lack genetic knowledge and awareness. Furthermore, innovative educational approaches, such as WhatsApp-based education, have been proposed to address this knowledge gap, unlike traditional educational methods. These approaches use technology and interactive platforms to engage nurses in dynamic and immersive learning experiences.

AIM

This study aimed to examine the impact of WhatsApp-based training on nurses' genetic knowledge levels and awareness.

METHOD

A quasi-experimental pre-test-post-test design was used. A total of 121 registered nurses participated in a WhatsApp-based training program comprising presentations on genetic issues. Data were collected using Genetics and Genomics in Nursing Practice Survey. Values, means, percentage frequency distributions, and paired-sample t-tests were used.

RESULTS

In the pre-training period, the mean knowledge score of the nurse group was found to be 3.31 ± 1.30 in the pre-training period and 9.58 ± 1.73 in the post-training period. The applied WhatsApp-based training was found to have an effect size of 0.752 on the GGNPS (Genetics and Genomics in Nursing Practice Survey) knowledge score of the sample group (F = 374.882, p = 0.000). In the post-training period, there were significant increases in all the GGNPS items.

CONCLUSION

WhatsApp-based educational programs have the potential to improve nurses' genetic knowledge and awareness. To fulfill the expanding needs of the nursing profession and to enhance patient care outcomes, this study emphasizes the importance of incorporating innovative educational tools into nursing education.

Nursing students' attitudes and beliefs towards addressing sexual health: A multicentre study and latent class analysis

BACKGROUND

To provide competent and respectful sexual health care, a critical and comprehensive assessment of students' attitudes towards sexuality is needed, which implies using reliable and valid questionnaires.

AIM

To assess whether the extended version of the Students Attitude Towards Addressing Sexual Health (SA-SH-Ext) provides different, additional information about students' attitudes towards providing sexual healthcare compared to the Sexual Attitude and Beliefs Survey (SABS), to explore SA-SH-Ext potential response patterns through latent class analysis and to assess students' attitudes towards providing sexual healthcare and evaluate the differences in their attitudes to the cultural background and sociodemographic characteristics.

DESIGN

Multicentre, descriptive, analytical, comparative, and correlational cross-sectional study at three nursing faculties.

PARTICIPANTS

Nursing students n = 514 (Serbia n = 180, Poland n = 150 and Lithuania n = 184).

METHODS

A general questionnaire for obtaining sociodemographic data, SA-SH-Ext and SABS were used as students' report measures.

RESULTS

One part of the variance of each instrument does not overlap with the other, indicating that these instruments, in addition to the shared variance, provide different, additional information. A solution with three latent classes was found in the domain of responses to the SA-SH-Ext items. The response pattern placed nursing students in the class Comfortable and prepared in some situations, and the SABS score revealed students' moderately positive attitudes towards providing sexual healthcare. Significantly more conservative attitudes were demonstrated by students from Poland, those identifying their religious affiliation as Catholic and females, while first-year students showed more positive attitudes than those in later years of study.

CONCLUSIONS

The SA-SH-Ext and SABS enable a reliable and quick assessment of nursing students' comfort and competence in providing sexual healthcare. However, the differences in students' attitudes towards sexuality concerning belonging to a specific group imply a need for curriculum redesign and facilitating students to be more open to communication about sexuality with people with mental illnesses and intellectual and physical disabilities.

Impact of Implementing Electronic Nursing Records on Quality and Safety Indicators in Care

Electronic Health Records (EHR) have been adopted to improve the quality of care. Despite the growing use of health information technology, nursing documentation remains a challenge. In Tunisia, the implementation of the Electronic Medical Record (EMR) system is gaining momentum as part of national initiatives to modernize healthcare. However, nursing documentation is still largely paper-based, and no studies in Tunisia have adressed this topic. This research aims to assess the effect of the Electronic Nursing Record (ENR) on the quality and safety of care indicators (QSCI). This is an interventional study structured in four phases: development, pre-implementation, implementation, and evaluation, integrating the principles of the 'Standards for Reporting Implementation Studies' (StaRI). A list of QSCI was defined and validated through a literature review and Delphi consensus. The impact of the ENR on these indicators was evaluated in a Tunisian university hospital through a quasi-experimental study. Indicators were measured before ENR, one month after, and six months after. Data analyses was conducted using SPSS with statistical tests. Initially, the study led to the identification and validation of seventeen QSCI. Subsequently, a quasi-experimental study was conducted to evaluate the impact of ENR implementation on these indicators. The results revealed a significant improvement in the intervention group (using ENR), particularly in the traceability of vital signs (p < 10⁻3) and infusion administration (p = 0.027). Conversely, the control group (using paper-based documentation) performed better in terms of traceability of inter-team handovers (95.1% compared to 71.9% for the intervention group). The electronic documentation system is seen as a major transformation in healthcare in many hospitals worldwide. Moreover, electronic nursing documentation is crucial for patient safety. Its implementation in our hospital revealed a positive impact of the ENR on certain aspects of care quality while highlighting gaps in inter-team handovers.

The effectiveness of postoperative delirium prevention, diagnosis, and intervention protocol in patients monitored in the intensive care unit after cardiac surgery: a quasi-experimental study

BACKGROUND

The incidence of delirium is high in the intensive care unit (ICU) after cardiac surgery. The development of evidence-based care protocols for delirium management and training of nurses in this regard can ensure effective management of delirium. This quasi-experimental study aimed to assess the effectiveness of a postoperative delirium prevention, diagnosis, and intervention protocol in patients undergoing monitoring in the ICU after cardiac surgery.

METHODS

This study included 64 patients who underwent cardiac surgery and met the inclusion criteria, along with 14 nurses working in the ICU. Patients were divided into control (n = 32) and intervention (n = 32) groups. The study comprised three phases: determining the incidence of delirium in the control group and the delirium diagnosis status of the nurses; providing training to nurses on postoperative delirium prevention, diagnosis and intervention protocol; implementing a preliminary study of the protocol; and finally, implementing the protocol in the intervention group. Statistical significance was set at p < 0.05.

RESULTS

While there was no significant agreement in delirium diagnosis between researcher and nurses in the control group (kappa: 0.207) (p > 0.05), significant agreement was observed in the intervention group (kappa: 1.00) (p < 0.001). The delirium diagnosis rate of the nurses was 14.3% in the control group and 100% in the intervention group, which was a significant difference. The incidence of delirium was 21.9% in the control group and 9.4% in the intervention group, although the difference was not significant.

CONCLUSION

Postoperative delirium prevention, diagnosis, and intervention protocol effectively enhance delirium diagnosis compliance among researchers and nurses and improve the accuracy of delirium diagnosis among postcardiac surgery ICU patients. The implementation of this protocol is recommended for delirium management in such patients.

TRIAL REGISTRATION

This study was retrospectively registered at Clinicaltrials.gov on 19.02.2024 (Clinical Trials ID: NCT06268119).

