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

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

OBJECTIVE

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

BACKGROUND

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

DESIGN

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

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

BACKGROUND

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

AIM

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

DISCUSSION

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

CONCLUSION

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

IMPLICATIONS FOR PRACTICE

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

COVID-19 vaccination refusal among the anti-vaccinationists in a Chinese society: a critical medical anthropology study of the vaccination barriers

Introduction

This study investigated the reasons for COVID-19 vaccination refusal among some Hong Kong residents who were anti-vaccinationists, despite the implementation of a vaccine incentive policy called the Vaccine Pass. The health belief model and the theory of planned behavior have been widely employed to analyze the determinants of COVID-19 vaccination. However, these two theories focus on the micro individual factors, which do not provide a sufficiently comprehensive analysis.

Study design

A qualitative descriptive approach with a critical medical anthropology framework.

Methods

This study adopts a critical medical anthropology framework that provides a micro and macro analysis at four social levels. A qualitative approach with individual, semi-structured, in-depth interviews was conducted from September 2022 to March 2023 with 30 individuals aged 20-59 years who did not receive COVID-19 vaccination in Hong Kong. The participants were recruited through purposive sampling and snowball sampling. A thematic analysis of data was implemented.

Results

The reasons for COVID-19 vaccination refusal involved intertwining relationships among factors in the four social levels of the critical medical anthropology framework. The participants' doubts about the safety of COVID-19 vaccines at the individual level were interacting with: (1) their ethnocultural beliefs and the perceived profit-oriented nature of vaccine production and distribution at the macro-social level, (2) their interpretation of the inconsistent advice of medical doctors at the micro-social level, and (3) their distrust in the government's vaccination policies at the intermediate-social level.

Conclusion

The participants' refusal of COVID-19 vaccines was correlated with perceived profit motives related to the vaccine, perceived conflict of interest of health-care providers, and the distrust of government.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

How to Limit Interdialytic Weight Gain in Patients on Maintenance Hemodialysis: State of the Art and Perspectives

Background: Interdialytic weight gain (IDWG), defined as the accumulation of salt and water intake between dialysis sessions, is a critical parameter of fluid management and a marker of adherence to dietary and fluid restrictions in hemodialysis patients. Excessive IDWG has been strongly associated with increased cardiovascular risk, including left ventricular hypertrophy, cardiac dysfunction, and cerebrovascular complications. Additionally, it necessitates more aggressive ultrafiltration, potentially compromising hemodynamic stability, impairing quality of life, and escalating healthcare costs. Despite international guidelines recommending an IDWG target of <4-4.5% of body weight, many patients struggle to achieve this due to barriers in adhering to dietary and fluid restrictions. This review explores the current state-of-the-art strategies to mitigate IDWG and evaluates emerging diagnostic and therapeutic perspectives to improve fluid management in dialysis patients. Methods: A literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science to identify studies on IDWG in hemodialysis. Keywords and MeSH terms were used to retrieve peer-reviewed articles, observational studies, RCTs, meta-analyses, and systematic reviews. Non-English articles, case reports, and conference abstracts were excluded. Study selection followed PRISMA guidelines, with independent screening of titles, abstracts, and full texts. Data extraction focused on IDWG definitions, risk factors, clinical outcomes, and management strategies. Due to study heterogeneity, a narrative synthesis was performed. Relevant data were synthesized thematically to evaluate both established strategies and emerging perspectives. Results: The current literature identifies three principal strategies for IDWG control: cognitive-behavioral interventions, dietary sodium restriction, and dialysis prescription adjustments. While educational programs and behavioral counseling improve adherence, their long-term effectiveness remains constrained by patient compliance and logistical challenges. Similarly, low-sodium diets, despite reducing thirst, face barriers to adherence and potential nutritional concerns. Adjustments in dialysate sodium concentration have yielded conflicting results, with concerns regarding hemodynamic instability and intradialytic hypotension. Given these limitations, alternative approaches are emerging. Thirst modulation strategies, including chewing gum to stimulate salivation and acupuncture for autonomic regulation, offer potential benefits in reducing excessive fluid intake. Additionally, technological innovations, such as mobile applications and telemonitoring, enhance self-management by providing real-time feedback on fluid intake. Biofeedback-driven dialysis systems enable dynamic ultrafiltration adjustments, improving fluid removal efficiency while minimizing hemodynamic instability. Artificial intelligence (AI) is advancing predictive analytics by integrating wearable bioimpedance sensors and dialysis data to anticipate fluid overload and refine individualized dialysis prescriptions, driving precision-based volume management. Finally, optimizing dialysis frequency and duration has shown promise in achieving better fluid balance and cardiovascular stability, suggesting that a personalized, multimodal approach is essential for effective IDWG management. Conclusions: Despite decades of research, IDWG remains a persistent challenge in hemodialysis, requiring a multifaceted, patient-centered approach. While traditional interventions provide partial solutions, integrating thirst modulation strategies, real-time monitoring, biofeedback dialysis adjustments, and AI-driven predictive tools represent the next frontier in fluid management. Future research should focus on long-term feasibility, patient adherence, and clinical efficacy, ensuring these innovations translate into tangible improvements in quality of life and cardiovascular health for dialysis patients.

