Charting the Course of the Nursing Professional Identity: A Qualitative Descriptive Study on the Identity of Nurses Working in Care for Older Adults

AIMS

To explore and describe the meaning of nurses working in care for older adults give to the nursing professional identity.

DESIGN

A qualitative approach was taken.

METHODS

Semi-structured interviews were conducted with 50 bachelor and vocational-educated nurses working in care for older adults. Interviews were conducted between December 2019 and May 2020. Data were analysed and interpreted through inductive content analysis.

RESULTS

Five themes embody the meaning of the nursing professional identity of nurses who work in care for older adults. The five themes are: born to care: a lifelong motivation to nursing; nursing through the noise: dedication in a demanding profession; the silent backbone: caught in the crossfire of interdisciplinary teams; learning under pressure: the demand for expanded nursing expertise and against the current: the barriers to advocacy in nursing.

CONCLUSION

The professional nursing identity of nurses working in care for older adults is multi-faceted. A personal dedication to patient care, where patients 'human' aspect is heavily valued, commits nurses to their profession and underscores their dedication to upholding the quality standard in nursing practice.

IMPLICATIONS FOR THE PROFESSION

The older adults' nursing identity highlights that nursing deserves acknowledgement as a professional occupation. Nurses should speak to the public about their professional roles to improve the public view of older adult nursing.

IMPACT

A clear understanding of the older adult nursing professional identity clarifies specific roles, experiences and expectations. This can help attract and retain nurses whose views of older adult nursing align with the nursing professional identity. This could help resolve nurse turnover and reduce shortages in older adult care.

REPORTING METHOD

We adhered to Consolidated Criteria For Reporting Qualitative Research guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Investigating different dimensions of women's childbirth experiences and its predictors among postnatal women: findings from a cross sectional study

BACKGROUND AND AIMS

Childbirth experience is an event in a woman's life with short- and long-term effects on her physical and mental health. This study aimed to investigate different dimensions of women's childbirth experiences and its predictors.

METHODS

This cross-sectional study was conducted on 430 postnatal women with vaginal delivery in 2021 in Northern Iran. Data were collected using the Iranian women's childbirth experience questionnaire (IWCEQ) and demographic and pregnancy-related characteristics questionnaire. Principal component analysis using Amos 24 and backward multiple linear regression using SPSS 22 were employed to analyze the data.

RESULTS

The mean score of childbirth experiences was 48.48 ± 19.09% out of 100 (95% CI: 46.68-50.28). The Principal Component Analysis revealed that the preparation (β = 0.84), positive perception (β = 0.78), and fear dimensions (β= -0.72) were the most important dimensions of women's childbirth experiences. Moreover, education (B = -7.14, p = 0.001), spouse's education (B = 7.40, p = 0.001), history of previous childbirth (B = 4.88, p = 0.001), obstetric problems of previous childbirth (B = - 7.73, p = 0.038), mother's preferred type of delivery (B = 9.34, p = 0.001), the simultaneous delivery of another baby in the delivery room (B = -3.39, p = 0.017), and birth weight (B = -5.79, p = 0.005) explained 40% of the variance of the childbirth experience score.

CONCLUSION

Childbirth experience is a unique experience that influenced by positive and negative issues. More studies to identify related factors to dimensions of childbirth experience may have some insights for developing national and local- level health policies and clinical protocols.

Caregivers' and nurses' perceptions of the Smart Discharges Program for children with sepsis in Uganda: A qualitative study

Sepsis arises when the body's response to an infection injures its own tissues and organs. Among children hospitalized with suspected sepsis in low-income country settings, mortality rates following discharge are high, similar to mortality rates in hospital. The Smart Discharges Program uses a mobile health (mHealth) platform to identify children at high risk of post-discharge mortality to receive enhanced post-discharge care. This study sought to explore the perceptions and experiences of the caregivers and nurses of children enrolled into the Smart Discharges Program and the program's effect on post-discharge care. We conducted an exploratory qualitative study, which included in-person focus group discussions (FGDs) with 30 caregivers of pediatric patients enrolled in the Smart Discharges Program and individual, semi-structured interviews with eight Smart Discharges Program nurses. The study was carried out at four hospitals in Uganda in 2019. Following thematic analysis, three key themes pertaining to the Smart Discharges program were identified: (1) Facilitators and barriers to follow-up care after discharge; (2) Changed caregiver behavior following discharge; and (3) Increased involvement of male caregivers. Facilitators included telephone/text message reminders, positive nurse-patient relationship, and the complementary aspects of the program. Barriers included resource constraints and negative experiences during post-discharge care seeking. With regards to behavior, when provided with relevant and well-timed information, caregivers reported increased knowledge about post-discharge care and improvements in their ability to care for their child. Enrolment in the Smart Discharges Program also increased male caregiver involvement, increased provision of resources and improved communication within the family and with the healthcare system. The Smart Discharges approach is an impactful strategy to improve pediatric post-discharge care, and similar approaches should be considered to improve the hospital to home transition in similar low-income country settings.

Best Practices in the Nursing Care of Patients With Injuries From Violence: An Integrative Review

BACKGROUND

The number of patients who have experienced violence is increasing worldwide. These patients have specific psychosocial and forensic needs and can present unique challenges to the health care workers caring for them.

OBJECTIVE

To identify best practices for the care of patients with injuries from violence in the emergency department or inpatient setting.

METHODS

The framework for integrative reviews by Whittemore and Knafl was used to conduct a literature search in MEDLINE, CINAHL, and ProQuest Nursing and Allied Health databases. Fourteen qualitative, quantitative, and mixed-methods studies from peer-reviewed journals were included in the review.

RESULTS

Themes included identifying patients as survivors of intimate partner violence or child abuse, the need to collect forensic evidence, the need for emotional support of patients and their loved ones, support for health care workers caring for patients with injuries from violence, prevention of further violence, and the challenges of caring for patients with injuries from violence with concurrent substance use disorders. Best practices for these aspects of care are summarized on the basis of literature analysis.

CONCLUSION

Screening procedures are needed to identify survivors of intimate partner violence and child abuse. Forensic evidence preservation policies should be in place. For survivors of sexual assault, a sexual assault nurse examiner should be available. Hospital systems should provide psychosocial resources for patients' and health care workers' mental health, implement violence reduction programs, and provide bias training. More research is needed to determine efficacy of care models and best practice.

Family-centered interventions and patient outcomes in the adult intensive care unit: A systematic review of randomized controlled trials

OBJECTIVE

There is a need to understand how family engagement in the intensive care unit (ICU) impacts patient outcomes. We reviewed the literature for randomized family-centered interventions with patient-related outcomes in the adult ICU.

DATA SOURCES

The MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library databases were searched from inception until July 3, 2023.

STUDY SELECTION

Articles involving randomized controlled trials (RCTs) in the adult critical care setting evaluating family-centered interventions and reporting patient-related outcomes.

DATA EXTRACTION

Author, publication year, setting, number of participants, intervention category, intervention, and patient-related outcomes (patient-reported, physiological, clinical) were extracted.

DATA SYNTHESIS

There were 28 RCTs (12,174 participants) included. The most common intervention types were receiving care and meeting needs (N = 10) and family presence (N = 7). 16 RCTs (57%) reported ≥1 positive outcome from the intervention; no studies reported worse outcomes. Studies reported improvements in patient-reported outcomes such as anxiety, satisfaction, post-traumatic stress symptoms, depression, and health-related quality of life. RCTs reported improvements in physiological indices, adverse events, mechanical ventilation duration, analgesia use, ICU length of stay, delirium, and time to withdrawal of life-sustaining treatments.

CONCLUSIONS

Nearly two-thirds of RCTs evaluating family-centered interventions in the adult ICU reported positive patient-related outcomes.

KEYPOINTS

Question: Do family-centered interventions improve patient outcomes in the adult intensive care unit (ICU)?

FINDINGS

The systematic review found that nearly two-thirds of randomized clinical trials of family-centered interventions in the adult ICU improved patient outcomes. Studies found improvements in patient mental health, care satisfaction, physiological indices, and clinical outcomes. There were no studies reporting worse patient outcomes. Meaning: Many family-centered interventions can improve patient outcomes.

Developing the future academic workforce: A descriptive cross-sectional study of the experiences of early career academics from registered health and social care professions

BACKGROUND

Healthcare academics are generally recruited for their expertise as practitioners, however this may not always convert into expertise in higher education.

OBJECTIVE

Investigate experiences of academics who transitioned from clinical roles by: DESIGN: Descriptive cross-sectional survey.

PARTICIPANTS

122 survey responses; 103 females, 89.3 % UK participants, 65.6 % nurses. Average years as clinician was 14.49 (SD 8.44), average age at time of transition was 39.99 (SD 8.28), average length of time in academia was 4.36 years (SD 6.51) and most were currently employed as a senior lecturer (36.9 %) or lecturer (28.7 %).

METHODS

An electronic survey using an amended version of the Career Transition Inventory (CTI), the HEXACO personality trait measure, and open questions for elaboration. Descriptive and inferential statistics were performed on statistical data and open questions were analysed thematically.

RESULTS

73 % of participants agreed they felt like a novice again and were overwhelmed in their first year of academia. Most felt they received support from their line manager and the transition was the right decision. Higher levels of extraversion were associated with a positive transition, and those open to new experiences were more likely to feel ready and confident in their career transition. The qualitative data identified four themes: the need to do something different, expectations not reflecting reality, levels of support, and it being a transformative experience.

