Prognostic value of CD163+ macrophages in solid tumor malignancies: A scoping review

Tumor-associated macrophages (TAMs) play crucial roles in development and progression of malignant diseases. Notably, CD163+ TAMs likely perform specific pro-tumorigenic functions, suggesting that this subset may serve as both prognostic biomarkers and targets for future anti-cancer therapy. We conducted a scoping review to map the current knowledge on the prognostic role of CD163+ TAMs in the five most lethal cancers worldwide: Lung, colorectal, gastric, liver, and breast cancer. For all cancer types, most studies showed that high tumoral presence of CD163+ cells was associated with poor patient outcome, and this association was more frequently observed when CD163+ cells were measured at the tumor periphery compared to more central parts of the tumor. These results support that CD163+ TAMs represent a biomarker of poor patient outcome across a variety of solid tumors, and highlight the relevance of further investigations of CD163+ TAMs as targets of future immunotherapies.

Diagnostic Techniques for Infantile Subglottic Hemangiomas: A Scoping Review

OBJECTIVE

Infantile subglottic hemangioma (SGH) poses a risk of airway compromise if untreated. Traditionally, operative endoscopy (OH) diagnoses SGH, but since the discovery of beta-blockers' efficacy in treating infantile hemangiomas (IHs) in 2008, and advances in endoscopic technology, nonoperative methods have emerged. This review identifies endoscopic practices for diagnosing and monitoring infantile SGH during the oral beta-blocker treatment era.

DATA SOURCES

A comprehensive literature search in October 2022 and August 2023 covered PubMed, Embase, Cochrane Library, SCOPUS, and Web of Science.

REVIEW METHODS

The search was limited to English-language studies published since 2008, considering this when propranolol was demonstrated as an effective treatment option for IH. The articles were screened for relevance based on predefined inclusion and exclusion criteria.

RESULTS

After inclusion and exclusion criteria, sixty final studies were identified, describing 240 cases of infantile SGH. Most children were diagnosed using OE alone (73.3%; n = 176/240), 23.3% (n = 56/240) using office-based laryngoscopy procedures (OBPs) followed by OE, 3.3% using OBP alone (n = 8/240). There were no reported diagnostic endoscopy-related complications. Twenty-nine studies described using endoscopy plus diagnostic imaging to either confirm an SGH lesion, characterize the extent of disease spread, or rule out other causes of presenting symptoms. The proportion of infants diagnosed with OE alone decreased from 2008 to 2023.

CONCLUSION

Operative endoscopy remains the SGH diagnostic standard, but OBP adoption is increasing. Further research is needed to determine the optimal SGH diagnosis and management approach.

LEVEL OF EVIDENCE

NA Laryngoscope, 135:1287-1294, 2025.

Impacts of Lifestyle Intervention by a Nurse-Led Smartphone Application on Blood Pressure, Weight, and Pregnancy Outcomes in Pregnant Women With Gestational Hypertension: A Randomized Controlled Trial

High blood pressure and excess weight during pregnancy can have adverse outcomes. This randomized controlled trial evaluated the effects of a nurse-led smartphone application-based lifestyle intervention on blood pressure, body weight, and pregnancy outcomes in pregnant women with gestational hypertension between August and December 2023. Pregnant women, between 20 and 28 weeks of gestation, were allocated to the intervention or control group. Control group (n = 99) received standard high-risk pregnancy management, while intervention group (n = 96) also received lifestyle guidance via a nurse-led smartphone application. Intervention group experienced longer gestations (p = 0.007), higher neonatal weights (p = 0.028), and lower incidences of pre-eclampsia (p < 0.001), small for gestational age infants (p = 0.003), and preterm births (p = 0.023) compared to control group. The mixed-effect models for repeated measures showed that the nurse-led smartphone application intervention had no impact on body mass index, while significantly reducing systolic and diastolic blood pressure measurements (β = -1.666, 95% confidence interval, CI: -2.814 to -0.519, p = 0.005 and β = -2.247, 95% CI: -3.349 to -1.145, p < 0.001, respectively). Both systolic and diastolic blood pressures showed a downward trend from 28 weeks (p < 0.05). The nurse-led smartphone application-based lifestyle intervention significantly reduced adverse pregnancy outcomes and positively influenced blood pressure management in pregnant women with gestational hypertension.

Stakeholder-driven multi-stage adaptive real-world theme-oriented (SMART) telehealth evaluation framework: a scoping review

Telehealth has revolutionized healthcare delivery by integrating cutting-edge technologies, yet evaluations of its services and programs often lack comprehensive frameworks, resulting in unclear standards for quality assurance. To address this gap, we conducted a scoping review of telehealth evaluation frameworks applicable to the United States healthcare system, following the Joanna Briggs Institute methodology and a published protocol. Twelve telehealth evaluation frameworks published between 2019 and 2023 were identified, focusing on four key themes: program implementation, clinical impact, economic impact, and equity. Guided through two auxiliary frameworks, we further developed a stakeholder-driven multi-stage adaptive real-world theme-oriented (SMART) conceptual framework for telehealth evaluation. We illustrated this framework through a use case on a remote patient monitoring program. This comprehensive telehealth evaluation framework not only facilitates stakeholders in developing tailored evaluation plans but also contributes to the standardization and enhancement of telehealth services, ultimately improving health outcomes and promoting greater equity across society.

Videodistraction to reduce agitation in elderly patients in the emergency department: an open label parallel group randomized controlled trial

BACKGROUND AND IMPORTANCE

Agitation of elderly patients in the emergency department (ED) often complicates workup and therapy.

OBJECTIVE

In this study, we investigated if agitation in the ED can be reduced by showing calming video sequences in elderly agitated patients.

DESIGNS

Prospective randomized intervention study.

SETTINGS AND PARTICIPANTS

ED patients aged ≥65 years were screened for the risk of agitation/delirium using the 4-A's test (4-AT) test. In case of ≥4 4-AT points, patients were scored using the Richmond Agitation-Sedation Scale (RASS) and the Nursing Delirium Screening Scale (Nu-DESC). They were included in the study if RASS was ≥+2 and Nu-DESC ≥ 4 after informed consent of the legal representative. Patients were then randomized to the intervention or control group. A total of n  = 57 patients were included in the study.

INTERVENTION

Patients in the intervention group were exposed to projections of calming video sequences for 60 min. Patients in the control group received standard care.

OUTCOME MEASURES AND ANALYSIS

Changes in RASS and Nu-DESC were assessed 30 and 60 min after the intervention was started.

MAIN RESULTS

A total of 57 patients were included in the study, with 30 patients in the intervention group and 27 patients in the control group. Before the intervention, the median (interquartile range) RASS scores were comparable between the intervention group [3 (2-3)] and the control group [3 (2-3)]. After 30 min of exposure to calming video sequences, patients in the intervention group showed significantly lower RASS and Nu-DESC scores compared to the control group [RASS: 1 (0-1) vs. 2 (1.5-3), P  < 0.001; Nu-DESC: 3 (2-4) vs. 5 (4-6), P  < 0.001]. This difference persisted at 60 min [RASS: 0 (0-1) vs. 2 (1-2.5), P  < 0.001; Nu-DESC: 2 (2-3) vs. 5 (4-6), P  < 0.001]. Additionally, fewer patients in the intervention group required additional sedating or antipsychotic medication (1/30) compared to the control group (9/27), with this difference being statistically significant ( P  = 0.004).

CONCLUSION

In this randomized controlled trial, the use of calming video sequences in elderly patients with agitation in the ED resulted in significant reductions in agitation and the need for additional sedative or antipsychotic medication.

Training programmes for healthcare professionals in managing epidural analgesia: A scoping review

BACKGROUND

Epidural analgesia (EA) is widely used for postoperative and labour pain management. Systematic training of healthcare professionals, particularly nurses, is essential for the safe administration and management. This scoping review aimed to identify and map existing EA training programmes.

METHODS

A PRISMA-ScR-guided search was conducted across multiple databases and grey literature. Studies on educational interventions for healthcare professionals in EA management were included. Data extraction and categorisation were performed using Kirkpatrick's Four-Level Training Evaluation Model.

RESULTS

Eighteen studies were included, covering classroom training, workshops, self-directed learning, simulation-based training, and on-the-job training. Participants were primarily nurses. Programmes addressed epidural techniques, monitoring and assessment, spinal anatomy and pharmacology, complication management, and patient care. Most studies focused on short-term knowledge gains, with a limited assessment of long-term clinical impacts.

CONCLUSION

Limited research exists on EA training, with most programmes targeting nurses and relying on classroom-based training. Training structures varied, and evaluations primarily assessed short-term knowledge gains.

EDITORIAL COMMENT

The authors conducted a literature search to get an overview of programmes that aimed to train healthcare staff in managing epidural pain relief. Most of the identified 18 studies described classroom teaching and focused primarily on knowledge about complications. Patient contact in this type of training was not reported. The effectiveness of this type of training in a clinical context was difficult to evaluate based on the published evidence.