Sting operations in biomedical publishing violate truthfulness and undermine trust in research

Biomedical research cannot function without the trust of peers and society. The truthfulness of claims made by knowledge-producing agents, such as authors of research, is a prerequisite for their trustworthiness, and violations of truthfulness are rightly seen as a threat to the existence and validity of such research. While most reflection on the lack of truthfulness has focused on fake research, little attention has been paid to how sting operations and hoaxes arguably pose an equally great risk to the ethical integrity of publishing. This paper posits that sting operations, like fake research, are examples of breaches of truthfulness. We also argue that for both fake research, as well as stings and hoaxes, the lack of respect for the ethical criterion of truthfulness makes those researchers who engage in them untrustworthy. Sting operations are akin to fighting fire with fire, further undermining trust in biomedical research. From a deontological perspective, we also argue that the reliance on anonymity in sting operations makes them just as bad, if not worse, than fake research. We advocate for critical scholarship as an alternative to hoaxes and sting operations to expose fake research, in order to promote truthfulness rather than violate it. Finally, we argue that journalists reporting on sting operations should insist less on their entertainment and sensationalist value, and focus more on their unethical nature.

[Post-Intensive Care Syndrome: functional impairments of critical illness survivors]

With a decrease in mortality of critically ill patients in recent years, intensive care medicine research has shifted its focus on functional impairments of intensive care units (ICU) survivors. ICU survivorship is characterized by long-term impairments of cognition, mental health, and physical health. Since 2012, these impairments have been summarized with the umbrella term Post-Intensive Care Syndrome (PICS). Mental health impairments frequently entail new are aggravated symptoms of depression, anxiety, and posttraumatic stress disorder. Beyond impairments in the three PICS domains, critical illness survivors frequently suffer from chronic pain, dysphagia, and nutritional deficiencies. Furthermore, they have a higher risk for osteoporosis, bone fractures, and diabetes mellitus. Taken together, these sequelae reduce their health-related quality of life. Additionally, ICU survivors are challenged by social problems such as isolation, economic problems such as treatment costs and lost earnings, and return to previous employment. Yet, patients and caregivers have described post-ICU care as inadequate and fragmented. ICU follow-up clinics could improve post-ICU care, but there is insufficient evidence for their effectiveness. Thus far, large high-quality trials with multicomponent and interdisciplinary post-ICU interventions have mostly failed to improve patient outcomes. Hence, preventing PICS and minimizing risk factors by optimizing ICU care is crucial, e.g. by implementing the ABCDE bundle. Future studies need to identify effective components of post-ICU recovery interventions and determine which patient populations may benefit most from ICU recovery services.

The effect of training given to patients who underwent ureteroscopy with double-J stent placement on anxiety before and after surgery and readiness for discharge

Patient education is effective in reducing the level of anxiety before and after surgery and increasing the level of readiness for discharge. Patient education provided by nurses can be planned and applied individually. Therefore, this study aims to determine the effect of the education in whom a double J stent after ureteroscopy on their pre- and postoperative anxiety and levels of readiness for discharge. This research study is a randomized controlled trial with control and intervention groups, pre- and posttests. This study was conducted between November 2021 and May 2022 in a university hospital in Turkey. The patients were divided at random into two groups, control (n = 61) and intervention (n = 61). The Personal Information Form, State-Trait Anxiety Inventory (STAI-I, STAI-II), Surgery-Specific Anxiety Scale (SSAS), Readiness for Hospital Discharge Scale for Adult Patients-Short Form (RHDS/SF) and Readiness for Hospital Discharge Scale- Adult-Nurse Assesment Short Form (RN-RHDS/SF) were used to collect the data. The mean SSAS and STAI-I scores on the morning of surgery and before discharge were found to be significantly lower in the intervention group than the control group. The mean RHDS/SF and RN-RHDS/SF scores on the before discharge were found to be significantly higher in the intervention group than the control group. It was concluded that the education provided to the patients in whom a double J stent after ureteroscopy reduced pre- and postoperative anxiety and increased the level of readiness for discharge.

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.

An eHealth Intervention to Improve Quality of Life, Socioemotional, and Health-Related Measures Among Older Adults With Multiple Chronic Conditions: Randomized Controlled Trial

BACKGROUND

In the United States, over 60% of adults aged 65 years or older have multiple chronic health conditions, with consequences that include reduced quality of life, increasingly complex but less person-centered treatment, and higher health care costs. A previous trial of ElderTree, an eHealth intervention for older adults, found socioemotional benefits for those with high rates of primary care use.

OBJECTIVE

This study tested the effectiveness of an ElderTree intervention designed specifically for older patients with multiple chronic conditions to determine whether combining it with primary care improved socioemotional and physical outcomes.

METHODS

In a nonblinded randomized controlled trial, 346 participants recruited from primary care clinics were assigned 1:1 to the ElderTree intervention or an attention control and were followed for 12 months. All participants were aged 65 years or older and had electronic health record diagnoses of at least three of 11 chronic conditions. Primary outcomes were mental and physical quality of life, psychological well-being (feelings of competence, connectedness, meaningfulness, and optimism), and loneliness. Tested mediators of the effects of the study arm (ElderTree vs active control) on changes in primary outcomes over time were 6-month changes in health coping, motivation, feelings of relatedness, depression, and anxiety. Tested moderators were sex, scheduled health care use, and number of chronic conditions. Data sources were surveys at baseline and 6 and 12 months comprising validated scales, and continuously collected ElderTree usage.

RESULTS

At 12 months, 76.1% (134/176) of ElderTree participants were still using the intervention. There was a significant effect of ElderTree (vs control) on improvements over 12 months in mental quality of life (arm × timepoint interaction: b=0.76, 95% CI 0.14-1.37; P=.02; 12-month ∆d=0.15) but no such effect on the other primary outcomes of physical quality of life, psychological well-being, or loneliness. Sex moderated the effects of the study arm over time on mental quality of life (b=1.33, 95% CI 0.09-2.58; P=.04) and psychological well-being (b=1.13, 95% CI 0.13-2.12; P=.03), with stronger effects for women than men. The effect of the study arm on mental quality of life was mediated by 6-month improvements in relatedness (α=1.25, P=.04; b=0.31, P<.001). Analyses of secondary and exploratory outcomes showed minimal effects of ElderTree.

CONCLUSIONS

Consistent with the previous iteration of ElderTree, the current iteration designed for older patients with multiple chronic conditions showed signs of improving socioemotional outcomes but no impact on physical outcomes. This may reflect the choice of chronic conditions for inclusion, which need not have impinged on patients' physical quality of life. Two ongoing trials are testing more specific versions of ElderTree targeting older patients coping with (1) chronic pain and (2) greater debilitation owing to at least 5 chronic conditions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03387735; https://clinicaltrials.gov/study/NCT03387735.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/25175.