CONCLUSIONS

Reasons for transitioning from clinical to academic roles are multifaceted. There is a lack of prior understanding around the complexities of the role, and expectations rarely reflect reality. Academic roles require extensive support and development, and time to transition into the role effectively.

Nursing interventions to improve care of people living with dementia in hospital: A mixed methods systematic review

BACKGROUND

There are growing numbers of people living with dementia being admitted to acute care hospitals. Hospitalization for people living with dementia can be difficult and is often associated with negative outcomes. Nurses play a significant role in shaping the hospital experience of people living with dementia, and there have been efforts to design, implement and evaluate interventions to improve nursing care of people living with dementia.

OBJECTIVE

To synthesize evidence on the effectiveness of, and experiences with, nursing interventions to improve care of hospitalized people living with dementia.

DESIGN

Mixed methods systematic review following the JBI convergent segregated approach to synthesis and integration of findings.

METHODS

The quantitative component considered studies that evaluated nursing interventions to improve the care of people living with dementia in hospital, comparing the intervention to usual care, other therapeutic modalities, or no comparator. The qualitative component considered studies that explored the experiences of nursing interventions from the perspectives of people living with dementia, caregivers, and nurses. A total of 8 databases were used to search for published and unpublished studies. Titles, abstracts, and full text selections were screened by two or more independent reviewers and assessed for methodological quality.

RESULTS

A total of 38 studies were included in the review, 24 quantitative, 9 qualitative and 5 mixed method designs. Critical appraisal scores were moderate. All studies regardless of methodological quality were included in the review. Interventions were grouped as principally related to (1) dementia education for nurses, (2) technology, (3) nursing skills, and (4) physical environment. Outcomes are presented related to health outcomes of people living with dementia; nurses' knowledge, confidence, and self-efficacy; and health system outcomes. As the interventions were heterogeneous, a meta-analysis of quantitative findings was not possible. The qualitative analysis incorporated 60 findings from 12 studies and led to nine categories and two synthesized findings recognizing external influences on nurses' practice with people living with dementia and the importance of interventions to humanize nurses' work with people living with dementia. Integration of the quantitative and qualitative results demonstrates the need to recognize the role of organization- and unit-level factors in the design and implementation of effective interventions.

CONCLUSIONS

There is limited high-quality evidence to demonstrate the effectiveness of interventions to improve nursing care of people living with dementia in hospital. Using approaches to intervention design and implementation that draw on models of behavior change and learning health systems may support effective change.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO 2021CRD42021230951.

Relationships Between Chemotherapy-Related Cognitive Impairment, Self-Care Ability, and Quality of Life in Breast Cancer Survivors: A Cross-Sectional Study

OBJECTIVES

It is not clear how chemotherapy-related cognitive impairment and self-care ability affect the quality of life of women with breast cancer. The purpose of this study was to explore the relationships between chemotherapy-related cognitive impairment, self-care ability, and quality of life in breast cancer patients, and test whether self-care ability plays a mediating role in the association between cognitive impairment and quality of life.

METHODS

This study was a cross-sectional study, conducted in China in 2022. Self-reported scales were used to assess cognitive function, self-care ability, and quality of life. Data were analyzed using descriptive statistics, spearman correlation analysis and hierarchical multiple regression analyses, the SPSS Process program was used to explore the mediating effect of self-care ability.

RESULTS

A total of 218 participants were investigated, and approximately 79.3% of patients experienced mild chemotherapy-related cognitive impairment, the mean quality of life score was 59.96 ± 14.15, and the mean self-care ability score was 107.4 ± 24.09. Significant correlations among cognitive impairment, self-care ability, and quality of life were observed (P < .05). Additionally, self-care ability played a partial mediating role between cognitive impairment and quality of life (P < .05), accounting for 24.3% and 22.3%, respectively.

CONCLUSIONS

Chemotherapy-related cognitive impairment and self-care ability are factors affecting the quality of life of breast cancer survivors. Self-care ability mediates the relationship between cognitive impairment and quality of life. Enhancing patients' self-care ability can improve the quality of life of patients with cognitive impairment.

IMPLICATIONS FOR NURSING PRACTICE

In the future, oncology nurses should not only pay attention to the severity of cognitive impairment, but also assess the level of patients' self-care ability, provide relevant medical and healthcare guidance, train self-management behavior and strengthen self-care ability by integrating multidisciplinary forces to improve the quality of life of breast cancer patients effectively.

Effect of the "aSSKINg" Model in Reducing Pressure Ulcer Risk: A Comparative Study Using the Braden Risk Assessment Score

Pressure ulcer is considered a common and costly problem in the care of patients. Prevention and management of pressure ulcer are very important due to the high cost of treatment and the adverse consequences of pressure ulcer. This study aimed to evaluate the effect of implementing "aSSKINg" model in reducing pressure ulcer risk. This study used a before- and after-intervention quasi-experimental design. This study was performed on 60 patients who were not randomly selected and assigned in to control and study group. The data collection tool was a 3-part sheet (Braden scale, skin health assessment, and Pressure ulcer assessment). The incidence of pressure ulcer was 19 (60.0%) in the control group versus 9 (30.0%) in the study group with statistical significant differences. The most common site of pressure ulcer was coccyx (6 [31.6%]) in the control group and Heel (3 [33.3%]) in the study group. The application of "aSSKINg" model in the patients with pressure ulcers is effective in reducing the incidence and severity of pressure ulcers.

Clinician Wellbeing and Mental Health Assessment Across Two Acute Care Hospitals During the COVID-19 Pandemic

OBJECTIVE

The purposes of this study were to determine whether positive work environments affect clinician wellbeing and mental health, and to identify participants' priority interventions to improve clinician wellbeing. This study was designed to determine the potential benefit of modifying the aforementioned factors for clinicians and hospitals to impact positive patient outcomes.

BACKGROUND

The SARS-CoV-2 virus pandemic has become one of the leading causes of death in the United States and worldwide, and has exacerbated widespread burnout among health care professionals. This has resulted in negative collateral implications for the stability of the clinician workforce. A Clinician Wellbeing study (CWS) was launched in two Magnet®-designated hospitals in the southeast. The CWS was part of a multi-site collaborative research project led by the Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania School of Nursing.

METHOD

A cross-sectional observational study design was implemented. Data were collected through anonymous surveys of 708 registered nurses (RNs) and advanced practice providers (APPs) working in two Magnet hospitals in the southeastern United States. Each participant completed 8 surveys.

RESULTS

Clinicians' self-reported level of burnout was higher for both RNs and APPs at Emory University Hospital than Emory Saint Joseph's Hospital including intent to leave and dissatisfaction with their jobs. RNs and APPs self-reported their overall health to be good or excellent and they reported sleep quality as fair. Both groups in both hospitals indicated that they experienced anxiety, depression, and stress. The APPs reported a higher percent that their work did not leave enough time for personal and family life. Data also indicated that the primary work environment concern was related to inadequate nurse staffing.

CONCLUSIONS

The data illuminated opportunities for the two hospitals to employ continuous improvement interventions to positively transform the work environment.

Nursing Students' Operating Room Experiences: A Qualitative Metasynthesis

PURPOSE

This study was conducted to analyze the findings of qualitative studies about nursing students' experiences with operating room (OR) practices. There is a need to conduct metasynthesis studies to highlight the overarching dimensions of nursing students' experiences in the OR learning environment, identify and summarize key elements, draw attention to the professional implications of the experience, and then help define the future research agenda. This original study is the first metasynthesis of qualitative studies focusing on nursing students' OR practice experiences.

DESIGN

A qualitative metasynthesis.

METHODS

This metasynthesis study was based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and registered with PROSPERO (International prospective register of systematic reviews) (CRD42021252129). This metasynthesis consists of qualitative studies that included themes, were conducted with nursing students with OR experience, and were published in English between December 2000 and June 2022. Data were analyzed using the two-step metasynthesis procedures proposed by Sandelowski and Barroso.

FINDINGS

This metasynthesis study was carried out by analyzing 12 qualitative studies that met the inclusion criteria, reflected the results of a total of 244 nursing students, and were conducted in 7 different countries. As a result of the analysis of the studies, two main themes and seven subthemes were determined about the OR experiences of nursing students. The main themes of the study included (1) the OR environment and (2) professionalism and career choices.

CONCLUSIONS

The synthesis of studies in this research revealed nursing students' OR experiences and provided evidence about the association between these experiences and their professionalism and career goals. The research drew attention to the limitations and facilitators of the OR learning environment for nursing students and provided guidance for a positive interactive learning environment.

Exploring the Safewards Programme to Reduce Restrictive Practices in Residential Aged Care: Protocol for a Pilot and Feasibility Study

INTRODUCTION

Restrictive practice use in residential aged care homes internationally is unacceptably high. Although policies and legislation mandate the reduction or elimination of restrictive practices, there remains a gap in knowledge regarding strategies that have been effective in achieving a sustained reduction in restraint use. There is an urgent need to identify effective and feasible interventions that aged care staff can implement in everyday practice to reduce restraint use. Safewards is an evidence-based programme that has demonstrated effectiveness in reducing conflict and restrictive practice use in inpatient psychiatric settings and has the potential to address the issue of restraint use in aged care homes. This study aims to evaluate the feasibility of Safewards in reducing restrictive practices in residential aged care homes.