A Conceptual Framework for Empowerment of Psychiatric Nurses Caring for Children with Mental Health Challenges

There are scanty empirical and theoretical studies focusing specifically on the implementation models for the care of psychiatric nurses caring for children. Staff contribution in the process of putting clinically relevant actions into practice contributes to effective implementation, increased acceptance, and commitment. These practises can be used to improve mental health care services of children at different levels. The aim is to deepen an understanding of the perspective of care for children with mental health challenges. A qualitative, exploratory, and descriptive design was used to allow for innovative thoughts to restructure the practice of child psychiatric nursing and is based on the Practice-Orientated Theory of Dickoff. A positive focus on aspects that facilitate care for children with mental health problems is informed by the data collected. A suite of services that include practice environment, trainings, and practical assistance is feasible to support psychiatric nurses. This framework implies that psychiatric nurses need professional competence to understand the context of the environment. Psychiatric nurses need to move beyond engagement to demonstrate how they help children with psychiatric challenges and to enable the development of psychiatric nursing practice through international collaboration.

A study of the effects of dance/movement therapy on parenting stress and emotions in mothers of children with autism spectrum disorder

Objective

Currently, many scholars are working to improve the core symptoms of children with autism spectrum disorder, while neglecting the mental health of caregivers of children with ASD. This study examined the effectiveness of dance/movement therapy (DMT) in reducing parenting stress in mothers of children with autism spectrum disorder and whether depression and anxiety mediated the effects thereof.

Methods

Forty mothers of children with autism spectrum disorder were recruited in Nanchang, China, and divided into an experimental group (20) and a control group (20). The subjects were assessed before and after 12 weeks of dance/movement therapy (DMT) using the Parenting Stress Index/Short Form (PSI-SF), Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS) as the assessment tools.

Results

The results found that parenting stress, depression, and anxiety scores of mothers of children with autism spectrum disorder were significantly reduced after the dance/movement therapy (DMT) intervention.

Conclusion

The mediating effects of depression and anxiety were significant, indicating that dance/movement therapy (DMT) is effective in reducing the levels of parenting stress, depression, and anxiety in mothers of children with autism spectrum disorder, and can indirectly play a role in reducing the levels of parenting stress in mothers of children with autism spectrum disorder by reducing their depression and anxiety.

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

BACKGROUND

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

OBJECTIVES

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

DESIGN

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Food Insecurity and Clinical Outcomes in Surgical Trauma Patients

Importance

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

Objective

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

Design, Setting, and Participants

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

Exposures

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

Main Outcomes and Measures

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

Results

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

Conclusions and Relevance

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

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

BACKGROUND

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

AIMS

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

METHODS

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

DISCUSSION

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

Optimizing Resident Charge Capture with Disappearing Help Text in Note Templates

OBJECTIVE

 This study aimed to assist residents in selecting the correct Current Procedural Terminology (CPT) code for evaluation and management (E/M) services through the addition of disappearing help text into a standardized note template.

