Alarm Management in Provisional COVID-19 Intensive Care Units: Retrospective Analysis and Recommendations for Future Pandemics

BACKGROUND

In response to the high patient admission rates during the COVID-19 pandemic, provisional intensive care units (ICUs) were set up, equipped with temporary monitoring and alarm systems. We sought to find out whether the provisional ICU setting led to a higher alarm burden and more staff with alarm fatigue.

OBJECTIVE

We aimed to compare alarm situations between provisional COVID-19 ICUs and non-COVID-19 ICUs during the second COVID-19 wave in Berlin, Germany. The study focused on measuring alarms per bed per day, identifying medical devices with higher alarm frequencies in COVID-19 settings, evaluating the median duration of alarms in both types of ICUs, and assessing the level of alarm fatigue experienced by health care staff.

METHODS

Our approach involved a comparative analysis of alarm data from 2 provisional COVID-19 ICUs and 2 standard non-COVID-19 ICUs. Through interviews with medical experts, we formulated hypotheses about potential differences in alarm load, alarm duration, alarm types, and staff alarm fatigue between the 2 ICU types. We analyzed alarm log data from the patient monitoring systems of all 4 ICUs to inferentially assess the differences. In addition, we assessed staff alarm fatigue with a questionnaire, aiming to comprehensively understand the impact of the alarm situation on health care personnel.

RESULTS

COVID-19 ICUs had significantly more alarms per bed per day than non-COVID-19 ICUs (P<.001), and the majority of the staff lacked experience with the alarm system. The overall median alarm duration was similar in both ICU types. We found no COVID-19-specific alarm patterns. The alarm fatigue questionnaire results suggest that staff in both types of ICUs experienced alarm fatigue. However, physicians and nurses who were working in COVID-19 ICUs reported a significantly higher level of alarm fatigue (P=.04).

CONCLUSIONS

Staff in COVID-19 ICUs were exposed to a higher alarm load, and the majority lacked experience with alarm management and the alarm system. We recommend training and educating ICU staff in alarm management, emphasizing the importance of alarm management training as part of the preparations for future pandemics. However, the limitations of our study design and the specific pandemic conditions warrant further studies to confirm these findings and to explore effective alarm management strategies in different ICU settings.

The mentee report: outcomes from implementing a mentorship program for international genetic counseling applicants

The first genetic counseling (GC) graduate training program was established in the United States (U.S.) in 1969 and GC is an emerging field of healthcare in many countries. Each year, at least 7% of applicants to U.S.-based GC graduate programs come from countries outside the U.S. ("international GC applicants''). To address the unique needs of international GC applicants, volunteers from the International Special Interest Group (ISIG) of the National Society of Genetic Counselors (NSGC) launched a semi-structured mentorship program (the "International Genetic Counseling Mentorship Program'' (IGCMP)) in 2021, which provides individualized mentorship and optional group activities for networking and learning. Fifty-two people from 19 countries signed up for the IGCMP across three application cycles. Of these, 47 were eligible to participate as mentees, and most were interested in one-on-one virtual meetings with international GCs in the U.S. (n = 41/47, 87.2%). An assessment form was sent to 17 mentees who applied to GC graduate school after participating in the first or second cycle of the IGCMP. Of the 12 responses received, 10 (83.3%) reported being extremely satisfied with their individual mentor(s), and the one-on-one meeting with a mentor was considered helpful to both the application and interview process by nine (75.0%) respondents. Importantly, feedback about program improvement revealed an interest in connecting with additional international applicants and mentors and all respondents expressed interest in receiving mentorship throughout graduate school. Future directions include collaborating with other mentorship and graduate programs to further enhance support for international applicants.