METHODS

This pilot and feasibility study will adopt a mixed methods process and outcomes evaluation. Safewards will be implemented in two Australian residential aged care homes. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will be used to evaluate implementation outcomes. Additionally, the Consolidated Framework for Implementation Research will be used to guide qualitative data collection (including semi-structured interviews with residents/family members, aged care leaders and staff) and explain the facilitators and barriers to effective implementation.

CONCLUSION

This study will provide pilot evidence on the feasibility of the Safewards programme in residential aged care homes. Understanding the processes and adaptations for implementing and evaluating Safewards in residential aged care will inform a future trial in aged care to assess its effectiveness. More broadly, the findings will support the implementation of an international aged care policy of reducing restrictive practices in residential aged care.

PATIENT OR PUBLIC CONTRIBUTION

A person with lived experience of caring for someone with dementia is employed as a Safewards facilitator and is a member of the steering committee. Residents and family members will be invited to participate in the project steering committee and provide feedback on their experience of Safewards.

TRIAL REGISTRATION

ACTRN12624000044527.

Resilience for working in Ontario home and community care: registered practical nurses need the support of themselves, family and clients, and employers

BACKGROUND

The context of practice is often not explicit in the discourse around the personal and professional resilience of nurses. The unique factors related to providing nursing care in home and community care may provide novel insight into the resilience of this health workforce. Therefore, this research addressed how nurses build and maintain resilience working in the home and community care sector.

METHOD

A qualitative study was conducted between November 2022 to August 2023 using 36 in-depth interviews (29 registered practical nurses [RPNs], five supervisors of RPNs, two family/care partners (FCPs) of clients receiving home and community care services). Analysis was consistent with a grounded theory approach including coding and comparative methods.

RESULTS

The factors of personal and professional resilience were not distinct but rather mixed together in the experience of nurses having resilience working in the home and community care sector. The process of building and maintaining resilience as home and community care nurses was informed by three categories: (1) The conditions of working in HCC; (2) The rapport RPNs held with FCPs; and (3) The nurses' ability for supporting the 'self'. Multiple components to inform these categories were identified and illustrated by the words of the nurse participants.

CONCLUSION

The process of building and maintaining resilience by RPNs working in the home and community care sector was guided by the day-to-day experiences of providing care for clients and the conditions of being a mobile health care provider. However, nurses may sense when they need to support their 'self' and must be empowered to request and receive support to do so.

Postoperative pain management after thoracic transplantations

PURPOSE OF REVIEW

Heart and lung transplantation evolution marked significant milestones. Pioneering efforts of Dr Christiaan Barnard with the first successful heart transplant in 1967, followed by advancements in heart-lung and single-lung transplants by Drs Bruce Reitz, Norman Shumway, and Joel Cooper laid the groundwork for contemporary organ transplantation, offering hope for patients with end-stage heart and pulmonary diseases.

RECENT FINDINGS

Pretransplant opioid use in heart transplant recipients is linked to higher mortality and opioid dependence posttransplant. Effective pain control is crucial to reduce opioid-related adverse effects and enhance recovery. However, research on specific pain management protocols for heart transplant recipients is limited. In lung transplantation effective pain management is crucial. Studies emphasize the benefits of multimodal strategies, including thoracic epidural analgesia and thoracic paravertebral blocks, to enhance recovery and reduce opioid use. Perioperative pain control challenges in lung transplantation are unique and necessitate careful consideration to prevent complications and improve outcomes.

SUMMARY

This review emphasizes the importance of tailored pain management in heart and lung transplant recipients. It advocates for extended follow-up and alternative analgesics to minimize opioid dependency and enhance quality of life. Further high-quality research is needed to optimize postoperative analgesia and improve patient outcomes.

Effects of educational methods using extended reality on pre-registration nursing students' knowledge, skill, confidence, and satisfaction: A systematic review and meta-analysis

AIMS

This study examined whether educational methods utilizing extended reality (XR) improve pre-registration nursing students' knowledge, skills, confidence, and satisfaction compared with traditional methods.

DESIGN

We conducted a systematic review and meta-analysis of the effectiveness of XR in nursing education based on the Cochrane methodology.

DATA SOURCES

Randomized controlled trials (RCTs) were searched in MEDLINE, CINAHL, ERIC, Web of Science, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi from inception of each database to March 21, 2024.

REVIEW METHODS

Two authors independently screened study titles and abstracts to identify potentially relevant studies. Subsequently, two reviewers independently assessed the eligibility of the studies based on full-text reviews and extracted the data. They calculated the pooled effect estimates associated with pre-registration nursing students' knowledge and skills, confidence, and satisfaction using a random-effects meta-analytic model.

RESULTS

Among the 1615 records identified, 128 studies were identified. Following full-text evaluation, 38 studies were included in the systematic review. The meta-analysis included 34 studies. XR had significant positive effects on knowledge (N = 1926, standard mean difference [SMD] = 0.55, 95 % confidence interval [CI]: 0.34 to 0.77), skills (N = 904, SMD = 1.00, 95 % CI: 0.46 to 1.54), and satisfaction (N = 574, SMD = 1.19, 95 % CI: 0.09 to 2.30). In particular, immersive virtual reality (VR) had significant positive effects on knowledge (N = 707, SMD = 0.60, 95%CI: 0.36 to 0.83), skills (N = 302, SMD = 1.60, 95%CI: 0.70 to 2.50), and satisfaction (N = 406; SMD = 1.63, 95%CI: 0.04 to 3.22).

CONCLUSIONS

XR may be a viable teaching strategy for improving knowledge, skills, and satisfaction acquisition. In particular, immersive VR improves knowledge, skills, and satisfaction. XR could not be a direct replacement for traditional methods but can complement pre-registration nursing students' traditional education methods.

Cognitive behavioral therapy for the treatment of insomnia in patients with cardiovascular diseases: a meta-analysis with GRADE analysis

Insomnia, as a difficulty in initiating and maintaining sleep, coupled with cardiovascular diseases (CVDs) increase the risk of aggravate daytime symptoms, mortality, and morbidity. Cognitive behavioral therapy (CBT) is thought to have a significant impact on insomnia treatment, but in patients with CVDs, there is a paucity of data. To provide a comprehensive appraisal on the impact of CBT on the treatment of insomnia in patients with CVDs. We searched Ovid, Scopus, Web of science, and Cochrane central, to randomized controlled trials (RCTs) from inception till November 2022. Outcomes of interest were insomnia severity index (ISI), Pittsburgh Sleep Quality Index (PSQI), sleep efficiency (SE), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), and sleep disorders questionnaire (SDQ). Pooled data were analyzed using mean difference (MD) with its 95% confidence interval (CI) in a random effect model using STATA 17 for Mac. Nine RCTs comprising 365 patients were included in the analysis. CBT significantly reduced scores of ISI (MD =  - 3.22, 95%  CI - 4.46 to - 1.98, p < 0.001), PSQI (MD =  - 2.33, 95%  CI - 3.23 to - 1.44, p < 0.001), DBAS (MD =  - 0.94, 95%  CI - 1.3 to - 0.58, p < 0.001), SDQ (MD =  - 0.38, 95%  CI - 0.56 to - 0.2, p < 0.001). Also, it increased the score of SE (MD = 6.65, 95% CI 2.54 to 10.77, p < 0.001). However, there was no difference in terms of ESS. CBT is an easy and feasible intervention with clinically significant improvement in insomnia symptoms. Further large-volume studies are needed to assess sustained efficacy.

Patterns of Physical Therapy Referral and Subsequent Attendance Among Childhood Cancer Survivors with Chemotherapy-Induced Peripheral Neuropathy at a Regional Childhood Cancer Survivorship Clinic

OBJECTIVES

Childhood cancer survivors are at risk for chemotherapy-induced peripheral neuropathy (CIPN). Physical therapy (PT) improves CIPN symptoms, but little is known about survivors' PT utilization. We described characteristics of survivors with ≥ grade 2 CIPN, investigated PT referral and attendance, and described characteristics of survivors who attended and did not attend PT.

METHODS

Childhood cancer survivors <21 years old at cancer diagnosis and ≥2 years posttherapy, living in the United States, evaluated at a regional survivorship clinic were included in this retrospective analysis if they had motor CIPN. Symptomatic CIPN (≥grade 2 by Common Terminology Criteria for Adverse Events) and PT referral/attendance were tabulated. Patient characteristics from the medical record, and neighborhood characteristics (retrieved using survivors' zip code from the National Neighborhood Data Archive) were described by group.

RESULTS

Among 91 survivors with CIPN (median 17.5 years old, 8.1 years postcancer diagnosis, 45.1% female), 35 (38.5%) had ≥ grade 2 CIPN. Survivors with ≥ grade 2 CIPN were 28.6% female, and 45.7% were <13 years old. Twenty-four (68.6%) survivors with ≥ grade 2 CIPN agreed to PT referral, and 15 (42.9%) attended PT. Among survivors who attended PT, 73.3% were <13 years old. Neighborhood characteristics of survivors included median percentage of adults without a high school diploma (6.7% PT attendees, 12.5% nonattendees), median percentage of adults who are foreign-born (11.5% PT attendees, 16.4% nonattendees), and median percentage of households with an annual income of <$15,000 (3.2% PT attendees, 6.5% nonattendees).

CONCLUSIONS

While 68.6% of survivors with ≥ grade 2 CIPN were referred to PT, only 42.9% attended. Studies to better understand barriers to PT attendance and interventions to improve attendance are needed, especially in older survivors.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can play a key role in survivor education and care coordination to help optimize PT attendance.