Enhancing physiotherapists' knowledge and skills in facilitating self-management of patients with chronic musculoskeletal pain conditions: a best practice implementation project

INTRODUCTION

Evidence-based self-management strategies in chronic disease management are associated with increased self-efficacy and improved health-related quality of life. Physiotherapists feel unprepared to promote these strategies in patients with chronic musculoskeletal pain conditions.

OBJECTIVE

The objective of this best practice implementation project was to assess and promote exercise-centered self-management strategies in physiotherapy care.

METHODS

JBI's Evidence Implementation Framework, Practical Application of Clinical Evidence System (PACES) audit tool, and Getting Research into Practice (GRiP) method were used. The project was conducted in Germany at the University Hospital of the Brandenburg Medical School in the Department of Physiotherapy. Barriers and facilitators to implementation were identified through qualitative interviews with musculoskeletal pain experts in the team (N  =  5). All team members (N  =  16) completed a 31-item standardized questionnaire to determine compliance with seven audit criteria. The results of the baseline audit informed the implementation strategy. A post-implementation audit was conducted to measure improvements in practice.

RESULTS

Baseline compliance with audit criteria ranged from 0% to 89%. Barriers to implementation included lack of knowledge on self-management facilitation (e.g., assessment of patient capabilities, pain education, goal-setting, self-monitoring, action plan development) and no standardized documentation. The implementation strategy combined interactive educational training with the introduction of two standardized assessment and documentation forms. Moreover, a short-form exercise diary was created to facilitate patient self-monitoring. In the follow-up audit, five of the seven audit criteria improved.

CONCLUSIONS

A combination of interactive educational training, standardized physiotherapy assessment and documentation, and a short-form exercise diary may be appropriate strategies to increase compliance for exercise-related self-management facilitation.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A345.

Leadership in Culturally and Linguistically Diverse Healthcare Workplaces: A Scoping Review

AIM

To map the existing literature and research themes related to leadership in culturally and linguistically diverse healthcare workplaces and identify potential research gaps to guide future studies.

DESIGN

A scoping review.

METHODS

The review followed the Joanna Briggs Institute scoping review methodology. A total of 15,078 studies were imported into Covidence for screening. Results were analysed using inductive content analysis.

DATA SOURCES

Searches were conducted on CINAHL, Medline (Ovid), ProQuest, Scopus, and the Finnish Medic database. Unpublished studies and grey literature were searched using MedNar. The scoping review included published and unpublished original studies in English, Finnish, and Swedish with no time or geographical limits.

RESULTS

The review included 19 studies. This scoping review identified four main categories of leadership in culturally and linguistically diverse healthcare workplaces: promoting cultural adaptation, being a cultural mediator, ensuring competence development and continuous education, and developing culturally sensitive leadership.

CONCLUSIONS

Leaders should adopt a supportive and open leadership style to promote cultural adaptation in culturally and linguistically diverse workplaces. Leaders' cultural competence can be enhanced through continuous education and training. Leaders should provide competence development opportunities for all employees in culturally and linguistically diverse workplaces. The findings highlight the need for more research (e.g., educational intervention studies) to understand the challenges and opportunities of leading a diverse workforce in a healthcare setting.

IMPLICATIONS FOR HEALTHCARE MANAGEMENT

The findings highlight the importance of leadership in promoting cultural adaptation and inclusive environments in culturally and linguistically diverse workplaces. Leaders should continually develop their cultural competence to effectively lead culturally and linguistically diverse workplaces. Developing culturally sensitive leadership requires strong communication skills and cultural understanding to promote inclusion.

IMPACT

Our review's results underscore the need for healthcare organisations to embrace leadership practices that are inclusive and culturally competent in increasingly diverse workplaces. As the workforce becomes more diverse, it is important to understand how leadership characteristics influence culturally and linguistically diverse healthcare workplaces.

REPORTING METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was used when reporting the results.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

TRIAL REGISTRATION

The protocol was registered in the Open Science Framework (10.17605/OSF.IO/2AK73).

The process of student engagement in school health promotion: a scoping review

BACKGROUND

Health Promoting Schools (HPS) is a whole school model that strengthens and maintains a healthy school environment. While a key component of HPS is the engagement of students, there is little known about the strategies for, facilitators of, and barriers to, student engagement. The purpose of this scoping review was to summarize and characterize the evidence on the process of student engagement in school health promotion, with a focus on whole school models like HPS.

METHODS

This scoping review followed the Joanna Briggs Institute guidelines and the Arksey and O'Malley scoping review framework. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guided reporting. Eligibility included sources examining the process of student engagement in school health promotion for children and youth (ages 5-19) in any country, who attended a private or public school. Both published and unpublished sources were included. Databases searched were: CINAHL, ERIC, MEDLINE, Scopus, and Google Scholar. Relevant organisational websites and sources identified by experts were also reviewed. Two independent reviewers screened the title, abstract, and full text of the sources. Descriptive analysis was conducted for quantitative data, and content analysis was employed for qualitative data.

RESULTS

1740 sources were screened, 133 citations were eligible for full text review and a total of 50 sources were included: 38 peer-reviewed publications, 7 grey literature sources, 2 peer-reviewed publications from reference-checking and 3 sources recommended by experts. The majority of articles reported on primary research (n = 34), employed qualitative methods (n = 28) and over half of all sources were published from European institutions/organizations (n = 26). Process strategies for student engagement predominantly related to participatory mechanisms including reflection and visioning, determining priorities and action-oriented learning. A wide range of intersecting facilitators and barriers were identified, with school structures largely acting as a barrier and adult approaches to engagement being a facilitator.

CONCLUSION

This scoping review described the strategies, facilitators and barriers involving the process of student engagement in school health promotion. The results can inform the development and implementation of future student engagement strategies to strengthen school health promotion actions.

The Meaning of Autism Friendly in Hospital Settings: A Scoping Review of the Autism Community's Perspectives

Hospitals are motivated to create more autism friendly environments to optimise access and experience for the community. However, there is a lack of clarity in what the term autism friendly in hospital settings means. We conducted a scoping review of four online databases and eleven national autism organisations to determine existing definitions for autism friendly within hospital settings. To operationalise the meaning of autism friendly hospital care, we then reviewed barriers and facilitators to hospital care from the perspective of autistic patients. Within the seven studies that considered the meaning of autism friendly, we found that the term autism friendly within a hospital context is undefined. To operationalise the meaning of autism friendly within hospitals, we identified barriers and facilitators in 16 studies that examined the hospital experience of autistic patients. We identified 19 facilitators and 23 barriers across three categories: people, place, and time. Flexibility underpinned the three categories, with flexible people, flexible place, and flexible timing reported as being integral to improving the hospital experience of patients with autism. Our findings provide clear guidance for creating autism friendly hospital care.

Rapid response systems, antibiotic stewardship and medication reconciliation: a scoping review on implementation factors, activities and outcomes

INTRODUCTION

Many patient safety practices are only partly established in routine clinical care, despite extensive quality improvement efforts. Implementation science can offer insights into how patient safety practices can be successfully adopted.

OBJECTIVE

The objective was to examine the literature on implementation of three internationally used safety practices: medication reconciliation, antibiotic stewardship programmes and rapid response systems. We sought to identify the implementation activities, factors and outcomes reported; the combinations of factors and activities supporting successful implementation; and the implications of the current evidence base for future implementation and research.

METHODS

We searched Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Education Resources Information Center from January 2011 to March 2023. We included original peer-reviewed research studies or quality improvement reports. We used an iterative, inductive approach to thematically categorise data. Descriptive statistics and hierarchical cluster analyses were performed.

RESULTS

From the 159 included studies, eight categories of implementation activities were identified: education; planning and preparation; method-based approach; audit and feedback; motivate and remind; resource allocation; simulation and training; and patient involvement. Most studies reported activities from multiple categories. Implementation factors included: clinical competence and collaboration; resources; readiness and engagement; external influence; organisational involvement; QI competence; and feasibility of innovation. Factors were often suggested post hoc and seldom used to guide the selection of implementation strategies. Implementation outcomes were reported as: fidelity or compliance; proxy indicator for fidelity; sustainability; acceptability; and spread. Most studies reported implementation improvement, hindering discrimination between more or less important factors and activities.

CONCLUSIONS

The multiple activities employed to implement patient safety practices reflect mainly method-based improvement science, and to a lesser degree determinant frameworks from implementation science. There seems to be an unexploited potential for continuous adaptation of implementation activities to address changing contexts. Research-informed guidance on how to make such adaptations could advance implementation in practice.

Advance care planning and goals of care discussions in perioperative care: a scoping review

BACKGROUND

Advance care planning is well established in general medical wards, but its implementation in anaesthesia and perioperative care presents unique challenges. Effective communication and shared decision-making regarding treatment limitations are essential to clarify care goals and provide timely, high-quality end-of-life care. Terminally ill patients with complex care needs can experience a higher risk of postoperative mortality during anaesthesia.