Patient Engagement in Evidence-Based Practice Frameworks

Evidence-based practice (EBP) is the cornerstone of contemporary healthcare, promoting the integration of scientific evidence, clinical expertise, and patient values to inform clinical decision-making and enhance patient outcomes. While patient engagement is recognized as a critical component of EBP, the extent to which it is incorporated in various EBP frameworks is unclear. This study is a secondary analysis of a scoping review which evaluated EBP frameworks used in healthcare settings. In the current study, our objective was to assess the level of patient engagement within those frameworks. To achieve this, we employed a patient engagement framework which characterizes engagement as a continuum, spanning consultation to involvement to shared leadership/partnership, across 3 healthcare domains: direct care, organizational design and governance, and policymaking. Our analysis revealed a gap in integrating patient values and preferences within EBP frameworks. Only 3 of the assessed frameworks showed a high degree of engagement across all domains. Future research should focus on developing strategies for implementing and evaluating meaningful engagement in EBP.

Implementing Music Medicine to Improve Pain Outcomes After Abdominal or Pelvic Surgery: A Quality Improvement Project

PURPOSE

Define the impact of the implementation of evidence-based music medicine (MM) on pain management outcomes after abdominal and pelvic surgery when combined with usual care.

DESIGN

This quality improvement project implemented MM in a hospital postanesthesia care unit using a pretest-posttest design. The Roy Adaptation Model and Kotter's Change theory guided all project phases.

METHODS

Nursing staff were educated in-person, via electronic formats and paper handouts. A convenience sample of adults who underwent abdominal or pelvic surgery was offered a preselected MM playlist (via earphones and MP3 players) in addition to usual care during the Phase I recovery period. The outcomes included administered opioids (oral morphine milligram equivalents), pain levels (numerical rating scale), heart rate, respiratory rate, and systolic blood pressure. The outcomes for those who accepted MM (music group) were compared to those for patients admitted to the postanesthesia care unit 1 month before project implementation (baseline group).

FINDINGS

The music group data revealed highly significant reductions in heart rate (P = .008, Cohen's d = 0.57) and systolic blood pressure (P < .001, Cohen's d = 0.78) at 30 minutes compared with pretest data. In contrast, the baseline group data showed no effect on systolic blood pressure levels (P = .274). The music group showed higher clinical significance (1.8 to >2-fold higher effect size) on reducing numerical rating scale scores at 30 minutes (music group: P < .001, Cohen's d = 1.19; baseline group: P = .008, Cohen's d = 0.55) and the final period in phase I (music group: P < .001, Cohen's d = 1.71; baseline group: P < .001, Cohen's d = 0.93). The mean morphine milligram equivalents dose for the music group (29.5 ± SD 19.8) compared with the baseline group (33.0 ± SD 26.6) was not significantly different (P = .376, Cohen's d = 0.18).

CONCLUSIONS

Adding MM with usual care leads to statistically and clinically significant reductions in pain indicators in adults who had abdominal or pelvic surgeries versus usual care alone.

Sleep quality differences among caregivers for persons living with and without dementia

OBJECTIVES

This study examined the relationship between caring for a person with/without dementia and caregiver sleep quality, and analyzed the extent to which perceived benefits of caregiving and assessments of caregiver-recipient relationship quality explain the relationship between care recipient dementia status and caregiver sleep quality.

METHOD

Data were analyzed from caregivers for persons with no or probable dementia who participated in the 2017 National Study of Caregiving (NSOC) and National Health and Aging Trends Study. Caregiver sleep quality was measured using NSOC time diary interview. Perceptions of caregiving and relationship quality were assessed using 4-item surveys. We used multivariable logistic regressions to examine the association between care recipient dementia status and caregiver sleep quality controlling for covariates.

RESULTS

The sample consisted of 1,374 caregivers (mean age = 62.3, SD = 14, 68.3% women, 69.4% non-Hispanic White). In multivariable models adjusting for caregiver and care recipient characteristics, being a caregiver for someone with dementia was associated with 23% lower odds of reporting "excellent/very good" sleep quality (OR: 0.77, 95%CI: 0.61-0.98, p = 0.032). Greater perception of caregiving benefits was associated with 8% greater odds of "excellent/very good" sleep quality (AOR: 1.08, 95%CI: 1.02-1.15, p = 0.013), but did not explain the relationship between dementia and caregiver sleep quality. Positive ratings of relationship quality explained the relationship between care recipient dementia status and caregiver sleep quality (AOR: 0.82, 95%CI: 0.65-1.05, p = 0.12).

CONCLUSION

Improving assessments of relationship quality and amplifying perceptions of caregiving benefits may reduce disparities in sleep quality between caregivers of persons living with or without dementia.

Simplified Chinese Trauma Advanced Practice Nurses' Core Competency Scale: A development and psychometric validation study

BACKGROUND

The core competency of trauma advanced practice nurses (APNs) is directly related to the quality of trauma nursing work.

OBJECTIVES

To develop an instrument to measure trauma APNs' core competency and examine its psychometric properties.

DESIGN

A cross-sectional psychometric validation study.

PARTICIPANTS

A total of 762 trauma nurses recruited from several tertiary hospitals in 14 different provinces of China between June 2023 and May 2024 provided valid data for analysis.

METHODS

The Simplified Chinese Trauma Advanced Practice Nurses' Core Competency Scale (TAPNCCS-SC) was developed through five steps. Step 1) Creation of the operational definition: Based on the onion model, an operational definition of core competencies for trauma nurses is proposed. Step 2) Item generation: Based on the theoretical model, literature review, semi-structured interviews, and Delphi consultation, a preliminary scale was developed. Step 3) Item content validation: 6 experts reviewed items for content validity; Step 4) Pilot study: 21 nurses were selected to test the readability of the preliminary scale; and Step 5) Psychometric evaluation: Item analysis, content validity, exploratory and confirmatory factor analyses, convergent validity, internal consistency reliability, and half-reliability were conducted.

RESULTS

The TAPNCCS-SC consists of 34 items and three dimensions (knowledge and skills, professional competencies, and occupational qualities). The explained variance of the 3-factor was 81.86 %. The CFA showed an acceptable-fitting 3-factor model (χ2/df = 3.653, RMSEA = 0.088, SRMR = 0.402, CFI = 0.920, IFI = 0.920, and TLI = 0.914). For convergent validity, AVE was 0.784-0.804 and CR was 0.974-0.980. The internal consistency and split-half reliability for the total scale were 0.991 and 0.945, respectively. The I-CVI ranged from 0.83 to 1.

CONCLUSIONS

The proposed scale exhibits high reliability and validity and is suitable for assessing the core competency of trauma APNs, which can help nursing managers plan relevant training and enhance trauma care competency.

The relationship between self-efficacy, malicious or benign envy in nurses: A cross-sectional study

AIM

To determine whether nurses' self-efficacy affected envy levels and to develop the necessary strategies.

BACKGROUND

Envy is a widespread global phenomenon. Envy can harm the individual, the work environment, and nursing care. However, the relationships between self-efficacy and envy have not been adequately explored in the nursing context.

METHODS

This study was conducted as a cross-sectional descriptive study. The study sample consisted of 361 nurses working in a university hospital in a province of Türkiye. The research model was analyzed using structural equation modeling. The participants were selected using convenience sampling. This study was reported using the STROBE checklist for cross-sectional studies.