Cryoanalgesia for Reducing Unconscious Patients' Pain During Arterial Puncture

Arterial puncture is a painful procedure performed to assess patients' respiratory status. Pain is a stressful situation for unconscious patients as they cannot communicate their feeling verbally. To control patients' pain and prevent the adverse effects of painkillers, nonpharmacological pain management strategies have been solicited. The aim of this study is to investigate the effect of cryoanalgesia on unconscious patients' pain during arterial puncture. We adopted a quasi-experimental one-group research design. A sample of 86 unconscious patients in a surgical intensive care unit were recruited in this study. The intervention was applying an ice pack over the puncture site for 5 minutes before the arterial puncture procedure. Pain was assessed for 2 times; before and after application of cryoanalgesia. A statistically significant difference in participants' pain scores between pre-tests and post-tests was noted. For the intubated ventilated participants, the mean pain score before and after applying cryoanalgesia was 5.26 versus 4.00 (P ≤ .05). For the non-intubated or intubated non-ventilated participants, the mean pain score was 6.66 versus 4.63 (P ≤ .05). Cryoanalgesia is a feasible and effective method incorporate during arterial puncture along with standard procedure elements to achieve maximum pain reduction for unconscious patients during arterial punctures.

Long-term effects of flexible visitation in the intensive care unit on family members' mental health: 12-month results from a randomized clinical trial

PURPOSE

The aim of this study was to assess the effects of flexible intensive care unit (ICU) visitation on the 1-year prevalence of post-traumatic stress, anxiety and depression symptoms among family members of critically ill patients.

METHODS

This is a long-term outcome analysis of a cluster-crossover randomized clinical trial that evaluated a flexible visitation model in the ICU (12 h/day) compared to a restrictive visitation model (median 1.5 h/day) in 36 Brazilian ICUs. In this analysis, family members were assessed 12 months after patient discharge from the ICU for the following outcomes: post-traumatic stress symptoms measured by the Impact Event Scale-6 and anxiety and depression symptoms measured by the Hospital Anxiety and Depression Scale.

RESULTS

A total of 519 family members were analyzed (288 in the flexible visitation group and 231 in the restrictive visitation group). Three-hundred sixty-nine (71.1%) were women, and the mean age was 46.6 years. Compared to family members in the restrictive visitation group, family members in the flexible visitation group had a significantly lower prevalence of post-traumatic stress symptoms (21% vs. 30.5%; adjusted prevalence ratio [aPR], 0.91; 95% confidence interval [CI] 0.85-0.98; p = 0.01). The prevalence of anxiety (28.9% vs. 33.2%; aPR 0.93; 95% CI 0.72-1.21; p = 0.59) and depression symptoms (19.2% vs. 25%; aPR, 0.78; 95% CI 0.60-1.02; p = 0.07) did not differ significantly between the groups.

CONCLUSION

Flexible ICU visitation, compared to the restrictive visitation, was associated with a significant reduction in the 1-year prevalence of post-traumatic stress symptoms in family members.

The impact of a continuous care model utilizing a smartphone application on quality of life and anxiety levels among gynecologic cancer patients: a randomized controlled trial

BACKGROUND

Patients diagnosed with gynecological cancers often face a range of complications that can impact their quality of life and increase their anxiety. Nursing models combined with mobile phone applications have the potential to improve outcomes for these patients. This study aimed to assess the impact of a continuous care model utilizing a smartphone application on quality of life and anxiety levels among gynecologic cancer patients.

METHODS

This study involved two phases: (1) mobile App development and (2) implementation of the intervention. The two-group randomized controlled trial included 70 participants with gynecological cancers referred to medical centers affiliated with Shahrekord University of Medical Sciences in 2023. The participants were randomized into control or intervention groups (n = 35 per group). Finally, 68 patients completed the trial. The intervention group received an 8-week intervention incorporating the continuous care model, whereas the control group received routine care (the standard support provided by nurses both during and after hospitalization). The participants completed the Spielberger state-trait anxiety and quality of life (QLQ-C30) questionnaires before, immediately after, and two months after the intervention. The data were analyzed via the chi-square test, independent samples t test, analysis of covariance, and repeated-measures ANOVA.

RESULTS

There were no significant differences in the baseline data between the two groups. However, after the intervention, the intervention group reported a significant increase in quality of life, with mean scores rising from 68.90 ± 17.50 to 73.78 ± 16.79 immediately after the intervention and to 80.61 ± 9.90 at the two-month follow-up. In contrast, the control group showed no significant improvement. Additionally, state anxiety significantly decreased in the intervention group from 51.64 ± 14.97 to 40.20 ± 11.70 at the follow-up, and trait anxiety scores in the intervention group decreased significantly from 49.91 ± 14.96 to 39.82 ± 10.28 at the follow-up, whereas the scores of the control group worsened.

CONCLUSION

The intervention improved quality of life and reduced anxiety in patients with gynecological cancers. Given the scant attention given to mobile application-based follow-up in gynecologic cancer patients in previous studies, this approach can be incorporated into routine care to support patients, and it is recommended for nurses, health care providers, and physicians.

TRIAL REGISTRATION

The study was registered as a randomized controlled trial in the Clinical Trial Registration Center of Iran. Registration Date: 2024-02-14, Registration Number: IRCT20231107059977N1.

Considerations across multiple stakeholder groups when implementing fall prevention programs in the acute hospital setting: a qualitative study

BACKGROUND

Falls in hospital remain a common and costly patient safety issue internationally. There is evidence that falls in hospitals can be prevented by multifactorial programs and by education for patients and staff, but these are often not routinely or effectively implemented in practice. Perspectives of multiple key stakeholder groups could inform implementation of fall prevention strategies.

METHODS

Clinicians of different disciplines, patients and their families were recruited from wards at two acute public hospitals. Semi-structured interviews and focus groups were conducted to gain a broad understanding of participants' perspectives about implementing fall prevention programs. Data were analysed using an inductive thematic approach.

RESULTS

Data from 50 participants revealed three key themes across the stakeholder groups shaping implementation of acute hospital fall prevention programs: (i) 'Fall prevention is a priority, but whose?' where participants agreed falls in hospital should be addressed but did not necessarily see themselves as responsible for this; (ii) 'Disempowered stakeholders' where participants expressed feeling frustrated and powerless with fall prevention in acute hospital settings; and (iii) 'Shared responsibility may be a solution' where participants were optimistic about the positive impact of collective action on effectively implementing fall prevention strategies.

CONCLUSION

Key stakeholder groups agree that hospital fall prevention is a priority, however, challenges related to role perception, competing priorities, workforce pressure and disempowerment mean fall prevention may often be neglected in practice. Improving shared responsibility for fall prevention implementation across disciplines, organisational levels and patients, family and staff may help overcome this.

A preventive care approach for oral health in nursing homes: a qualitative study of healthcare workers' experiences

BACKGROUND

Oral health problems are common among care-dependent older adults living in nursing homes. Developing strategies to prevent the deterioration of oral health is therefore crucial to avoid pain and tooth loss. A standardized work widely used in nursing homes in Sweden is the quality register Senior Alert (SA), which assesses age-related risks concerning e.g. pressure sores, falls, malnutrition and oral health. The oral health assessment is performed with the Revised Oral Assessment Guide-Jönköping (ROAG-J), which also includes planning and implementation of preventive oral care interventions with the goal of achieving good quality care. However, what facilitates and hinders healthcare workers in working with oral health in SA remains unexplored. The aim of this study was to describe healthcare workers' experiences of assessing oral health with the ROAG-J, planning and performing preventive oral health care actions in accordance with SA in nursing homes.

METHODS

Healthcare workers (n = 28) in nursing homes in two Swedish municipalities participated and data was collected through six focus group interviews. Reflexive thematic analysis was used to identify patterns of meaning in the data.

RESULTS

Themes generated in the analysis were: (1) A structured process promotes communication and awareness and stresses the importance of oral health; (2) Oral care for frail older adults is challenging and triggers ethical dilemmas; (3) Unclear responsibilities, roles and routines in the organization put oral health at risk; (4) Differences in experience and competence among healthcare staff call for educational efforts.

CONCLUSIONS

The structured way of working increases staff awareness and prioritization of oral health in nursing homes. The main challenges for the healthcare workers were residents' reluctance to participate in oral care activities and oral care being more complicated since most older adults today are dentate. Organizational challenges lay in creating good routines and clarifying staff roles and responsibilities, which will require continuous staff training and increased management involvement.

Impact of exercise training on clinical outcomes and quality of life in chronic congestive heart failure: A systematic review and meta-analysis

BACKGROUND

Exercise training is a well-established intervention for patients with heart failure with reduced and preserved ejection fraction. Still, the evidence of its effects on mortality, hospitalization, and quality of life needs to be more conclusive. We aim to evaluate exercise training clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).

METHODS

We searched five databases and three clinical trial registries for RCTs that compared exercise training plus usual care versus usual care alone in congestive heart failure (CHF) patients. We extracted data on all-cause mortality, hospital admission, heart failure hospitalization, and health-related quality of life measured by the Minnesota Living with HF questionnaire (MLHFW) and other scales. We pooled the data using random-effects or fixed-effects models, depending on the heterogeneity of the outcomes. We performed subgroup analyses for patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).

RESULTS

We included 61 RCTs with 9062 participants. There was no mortality benefit, but exercise training improved health-related quality of life, reduced hospital admission at 12 months and longer follow-up, and reduced heart failure hospitalization. We observed substantial enhancement in health-related quality of life and a greater decrease in hospital admissions in the HFpEF group compared to the HFrEF group.