METHODS

This scoping review examines the literature describing when and how advance care planning has been studied in perioperative care, focusing on patient characteristics, the content of advance care planning discussions, and impact on patient outcomes. The study follows PRISMA-ScR guidelines. Articles were collected from MEDLINE, CENTRAL, and CINAHL databases, using search terms from MeSH and synonyms for anaesthesia, surgery and perioperative care, advance care planning, living wills or advance directives, goals of care and terminal care, resuscitation orders, shared decision-making, and palliative care discussions.

RESULTS

Advance care planning documentation varies across surgical specialties and settings, with higher rates in emergency and palliative surgery. Patient factors, such as age and comorbidities, impact completion of advance care planning. Structurally, the presence of interdisciplinary teams, increased decision-making aids, and structured discussions improve implementation. Barriers included a lack of consistency in terminology, poor timing of needed conversations, a lack of cultural sensitivities, and patient fears of abandonment and palliative care.

CONCLUSIONS

Further research is required to determine the most appropriate and beneficial methods and outcomes for implementing advance care planning into perioperative and end-of-life care, ensuring appropriate, timely, and patient-oriented care delivery.

Integrating Cultural Competence in Nursing: A Scoping Review of Purnell's Model in Clinical Practice and Education With Data Mining Analytics

INTRODUCTION

Purnell's Model for Cultural Competence outlines that cultural competence is essential for bridging the gap between health care providers and patients from diverse cultural backgrounds.'

METHODOLOGY

This study followed PRISMA-ScR guidelines, focusing on studies involving nurses, nursing students, and educators using Purnell's Model. Literature was searched across six databases up to July 2024.

RESULTS

From 834 records, 20 studies met the inclusion criteria. The primary themes identified were "Cultural competence in health care" and "Nursing interventions and patient relationships." Subtopics included Cultural health care practices, Patient-centric nursing, holistic and culturally sensitive care, and integrated care and education. These subtopics provide a nuanced understanding of cultural competence application across various settings.

DISCUSSION

Findings highlight the importance of integrating cultural competence training to reduce health care disparities, improve patient-provider communication, and enhance the efficacy of nursing interventions in diverse populations. Incorporating these aspects into education and practice is crucial for achieving cultural competence in nursing.

Factors shaping learning in clinical environments for healthcare professionals in low- and middle-income countries: a scoping review protocol

INTRODUCTION

The clinical environment is recognised to influence learning for healthcare professionals, with the described challenges likely extenuated in low- and middle-income countries that are tackling resource limitations. There is limited research on factors influencing learning in clinical environments in low- and middle-income countries, with no scoping review on this topic published to date. This review will identify the key factors described to shape learning in clinical environments for healthcare professionals in low- and middle-income countries.

METHODS AND ANALYSIS

A scoping review will be performed according to Joanna Briggs Institute (JBI) methodology and reported following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Databases to be searched include MEDLINE (Ovid), Embase (Elsevier), CINAHL (EBSCO), Web of Science, ERIC (Education Resources Information Center) and Global Health (CABI) from 1990 to present with no language restriction. Following abstract and full-text screening by two independent reviewers, data will be extracted by two independent reviewers and presented in diagrammatic or tabular form, accompanied by a narrative summary. Results will be summarised using quantitative and qualitative analyses. Data will be organised using the components of the clinical learning environment to present factors shaping learning, described challenges, outcomes of interventions and reported recommendations for improvement.

ETHICS AND DISSEMINATION

Ethics approval is not required. Findings will be disseminated through conference presentations and publication in a scientific journal. Results will be used to inform future studies exploring stakeholder perspectives on clinical learning in paediatric oncology in low- and middle-income countries.

TRIAL REGISTRATION DETAILS

This protocol was registered on Open Science Framework on 5 September 2024; https://osf.io/ysedk.

Improving post-operative pain management after total hip and knee replacement in a special care unit: a best practice implementation project

INTRODUCTION

Post-operative pain is often underestimated (70% of surgical patients experience some degree of pain) and is insufficiently treated. This increases morbidity and mortality, mainly due to respiratory and thromboembolic complications, longer hospital stays, deterioration in quality of life, and occurrence of chronic pain.

OBJECTIVES

This study aimed to improve post-operative pain management in the first 4 hours after total hip and knee replacement by promoting best practices.

METHODS

This project used the JBI Evidence Implementation Framework. JBI's Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit tools were used to collect data and develop implementation strategies, in line with identified barriers. The project was conducted in a special care unit in a primary hospital in Spain using a sample of 30 patients. Three phases of activity were followed: conducting a baseline audit, implementing improvement strategies, and conducting follow-up audits to assess intervention outcomes. The evaluation criteria used in the audits were derived from a JBI evidence summary on post-operative pain management.

RESULTS

The baseline audit identified five barriers: lack of nursing staff knowledge of appropriate pain assessment scales; lack of complete pain assessment record in the electronic nursing records; lack of staff confidence in evidence-based practice; lack of dedicated training time for staff; and low staff participation in consensus process. Strategies were formulated to address these barriers using JBI's GRiP method. Following implementation, compliance with all audit criteria significantly improved.

CONCLUSION

The strategies developed using the JBI Evidence Implementation Framework positively impacted compliance with best practices.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A339.

Educational Needs of Patient Safety Care Among Nurses in General Hospitals

BACKGROUND

Education is one of the effective strategies to improve patient safety care in healthcare. For better education, it is essential to identify areas where intervention is needed.

OBJECTIVE

This study was designed to analyze nurses' educational needs by comparing the perceived importance and performance of patient safety care in general hospitals in Korea.

METHODS

A cross-sectional study of 296 nurses in Korea was conducted between November and December 2022. The importance-performance analysis (IPA), Borich rank assessment, and the locus for focus (LF) model were used to compare nurses' perceived importance and performance of each aspect of patient safety care.

RESULTS

Overall, the mean performance score of patient safety care (4.47 ± 0.52) was significantly lower than the mean importance score (4.59 ± 0.51) (t = 5.05, P < .001). As determined using IPA and the LF model, the top-priority educational needs were related to proper hand hygiene practice and side effect monitoring after medication administration.

CONCLUSIONS

This study provided areas where general hospital nurses need additional education to ensure patient safety. The results suggest the need for developing systematic education programs to enhance nurses' patient safety competencies, which could contribute to improving the quality of healthcare services.

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

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

The psychological impact of working as a midwife in Australia: Findings from a scoping review

BACKGROUND

Burnout, stress, trauma and other psychological health issues are major drivers of attrition, absenteeism, and reduced workplace engagement for midwives. Given the central roles midwives play in providing quality maternity care, it is important to monitor the mental and emotional health of midwives and to understand factors that are associated with a higher or lower incidence of problems. The aim of this review was to report on empirical literature pertaining to the psychological impact of midwifery work for midwives working in Australia.

METHODS

The Joanna Briggs scoping review methodology was used. MEDLINE, Embase, Emcare, Maternity & Infant Care Datacare, CINAHL and SCOPUS were searched to identify research pertaining to the psychological impact of midwifery work for Australian midwives.

RESULTS

A total of 26 papers met inclusion criteria. Midwifery work in Australia carried a significant psychological burden, with high rates of burnout, emotional exhaustion, depression, anxiety, and stress. Most midwives had witnessed traumatic events. Working in continuity of midwifery carer models was associated with lower rates of mental health concerns, while younger midwives and those with fewer years in the workforce were negatively impacted.

DISCUSSION

Midwives in Australia are impacted significantly by their work; especially by burnout, the impact of witnessing traumatic events, depression, stress and anxiety, and moral distress. Midwifery continuity of carer models were protective for psychological impacts.

CONCLUSIONS

Effective workplace interventions to better support the midwifery workforce, including access to continuity models, are required to sustain Australia's high quality maternity care system.

Assessment and diagnosis of non-traumatic shoulder instability: A scoping review

Background

Given its complexity, there is no consensus regarding the assessment of non-traumatic shoulder instability (NTSI) to this day. We, therefore, conducted a scoping review to map the existing white and grey literature regarding diagnostic and assessment tools for the NTSI population.

Method

We followed the Arksey and O'Malley five-stage guideline for the conduct of scoping reviews and searched through 12 electronic databases for English-language articles and reviews from 2000 to 2024 related to NTSI's diagnosis and assessment tools.

Results

Among the 3426 identified studies, 58 were included (describing 59 different interventions). Case-control studies (43.1%, 25/58) and narrative reviews (34.5%, 20/58) were the most prevalent. Diagnostic imaging was the most studied intervention (35.6%, 21/59). Twenty-seven studies specified a direction of instability, of which 59% (16/27) were multidirectional instability. Non-traumatic shoulder instability often affects young individuals, with complex symptoms, including neuromotor deficits, muscular imbalances and kinematic alterations, involving psycho-behavioural and somatosensory components.