RESULTS

Nurses' educational status affected their self-efficacy. No other personal characteristics influenced self-efficacy and envy. There was a positive relationship between malicious and benign envy. As nurses' self-efficacy increased, malicious envy decreased and benign envy increased.

CONCLUSIONS

The results of this study showed that nurses' education level affected self-efficacy, and self-efficacy level affected envy, and malicious envy could be reduced by improving nurses' self-efficacy.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nursing managers and policymakers should support nursing education at the minimum undergraduate level, encourage nurses to continue their professional education to improve their self-efficacy, and provide training to increase their self-efficacy.

Factors Associated with Take Home Naloxone Refusal among Emergency Department Patients Participating in an Opioid Overdose Prevention Program

BACKGROUND

Increasing the equitable distribution of take home naloxone (THN) may result in reduced deaths from opioid overdose (OD).

OBJECTIVES

The primary study objective is to describe the demographic and clinical characteristics of emergency department (ED) patients who decline THN. The findings of this descriptive study may generate new hypotheses for successful THN distribution.

METHODS

Retrospective chart review using prospectively collected program evaluation data from a single urban EDs Health Education THN database and electronic health record. Characteristics of participants who refused versus accepted THN were compared using Chi-square testing for categorical variables and t-tests for continuous variables. A multivariate model was built to assess associations of statistical and clinically relevant characteristics with THN refusal.

RESULTS

A total of 711 ED patients were offered THN of which 334 (46%) declined. In unadjusted analysis, with the independent variable being refusal of the THN offer, being currently on medication for opioid use disorder (MOUD) was associated with a greater odds of refusal (OR 1.9, 95%CI 1.3-2.6) while any drug related overdose (OR 0.6, 95%CI 0.4-0.8) or being given a prescription for buprenorphine in the ED (OR 0.2, 95%CI 0.1-0.9) were both associated with a lower odds of refusal.

CONCLUSIONS

Demographic characteristics did not differ between those who accept versus refuse THN. Patients already receiving MOUD were more likely to refuse THN while those starting MOUD in the ED were less likely to refuse THN. Further studies are needed to determine the root causes of patients' declination of THN and develop targeted interventions to address these causes.

Adapting to Adulthood: A Review of Transition Strategies for Osteogenesis Imperfecta

Osteogenesis Imperfecta (OI), known as "brittle bone disease," presents a rare genetic disorder characterized by bone fragility, often accompanied by skeletal deformities and extraskeletal complications. OI is primarily associated with collagen type I defects, responsible for the syndromic nature of the disease affecting a broad range of tissues. As such, its multisystemic complexity necessitates multidisciplinary care approaches in all patient life stages. OI treatment remains largely supportive, commonly including bisphosphonates and orthopedic surgeries, which show promise in children. Although rehabilitation programs for children exist, guidelines for adult care and especially the transition from pediatric to adult care, are lagging behind in OI care and research. The current systematic review summarizes the literature on OI patient pediatric to adult care transition experiences and compares OI transition approaches to other chronic diseases. The review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Systematic searches were conducted across multiple databases. Search terms encompassed synonyms and closely related phrases relevant to "OI" and "Transition to adult care". The initial screening involved the evaluation of article titles, followed by a thorough review of abstracts to assess relevance for the purpose of the current review. Programs aimed at easing the transition from pediatric to adult OI care necessitate a multifaceted approach. Collaborative efforts between different medical disciplines including pediatricians, endocrinologists, orthopedics, cardiology, pulmonology, ophthalmology, otolaryngologists, maxillofacial specialists, psychologists and medical genetics, are crucial for addressing the diverse needs of OI patients during this critical life phase. Comprehensive education, readiness assessments, personalized transition plans, and further follow-up are essential components of a structured transition framework. Further research is warranted to evaluate the feasibility and efficacy of sequential stepwise transition systems tailored to individuals with OI.

Nurse Managers' Perceptions of Family and Community Nurse Practitioners Joining Primary Care Teams in Spain: A Qualitative Study

The aim of this study was to explore and describe nurse managers' perceptions of family and community nurse practitioners' impact on primary care teams and public health. A descriptive qualitative study was carried out. The participants were recruited by means of convenience sampling during the months of April and May 2023. 20 nurse managers from different autonomous communities in Spain were interviewed. The data were analyzed following a thematic analysis method using ATLAS.ti nine software. Two main themes and sub-themes were drawn from the data analysis: (1) Nurse managers' view of primary care: (a) The driving force of primary care and (b) Resistance to the integration of family and community nurse practitioners; (2) Proposals for improvement in light of the Family and Community Nurse Practitioner's unique situation. These specialists are highly qualified professionals in primary care teams, whose expertise is evident in how they deliver community and health education activities, empower patients, and lead the training of new specialists.

There is 'no cure for caregiving': the experience of women caring for husbands living with Parkinson's disease

BACKGROUND

Parkinson's disease is a progressive neurodegenerative disorder. The majority of the nearly 9 million people living with Parkinson's disease are men. As such, caregiving is often assumed by wives as the disease progresses. However, there is little research about the lived experience of wives as they transition to caregivers.

OBJECTIVE

To describe the lived experience of wife caregivers of male spouses living at home with Parkinson's disease.

METHODS

A descriptive phenomenological study. Semi-structured interviews were recorded and transcribed for analysis in Atlas.ti using Colaizzi's method.

RESULTS

Thirteen women, aged 50 to 83 years, were interviewed. Five themes emerged from the analysis, (1) caregiver who? (2) taking it day by day, (3) not sure what to do next, (4) just too much, and (5) caring is your soul's growth, to support the central theme "there is no cure for caregiving."

CONCLUSION

Transitioning from wife to caregiver was a gradual but difficult process. Although the wife caregivers wanted to be part of the health care team, they remained outsiders. Clinicians need to recognize the wives as care coordinators linking medical management with home care. Policy makers need to develop reimbursement models that provide wife caregivers with support groups, education programs, and telemental health services.

Factors contributing to the promotion of moral competence in nursing

Ethics is a foundational competency in healthcare inherent in everyday nursing practice. Therefore, the promotion of qualified nurses' and nursing students' moral competence is essential to ensure ethically high-quality and sustainable healthcare. The aim of this integrative literature review is to identify the factors contributing to the promotion of qualified nurses' and nursing students' moral competence. The review has been registered in PROSPERO (CRD42023386947) and reported according to the PRISMA guideline. Focusing on qualified nurses' and nursing students' moral competence, a literature search was undertaken in January 2023 in six scientific databases: CINAHL, Cochrane Library, PsycINFO, PubMed Medline, Scopus and Web of Science. Empirical studies written in English without time limitation were eligible for inclusion. A total of 29 full texts were retrieved and included out of 5233 citations. Quality appraisal was employed using Joanna Briggs Institute checklists and the Mixed Method Appraisal Tool. Data were analysed using inductive content analysis. Research about the factors contributing to the promotion of qualified nurses' and nursing students' moral competence is limited and mainly explored using descriptive research designs. The contributing factors were identified as comprising two main categories: (1) human factors, consisting of four categories: individual, social, managerial and professional factors, and ten sub-categories; and (2) structural factors, consisting of four categories: educational, environmental, organisational and societal factors, and eight sub-categories. This review provides knowledge about the factors contributing to the promotion of qualified nurses' and nursing students' moral competence for the use of researchers, nurse educators, managers, organisations and policymakers. More research about the contributing factors is needed using complex intervention, implementation and multiple methods designs to ensure ethically sustainable healthcare.