CONCLUSIONS

Despite the lack of mortality benefit, exercise training is a beneficial intervention for CHF patients, improving health-related quality of life and reducing hospitalization.

Development of advanced practice nursing core competencies in Saudi Arabia: A modified Delphi study

BACKGROUND

Advanced practice nursing requires a diverse set of competencies that define what advanced practice nurses need to know and be able to do to deliver safe, effective, and high-quality healthcare. Given the lack of evidence regarding core competencies and the evolution of advanced practice nursing roles in Saudi Arabia, it is becoming increasingly important to develop core competencies to standardize educational and clinical training programs.

OBJECTIVE

To define the core competencies of advanced practice nursing in Saudi Arabia.

DESIGN

Utilizing a modified Delphi design and snowball sampling technique, data were collected between April and July 2023 using an online questionnaire consisting of 28 core competencies that was developed based on an in-depth literature review and a critical analysis of advanced practice nursing core competencies published by leading professional organizations. Two rounds of Delphi surveys were conducted.

SETTINGS

The study was set in clinical and academic settings in Saudi Arabia.

PARTICIPANTS

Nursing experts with graduate degrees as advanced practice nurses.

RESULTS

In Round 1, 34 advanced practice nursing experts reached full consensus on 24 of the 28 core competencies, and four core competencies reached partial consensus. Based on suggestions and feedback from the experts, the investigators revised ten core competencies to reflect the improvement suggestions and created three new core competencies. A total of 26 core competencies were used in Round 2, which achieved a full consensus among the 34 advanced practice nursing experts, under the following six core competency domains: knowledge of advanced practice nursing, person-centered care, professional improvement, professionalism, communication and interprofessional partnership, and leadership and system-based practice.

CONCLUSIONS

Given the need for a standardized competency framework, the 26 core competencies proposed in our study have the potential to guide education and training in academic programs and facilitate the implementation of advanced practice nursing in clinical settings.

Nurses' experience with patient deterioration and rapid response teams

BACKGROUND

While timely activation and collaborative teamwork of Rapid Response Teams (RRTs) are crucial to promote a culture of safety and reduce preventable adverse events, these do not always occur. Understanding nurses' perceptions of and experiences with RRTs is important to inform education and policy that improve nurse performance, RRT effectiveness, and patient outcomes.

AIM

The aim of this study was to explore nurse perceptions of detecting patient deterioration, deciding to initiate RRTs, and experience during and at conclusion of RRTs.

METHODS

A qualitative descriptive study using semi-structured focus group interviews was conducted with 24 nurses in a Chicago area hospital. Interviews were audio-recorded, transcribed verbatim, and coded independently by investigators. Thematic analysis identified and organized patterns of meaning across participants. Several strategies supported trustworthiness.

RESULTS

Data revealed five main themes: identification of deterioration, deciding to escalate care, responsiveness of peers/team, communication during rapid responses, and perception of effectiveness.

CONCLUSIONS

Findings provide insight into developing a work environment supportive of nurse performance and interprofessional collaboration to improve RRT effectiveness. Nurses described challenges in identification of subtle changes in patient deterioration. Delayed RRT activation was primarily related to negative attitudes of responders and stigma. RRT interventions were often considered a temporary fix leading to subsequent RRTs, especially when patients needing a higher level of care were not transferred. Implications include the need for ongoing RRT monitoring and education on several areas such as patient hand-off, RRT activation, nurse empowerment, interprofessional communication, role delineation, and code status discussions.

Use of Speech-to-Text Translation Resources to Address Communication Barriers in Patients With Hearing Loss: A Systematic Review

OBJECTIVE

Patients with concomitant limited English proficiency (LEP) and hearing loss may experience communication barriers, not fully mitigated by traditional interpreter services. Although there is no clear consensus on the most reliable and optimal resources for these patients, speech-to-text (STT) applications with translation capability may bridge these barriers. We review the existing literature applying STT translation programs in clinical settings and identify commercially available STT translation resources to evaluate their prospective application in the otology setting.

DATABASES REVIEWED

PubMed MEDLINE, Embase, and Web of Science.

METHODS

A systematic review of English language peer-reviewed literature was conducted, examining STT translation in clinical settings. An additional search identifying STT software with translation capabilities was completed.

RESULTS

Seven out of 591 unique citations met the inclusion criteria, and 29 unique STT translation applications were identified, supporting up to 140 languages. Stakeholders endorse positive perceptions of STT translation programs. Facilitators to implementation included time and cost feasibility, whereas barriers included risk of mistranslation and inability to assess accuracy. Ongoing machine-learning efforts are underway for developing and improving STT translation technologies, but there is paucity of literature evaluating their application in patients with hearing loss.

CONCLUSIONS

Small studies have suggested an acceptable level of accuracy for STT translation programs as adjunctive to standard of care services. Further work should proactively address implementation challenges with special attention to use of these technologies for patients with concomitant LEP and HL, while supporting additional technological advancement for application of these technologies in otology practice.

Assessment of Nursing Workload and Complexity Associated with Oncology Clinical Trials: A Scoping Review

OBJECTIVES

Clinical trials (CTs) play a crucial role in advancing medical knowledge and patient care but are increasingly complex and resource-intensive. This scoping review aims to explore the current approaches for evaluating workload (WL) in oncology CTs and identify tools for measuring clinical research nurses' WL.

METHODS

The search was conducted through MEDLINE, Scopus, CINAHL, and COCHRANE databases and carried out through the framework developed by Arksey and O'Malley and revised by the Joanna Briggs Institute. Data extraction and synthesis were performed to analyze instruments used for WL assessment and their dimensions.

RESULTS

Of the 1,005 records identified, 12 meet the inclusion criteria. The complexity and WL associated with CTs can be attributed to five main domains: (1) protocol, (2) single case, (3) data management, (4) regulatory, and (5) worker-related. These instruments varied in their approaches, scoring systems, and domains assessed. Notably, the protocol-related domain was prevalent across most instruments, highlighting its importance in WL evaluation. Furthermore, findings revealed a wide range of WL scores across different studies, emphasizing the complexity and variability in WL management within CTs.

CONCLUSIONS

This scoping review underscores the importance of evaluating WL in CTs and provides insights into existing tools and approaches. Nurses, as integral members of clinical research teams, bear significant responsibilities in trial management, necessitating a balanced approach to WL allocation. Future research should focus on validating and standardizing assessment tools to optimize resource allocation and enhance research efficiency in CT centers.

IMPLICATIONS FOR NURSING PRACTICE

Understanding WL dynamics in CTs is essential for nurses involved in research delivery. By utilizing validated WL assessment tools, nurses can advocate for appropriate staffing levels and promote efficient trial management, ultimately improving patient outcomes and research quality in CT settings.

Alterations in GABAA receptor-mediated inhibition triggered by status epilepticus and their role in epileptogenesis and increased anxiety

The triggers of status epilepticus (SE) in non-epileptic patients can vary widely, from idiopathic causes to exposure to chemoconvulsants. Regardless of its etiology, prolonged SE can cause significant brain damage, commonly resulting in the development of epilepsy, which is often accompanied by increased anxiety. GABAA receptor (GABAAR)-mediated inhibition has a central role among the mechanisms underlying brain damage and the ensuing epilepsy and anxiety. During SE, calcium influx primarily via ionotropic glutamate receptors activates signaling cascades which trigger a rapid internalization of synaptic GABAARs; this weakens inhibition, exacerbating seizures and excitotoxicity. GABAergic interneurons are more susceptible to excitotoxic death than principal neurons. During the latent period of epileptogenesis, the aberrant reorganization in synaptic interactions that follow interneuronal loss in injured brain regions, leads to the formation of hyperexcitable, seizurogenic neuronal circuits, along with disturbances in brain oscillatory rhythms. Reduction in the spontaneous, rhythmic "bursts" of IPSCs in basolateral amygdala neurons is likely to play a central role in anxiogenesis. Protecting interneurons during SE is key to preventing both epilepsy and anxiety. Antiglutamatergic treatments, including antagonism of calcium-permeable AMPA receptors, can be expected to control seizures and reduce excitotoxicity not only by directly suppressing hyperexcitation, but also by counteracting the internalization of synaptic GABAARs. Benzodiazepines, as delayed treatment of SE, have low efficacy due to the reduction and dispersion of their targets (the synaptic GABAARs), but also because themselves contribute to further reduction of available GABAARs at the synapse; furthermore, benzodiazepines may be completely ineffective in the immature brain.

Methodological and ethical challenges in designing and conducting research at the end of life: A systematic review of qualitative and textual evidence

AIM

This systematic review aims to identify methodological and ethical challenges in designing and conducting research at the end of life from the perspective of researchers and provide a set of recommendations.

BACKGROUND

Conducting research with patients and family carers facing end-of-life issues is ethically and methodologically complex.

DESIGN

A systematic review was conducted.

DATA SOURCES

Four databases (MEDLINE, EMBASE, CINAHL, PsycInfo) were searched from inception until the end of 2021 in February 2022.

REVIEW METHODS

The Preferred Reporting Items for Systematic Reviews was followed, and the JBI Approach to qualitative synthesis was used for analysis.

RESULTS

Seventeen of 1983 studies met inclusion criteria. Data were distilled to six main themes. These included (1) the need for flexibility at all stages of the research process; (2) careful attention to timing; (3) sensitivity in approach; (4) the importance of stakeholder collaboration; (5) the need for unique researcher skills; and (6) the need to deal with the issue of missing data.