Discussion

Non-traumatic shoulder instability's aetiologies and clinical manifestations are multifactorial. The prevalence and incidence of this dysfunction are probably underestimated. Clinical history is crucial to retrace a complex and chronic dysfunction. The use of orthopaedic shoulder tests and the routine use of imaging currently appear to have limited relevance as a first-line approach.

Addressing health equity during design and implementation of health system reform initiatives: a scoping review and framework

BACKGROUND

Health equity is a commonly asserted goal of health systems. However, there is a limited understanding on how best to promote equity as a part of health system reform initiatives. We conducted a scoping review to (1) identify and characterise strategies that promote health equity during the design and implementation of health system reform initiatives; and (2) determine opportunities to strengthen health equity informed policy design and implementation processes and outcomes.

METHOD

We systematically searched peer-reviewed literature from 2013 to 2022 focussing on four search domains: (1) health equity; (2) implementation; (3) health system; and (4) reform, policy, or theories, and only included papers that represented a population health or system-wide intention. Health equity promoting strategies were categorised into those occurring at national, regional, state, or local levels. Themes common across system levels were mapped, which alongside theory, informed the development of a health equity promoting framework for reform initiatives.

RESULTS

The search returned 10,999 articles after duplicates were removed. 384 articles underwent full text review and 68 met the inclusion criteria. Thematic analysis of results identified health equity promoting themes derived from numerous strategies, with a median of 10 strategies (interquartile range 7,15) per article. Accountability, commitment, shared power, and adaptability emerged as some of the most prominent equity promoting themes applicable at all system levels. Across strategies, two cardinal conditions were identified: (1) the need for health equity implementation strategies to be made explicit, and (2) the need for alignment and complementarity of strategies. The framework developed demonstrates equity-oriented reform implementation, which embeds broader equity change throughout the system through inclusive and reflexive governance.

CONCLUSION

This review synthesises diverse literature about how health equity has been considered across levels of the health system during reform design and implementation, providing to our knowledge, the first comprehensive multi-level approach to this issue. Our resulting framework presents policymakers, implementers, and researchers a novel cross-scholarship perspective and process to support the implementation of health equity within system reform initiatives. Throughout design and implementation, consistent vision and a coordinated approach for equity across system levels, underpinned by reflexive governance, will be vital to ensuring that those most in need of healthcare benefit equitably.

Safety of Silver Dressings in Infants; a Systematic Scoping Review

Silver-based dressings are used to reduce infection risk and optimize conditions for wound healing. They are widely used in the management of burns and other complex wounds. However, reports of elevated serum silver and concern over systemic toxicity have meant that their use in young children has been questioned. The aim of the current study was to map the literature relating to the use of silver-based dressings in children under 1 year of age. A systematic scoping review was conducted according to the methodology described by the Joanna Briggs Institute. Sources were identified from major medical databases as well as the gray literature. Inclusion criteria were the use of silver-based dressing in children under 1 year of age. Outcomes of interest were complications or adverse events attributed to silver-based dressings and elevated serum silver levels. A total of 599 sources were identified through the search strategy, with 110 included for review. Complications were described in 31 sources, with the most frequent being wound infection. No cases of argyria, kernicterus, or methemoglobinemia were reported. Six sources documented elevated serum silver levels in infants but none reported adverse events related to this. On the basis of current evidence, we suggest reserving silver dressings in infants under 1 for wounds that are at high risk of infection. Wound area and duration of treatment should be considered when assessing the risk of systemic absorption of silver. Standardized data collection and recording of complications and adverse events is recommended to better inform future clinical decision-making.

Nurses' use of the five rights of medication administration in a comprehensive care unit: a best practice implementation project

INTRODUCTION

The "five rights" of medication administration are used by nurses daily to prevent patient medication errors. The five rights of medication administration are the right patient, drug, route, dose, and time. In the United States alone, between 7,000 and 9,000 medication administration errors occur annually. Internationally, medication errors are a leading cause of injury and harm.

OBJECTIVES

This project aimed to improve compliance with medication administration rights in a comprehensive care unit among nurses in the acute care hospital setting.

METHODS

This project was conducted using an audit and feedback strategy, as recommended by the JBI Evidence Implementation Framework. Included in the project was the use of the JBI Practical Application of Clinical Evidence System (PACES) for pre- and post-audit data analysis and the JBI Getting Research into Practice (GRiP) approach to identify barriers, strategies, and outcomes. The project identified eight best practice criteria for medication administration to be used by nurses, including the five rights. After the baseline audit, barriers were identified, and educational interventions were implemented to improve adherence to best practices. A follow-up audit was conducted, and the results of both audits were compared.

RESULTS

In the baseline audit, two of the eight criteria, including checking the expiry date of medication and verbal identification of patient identifiers, were found to have lower adherence. Nursing staff education and visual reminders were implemented. A post-implementation audit was conducted, showing improved compliance with medication administration best practices.

CONCLUSIONS

Staff education and visual reminders for best practices improved adherence to the five rights of medication administration. Annual competency training to reinforce best practices will prevent the incidence of medication errors, thereby maintaining quality and safety in patient care.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A321.

Responsive service design and workforce strengthening: Recommendations to improve aged care for Aboriginal and Torres Strait Islander peoples

OBJECTIVE

This study aimed to develop innovative and practical strategies and recommendations for aged care policy and practice that support the needs of Aboriginal and Torres Strait Islander peoples.

METHODS

A research symposium was held in June 2023 on Kaurna Country at the South Australian Health and Medical Research Institute. The symposium brought together 70 attendees including aged care consumers, Federal and State Government representatives, advocacy services, health, aged care and social service providers, and health and aged care researchers. Two roundtable sessions titled 'Responsive Service Design' and 'Workforce Strengthening' were conducted following a World Café approach. Data were analysed thematically.

RESULTS

This paper proposes recommendations relating to innovation and improvement within aged care policy and practice. Recommendations for responsive service design and workforce strengthening include the following: (1) promote genuine engagement and involvement, (2) establish partnerships between sectors, (3) ensure compliance, (4) innovative communication and feedback pathways, (5) holistic approaches to well-being, (6) prioritise cultural safety and (7) flexible recruitment and retention strategies.

CONCLUSIONS

Working together and building partnerships between diverse stakeholders including community members, workforce, service providers and policymakers is required for sustainable and meaningful innovation within the aged care sector. Our recommendations, driven by community needs, provide an opportunity to ensure the innovation and implementation of ongoing aged care reforms meet the needs and expectations of Aboriginal and Torres Strait Islander peoples.

Medical device-related pressure injuries in the operating room: A scoping review

AIMS

To map the existing literature describing medical device-related pressure injuries in patients during surgery, including investigation of the incidence, types of medical devices, risk factors and strategies for preventing medical device-related pressure injuries.

DESIGN

A scoping review.

DATA SOURCES

In April 2023, three databases were searched. Studies about adult patients undergoing surgery, from 2014 onwards, in English and Chinese were included. Data were extracted about study characteristics and data related to research questions. The Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework were used to synthesize findings.

RESULTS

Two different types of evidence were included in this review; 14 research studies and two quality improvement studies. The incidence of medical device-related pressure injuries in the operating room was 0.56%-24.5% and respiratory devices were the most common medical devices investigated. Length of surgery, age and BMI were risk factors for medical device-related pressure injuries in a few studies. The application of a prophylactic dressing and dressing maintenance was the most common prevention strategy.

CONCLUSION

Ongoing research is needed to confirm the incidence of, and risk factors for, medical device-related pressure injuries in the operating room. Additionally, more high-quality evidence is needed to underpin current prevention strategies.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Operating room nurses need to be aware of the risks of medical device-related pressure injuries and assess and plan prevention strategies accordingly. Once more high-quality evidence is available, operating room nurses could implement prevention strategies like prophylactic dressings.

REPORTING METHOD

Scoping Reviews (PRISMA-ScR) checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Exploring ageism in medical education: A scoping review of the educational factors affecting the attitudes of medical students and junior doctors towards older inpatients

OBJECTIVES

Ageism is a significant issue in health care and exists among medical learners in the teaching hospital setting. To highlight potential strategies and interventions that may address ageism among medical students and junior doctors, we aimed to explore and understand the educational factors within hospital training environments that influence the attitudes of medical students and junior doctors towards older inpatients.

METHODS

A scoping review of academic peer-reviewed English literature was conducted using seven academic databases. The first 100 results of an advanced Google Scholar search were also screened. One researcher screened identified articles and extracted relevant data from those that were included. Two researchers analysed the data using a modified content analysis.

RESULTS

A total of 18 articles were included for review, published between 1982 and 2023, mostly from English-speaking countries. The articles described factors contributing to both positive and negative attitudes of medical students and junior doctors towards older inpatients. Four themes regarding these attitudes were identified: (1) the intersectionality of patient age, comorbidity and complex care needs; (2) the hospital environment; (3) clinical interactions; and (4) training in and exposure to Geriatric Medicine.