Comparative efficacy of non-pharmacological interventions on xerostomia and salivary flow rate among haemodialysis patients: A systematic review and network meta-analysis

Background

Xerostomia is a distressing symptom experienced by patients undergoing dialysis. We sought to compare and rank the efficacy of different non-pharmacological interventions on xerostomia and salivary flow rate among dialysis patients.

Methods

A systematic search was conducted in six English-language databases: PubMed, CINAHL, Scopus, Web of Science, Embase and Cochrane Central Register of Controlled Trials, in April 2023. Screening, quality appraisal and data extraction were undertaken by two independent reviewers. A network meta-analysis was performed to assess the relative efficacy of different non-pharmacological interventions.

Results

The analysis included 11 randomized controlled trials involving 739 patients and eight non-pharmacological interventions. The pairwise analysis indicated that compared with the control group, sugarless candy, chewing sugarless gum, acupressure auricular and licorice mouthwash had a significant positive effect on reducing the severity of xerostomia; also, transcutaneous electrical nerve stimulation (TENS), licorice mouthwash, sugarless chewing gum, photobiomodulation and pure water mouthwash significantly improved the saliva flow rate. The network analysis indicated that sugarless chewing gum significantly reduced the symptoms of xerostomia, while TENS and sugarless chewing gum were effective in improving the unstimulated whole salivary rate. Among dialysis patients, chewing sugarless gum and using TENS were the top-ranked interventions for relieving xerostomia and enhancing saliva flow rate, respectively.

Conclusions

Several non-pharmacological interventions have demonstrated effectiveness in relieving xerostomia and enhancing saliva flow rate. While further research may be needed to confirm and refine these findings, the interventions used in this review offer promising results and should be incorporated into the standard care of dialysis patients experiencing these symptoms to enhance their quality of life and oral health.

Health for Hearts United Longitudinal Trial: Improving Perceived Stress and Allostatic Load Outcomes of Mid-Life and Older African American Women

Cardiovascular disease (CVD) continues to be the leading cause of death in the United States, with African Americans experiencing higher age-adjusted mortality compared to Whites. African American women in particular carry a high CVD burden due to more exposure to adverse personal and socioenvironmental challenges. Church-based interventions can improve health behaviors and health status of African Americans, yet few have addressed stress-related health. The purpose of this study was to determine the effectiveness of the 18-month Health for Hearts United intervention in relation to stress-related outcomes (perceived stress, allostatic load) of mid-life and older African American women (≥45 years of age; n = 152 overall sample, n = 65 clinical subsample). The results of the repeated measures analysis of variance (ANOVA) analyses showed overall significant decreases in perceived stress and allostatic load for both treatment and comparison groups over the measurement occasions (baseline and 18 months) with educational level remaining as a significant correlate over time. There was no significant interaction between treatment and time, yet there were trends in improvements for the treatment group compared to the comparison group. The findings demonstrate the potential of church-based interventions in reducing both self-reported stress and allostatic load in African American women, and highlight the need for further investigation of educational level and other possible factors influencing stress management in these settings.

A pilot randomized controlled trial investigating the effects of an anti-inflammatory dietary pattern on disease activity, symptoms and microbiota profile in adults with inflammatory bowel disease

BACKGROUND/OBJECTIVES

There is a lack of certainty in dietary prescription for individuals with inflammatory bowel disease (IBD) due to heterogeneity in studies to date. The aim of this study was to investigate the efficacy on disease activity of a modified anti-inflammatory dietary pattern purposely designed to reduce intake of food additives (IBD-MAID), compared to standard care, in adults with IBD.

SUBJECT/METHODS

Adults with IBD were randomised to IBD-MAID (meals provided) [n = 29] or general healthy eating (GHE) [n = 29] for 8 weeks. Disease activity, faecal calprotectin (FC), C-reactive protein (CRP), symptoms, and quality of life (S&QOL) were assessed using validated tools.

RESULTS

The IBD-MAID was well tolerated and adhered to (92% adherence). At week 8, there was no statistically significant difference in change from baseline in outcome measures between groups. However, baseline to week 8 analysis indicated: (1) statistically significant improvements in S (p = 0.001) & QOL (p = 0.004), FC (p = 0.007), and Crohn's disease activity (p = 0.03) but not ulcerative colitis, in individuals following the IBD-MAID and (2) statistically significant improvement in QOL in individuals receiving GHE (p = 0.015). Correlation analysis on change from baseline to week 8 revealed a greater decrease in food additives intake was associated with statistically significant improvements in FC, S & QOL and alignment of anti-inflammatory dietary principles with improvements in QOL.

CONCLUSION

The IBD-MAID was well tolerated. The most novel finding pertains to the correlation between reduced food additives intake and improvements in inflammatory markers, S&QOL. Further research is needed to explore the effects of food additives exposure on IBD course.

TRIAL REGISTRATION

12619001500145.

Attitudes of nurses and nurse managers towards violence risk assessment and management: A cross-sectional study in psychiatric inpatient settings

WHAT IS KNOWN ON THE SUBJECT

Workplace violence is a significant challenge in psychiatric hospital care. Some existing practices of violence risk assessment and management are based on nurses' intuition and clinical experience instead of structured tools.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Nurses and nurse managers consider violence risk assessment and management their responsibility. Still, nurses and nurse managers have mixed attitudes towards the use of validated risk assessment tools. The attitudes towards service users' positive risk-taking in nurses and nurse managers vary, with some nurses and nurse managers supporting its importance.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

Change in nurses' and nurse managers' attitudes towards risk assessment tools is required before their implementation into practice. More profound change in practices towards recovery-oriented care is required also in risk assessment.

ABSTRACT

INTRODUCTION: Workplace violence is a prevalent issue in psychiatric inpatient care. Prevention efforts require the identification of at-risk service users using validated violence risk assessment tools. The shift in violence prevention emphasises preventive measures and collaborative risk assessment together with service users. Nurses have a central role in this process. Therefore, their attitudes are crucial when implementing evidence-based methods.

AIM

To assess the attitudes of nurses and nurse managers towards violence risk assessment and management.

METHOD

A cross-sectional online survey in Finnish psychiatric inpatient care. Data analysis was conducted with statistical methods. The STROBE guideline was used in reporting.

RESULTS

Nurses (n = 142) valued risk assessment and felt that it was their responsibility. Attitudes towards service users' risk-taking as part of their recovery varied. Nurses had mixed attitudes regarding the effectiveness of risk assessment tools. Older participants and nurse managers had more positive attitudes towards risk assessment tools.