CONCLUSION

The findings illuminate several considerations that can inform training programmes, ethical review processes and research designs when embarking on research in this field.

Anthracycline-induced cardiotoxicity: An overview from cellular structural perspective

Anthracyclines are broad-spectrum anticancer drugs, but their clinical use is limited due to their severe cardiotoxicity. Anthracycline-induced cardiotoxicity (AIC) remains a significant cause of heart disease-related mortality in many cancer survivors. The underlying mechanisms of AIC have been explored over the past few decades. Reactive oxygen species and drug-induced inhibition of topoisomerase II beta are well-studied mechanisms, with mitochondria being a prominently investigated organelle. Emerging mechanisms such as ferroptosis, Ca2+ overload, autophagy and inflammation mediators have been implicated in recent years. In this review, our goal is to summarize and update the roles of various mechanisms in AIC, focusing on different cellular levels and further explore promising therapeutic approaches targeting these organelles or pathways.

Adjusting to living with chronic liver disease among patients who continue regular healthcare visits for hepatocellular carcinoma surveillance: A grounded theory study

AIM

To explore patients' process of living with chronic liver disease while continuing regular healthcare visits for hepatocellular carcinoma surveillance.

METHODS

Semistructured interviews and participant observations were conducted in this qualitative constructivist grounded theory study. The participants included 11 patients undergoing regular hepatocellular carcinoma surveillance every 1-6 months for 2-30 years. Data were analyzed using coding, memo-writing, theoretical sampling, and constant comparison.

RESULTS

The participants incorporated regular healthcare visits into their living cycle. The cycle's core comprised two categories ("inferring my liver condition" and "desiring status quo"). The cycle underwent a transition described by three phases ("seeking ways to live with my chronic liver disease," "being overwhelmed by living with my chronic liver disease," and "reconstructing my life to live with my chronic liver disease"). This transition involved adjusting to living with chronic liver disease while continuing regular healthcare visits. The relative importance of the cycle's core progressively shifted from "inferring my liver condition" to "desiring status quo."

CONCLUSIONS

This study revealed the transition phases of patients' living cycles in adjusting to living with chronic liver disease while continuing regular healthcare visits. Understanding the different phases in which patients are and the psychological impact of healthcare visits can help them look forward to recuperative actions. Furthermore, patients who have a sense of ownership experience loneliness because of regular healthcare visits. A support system including nurses as part of regular hepatocellular carcinoma surveillance should be established to help ease patients' sense of loneliness by utilizing their sense of ownership.

Intensive and critical care nurses patient safety, care quality, professional self-efficacy, and missed nursing care: Structural equation model analysis

BACKGROUND

Globally, nurses' patient safety, care quality, and missed nursing care are well documented. However, there is a paucity of studies on the mediating roles of care quality and professional self-efficacy, particularly among intensive and critical care unit (ICCU) nurses in developing countries like the Philippines.

AIM

To test a model of the interrelationships of patient safety, care quality, professional self-efficacy, and missed nursing care among ICCU nurses.

METHODS

A cross-sectional, correlational design study was used. ICCU nurses (n = 335) were recruited via consecutive sampling from August to December 2023 and completed four validated self-report scales. Spearman Rho, structural equation modeling, mediation, and path analyses were utilized for data analysis.

RESULTS

The emerging model demonstrated acceptable fit parameters. Patient safety positively influenced care quality (β = .34, p = .002) and professional self-efficacy (β = .18, p = .011), while negatively affecting missed nursing care (β = -.34, p = .003). Care quality positively and negatively influenced professional self-efficacy (β = .40, p = .003) and missed nursing care (β = -.13, p = .003), respectively. Professional self-efficacy indirectly impacted missed nursing care (β = -.32, p = .003). Care quality (β = -.10, p = .003) and professional self-efficacy (β = .13, p = .003) showed mediating effects between patient safety and missed nursing care.

LINKING EVIDENCE TO ACTION

ICCU nurses' care quality and professional self-efficacy are essential mediating factors that can bolster patient safety practices, hence reducing missed nursing care. Therefore, healthcare organizations, nurse managers, and policymakers should cultivate care quality and self-efficacy by creating support programs and providing a positive practice environment. Nurses and nurse supervisors could directly observe missed nursing care in the ICCU to understand its underreported causes.

Knowledge, attitudes, and perceived barriers regarding pain assessment and management among Thai critical care nurses: A cross-sectional study

BACKGROUND

Pain is a distressing problem which commonly occurs among critically ill patients. Nurses' knowledge of, attitudes, and perceived barriers to pain assessment and management can influence the effectiveness of nursing care.

OBJECTIVE

To explore the current knowledge of, attitudes, and perceived barriers to pain assessment and management among Thai critical care unit nurses.

METHODS

A cross-sectional survey conducted between November 2022 and January 2023 among 158 Thai nurses working in one of eight adult critical care units in a tertiary hospital, evaluated their knowledge of, attitudes, and perceived barriers to pain assessment and management.

RESULTS

Nurses possessed inadequate knowledge and negative attitudes regarding pain assessment and management. The most important barrier to pain assessment and management was "patients are unable to communicate their pain". The results showed a significantly weak positive correlation between nurses' attitudes toward pain assessment and management age (r = 0.26, p = 0.001), year of ICU experience (r = 0.29, p < 0.001), and obtaining a certificate in intensive care nursing (r = 0.37, P < 0.001).

CONCLUSIONS

Thai critical care unit nurses possessed inadequate knowledge and negative attitudes. Further training and education regarding pain assessment and management could include case studies or simulation and immersive virtual reality to improve critical care unit nurses' knowledge and attitudes as well as identifying potential barriers to pain assessment and management in the critical care settings.

IMPLICATIONS FOR CLINICAL PRACTICE

The implications for clinical practice recommend that continued quality assurance procedures should be implemented and maintained to evaluate the effectiveness of current pain assessment practices. Additionally, the perceived barriers to effective pain assessment and management should be considered and managed not only through continued education and training but could include using nursing case review, morbidity and mortality data identifying those patients that experience chronic pain post-ICU discharge.

Nursing strategies to mitigate separation between hospitalized acute and critical care patients and families: A scoping review

OBJECTIVE

To describe the nursing strategies used to mitigate the impact of forced separation between hospitalized acute and critical care patients and their families during the COVID-19 pandemic.

RESEARCH METHODOLOGY/DESIGN

A scoping review was performed in accordance with JBI methodology.

SETTINGS

Those acute and critical care areas in which sudden, often unexpected, emergent episodes of illness or injury were treated.

MAIN OUTCOME MEASURES

Articles written in English and French between March 2020 and September 2023 in Medline, CINAHL Complete, APA PsycInfo, Embase and the Cochrane COVID-19 study register databases that met our inclusion criteria were included. Gray literature included dissertations, theses and Base Bielefeld Academic Search Engines.

RESULTS

Among the 1,357 articles screened, 46 met the criteria for inclusion. Most of the articles were published in North America. Adult critical care units were the most frequently reported settings, followed by neonatal intensive care units. The most frequently reported strategies were virtual telephone or video communications. A majority of the innovative strategies involved interprofessional collaboration at the unit level. Core components included the provision of relational nursing practices, virtual visits, tailored information, fostering relationships between family members, palliative care support regarding end of life, and general information about hospitalization and COVID-19. Pediatric care settings were more likely than adult care settings to accommodate physical visitation.

CONCLUSION

Nurses used synchronous, episodic, and structured virtual interactions, either alone or as part of an interprofessional team, to mitigate separation between patients and families during the COVID-19 pandemic in acute and critical care settings.

IMPLICATIONS FOR CLINICAL PRACTICE

Permanent policy changes are needed across acute and critical care settings to provide support for nurses in mitigating patient and family separation. We recommend that family members be considered as caregivers and care receivers, not visitors in patient and family-centered care in acute and critical care settings.

Association Between Oral Health Status and Survival Time in Terminally Ill Cancer Patients

INTRODUCTION

Patients with terminal cancer often experience various oral problems. Whether oral health status is associated with the survival of terminally ill cancer patients receiving palliative care remains unclear.

METHODS

We analyzed the data of 59 Korean patients with terminal cancer receiving palliative care, including their oral health status, using a modified Korean version of the Oral Health Assessment Tool (OHAT). Patients were categorized into "Good," "Moderate," or "Poor" groups based on OHAT scores. The Kaplan-Meier method was used to compare the median survival time, and the prognosis between groups was estimated using Cox proportional hazard models.

RESULTS

The most common oral symptoms observed were xerostomia (69.5%) and mucositis (17.0%). Significantly shorter survival times were observed in patients with hyperbilirubinemia, elevated creatinine levels, and no use of dentures. The "Poor" group had a shorter survival than the "Good" oral group (P = .010). A multivariate Cox proportional hazards analysis revealed that the "Poor" group was significantly associated with poor survival compared to the "Good" group (hazard ratio, 2.05; P = .047).

CONCLUSION

Terminally ill cancer patients with poor oral health may have a higher risk of shorter survival. Palliative care professionals should pay attention to oral health. Further research is needed to determine the effects of oral care on survival.

Health professionals' presence and attributes in connecting with parents of children with cancer: A qualitative study through the lens of compassion

PURPOSE

Throughout a child's cancer treatment, health professionals (HPs) constitute an important source of support for the entire family. However, the understanding of their presence and essential attributes is unclear. This study explored HPs' presence and attributes in connecting with parents and identified facilitators and barriers for connectedness.