CONCLUSIONS

There are several educational factors in the hospital training environment that affect the attitudes of medical students and junior doctors towards older inpatients. Exposure to and training in Geriatric Medicine may promote more positive attitudes towards older inpatients, but further research is required to determine whether this is of clinical significance.

Knowledge, perceptions, facilitators, and barriers towards asthma self-management among patients: A systematic review of the literature

Background

Asthma self-management is an effective approach that empowers patients with asthma to control their condition and reduce its impact on their daily lives.

Objective

This systematic review aims to synthesize evidence regarding the knowledge, perceptions, facilitators, and barriers related to asthma self-management among patients.

Methods

A systematic literature search was conducted across five databases (PubMed, Science Direct, Scopus, Web of Science, and Google Scholar) using specific key terms. Studies that reported knowledge, perceptions, facilitators and barriers towards asthma self-management were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to report this review. All the data from included studies were analyzed through narrative synthesis approach.

Results

A total of 17 studies were included in this review. The findings indicated that most patients had inadequate knowledge of asthma self-management, particularly regarding asthma fundamentals, and inhaler techniques. Patients' cultural beliefs, and perceived social stigma influenced their self-management practices. Facilitators of asthma self-management included strong partnerships with healthcare providers, social support, access to medication, and having a written asthma action plan. Conversely, poor communication with healthcare professionals, travel, smoking, and workplace challenges were identified as barriers.

Conclusion

There is a pressing need for education and training programs to enhance understanding of the disease, and inhaler technique in patients with asthma. Healthcare professionals should create tailored asthma action plans according to patients' beliefs and needs. Moreover, healthcare policies should be developed to promote facilitators and address barriers, to ensure effective asthma management.

Metabolic Monitoring for Adults Living with a Serious Mental Illness on a Second-Generation Antipsychotic Agent: A Scoping Review

Premature mortality in people living with a severe mental illness (SMI) is often attributed to multiple factors including the use of medicines such as antipsychotics. Second-generation antipsychotics (SGAs) are known to cause metabolic syndrome which can increase the risk of cardiovascular disease. Practice guidelines have recommended regular physical health monitoring, particularly of metabolic parameters, however, metabolic monitoring for people living with SMI using antipsychotics remains suboptimal. Therefore, highlighting the need for ongoing research. This scoping review aimed to provide an overview of current metabolic monitoring practices. We anticipate that this information will assist clinicians and policymakers and inform future research. The following databases were searched: MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), the Cochrane Database of Systemic Reviews (Wiley), APA PsycInfo (Ovid) and Scopus (Elsevier Science Publishers). The target group was adults (aged ≥ 18) diagnosed with SMI (including bipolar disorder, major depressive disorder and psychotic disorders) and taking SGAs. In total, 44 studies from 14 countries were retrieved. Our findings highlighted that most studies conducted in hospitals did not report on metabolic monitoring practices. Additionally, the roles and responsibilities of healthcare professionals in metabolic monitoring for SMI were infrequently described and parameters such as waist circumference and BMI were often poorly monitored. The scoping review highlights that no streamlined approach towards metabolic monitoring currently exists. There is a need to stipulate and define the roles and responsibilities of all health professionals involved in metabolic monitoring in SMI to optimise care for these individuals. Moreover, there is a need for ongoing research, particularly in the community setting, to promote increased accessibility to metabolic monitoring for SMI.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

A multi-faceted construct to guide geriatric dental education: Findings from a scoping review with consultation

BACKGROUND AND OBJECTIVES

Older adults report unmet oral health care needs and barriers in access to care, due in part to provider attitudes and discomfort towards treating older patients. Our study asked: What is known from the literature about the use of undergraduate dentistry programmes to influence dental students' attitudes, perceptions and comfort towards treating geriatric patients? And how can interdisciplinary care facilitate the ability of dentists to work with geriatric patients?

MATERIALS AND METHODS

A scoping review and stakeholder consultation followed established methodological guidelines. Four databases and two grey literature sources were searched. Two researchers independently selected articles using predefined inclusion criteria. Pertinent information was inputted into an iteratively developed extraction table. NVivo 12 was used to organise the extracted data into themes. Key findings were confirmed through stakeholder consultation.

RESULTS

Sixty-eight articles were included in the scoping review. Five key themes emerged: (1) Curricular targets; (2) Intervention components; (3) Dentist and patient factors; (4) The role of interdisciplinary care; and (5) Post-graduation insights on knowledge-seeking patterns. Stakeholder consultations involved 19 participants from Southwestern Ontario and generally confirmed our findings.

CONCLUSIONS

Inconsistent reporting of multiple intervention dimensions constrains our ability to strengthen this knowledge. Future interventions and their reporting could be improved by adopting "willingness to treat" as an overarching, multi-faceted concept which encompasses knowledge on ageing, attitudes towards older patients, perceived competence and empathy. Stakeholder interviews complemented these findings.

A multimedia tool for infection prevention and control practices in the intensive care unit: a participatory interventional before-after study

Background

Infection prevention and control (IPC) practices by critical care nurses are crucial in preventing ventilator-associated pneumonia (VAP) and central-line-associated bloodstream infection (CLABSI).

Aim

To implement an integrative approach to developing a set of IPC practices and disseminating information on the IPC practices through an educational multimedia tool to improve compliance with the practices.

Methods

This participatory interventional before-after study was conducted in a single tertiary care centre's cardiac surgical intensive care unit (ICU) from May 2022 to March 2023. Thirty-seven nursing IPC practices related to VAP and eight for CLABSI were finalized through a three-step process: systematized review, focused group discussions (five rounds), and Delphi rounds (three rounds). The IPC practices were disseminated through a multimedia tool, displayed continuously in the ICU. Nurses' compliance with the IPC practices observed directly was compared before and after implementing the multimedia tool.

Results

A total of 6043 observations for practices related to VAP and 1957 observations for those of CLABSI were performed. There was an increase in compliance post implementation for 11 IPC practices related to VAP and two IPC for those of CLABSI. There was an increase in compliance with practices relevant to chlorhexidine baths, oral care, cuff pressure maintenance, hypertonic saline nebulization, endotracheal suctioning, scrubbing the hub for central line access, and assessment of the central line for removal.

Conclusion

Through a participatory approach, we developed a set of IPC nursing practices for VAP and CLABSI. Implementing a multimedia tool, which encompasses the newly implemented IPC practices, improved compliance with many practices.

Supportive Interventions Involving Family Carers of Patients With Delirium Superimposed on Dementia in Hospital: A Scoping Review

BACKGROUND

People with dementia admitted to hospital are at risk of developing delirium. Patients with delirium superimposed on dementia (DSD) have higher mortality rates, longer hospital stays and further cognitive loss. The role of family is often recommended as a resource to inform and support how patients with dementia's needs are understood. This review focuses on ward-based interventions that enable family carers and health care professionals to work together to improve patient experience and outcomes.

AIM

To review evidence on ward-based approaches involving family (or their proxies) and staff working together to prevent and manage delirium for patients living with dementia.

METHODS

We undertook a scoping review including all types of research. Six electronic databases were searched (CINAHL, MEDLINE (run twice), EMBASE, Cochrane, PsycINFO and PubMed). The search was limited to papers written in English and published from 2009 to 2019. The search was updated in 2023. Papers were independently read by two researchers. Findings were presented through narrative synthesis (Prospero CRD42019130369).

RESULTS

Fifteen papers were included. Studies focused on educational and system change to improve the care of people with DSD. Family involvement ranged from enabling baseline assessment of delirium, commenting on different resources and measures designed to support their involvement in care or simulate their presence. The evidence of effectiveness was varied. Interventions to support personalised care and give family carers and staff confidence were positively evaluated in some studies but not all included both family carers and staff. Benefits to patients over time were less clearly demonstrated.

CONCLUSION

This review identified the potential of family to mitigate the risk of delirium and improve patient outcomes. Further research is needed to understand how system and practitioner changes to enable family involvement in the support of people with DSD benefit patients in the short and long term.

RELEVANCE TO CLINICAL PRACTICE

The review findings provide evidence for clinical practice when selecting existing interventions and approaches involving family in supporting patients with DSD.

PATIENT OR PUBLIC CONTRIBUTION

Not required as this was a review, not an original piece of research.

Exploring co-creation with student nurses in contemporary nursing education: A systematic scoping review

BACKGROUND AND AIMS

Co-creation in educational design and development is evolving and increasingly recognised as a vital component of contemporary nursing education. However, there remains a need to strengthen the knowledge base for this approach. Therefore, this study aimed to provide a comprehensive overview of empirical research on co-creation within nursing education and identify gaps in knowledge and areas requiring further investigation.