DISCUSSION

The study findings highlight a feeling of responsibility of nurses towards violence risk assessment and at the same time their preference towards their own clinical judgement.

IMPLICATIONS FOR PRACTICE

Understanding nurses' attitudes is crucial in training and implementation processes to address concerns, provide support and enhance positive attitudes.

Role, education, policies and competencies for advanced practice in paediatric haematology-oncology nursing in Europe: A scoping review

The aim of this scoping review is to describe the role, education, policies/regulation, skills and competencies required for advanced practice in paediatric haematology-oncology nursing in Europe, highlighting the differences in development between the different European countries. A scoping review was conducted following the methodological framework of guidelines by Arksey and O'Malley and the recommendations for advancing the methodology by Levac et al. We searched MEDLINE/PubMed, EMBASE, CINAHL, Cochrane Library, Scopus, grey literature, webpages, reference lists and performed a manual search, without any restrictions on language or time. The intersection between databases, grey literature and evidence documents traced from the sites of the most authoritative European organisations in the field made it possible to identify the regulatory and training differences between the various countries that were examined. This scoping review highlights how advanced knowledge and competences are used in the care of paediatric haematology-oncology patients, which are strictly necessary for implementing quality care. At present these competences are not recognised in policies and regulation in most of the countries that were examined. It is desirable that all EU member states work to implement a radical change and allow these more competent figures to assist patients in the best possible way.

Manifestations of and factors influencing posttraumatic growth among Chinese Crohn's disease patients: a qualitative exploration

OBJECTIVE

This qualitative study aims to explore the manifestations of posttraumatic growth among Chinese patients with Crohn's disease from a cultural perspective and to identify the factors influencing it.

METHODS

A descriptive qualitative research method was used. Semistructured interviews were conducted with 19 patients with Crohn's disease from several hospitals in Hangzhou, Zhejiang Province, China, and the China Crohn's and Colitis Foundation.

RESULTS

There were five key manifestations of posttraumatic growth experienced by Chinese patients with Crohn's disease: improving interpersonal relationships, enhancing personal strengths, changing life priorities, expanding possibilities and gaining religious faith. Posttraumatic growth among patients was predominantly influenced by individual factors, the disease condition and social support.

CONCLUSION

The findings regarding the manifestations of and factors influencing posttraumatic growth in Chinese patients with Crohn's disease are consistent with those in previous studies in patients with chronic diseases. However, our study underscores the multifaceted impact of Chinese cultural characteristics on posttraumatic growth among Crohn's disease patients. These findings can offer valuable guidance for future complex interventions and relevant clinical studies conducted within the Chinese population.

Neurosteroid replacement approaches for improving outcomes after compromised pregnancies and preterm birth

The levels of the key neurosteroid of pregnancy, allopregnanolone, are very high in the fetal and maternal brain compared to after birth. These levels are maintained by the placenta which forms a placental connection to fetal brain development. Maternal stresses depress placental synthesis resulting in a fall in allopregnanolone levels leading to deficits in myelination that continue into childhood. This contributes to an increased incidence of behavioural disorders. Supplementing neurosteroid action with allopregnanolone analogues or raising endogenous production with mitochondrial translocator protein (TSPO) ligands reverses these deficits. Preterm birth leads to an early dramatic loss of neurosteroid support for brain development leading to marked deficits in myelination and susceptibility to hypoxic-ischaemic injury. Postnatal treatment with the allopregnanolone analogue ganaxolone improves myelination and reduces hyperactive behaviour. TSPO ligands such as emapunil have been shown to improve oligodendrocyte maturation. These findings support the use of allopregnanolone supplementation approaches after pregnancy compromises to improve outcome.

Consumer-oriented (patient and family) outcomes from nursing in genomics: a scoping review of the literature (2012-2022)

Introduction

Genomics is a lifespan competency that is important for improving health outcomes for individuals, families, and communities. Nurses play a key role in genomic healthcare and realizing the potential of the genomic era.

Methods

We aimed to chart the current state of genomics in nursing by conducting a systematic scoping review of the literature in four databases (2012-2022). We categorized included articles using the Cochrane Collaboration outcome domains/sub-domains and identify key topical areas.

Results

Of 8532 retrieved articles, we identified 67 articles on 'consumer-oriented outcomes' (patient and family) for analysis. Identified articles primarily centered on themes of genetic testing and screening. Most studies reported non-interventional studies 39/67 (58%) and more than half were from the U.S.A. 34/67 (51%). Six of nine subdomains were reported on. The "patient involvement in care" subdomain was the most commonly reported subdomain (17/67, 25%) while "treatment outcomes" had the fewest reports (5/67, 8%). Overall, consumers (i.e., patients and families) had high satisfaction with nurse-led interventions.

Discussion

Synthesizing findings revealed key knowledge gaps and unmet patient informational needs around genetic testing and decision support. There are opportunities for interprofessional collaboration between nursing and genetic counseling to meet the mounting demand for genomic healthcare and develop more person-centered approaches to genetic counseling and decisional support. Findings support the need for interventional studies and enhanced focus on implementation for nurses to improve consumer-oriented outcomes.

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.

Activities of persons with dementia at home and after nursing home admission: A survey study

OBJECTIVES

This study compared whether the categories of activities that persons with dementia engage in changed between home and after nursing home admission. Also investigated were the methods for assessing the wishes, needs, and abilities regarding activities, and informal caregivers' satisfaction with the degree of assessment of activities during the transition.

METHODS

A cross-sectional survey in which 81 informal caregivers of nursing home residents with dementia participated (37 % male, mean age 65.0 years, SD 10.1).

RESULTS

Persons with dementia performed activities in fewer activity categories in the nursing home compared to home (Z = -3.74, p<.01). Conversation was the most used assessment method. Informal caregivers rated their satisfaction with the degree of assessment of activities during transition with a median score of 7 (IQR 5-8) on a scale from 0 to 10.

CONCLUSION

Monitoring the activities for persons with dementia during the transition is essential and activities should be assessed repeatedly over time to prevent potential activity decline.

Using ChatGPT in Nursing: Scoping Review of Current Opinions

Background

Since the release of ChatGPT in November 2022, this emerging technology has garnered a lot of attention in various fields, and nursing is no exception. However, to date, no study has comprehensively summarized the status and opinions of using ChatGPT across different nursing fields.

Objective

We aim to synthesize the status and opinions of using ChatGPT according to different nursing fields, as well as assess ChatGPT's strengths, weaknesses, and the potential impacts it may cause.

Methods

This scoping review was conducted following the framework of Arksey and O'Malley and guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A comprehensive literature research was conducted in 4 web-based databases (PubMed, Embase, Web of Science, and CINHAL) to identify studies reporting the opinions of using ChatGPT in nursing fields from 2022 to September 3, 2023. The references of the included studies were screened manually to further identify relevant studies. Two authors conducted studies screening, eligibility assessments, and data extraction independently.