METHODS

 We created a disappearing text block that summarizes E/M requirements and embedded it into the note template used by residents at a pediatric urgent care clinic. An intervention cohort composed of postgraduate year 1 (PGY 1) residents was instructed to use this note template, while senior residents (PGY 2-3) were instructed to use an identical template that lacked the help text. We evaluated the incidence of CPT change by the attending physician for each visit as a proxy for improvement in resident billing practices. Logistic regression with a primary outcome of whether the encounter CPT code was changed was completed.

RESULTS

 There were 2,869 encounters during the 255-day study period; the help text was used in 1,112 (38.8%) encounters. There was some crossover in note use; that is, PGY 1s used the note without help text and PGY 2s used the note with help text. Nevertheless, all residents who used the help text had a lower unadjusted rate of CPT change (22.1 vs. 30.6%, odds ratio [OR] = 0.64, p < 0.0001). This pattern persisted when stratified by trainee level-PGY 1 (22.6 vs. 45.3%, OR = 0.35, p < 0.0001) and PGY 2-3 (12.2 vs. 27.8%, p = 0.018). Adjusting for multiple factors, the use of help text was associated with a lower incidence of CPT change (OR = 0.28, 95% confidence interval [CI]: 0.19-0.44).

CONCLUSION

 Residents' use of the disappearing help text was associated with a large decrease in CPT code adjustment by attending physicians, which demonstrates its promise for improved E/M coding and other applications.

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

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

Digital Motherhood in the Postpartum Period: A Descriptive Study

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

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

BACKGROUND

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

AIMS

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

MATERIEL AND METHODS

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

RESULTS

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

CONCLUSION

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

Nurses communication competencies in social media: A bibliometric review

OBJECTIVE

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

DESIGN

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

DATA SOURCES

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

METHODS

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

RESULTS AND DISCUSSION

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

CONCLUSION

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

Sudden cardiac arrest prediction via deep learning electrocardiogram analysis

Aims

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

Methods and results

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

Conclusion

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

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

PURPOSE/AIMS

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

DESIGN

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

AIM

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

DESIGN

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

PARTICIPANTS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Designing Effective Multidisciplinary Team Meetings in the Greek National Health System: Opinions, Obstacles, and Implementation

INTRODUCTION

The implementation and accessibility of multidisciplinary team meetings (MDTMs), which ensure equal opportunities for health professionals to participate, are fundamental to the functioning of any national health system.

AIM

This study aims to describe the main characteristics of MDTMs and assess the opinions and experiences of healthcare professionals who participated in these meetings.

MATERIALS AND METHODS

We conducted a cross-sectional study of health professionals who participated in MDTMs at tertiary referral health centers within the Greek national health system. We employed a simple random sampling methodology, and the questionnaires were completed automatically. The survey was conducted from February to April 2022.

RESULTS

Ninety-eight questionnaires were distributed, and 72 complete responses were returned (response rate: 73.5%). The mean age of respondents was 47.2 ± 7.4 years. Sixty-five participants (90.3%) were specialized doctors, and thirty-nine (54.17%) stated that the time allocated for MDTM sessions was insufficient. Meanwhile, the majority agreed that MDTMs improved patient treatment allocation (n=59, 82%), were beneficial for healthcare professionals' education (n=60, 83.4%), and enhanced the practical and educational skills of medical interns (n=57, 79.2%). Regarding case discussions in MDTMs, participants agreed that comorbidities (n=67, 93.1%), social-psychological factors (n=59, 82%), and patients' preferences (n=62, 86.1%) should always be considered during meetings. The primary challenges in achieving a complete therapeutic plan were identified as inadequate teamwork (n=11, 15.3%), complexity of referred cases (n=9, 12.5%), and time constraints (n=9, 12.5%).

CONCLUSIONS

Weaknesses in the healthcare system have emerged, necessitating action to address areas requiring improvement. Differences in the conceptual framework of MDTM functionality, particularly regarding specialists' specific roles and responsibilities, have been observed. Since the Greek national health system lacks specific protocols for the universal implementation of MDTMs, this study underscores the need for structured MDTM protocols in Greece to enhance healthcare professionals' participation and optimize patient care.

Effect of Night-Time Noise Control Combined with Detailed Nursing on Negative Emotions and Sleep Quality in Patients with Upper Gastrointestinal Bleeding

OBJECTIVE

The aim of the study was to investigate the effect of nighttime noise control, combined with detailed nursing, on negative emotions and sleep quality in patients suffering from upper gastrointestinal bleeding.