METHODS

This study utilised a systematic scoping approach and followed a five-stage methodological framework: (1) identifying the research question; (2) selecting relevant studies; (3) choosing appropriate studies; (4) charting and organising the data; and (5) synthesising, summarising, and reporting the results. It searched the ERIC, Web of Science, Scopus, Medline, CINAHL, and PubMed databases to identify relevant articles, which then underwent double-blind screening, identifying 14 that met the inclusion criteria for this scoping review.

RESULTS

The analysis identified five themes that reflect the scope and nature of empirical research on co-creation in nursing education: (1) scarcity of studies and varied conceptualisation of co-creation, (2) dominance of digital educational co-creation initiatives, (3) underrepresentation of multidisciplinary collaboration in co-creation initiatives, (4) workshops as key activities of co-creative collaboration and engagement, and (5) paucity of knowledge on co-creation effectiveness.

CONCLUSIONS

This review highlights the need for more comprehensive research systematically examining the benefits, impacts, and facilitators of co-creation in nursing education. Future studies should incorporate the perspectives of multiple stakeholders, especially within clinical nursing education, and investigate the scalability of co-creation, including its costs and benefits.

Sleep-enhancing nursing interventions in hospital wards: A systematic review

AIM

To identify sleep-promoting nursing interventions in hospitalized adults and older people.

BACKGROUND

Sleep is necessary for maintaining good physical and mental health, as well as a high quality of life. Hospitalization can significantly disrupt sleep patterns, which is an often-overlooked issue. Nurses are the main participants in promoting sleep in hospitalized patients.

METHODS

Systematic literature review based on the question: "What interventions can nurses implement to promote sleep in hospitalized adults and older people?". The research was conducted on April 4, 2023, in CINAHL Complete, MEDLINE, Cochrane, Scopus, and Web of Science, filtering the articles published in the last 10 years. For a study to be included, it must feature adult or older participants, an intervention that aims to enhance sleep, and the research should have been conducted within a hospital setting. We followed the PRISMA flow diagram and analyzed the quality of the articles according to the Joanna Briggs Institute criteria for quality assessment. The results were subjected to a narrative synthesis.

RESULTS OR FINDINGS

Of the 712 articles found, 13 were selected. The sample encompasses 1975 participants. These selected articles emphasize educational and communicative interventions, dietary and sensory interventions, symptomatic and environmental control, daily activity planning, sleep assessment and documentation, and individualized nursing care.

DISCUSSION

There is a need for a systematic approach incorporating physical, psychosocial, and relational dimensions within the care context.

CONCLUSION

It is necessary to raise the nurses' awareness of the factors that affect sleep experience and empower them to promote sleep in partnership with hospitalized patients.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Sleep interventions can be promoted by implementing hospital policies, including environmental modifications in the design and refurbishment of facilities and restricting nighttime patient transfers to reduce noise and disturbances. Encouraging research studies that explore the effectiveness of these interventions will further support the development of evidence-based policies aimed at improving sleep quality in hospitalized patients.

Factors associated with burnout among internationally educated nurses: A scoping review

BACKGROUND

The increasing nursing shortage in the healthcare industry has become a concern in many countries. Recruiting certified nurses from outside a country is one strategy to address this shortage. While the hiring of internationally educated nurses (IENs) fills the labor gap, a supportive work environment is necessary to retain IENs in the field.

METHODS

We conducted this scoping review based on the Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines. It is reported along with the PRISMA-ScR checklist. A literature search was conducted across six electronic databases (PubMed, Web of Science, CINAHL, PsycINFO, Ichushi, and CNKI) on September 8, 2023, from which 722 articles were identified. Titles and abstracts were initially screened based on inclusion and exclusion criteria, followed by a full-text review of the selected articles. Eight articles satisfied the search criteria.

FINDINGS

From the characteristics of the factors related to nurses' burnout, all the components were categorized into organizational and individual factors. Organizational factors that contribute to higher burnout include poor professional-practice environment, high patient-to-nurse ratios, lower job satisfaction, and working in hospital wards and private hospitals. Individual factors include being younger IENs, being single (not married), being female, possessing higher educational degrees, short duration of employment, religion (Muslim), job title as a staff nurse, high stress, poor local-language capability, and first-time employment in a host country.

DISCUSSION

Individual factors are more specific to IENs' backgrounds, whereas organizational factors are common to both internationally educated and host-country nurses. Both factors should be considered to reduce burnout among IENs.

IMPLICATIONS FOR NURSING

Healthcare organizations and administrators can develop targeted strategies to prevent and address the burnout experienced by IENs. Also providing understanding and support for religious backgrounds and language proficiency is crucial for alleviating intercultural stress. Through these measures, it is essential to create a work environment where internationally educated nurses can feel secure and comfortable.

Lymphoma in Sub-Saharan Africa: a scoping review of the epidemiology, treatment challenges, and patient pathways

PURPOSE

Improving cancer outcomes in Sub-Saharan Africa (SSA) requires effective implementation of evidence-based strategies. This scoping review maps the evidence on lymphoma epidemiology, treatment challenges, and patient pathways in SSA from 2011 to 2022.

METHODS

A comprehensive three-step search was conducted without language restrictions.

RESULTS

Eighty-four publications were included, 83% published after 2017. Southern and Eastern Africa led in output. Most studies were chart reviews (47.6%) and cohort studies (25%). NHL accounted for over 80% of cases, with an age-standardized rate (ASR) reaching 10.9/100,000, while HL had an ASR of 0.4-2.3/100,000. Compared to studies in Europe and US, SSA studies reported lower incidence rates, higher HIV comorbidity, and younger median ages. Diagnosis is often delayed, incomplete and lacks sub-classification with HIV and tuberculosis further complicating care. One-year survival rates are around 50% for NHL and over 75% for HL. Treatment is well-tolerated with an acceptable treatment-related mortality rate. However, outcomes are affected by diagnostic delays, late presentations, and treatment abandonment. Non-clinical aspects of care such as financial constraints negatively impact patient pathways.

CONCLUSION

Addressing diagnostic delays, misdiagnosis, and treatment abandonment is crucial. Strengthening care access, diagnostics, and integrating innovative strategies including a multidisciplinary approach and re-designing efficient clinical diagnostic pathways are vital.

Enhancing healthcare professionals' biopsychosocial perspective to chronic pain: assessing the impact of implementing an interdisciplinary training program

ABSTRACT

Advancements in clinical science have shown the necessity for a paradigm shift away from a biomedical toward a biopsychosocial approach. Yet, the translation from clinical science into clinical practice is challenging. The aim of this study was to assess the short-term and mid-term changes in pain knowledge and attitudes and guideline-adherent recommendations of healthcare professionals (HCP) by means of an interdisciplinary training program (ITP) about chronic pain. Belgian HCPs, with a priority for medical doctors, physiotherapists, occupational therapists, nurses, psychologists, and pharmacists in primary care, participated in the ITP, which contained 2 e-learning modules and two 7-hour workshops provided in small interdisciplinary groups in 5 cities. The objective of ITP was to improve HCP's competencies for integrating biopsychosocial chronic pain management with a cognitive behavioral approach into clinical practice. Primary outcomes were changes in knowledge and attitudes about pain and guideline-adherent recommendations for continuation of physical activity, sports, and work; avoiding bed rest; and not supporting opioid usage measured through 2 clinical vignettes. They were measured before, immediately after, and 6 months after the ITP. Changes were analyzed using (generalized) linear mixed models. A total of 405 HCPs participated. The knowledge and attitudes about pain scores improved at post-training (Δ = 9.04, 95% confidence interval 7.72-10.36) and at 6-month follow-up (Δ = 7.16, 95% confidence interval 5.73-8.59). After the training program, HCPs provided significantly more recommendations in accordance with clinical guidelines. Thus, an ITP can improve the biopsychosocial perspective of chronic pain management among HCPs in the short-term and mid-term.

Preliminary clinical evaluation (PCE): A transnational scoping review of current radiography practice

INTRODUCTION

Image interpretation by radiographers has gained widespread recognition; however, current evidence provides very limited knowledge of the state and scope of practice transnationally. This study therefore sought to explore the current state and scope of preliminary clinical evaluation (PCE) practice to further understand international best practices in terms of policy, training and education, and practice competence of radiographers when carrying out PCE.

METHOD

A comprehensive literature search was completed via federated electronic databases (EBSCOhost and Web of Science) and professional radiography platforms for journal articles and policy or practice guidance documents, respectively. Data were charted from eligible studies following screening of articles in accordance with the predefined eligibility criteria. Themes were generated using inductive narrative analysis.

RESULTS

Thirty-one peer reviewed articles and 5 radiography practice policy documents were identified. Over 60% of the included studies were carried out in the United Kingdom and Australia with about 60% focused on projectional radiography of the appendicular and axial skeletons. Three main themes were developed and included: scope of PCE practice and implementation; PCE proficiency indicators; factors influencing PCE participation and performance.