Results

A total of 30 studies were included. The United States (7 studies), Canada (5 studies), and China (4 studies) were countries with the most publications. In terms of fields of concern, studies mainly focused on "ChatGPT and nursing education" (20 studies), "ChatGPT and nursing practice" (10 studies), and "ChatGPT and nursing research, writing, and examination" (6 studies). Six studies addressed the use of ChatGPT in multiple nursing fields.

Conclusions

As an emerging artificial intelligence technology, ChatGPT has great potential to revolutionize nursing education, nursing practice, and nursing research. However, researchers, institutions, and administrations still need to critically examine its accuracy, safety, and privacy, as well as academic misconduct and potential ethical issues that it may lead to before applying ChatGPT to practice.

Effect size estimates of risk factors for post-intensive care syndrome: A systematic review and meta-analysis

OBJECTIVE

To provide updated evidence on the risk factors and accurately quantify the effect size of the risk factors associated with post-intensive care syndrome (PICS), encompassing cognitive, mental, physical and socio-economic domains.

RESEARCH METHODOLOGY

We conducted a systematic review of literature from January 2010 to October 2023. The meta-analysis was conducted to calculate an effect size for every risk factor, and odds ratio and 95% confidence intervals were used as summary statistics.

RESULTS

Of 67,468 retrieved studies, 160 were included in qualitative synthesis, 102 were included in quantitative synthesis. A total of 60 factors were identified, categorized into 17 person-related, 23 disease-related and 20 ICU-related categories. The strongest correlations with cognitive health were observed for previous cognitive problems, sedatives and delirium. Factors most strongly correlated with mental health included previous mental problems, delirium, lack of social support, illicit drug and bad experience in ICU. The strongest correlations with physical health involved previous mental problem, delirium, organ dysfunction of neurologic and respiratory support. For socio-economic domains, older age and female were identified as significant risk factors.

CONCLUSIONS

This systematic review and meta-analysis identified and quantified the person, disease, and ICU-related risk factors associated with PICS. These findings may enable clinicians to better recognize the patient at high risk for PICS at an early stage during their stay in ICU.

IMPLICATIONS FOR CLINICAL PRACTICE

A thorough investigation of risk factors across the four domains of PICS is necessary to gain a holistic understanding. The identification and integration of risk factors associated with PICS empower critical care multidisciplinary teams to optimize management strategies, thereby assisting ICU survivors a better recovery. Since multiple risk factors may be simultaneously associated with the four domains of post-intensive care syndrome, it is imperative to develop a comprehensive prediction algorithm.

Two sides of trust: How cancer survivors' communication with healthcare providers and on social media predicted healthy behaviors during COVID-19

OBJECTIVES

COVID-19 exacerbated pre-existing social inequalities. Using three theories linking clinical and media contexts to patients' health outcomes, our study investigated (1) potential factors of cancer patients' trust in healthcare providers and social media; (2) how such trust may influence healthy lifestyles during COVID-19.

METHODS

Using structural equation modeling, we investigated effects of key patient-provider communication variables and media factors on healthy behaviors among cancer survivors (N = 1130) using a nationally representative dataset (HINTS-SEER restricted use files, January-July 2021).

RESULTS

More healthy behaviors since COVID-19 began were associated with more trust in healthcare providers, lower trust in social media about COVID-19, and more use of social media for health purposes. More trust in social media about COVID-19 was associated with more use of social media for health purposes (p < .01). More trust in healthcare providers about COVID-19 was associated with increased perceptions of patient-provider communication (p < .01).

CONCLUSIONS

Findings can inform interventions to connect at-risk cancer patients (e.g., those younger and with lower educational background) with providers in trust-enhancing conversations during situations like COVID-19.

PRACTICE IMPLICATIONS

Partnership building between providers and patients can be supplemented with scientific videos on popular social media sites like YouTube during public health crises and emergencies.

Effectiveness of flaxseed consumption and fasting mimicking diet on anthropometric measures, biochemical parameters, and hepatic features in patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): a randomized controlled clinical trial

BACKGROUND AND AIM

Although benefits of flaxseed and fasting mimicking diet (FMD), each alone, have been shown in the management of metabolic dysfunction-associated steatotic liver disease (MASLD), the benefit of combining the two is not clear. This study aimed to investigate the effect of the combination of FMD and flaxseed supplementation on surrogate measures of MASLD.

METHODS

The present study was conducted as a randomized, parallel, open-label controlled clinical trial on a hundred patients with MASLD for 12 weeks. Eligible participants were assigned to four groups including control group (lifestyle modification recommendations); flaxseed group (30 g/day of flaxseed powder consumption); FMD group (16 h of fasting per day), and combination of FMD with flaxseed. Changes in anthropometric parameters, serum levels of lipids, glycemic measures, High-sensitivity C-reactive protein (hs-CRP), and liver enzymes, and hepatic steatosis and fibrosis by transient elastography were assessed.

RESULTS

Serum triglycerides, total cholesterol, fasting blood glucose and insulin, hs-CRP and liver enzymes decreased in all intervention groups. Hepatic steatosis score decreased in the intervention groups, but not significantly in comparison to the control group. Hepatic fibrosis score decreased significantly in the intervention groups compared to control.

CONCLUSION

Our data indicate that the combination of FMD with flaxseed consumption is not superior to either of the interventions alone in the management of MASLD.

Spirituality, Spiritual Distress and Experiences of Joy, Meaning and Growth Among Parkinson's Disease Caregivers in the United States

Caregiving challenges of Parkinson's disease can result in loss of faith, meaning, and spiritual distress. The purpose of this study is to describe Parkinson's disease caregivers' perceptions and experiences related to spiritual distress, sources of spiritual and religious support, acts, and experiences of growth, and finding meaning and joy in the midst of spiritual distress. We conducted semi-structured interviews with caregivers of persons with Parkinson's disease (n = 16) and identified five themes: (a) Bearing witness to suffering underlies spiritual distress; (b) Prayers are pleas for "soul help"; (c) Spiritual guidance and support are important; (d) Faith and community are sources of spiritual support; and (e) Joy, meaning, and growth help to transcend spiritual distress. Interventions that target sources of spiritual distress and joy are needed.

Understanding Experiences of Diabetes Distress: A Systematic Review and Thematic Synthesis

Background: Diabetes distress is a common emotional issue for those living with diabetes, which has the potential to negatively impact well-being, management behaviors, and HbA1c levels. These implications have led to diabetes distress becoming an important consideration in diabetes healthcare and management. Nonetheless, discussions remain ongoing on how to best conceptualize this experience. Recent research has attempted to enhance conceptualization by considering the underlying emotional mechanisms that may underpin the highly contextualized experience of diabetes distress. Qualitative insights can further add to these understandings; however, the research in this remit is yet to be systematically reviewed. This review therefore sought to add to the growing body of literature attempting to better conceptualize diabetes distress and the underlying mechanisms that may contribute to this experience. A secondary aim was to leverage this understanding to consider ways to improve patient-healthcare interactions. Methods: A qualitative systematic review and thematic synthesis was undertaken. Eligible studies were identified through PsycINFO, MEDLINE, CINAHL, and EMBASE databases from November 2020 to May 2021. Study quality was assessed using the McMaster Critical Review Form. Results: Nineteen papers were included in the review. The analysis resulted in seven descriptive themes which contributed to three analytical themes: (1) threatened autonomy, (2) sense of helplessness, and (3) negative sense of self. These results highlight that a major area underpinning experiences of diabetes distress is not feeling in control. Conclusions: Consideration should be given to how psychological factors, such as locus of control and learned helplessness, may constitute underlying mechanisms impacting emotional regulation in those experiencing diabetes distress. Clinicians should consider including and leading discussions around distress during appointments, as well as using approaches that promote patient autonomy and empowerment.