METHODS

This retrospective analysis was conducted on 100 patients with upper gastrointestinal bleeding who were admitted to the Fifth People's Hospital of Wuxi from January 2021 to January 2024. Patients were divided into the noise control group and the detailed nursing group based on different nursing care methods, with each group containing 50 cases. The detailed nursing group received detailed nursing, whereas the noise control group received nighttime noise control combined with detailed nursing. The results of the Fear Visual Analog Scale (FVAS), Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), and subjective assessment of noise of the two groups were compared.

RESULTS

After management, the HAMA, HAMD, FVAS, and PSQI scores of both groups showed a significant decrease compared to baseline (P < 0.05). Additionally, the HAMA, HAMD, FVAS, and PSQI scores of the noise control group were significantly lower than those of the detailed nursing group (P < 0.05).The subjective assessment of noise in both groups was significantly higher after management than before management, with the noise control group reporting a significantly higher subjective noise assessment than the detailed nursing group (P < 0.05).

CONCLUSION

Nighttime noise control combined with detailed nursing is effective in patients with upper gastrointestinal bleeding. This approach helps reduce negative emotions such as anxiety, depression, and fear; lowers the subjective assessment of noise; and improves sleep quality.

Beliefs and misconceptions about hypertension disease: A qualitative study among patients in a peri-urban community in Ghana

ObjectiveThis study aims to explore beliefs and perceptions about hypertension among patients living with hypertension in a local district in the Eastern region of Ghana.MethodsA descriptive qualitative approach was adopted, and the Health Belief Model was used to guide the data collection, analysis, and organization of the study findings. Overall, seventeen participants were interviewed. In-depth interviews were conducted using a semistructured interview guide. Participants were conveniently selected from a district local Government Hospital. Data gathered were transcribed verbatim and analyzed using thematic analysis.ResultsAlmost all the participants acknowledged hypertension as a severe but chronic illness that can cause sudden death. They also identified that lifestyle practices and individual attitudes were associated with the hypertension condition's causes, management, and control. The findings revealed several unscientific misconceptions and beliefs about hypertension, which could influence their disease management and control decisions.DiscussionPatients' decisions on alternative treatment for hypertension are primarily based on beliefs and misconceptions based on the information they receive from unregulated media and peers. The prevention and control of hypertension should focus on behavior and lifestyle modification which needs reinforcement through health education and promotion.

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

OBJECTIVE

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TeamSTEPPS® in Home Health

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

Digital Health Interventions Supporting Recovery for Intensive Care Patients and Their Family Members: A Scoping Review

Digital innovation in interventions to promote recovery for intensive care unit (ICU) patients and their family members holds promise for enhancing accessibility and improving physical, psychological, and cognitive outcomes. This scoping review provides a comprehensive overview of digital health interventions designed to support the recovery of ICU patients and their family members described in peer-reviewed publications. We searched 6 databases (inception to September 2023); 2 reviewers independently screened citations against predefined eligibility criteria and extracted data. We screened 3485 records and identified 18 original studies and 8 study protocols with a range of study designs published between 2016 and 2023. Most (n=15) completed studies recruited patients only. Digital interventions were delivered through applications, virtual reality, videoconferencing, and smartwatches. In the completed studies, outcomes are described as feasibility, intervention efficacy, or both. Digital interventions supplemented with professional support and personalized feedback were more feasible than self-directed interventions. Further research is essential to ascertain the efficacy and cost-effectiveness of digital interventions in improving outcomes for ICU survivors and their family members.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

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

AIM

To explore interventions developed to improve nurses' clinical judgment.

BACKGROUND

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

DESIGN

A systematic review with narrative synthesis.

METHODS

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

RESULTS

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

CONCLUSIONS

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

REPORTING METHOD

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

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

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

PURPOSE

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

AIMS

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

STUDY DESIGN

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

RESULTS

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

CONCLUSIONS

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

RELEVANCE TO CLINICAL PRACTICE

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

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

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

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

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

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

CONTEXT

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

OBJECTIVES

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

METHODS

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

DISCUSSION

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

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Concept analysis of health research translation nomenclature

INTRODUCTION

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

OBJECTIVES

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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