METHODS

This qualitative study was undertaken in a compassion paradigm, designed and guided by Heidegger's and Gadamer's philosophical concepts, and employed compassionate methods. Data were generated through ethnographic fieldwork (144 h), parent interviews (n = 16), and focus group interviews with parents of cancer survivors (n = 2) and HPs (n = 3). Inductive content analysis was utilised to analyse data.

RESULTS

Many HP-parent contacts developed into close, genuine connections based on HPs' great commitment and ability to balance the act of closeness and distance. This involved HPs' sensitivity, humanity, humility, honest communication, genuine interest, and high clinical competencies; all promoting trust. Adapting and ending close relationships when approaching the end of treatment had little attention and was difficult for families, making some find ways of keeping contact on a personal level. Barriers disclosed were structural work changes, busyness, dishonest, poor, or lack of communication, and poor or lack of interpersonal chemistry.

CONCLUSION

Human interconnectedness is powerful in long-term professional relationships and strengthens the parents. More research and clinical attention are needed to develop the understanding and help target actions toward building, maintaining, and ending relationships. Further, cultivating being present in the moment, through mindfulness and compassion, may support HPs in maintaining a receptive mind and a caring role.

Validation of the Japanese version of Algoplus® for the assessment of acute postoperative pain in older patients with cancer

AIM

This study aimed to validate a Japanese version of the Algoplus® tool by assessing postoperative pain in older Japanese patients with cancer and examining the scale's psychometric properties.

METHODS

After translating Algoplus® into Japanese, we conducted a cross-sectional study of patients aged 65 years or older who underwent surgery to remove malignant tumors. Two registered nurse-certified investigators used the Numerical Rating Scale, the Japanese version of Algoplus®, and the Japanese version of the Abbey Pain Scale before and after analgesic use on postoperative days 3 and 5 to evaluate response to pharmacologic therapy. Validity was tested by a correlation analysis between the Japanese version of Algoplus®, two pain scales, and nine hypotheses related to demographic variables and surgical invasions. The Kuder-Richardson-20 test and Cohen's Kappa coefficient were used for internal consistency and inter-rater reliability, respectively.

RESULTS

The total score of the Japanese version of Algoplus® showed strong to moderate correlations with the two pain scales. Demographic characteristics were not associated with the total score of the Japanese version, but significant correlations with operative time and postoperative analgesia administration existed. The scale demonstrated good internal consistency (Kuder-Richardson-20 α: .70) and inter-rater reliability (Kappa coefficient .72). The total score of the Japanese version decreased significantly after analgesic use in both postoperative assessments.

CONCLUSIONS

The Japanese version of Algoplus® is a reliable and valid instrument for nurses to easily assess acute postoperative pain in older Japanese patients with cancer and shows good responsiveness for detecting the change in pain status.

The hotspots and trends of nursing master's education in China: a bibliometric analysis from 2000 to 2022

BACKGROUND

Graduate nursing education is the main way to train high-quality nursing personnel. Globally, the nursing education system has been gradually improved, forming a multi-level, multi-channel, and multi-specification education system including secondary, specialized, undergraduate, and postgraduate.

OBJECTIVE

To analyze the research hotspots and trends of nursing postgraduate education in China by using bibliometric methods, and to provide reference for scholars at home and abroad to understand the current status of this field.

METHODS

Literature related to graduate nursing education was searched in the Chinese full-text journal database (CNKI) from January 2000 to May 2022 and analyzed using CiteSpace software.

RESULTS

A total of 998 kinds of literature were included, with a growing trend in the number of articles issued. The research hotspots and trends of nursing graduate education in China are clinical practice, cultivation mode, and core competence.

CONCLUSION

Chinese nursing graduate education is improving. Foreign experience should be drawn upon, combined with the hotspots and trends summarized in this study, to promote the development of nursing graduate education in China.

Breast cancer patients' perspectives and needs about wed-based surgical decision aid: A qualitative study

PURPOSE

Breast cancer diagnosis often presents patients with complex treatment decisions, particularly concerning surgical options. A patient decision aid can assist patients in making better decisions, and ultimately improving health outcomes positively. This study aims to explore the perceptions and needs of breast cancer patients regarding the utilization of wed-based surgical decision aids.

METHODS

A descriptive qualitative study was conducted using semi-structured interviews with purposive sampling that were audio recorded and transcribed verbatim. A thematic analysis was conducted using NVivo 12 software. Participants were recruited from a tertiary general hospital in Shanghai, China. Inclusion criteria were being diagnosed with breast cancer, age over 18 years old, considering breast cancer surgery as a treatment option and able/willing to give informed consent.

RESULTS

From March to May 2023, 16 patients consented to participate and completed the interviews. Three major themes were revealed, with corresponding sub-themes: (1) informative and useful content (need to know as much information as possible, easy to understand and presented in multiple ways and highly credible from reliable resource); (2) user-friendly on design (easy to operate, simple function and man-machine interaction); and (3) suggested timing of use.

CONCLUSIONS

Patients' perspectives and needs about wed-based surgical decision aids are numerous and diverse. In designing wed-based surgical decision aids for breast cancer patients, content, design and timing are all factors that need to be taken into consideration to encourage informed surgical decisions. Further work will focus on developing a feasible and acceptable web-based surgical patient decision aid (PtDA), and test its usability in a clinical setting to understand if the PtDA can meet the decisional needs of breast cancer patients, thus to improve quality of decision-making.

Situations and Risk Factors of Unplanned Extubation of Nasogastric Tubes in Inpatients: A Retrospective Study

OBJECTIVE

The aim of the study is to understand whether the risk factors of the unplanned extubation (UE) of nasogastric (NG) tubes vary among different inpatient situations.

METHODS

Inpatients who experienced UE between 2009 and 2022 at a medical center were selected, and electronic medical records were used to collect patient background data and their conditions during UE. A total of 302 patients were included in our analysis.

RESULTS

Conscious patients were at greater risk of UE when coughing, scratching their nose, blowing their nose, or sneezing than those who were confused (odds ratio [OR] = 0.07, P < 0.001) and those who were drowsy or comatose (OR = 0.15, P = 0.026). During activity, repositioning, bathing, or changing incontinence pads, the risk of UE was higher in patients whose hands were not restrained at the time of UE than in those whose hands were restrained (OR = 0.05, P = 0.004), higher in those with companions than in those without companions (OR = 7.78, P = 0.002), and higher in those with longer NG tube placement time (OR = 1.05, P = 0.008). Accidental extubation (OR = 2.62, P = 0.007) occurred more frequently during activity, repositioning, bathing, or changing incontinence pads.

CONCLUSIONS

There is an increased risk of UE in conscious patients during activity, repositioning, bathing, or changing incontinence pads. Patients inserted with an NG tube for a longer period of time were at greater risk of accidental extubation during activity, repositioning, bathing, or changing incontinence pads irrespective of whether a companion could aid them if their hands were or were not restrained.

Social connectedness and the role of virtual reality: experiences and perceptions of people living with dementia and their caregivers

PURPOSE

People living with dementia are often at increased risk of becoming socially disconnected due to dementia-related challenges. In recent years, digital technology has been designed to help address the social health of people living with dementia and provide opportunities to promote or maintain their social connectedness. This paper presents the findings from phase two of a participatory action research project, which explored people living with dementia and their caregiver's experiences and perceptions of social connectedness and the potential role of Virtual Reality (VR) in promoting or maintaining same.

MATERIALS AND METHODS

People living with dementia (n = 8) and their informal caregivers (n = 8) participated in an individual, 1:1 online interview. Data analysis was guided by reflexive thematic analysis.

RESULTS

The findings presented four themes: social connectedness: lived experiences and insights, facilitating social connectedness, barriers to social connectedness and the potential of multi-user VR for social connectedness. People living with dementia experienced a range of personal, community and societal connectedness. Facilitators of social connectedness included supportive, non-judgemental, and reciprocal relationships, technology adoption, and personal and contextual facilitators. Dementia-related difficulties and periods of disruption or change were considered barriers to social connectedness. Multi-user VR was perceived as useful for promoting and maintaining social connectedness.

CONCLUSIONS

The perceived usefulness of multi-user VR for social connectedness indicates its potential for use with this population. Understanding the lived experiences, barriers, and facilitators of social connectedness will assist researchers and the human-computer interaction community to inform the design of future multi-user VR for social connectedness outcomes with people living with dementia and their caregivers.

Nursing Students' Perception of Missed Perioperative Nursing Care: Hermeneutic Phenomenology

PURPOSE

Missed nursing care is a condition that is likely to be encountered frequently in the surgical care process and is generally related to the educational and emotional needs of the patients. Perception of and witnessing missed care can affect nursing images, expectations, and experiences by causing nursing students to experience professional disappointment. The purpose of the study was to explore nursing students' perception of perioperative missed nursing care (PMNC) according to "role theory" and Benner's "novice to expert" theories.

DESIGN

The study used a qualitative design based on Heidegger's hermeneutical phenomenological approach.

METHODS

Study data were collected using a semistructured interview form prepared by the researchers through face-to-face interviews lasting approximately 50 minutes. The analysis of the data was conducted using van Manen's thematic analysis. The Standards for Reporting Qualitative Research checklist was used in reporting the study.