CONCLUSION

Gaps exist around defined scope of practice, standardisation, commenting format and compliance with policy. There is very limited evidence around PCE practice in cross-sectional imaging, thus, it is difficult to ascertain the current state and scope of practice internationally. There is a need for countries to develop standard commenting frameworks as well as enforcement of compliance. Additionally, more research is required to ascertain the competence and benefits of PCE practice within cross sectional imaging.

Predictors for noncompliant intravascular catheter insertion site dressings at a large academic center

Using intravascular catheter dressing audit data, we evaluated factors associated with noncompliant dressing. Male sex and gauze dressing had a higher risk of noncompliant dressing; presence of one or more lumens infusing, central venous catheter, peripherally inserted central catheters line, implantable port and contact precautions were associated with a lower risk of noncompliant dressing.

How do social norms influence the sexual and reproductive health of very young adolescents in sub-Saharan Africa? A scoping review protocol

Introduction

Introduction Very young adolescents (VYAs, aged 10-14 years) in sub-Saharan Africa (SSA) have the worst sexual and reproductive health (SRH) outcomes of this age group worldwide due to structural, behavioural, socioeconomic and other factors. Social and gender norms have important consequences for the SRH and wellbeing of VYAs both now and over their life course. SRH programming often focuses on older adolescents (aged 15-19 years), overlooking younger ones. This scoping review sets out to explore how social and gender norms influence VYAs' SRH in SSA, in addition to exploring interventions that have been effective, to inform a context-specific intervention.

Methods

We will employ the methodology developed by Arksey and O'Malley to review the available literature. We will search online databases (PubMed/MEDLINE, CINHAL, EMBASE, PsycINFO, Cochrane Library, and African Index Medicus) for original studies published between 1 January 2000 and 31 December 2024. Further, we will perform a manual search to include relevant grey literature. The steps in the review are: 1) defining the research question, 2) identifying relevant studies, 3) selecting studies, 4) charting the data, and 5) collating, summarising, and reporting the results.

Results

Results We will report findings in accordance with the guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement. We will analyse and summarise data about study characteristics using descriptive statistics. We will use thematic analysis to analyse and summarise key themes and issues. We will triangulate quantitative and qualitative findings.

Discussion

The review will map the breadth of studies focusing on social and gender norms, and SRH among VYAs, in addition to exploring interventions that have been effective. Findings will help us and others develop context-specific, bespoke interventions.

The use of tranexamic acid for post-tonsillectomy hemorrhage: A scoping review protocol

BACKGROUND

Post-tonsillectomy hemorrhage (PTH) is a highly studied outcome of tonsillectomy with serious consequences. Various treatments and interventions have been utilized to decrease post-tonsillectomy hemorrhage. The off-label use of tranexamic acid (TXA) is of growing interest to control PTH but has not been incorporated in management guidelines. This scoping review plans to summarize existing studies from the scientific literature on the use of tranexamic acid for post-tonsillectomy hemorrhage.

METHODS

We used the Preferred Reporting Items for Systematic Reviews or Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). The review will cover studies including patients undergoing tonsillectomy who were treated with TXA in the peri-operative or post-operative period. We include randomized controlled trials, retrospective, prospective, and case series. A database-specific search strategy will be used to search records across. Two reviewers will independently screen and extract data. Tables and visual representations will be utilized to present the extracted data.

REGISTRATION DETAILS

The protocol will be registered in Open Science Framework and published in PLOS One.

Self-medication practices in Ethiopia: An umbrella review protocol

BACKGROUND

Self-medication is the practice of obtaining and using drugs without proper guidance or supervision. It can involve various behaviours that may harm individuals and society. Self-medication can cause serious health and economic problems for countries and healthcare systems. Therefore, current review aimed at examining self-medication practices in Ethiopia.

METHODS

This umbrella review will consider all systematic reviews that include self-medication practices of adult age greater than 18 years in Ethiopia. Study protocols, papers other than systematic reviews, papers not reporting on self-medication practices, and papers published in languages other than English will be excluded from the review. MEDLINE, Embase, and the Cochrane Database of Systematic Reviews will be searched. Two reviewers will screen the titles and abstracts against the eligibility criteria. Data extraction will be performed by 2 independent reviewers on the reviews selected for inclusion. The characteristics of studies like author name, year published, databases searched, number of studies/patients included, and self-medication practices will be extracted. The quality of included studies will be reported using the JBI critical appraisal checklist for systematic reviews and research syntheses. A summary of the extracted data will be presented in tabular format and a narrative synthesis will be performed on the collected systematic reviews that meet the inclusion criteria.

DISCUSSION

This protocol is expected to bring pooled evidence on self-medication practice among different population groups like pregnant mothers, adult population, students, and general population. Evidence from this review will be used to tackle current global problem related with anti-microbial resistance. Therefore, our review will call for government and non-government interventions in reducing current challenge of global issue related with anti-microbial resistance in resource limited country like Ethiopia.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42023182552.

Diagnostic investigations in adults with suspected stroke-improvement of door-to-imaging time: a best practice implementation project

OBJECTIVES

This evidence implementation project aimed to assess and improve compliance with evidence-based neuroimaging criteria for adult patients with suspected stroke.

INTRODUCTION

Stroke is the second leading cause of mortality and severe disability, requiring timely and accurate diagnosis. Clinical guidelines recommend brain imaging within 60 minutes of hospital arrival for suspected stroke patients. This project involved hospitals in North West Anglia NHS Foundation Trust, UK, serving 850,000 people with over 800 admissions annually.

METHODS

The JBI Evidence Implementation Framework was used to guide this project. JBI software, the Practical Application of Clinical Evidence System (PACES), as well as JBI's Getting Research into Practice (GRiP) approach, were used to conduct the audit and implementation phases. The project followed three stages: (1) implementation planning, (2) baseline assessment and implementation, and (3) impact evaluation. Three audit criteria were used to represent best practices for diagnosing suspected stroke patients.

RESULTS

The baseline audit revealed low compliance with the first criterion, with only 2.9% (1/35) of patients receiving a CT head scan within 1 hour of admission. In the follow-up audit, compliance improved to 45.2% (14/31). The other two criteria, diagnosis by a trained health care professional and baseline ECG assessment, had already achieved 100% compliance in the baseline audit.

CONCLUSIONS

Compliance with evidence-based neuroimaging criteria improved after implementing targeted educational strategies and training. The rate of CT scans conducted within 1 hour increased, although door-to-imaging times remain suboptimal compared with achievable benchmarks of ≤ 20 minutes. Ongoing education and training are crucial for sustaining high compliance and improving stroke patient outcomes.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A324.

Quality Improvement Interventions for Peripheral Intravenous Catheter Nursing Practices: A Systematic Review

BACKGROUND

The use of peripheral intravenous catheters (PIVC) is a crucial nursing practice for ensuring patient safety.

PURPOSE

This systematic review assessed quality improvement (QI) articles focused on nursing insertion and management practices related to PIVCs.

METHODS

A comprehensive search was performed. The Quality Improvement Minimum Quality Criteria Set (QI-MQCS) was used to appraise the quality of QI studies by 2 independent reviewers.

RESULTS

A total of 27 studies were included. More than half of the studies did not meet the sustainability and spread QI-MQCS criteria. QI interventions focused on ultrasound-guided PIVC placement, PIVC dressing products or other catheter devices, and bundles for PIVC practices. The improvements in PIVC-related patient outcomes and nurses' capabilities were reported.

CONCLUSION

Further research is needed to identify detailed QI protocols for ensuring the sustainability and cost-effectiveness of interventions and to facilitate the application of QI in diverse types of hospitals.

Implementation of the Community Component of the Mental Health Gap Action Programme (mhGAP): A Scoping Review

Objectives

To identify implementation variables and justify the use of the community component of the Mental Health Gap Action Programme (mhGAP).

Method

The search was carried out in Cochrane, PubMed, Emerald, Scopus, Scielo, Redalyc and Google Scholar databases. Studies that analyzed the implementation of the community component of mhGAP were included, excluding those focused solely on the clinical component of mhGAP.

Results

Out of the 726 records initially identified, only four met the inclusion criteria. The findings reveal that the evaluation of the community component of mhGAP has primarily been conducted in conjunction with other global and community mental health strategies, as part of multimodal approaches. Factors are recognized as key barriers and facilitators for the successful implementation of the program.

Conclusion

The community component of mhGAP presents itself as a promising proposal to strengthen community-based mental health strategies. However, there is an urgent need to generate more evidence on the implementation of these strategies, particularly in terms of resource availability, long-term sustainability, and outcome monitoring.

Enhancing Pain Assessment Among Post-Surgery Patients at a Tertiary Hospital in China: A Best Practice Implementation Project

BACKGROUND

Postoperative pain is a common complication that can delay recovery and increase hospital stays and costs. Accurate pain assessments are essential for effective management.