Clinical practice and standard discrepancies in aspiration prevention among advanced practice nurses in geriatrics: A cross-sectional survey

AIM

To investigate the discrepancies between clinical practices and aspiration prevention standards among advanced practice nurses (APNs) in geriatrics and provide a basis for risk evaluation and prevention strategies for older adults.

METHODS

Using convenience sampling from November 20 to December 30, 2023, we surveyed 227 APNs in geriatrics from Guangdong Province, China. Data were collected using demographic forms and questionnaires focused on aspiration prevention strategies for older adults. Univariate and multivariate linear stepwise regression analyses were conducted to identify factors that influenced the effectiveness of aspiration prevention by APNs.

RESULTS

The mean score of APNs in geriatrics for older adult aspiration prevention was 94.9 ± 17.4. The multivariate regression analysis identified hospital level, evidence-based practice, and job satisfaction as significant factors.

CONCLUSION

This study highlights the essential contribution of APNs to geriatric care and emphasizes the need for sustained professional development and adherence to evidence-based protocols to optimize aspiration prevention strategies.

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.

Effects of different types of intermittent fasting on metabolic outcomes: an umbrella review and network meta-analysis

BACKGROUND

Intermittent fasting (IF) holds promise for enhancing metabolic health. However, the optimum IF forms and their superiority over continuous energy restriction (CER) remain unclear due to disconnected findings.

METHODS

We systematically searched PubMed, Embase, and the Cochrane databases for meta-analyses of randomized controlled trials (RCTs) investigating the association between IF and metabolic health outcomes. Subsequently, we performed an umbrella review and network meta-analysis (NMA) to evaluate the efficacy of different forms of IF (time-restricted eating (TRE), alternate-day fasting (ADF), and 5:2 diet (regular eating for 5 days and energy restriction for 2 days per week)) compared to CER and usual diets on metabolic health outcomes. To assess the certainty of both direct and indirect estimates, we employed the Confidence in Network Meta-Analysis (CINeMA) approach. Additionally, we calculated the surface under the cumulative ranking curve (SUCRA) for each dietary strategy to determine their ranking in terms of metabolic health benefits.

RESULTS

Ten of the best and non-redundant meta-analysis studies, involving 153 original studies and 9846 participants, were included. When considering direct evidence only, all IF forms significantly reduced body weight compared to usual diets. In NMA incorporating indirect evidence, all IF regimens also significantly reduced body weight compared to usual diets. In the SUCRA of NMA, IF ranked higher than usual diets or CER in 85.4% and 56.1% of the outcomes, respectively. ADF had the highest overall ranking for improving metabolic health (ranked first: 64.3%, ranked second: 14.3%).

CONCLUSIONS

Overall, all IF forms demonstrate potentials to improve metabolic health, with ADF appearing to produce better outcomes across investigated outcomes. Further high-quality trials are warranted to confirm the (relative) efficacy of IF on metabolic health.

TRIAL REGISTRATION

PROSPERO (record no: CRD42022302690).

Nurses' models of spiritual care: Predictors of spiritual care competence

OBJECTIVES

Previous studies have shown that nurses' spiritual care competence is related to characteristics of personal spirituality, training adequacy, and comfort, confidence, and frequency of provision of spiritual care. However, these studies assumed that all participants understood spiritual care in the same way, and used self-ratings of spiritual care competence, which are problematic. Our previous study found that spiritual care was understood in 4 qualitatively different ways that can be arranged in order of competence. This study aimed to re-examine the relationships between nurse characteristics and spiritual care competence, using spiritual care understanding as a proxy for competence.

METHODS

Data was collected from a convenience sample of nurses who completed an anonymous, online survey. The survey provided qualitative data about what spiritual care means for them. The survey also provided quantitative data regarding nurse characteristics. This study created sub-groups of nurses based on their understanding of spiritual care, and used the quantitative data to construct a profile of nurse characteristics for each sub-group. Kruskal-Wallis statistical tests determined whether nurse characteristics differed across the 4 sub-groups.

RESULTS

Spiritual care competence was not related to confidence or comfort in providing spiritual care. Relationships with spirituality, training adequacy, and frequency of provision of spiritual care were not linear; i.e., higher competence did not always correspond with higher scores of these characteristics.

SIGNIFICANCE OF RESULTS

The results raise concerns about the construct validity of using comfort and confidence as estimates of spiritual care competence. That the relationships between competence and spirituality, training adequacy, and frequency of spiritual care provision was not as linear as portrayed in extant literature, suggests that outcomes of training may depend on the type of spiritual care understanding subscribed to by training participants. The findings offer insights about how nurses could achieve high levels of spiritual care performance.

Parental stress and nurse-parent support in the neonatal intensive care unit: a cross-sectional study

BACKGROUND

Admission of a preterm infant to the Neonatal Intensive Care Unit (NICU) is highly stressful for parents. NICU nurses play a crucial role in providing support, positively impacting health and aiding effective stress management during this challenging period. This study assesses stress and nurse-parent support for parents with preterm infants in the NICU, exploring connections between stress, support, and various parental and infant variables.

METHODS

This descriptive cross-sectional study was conducted between January and July 2019 on a total of 150 parents (75 mothers and 75 fathers) with preterm infants in a private hospital's NICU in Ankara, Turkey. Data were collected using the Parent and Infant Information Form, Parental Stressor Scale: NICU (PSS: NICU), and Nurse-Parent Support Tool (NPST).

RESULTS

There was no significant correlation between PSS: NICU and NPST scores (p > 0.05). However, a significant difference was observed in the overall NPST score (p = 0.036) and its emotional support subscale (p = 0.013). Mothers' PSS: NICU was influenced by infant information (p = 0.027) and marital duration ((p = 0.002), while fathers' was influenced by number of children (p = 0.040) and infant care participation (p = 0.001). NPST was affected by number of children (p = 0.004) and infant respiratory status (p = 0.011) for mothers and number of children for fathers (p = 0.038). Since parents require informational, emotional, and care-related support, nurses should continuously enhance their professional and communication skills to establish effective communication with parents and provide targeted support.

CONCLUSION

This study found mothers received greater nurse support than fathers. Mothers with one child had higher nurse support, while mechanical ventilation for mothers and having more than one child for fathers were linked to reduced support. Lower stress levels were noted in mothers married for 6-10 years, those informed about the infant, and fathers actively participating in infant care with more than one child.