FINDINGS

This study, which was conducted to explore awareness of PMNC, consisted of 12 students, including five males and seven females. It was understood that nursing students noticed PMNC in clinical practice, experienced internal conflict about the issue, were concerned about the image of nursing, and experienced role and professional identity confusion. The themes of the study were formed in light of these experiences of nursing students. Three themes and 11 subthemes emerged in the study. The themes of the study were (1) perceived PMNC application-behavior patterns, (2) internal reflections of PMNC-its impact on professional identity development, and (3) perceptions of professionalism in perioperative nursing.

CONCLUSIONS

This study provided important data about the awareness of PMNC in the surgical clinical practice of nursing students in Turkey and the effects of this awareness on the professional roles and professional identity process. Students were aware of the behavioral patterns of PMNC and that they experienced internal conflict, anxiety about the nursing image, role confusion, and professional identity confusion due to this awareness. Some students justified the PMNC behaviors of the nurses and others saw themselves as the power to change the PMNC behaviors.

Nursing effectiveness reconsidered: Some fundamental reflections on the nature of nursing

Despite being considered the proverbial backbone of our healthcare systems, nursing still seems to struggle to scientifically demonstrate its contribution to care experiences and patient outcomes. This leads to erosive tendencies that threaten the development of the profession and its progress as an academic discipline. With this paper, we want to contribute to the theoretical discourse concerning the nature of nursing and the research into its effectiveness. We begin by outlining a set of prevailing paradoxes and their consequences relating to nursing and nursing research: the issue of demonstrating its unique contribution despite a clear societal mandate; a discrepancy between subjectively experienced effectiveness and objectively ascertainable effectiveness; and a mismatch between theoretical premises of nursing and task-oriented cultures in practice environments. Using an example of a seemingly simple nursing intervention, we intend to demonstrate the qualities and complexities of nursing. We further illustrate this by drawing on several of our research projects using theory-based evaluation methodologies. From these illustrative examples, we distil two insights relating to nursing interventions that we consider fundamental: the nurse, as a person, is central to its unique effectiveness; and there is always an interplay between context, intervention and its intended effect. We summarise our considerations and argue the case for conceiving research designs in alignment with theoretical premises of nursing.

Nursing Quality Indicators in Emergency Nursing: A Scoping Review

BACKGROUND

Nursing quality indicators (NQIs) are essential for evaluating and managing care, yet few validated NQIs exist for emergency nursing. The dynamic nature of this field demands specific, validated indicators.

PURPOSE

The purpose of this review was to identify NQIs in adult emergency nursing using Donabedian's quality categories (structure, process, outcome) and explore their validation.

METHODS

A scoping review was conducted including articles from 2010 to February 2023, using the Cumulative Index to Nursing and Allied Health Literature and Medline (Ovid) databases.

RESULTS

Among 936 screened articles, 18 were included, identifying 85 NQIs across structure (n = 14), process (n = 45), and outcome (n = 26) in emergency nursing. However, the validation of these NQIs was limited.

CONCLUSIONS

NQIs evaluate emergency nursing quality, primarily in process assessment. Future work should validate the NQIs identified in this review for adult emergency nursing and search for potential new ones.

Exploring work-related stressors experienced by mental health nurses: A qualitative descriptive study

INTRODUCTION

The challenging work environments mental health nurses (MHNs) encounter can negatively impact their mental health, psychological well-being and physical health. While these impacts have been investigated in quantitative research, little is known about work-related stress from the perspective of MHNs.

AIM

To explore the stresses faced by nurses working in mental health settings and to gain an understanding of the underlying workplace context.

METHOD

A descriptive qualitative study with data collected via semi-structured individual telephone interviews conducted with n = 21 Western Australian MHNs. Data were analysed using reflexive thematic analysis.

RESULTS

A total of 85 codes were generated that led to the identification of 13 subthemes and 4 main themes: (1) mental health nursing context, (2) work environment stressors, (3) factors that alleviate stress and (4) the impact of workplace stress.

DISCUSSION

Many of the stressors MHNs were exposed to are modifiable, such as understaffing and poor skill mix. Modifiable stressors increased risk for MHNs, impeded patient care and exacerbated inherent stressors such as patient acuity and complexity.

IMPLICATIONS FOR PRACTICE

This study collected data that provide rich descriptions of the experiences of MHNs and identify modifiable work-related stressors that could be alleviated through effective leadership and management.

Prediction Model for Delayed Behavior of Early Ambulation After Surgery for Varicose Veins of the Lower Extremity: A Prospective Case-Control Study

OBJECTIVE

To analyze influencing factors and establish a prediction model for delayed behavior of early ambulation after surgery for varicose veins of the lower extremity (VVLE).

DESIGN

A prospective case-control study.

SETTING

Patients with VVLE were recruited from 2 local hospitals.

PARTICIPANTS

In total, 498 patients with VVLE were selected using convenience sampling and divided into a training set and a test set.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

We collected information from the selected participants before surgery and followed up until the day after surgery, then divided them into a normal and delayed ambulation group. Propensity score matching was applied to all participants by type of surgery and anesthesia. All the characteristics in the 2 groups were compared using logistic regression, back propagation neural network (BPNN), and decision tree models. The accuracy, sensitivity, specificity, and area under the curve (AUC) values of the 3 models were compared to determine the optimal model.

RESULTS

A total of 406 participants were included after propensity score matching. The AUC values for the training sets of logistic regression, BPNN, and decision tree models were 0.850, 0.932, and 0.757, respectively. The AUC values for the test sets were 0.928, 0.984, and 0.776, respectively. A BPNN was the optimal model. Social Support Rating Scale score, preoperative 30-second sit-stand test score, Clinical-Etiology-Anatomy-Pathophysiology (CEAP) grade, Medical Coping Modes Questionnaire score, and whether you know the need for early ambulation, in descending order of the result of a BPNN model. A probability value greater than 0.56 indicated delayed behavior of early ambulation.

CONCLUSIONS

Clinicians should pay more attention to those with lower Social Support Rating Scale scores, poor lower limb strength, a higher CEAP grade, and poor medical coping ability, and make patients aware of the necessity and importance of early ambulation, thereby assisting decision-making regarding postoperative rehabilitation. Further research is needed to improve the method, add more variables, and transform the model into a scale to screen and intervene in the delayed behavior of early ambulation of VVLE in advance.

The effect of laughter therapy on self-efficacy and psychological well-being in nursing students

BACKGROUND

Academic self-efficacy and psychological well-being play a crucial role in the mental health of nursing students and influence whether they decide to remain in the nursing profession.

AIMS

This study aimed to determine the effect of laughter therapy on self-efficacy and psychological well-being in nursing students.

METHODS

In this randomized controlled study, 208 nursing students were randomly assigned to an experimental (n = 102) and a control (n = 106) group. The experimental group received laughter therapy face-to-face once a week for eight weeks. No intervention was applied to the control group. In both groups, data were collected at the beginning of the study and the end of the eighth week using a Sociodemographic Questionnaire Form, the Academic Self-Efficacy Scale, and the Psychological Well-Being Scale.

RESULTS

In the post-study group comparisons, there was a statistically significant difference in the scores for the total Academic Self-Efficacy Scale, the external emotion management and collegiality subscales, and the total Psychological Well-Being Scale (p > 0.05). With regard to all the scale scores, no statistically significant difference was found in the groups in the pre- and post-comparisons (p > 0.05).

CONCLUSIONS

It was determined that laughter therapy increased the mean psychological well-being score in the experimental group. It was also found that after the laughter therapy, distraction and loss of interest in lectures decreased, stress and anxiety levels decreased, eating and sleeping habits were regulated, and social media use decreased. Laughter therapy can be used to increase self-efficacy and psychological well-being.

The Effect of Swaddling and Oropharyngeal Colostrum During Endotracheal Suctioning on Procedural Pain and Comfort in Premature Neonates: A Randomized Controlled Trial

BACKGROUND

Endotracheal suctioning (ES) is a painful procedure frequently performed in the neonatal intensive care unit. This procedure negatively affects the comfort level of premature neonates.

PURPOSE

To determine the effect of 2 nonpharmacologic methods, swaddling and the administration of oropharyngeal colostrum, on the pain and comfort levels of preterm neonates during ES.

METHODS

This randomized controlled experimental study comprised 48 intubated premature neonates (swaddling group n = 16; oropharyngeal colostrum group n = 16; and control group n = 16) at 26 to 37 weeks of gestation. The neonates were swaddled with a white soft cotton cloth or administered 0.4 mL of oropharyngeal colostrum 2 minutes before ES, according to the group in which they were included. Two observers evaluated the pain levels (Premature Infant Pain Profile-Revize [PIPP-R]) and comfort (Newborn Comfort Behavior Scale [COMFORTneo]) of the infants by observing video recordings of before, during, and after the procedure.

FINDINGS/RESULTS

A significantly lower mean PIPP-R score was found in the swaddling group during ES compared with the control group ( P = .002). The mean COMFORTneo scores of the swaddling and oropharyngeal colostrum groups during ES ( P < .01, P = .002) and the mean PIPP-R and COMFORTneo scores immediately after ES and 5, 10, and 15 minutes later were significantly lower than the control group ( P < .005).

IMPLICATIONS FOR PRACTICE AND RESEARCH

Swaddling was effective both during and after the procedure, while oropharyngeal colostrum was effective only after the procedure in reducing ES-related pain in premature neonates. Swaddling and oropharyngeal colostrum were effective in increasing comfort both during and after the procedure.