LOCAL PROBLEM

Compliance with evidence-based pain assessment protocols in the Anesthesia Intensive Care Unit (AICU) at a teaching hospital in Hefei, China, was suboptimal.

METHODS

This evidence-based implementation project, conducted from December 2023 to August 2024, utilized the Joanna Briggs Institute (JBI) Implementation Framework and Model of Evidence-Based Health Care. A baseline audit of 23 nurses and 50 patients was followed by a post-implementation audit. Data were analyzed using JBI's PACES software.

INTERVENTIONS

Educational programs and stakeholder focus groups were introduced to enhance compliance with pain assessment protocols.

RESULTS

Compliance with 3 audit criteria increased by 66% to 92% following the intervention.

CONCLUSIONS

The project successfully enhanced compliance with evidence-based pain assessment, improving postoperative pain management in the AICU.

Prevention and management of postoperative delirium in adult patients: a best practice implementation project

OBJECTIVE

To describe the process of implementing evidence-based best practices to improve the prevention and management of Postoperative Delirium in the Post-Anesthesia Care Unit.

METHOD

Report on an evidence implementation project applying the JBI based on the audit and feedback process, with a structured approach to identifying and managing barriers in accordance with recommended clinical practices. Medical records, electronic nursing record systems, and staff interviews were used to assess compliance rates.

RESULTS

In the baseline audit, a zero compliance rate was found in most criteria in relation to the best evidence. Following this phase, interprofessional training was carried out, a validated tool was provided to identify patients at risk of delirium, and changes were made to the electronic nursing records system. In the first follow-up audit, there was an increase in the compliance rate in four of the nine criteria audited. Four criteria achieved 100% compliance in the second follow-up audit.

CONCLUSION

Best practices were implemented that contributed to improving the prevention and management of Postoperative Delirium. Subsequent to new training and re-auditing after one year, an increase in adherence to best practices was observed.

Evaluating the Instructional Strategies Influencing Self-Regulated Learning in Clinical Clerkship Years: A Mixed Studies Review

Self-regulated learning (SRL) can significantly improve academic achievement and clinical performance. The clinical clerkship is a crucial setting for reinforcing and extending SRL skills and behaviors into clinical practice. However, learning in clinical settings is often opportunistic and contextual, requiring diverse instructional strategies and tailored learning opportunities. Studies from the past two decades have indicated challenges in implementing SRL strategies particularly in Asian countries. While many of the pedagogical approaches used in medical education include aspects of SRL theory, a comprehensive overview of effective SRL instructional strategies in clinical clerkships is lacking. We reviewed all studies (published between January 2012 and May 2024, identified via systematic search of EBSCOhost, PubMed, ScienceDirect, Scopus, and Web of Science) that discuss instructional strategies influencing SRL among clinical clerkship students, in general, and with special reference to the Asian context. Twenty seven articles were included in the final analysis. We conducted convergent integrated synthesis on the data extracted from all included studies to generate categories and themes. SRL instructional strategies reported included implementing learning plans and goal setting, operationalizing formal mentoring and feedback processes, utilizing technology-enhanced learning, facilitating collaborative group learning, providing simulation-based learning experiences, and applying experiential learning strategies. When implemented effectively, such strategies were shown to promote self-regulated learning, motivational beliefs, self-monitoring, and self-reflection. Faculty support, mentoring and timely feedback were crucial in successfully implementing SRL strategies. Incorporating SRL into existing curricula was ideal for ensuring feasibility and long-term sustainability. Limited research from the Asian region indicates that SRL has not been used to its full potential in Asian medical education. Asian medical students' SRL potential could be maximized with shared roles of students and teachers in a student-driven approach. Medical educators should take responsibility for providing opportunities and a conducive environment to foster SRL among clinical clerkship students. Future research should prioritize longitudinal, experimental studies with comparison groups and objective SRL outcome measures to rigorously evaluate the impact of instructional strategies in the clinical clerkship context.

Daily life situations and participation of siblings of children with childhood-onset disabilities: a scoping review

BACKGROUND

Siblings of children with disabilities or childhood-onset chronic conditions (eg, autism, cerebral palsy or congenital heart disease) often face challenges in mental health, quality of life and psychosocial adjustment. However, comprehensive knowledge of their participation in daily activities remains limited. Understanding their participation patterns and potential restrictions can help clarify their needs.

AIMS AND METHODS

This scoping review aims to summarise current research on the participation of siblings of children with childhood-onset chronic conditions. Following the Joanna Briggs Institute methodology, we systematically searched MEDLINE, CINAHL, AMED, PsycINFO and ERIC for peer-reviewed studies published in English between 2001 and 2024. Eligible studies focused on siblings of children with disabilities or early-onset chronic conditions (population) and their participation, including attendance and involvement in daily activities (concept) across children's homes, communities and schools (context). The review adheres to the Preferred Reporting Items for Scoping Reviews guidelines.

RESULTS

A total of 62 articles met the inclusion criteria: 45 qualitative (73%) and 7 quantitative (11%) studies, 7 reviews (11%) and 3 meta-studies (5%). The studies covered various chronic conditions (eg, cancer, chronic kidney disease and Down syndrome), with autism being the most common (22 studies). Key participation themes identified include family life, home participation, school involvement, leisure activities, social interactions with peers, information-seeking and continuous meaning-making. Factors such as normalcy, advocacy, identity, gender, age, culture and socioeconomic status were found to intersect with participation.

CONCLUSIONS

This review provides a comprehensive overview of current research and contributes to our understanding of how participation in daily activities has been studied so far in the population of siblings of children with disabilities. It reveals a gap in research specifically measuring participation among siblings. The identified themes enhance our understanding of potential participation restrictions in this population.

Patient and family engagement interventions for enhancing patient safety in the perioperative journey: a scoping review

BACKGROUND

Surgical procedures present intricate challenges within healthcare delivery, often associated with higher risks of adverse events compared with non-surgical contexts. Patient and family engagement (PFE) throughout the perioperative journey is a possibility to enhance care quality, safety and patient-centredness. However, literature addressing PFE across the entirety of the perioperative journey remains sparse.

OBJECTIVE

The current scoping review aims to comprehensively map the existing interventions with PFE approach focused on improving patient safety across various types of surgical procedures throughout the perioperative journey. In addition, the review aims to understand the level and type of PFE approach adopted in this context.

ELIGIBILITY CRITERIA

Articles published in indexed peer-reviewed journals from 2003 to 2023, written in English, Portuguese or Spanish, that report on interventions with PFE approach targeting adult surgical patients, their families, caregivers, patient advocates and patient champions. The review includes articles reporting on both inpatient and ambulatory surgical patients.

METHODS

Following Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews framework, this review systematically searched PubMed, Web of Science, SCOPUS, CINAHL, and PsycINFO for relevant articles. Eligible interventions were categorised using PFE framework regarding the level of engagement and mapped according to the WHO Global Patient Safety Action Plan 2021-2030.

RESULTS

Out of 765 records initially identified, 32 met the eligibility criteria for data extraction and analysis, of which 40% originated from the USA, followed by the UK (18%) and Canada (12%). 47% of the interventions targeted 'multiple/all types' of procedures, 19% focused on cardiothoracic surgeries and 9% on gynaecological procedures or organ transplant. The majority of the interventions (88%) focused on PFE at the direct care level, predominantly adopting a consultation-based approach. Furthermore, 81% of eligible interventions emphasised patient information and education, 16% addressed codevelopment of policy and 3% of interventions focused on patient advocacy.

CONCLUSION

The findings show a predominant focus on PFE interventions targeting patient safety at the direct care level, particularly in the provision of patient information and education. However, interventions at organisational and policy-making levels are notably scarce. Further investment is required to promote interventions engaging patients and families at broader organisational and policy-making levels.

Cross-Analysis of mHealth Social Acceptance Among Youth: A Comparative Study Between Japan and China

Although mobile health (mHealth) technologies have emerged as a revolutionary approach to enhance healthcare delivery, few studies have examined how it is perceived and accepted in different cultures. This study investigated mHealth's social acceptance among young people in Japan and China, with a focus on cultural influences on technology adoption. A comparative analysis approach was adopted, employing an extended unified theory of acceptance and use of the technology model. University students from both countries, recruited using harmonized sampling methods, completed questionnaires. We employed descriptive statistics to summarize the sample characteristics, confirmatory factor analysis to validate the constructs, multigroup analysis to test for measurement invariance and ensure the applicability of the model in both cultural contexts, and comparative path analysis to explore differences in the various factors influencing mHealth acceptance in each cultural setting. The findings revealed distinct cultural effects on mHealth acceptance. Japanese young people showed cautious acceptance influenced by societal norms and infrastructure, whereas Chinese young people demonstrated strong engagement driven by government support and the growing digital health industry. The study emphasizes the importance of considering cultural and systemic dynamics when integrating mHealth into youth healthcare models and suggests tailored strategies for successful implementation.