Family Caregivers of Persons with Bipolar Disorder: Caregiver Demographics and Need and Preference for Intervention

The unpredictability of bipolar disorder is highly distressing for family caregivers, who differ in their needs and preferences for stress-reducing or educational interventions. Applying Ryan and Sawin's model, this study examined associations between caregiver demographics (age, gender, and race) as contextual factors and caregiver needs and preferences for three interventions as process factors within a preliminary descriptive analysis of 306 family caregivers from a randomized clinical trial. Caregiver needs for education about bipolar disorder, biofeedback, and Resourcefulness Training© were determined by established cut scores on validated measures of bipolar knowledge, heart rate variability, and resourcefulness. Frequencies for need and preference for intervention were compared by caregiver age, gender, and race. Discrepancies between caregiver need and preference for interventions were analyzed. Non-White caregivers showed greater need for education (X2=33.68, p < 0.001). Middle-aged caregivers showed greatest need for biofeedback (X2=19.58, p < 0.001). Need for Resourcefulness Training© was similar across age, gender, and race. We found 58% needed biofeedback, 34% education, and 18% Resourcefulness Training©; 46% of those in the preference group chose Resourcefulness Training©. Further caregiver intervention research should consider the effect of caregiver needs and preferences on their health. The findings support the essentiality of assessing caregiver demographics, needs, and preferences before implementing interventions.

Machine learning methods to discover hidden patterns in well-being and resilience for healthy aging

BACKGROUND

A whole person approach to healthy aging can provide insight into social factors that may be critical. Digital technologies, such as mobile health (mHealth) applications, hold promise to provide novel insights for healthy aging and the ability to collect data between clinical care visits. Machine learning/artificial intelligence methods have the potential to uncover insights into healthy aging. Nurses and nurse informaticians have a unique lens to shape the future use of this technology.

METHODS

The purpose of this research was to apply machine learning methods to MyStrengths+MyHealth de-identified data (N = 988) for adults 45 years of age and older. An exploratory data analysis process guided this work.

RESULTS

Overall (n = 988), the average Strength was 66.1% (SD = 5.1), average Challenges 66.5% (SD = 7.5), and average Needs 60.06% (SD = 3.1). There was a significant difference between Strengths and Needs (p < 0.001), between Challenges and Needs (p < 0.001), and no significant differences between average Strengths and Challenges. Four concept groups were identified from the data (Thinking, Moving, Emotions, and Sleeping). The Thinking group had the most statistically significant challenges (11) associated with having at least one Thinking Challenge and the highest average Strengths (66.5%) and Needs (83.6%) compared to the other groups.

CONCLUSION

This retrospective analysis applied machine learning methods to de-identified whole person health resilience data from the MSMH application. Adults 45 and older had many Strengths despite numerous Challenges and Needs. The Thinking group had the highest Strengths, Challenges, and Needs, which aligns with the literature and highlights the co-occurring health challenges experienced by this group. Machine learning methods applied to consumer health data identify unique insights applicable to specific conditions (e.g., cognitive) and healthy aging. The next steps involve testing personalized interventions with nurses leading artificial intelligence integration into clinical care.

Investigating Patient Perspectives on Using eHealth Technologies for the Self-Management of Inflammatory Bowel Disease: Mixed Methods Study

BACKGROUND

Inflammatory bowel disease (IBD) poses significant challenges for patients, requiring continuous monitoring and self-management to improve quality of life.

OBJECTIVE

This study aims to investigate the viewpoints of individuals living with IBD on the use of information and communication technology (ICT) for the self-management of their condition, with a particular focus on the concept of a "smart" toilet seat as an example of ICT for IBD self-management.

METHODS

We conducted an analysis of questionnaire responses obtained from 724 participants. They were encouraged to share their use cases and identify any perceived barriers associated with ICT adoption for managing their condition. To assess their responses, we used descriptive quantitative analysis, summative content analysis, and thematic qualitative analysis. We combined these results in an epistemic network analysis to look for meaningful patterns in the responses.

RESULTS

Of the 724 participants, more than half (n=405, 55.9%) were already using various forms of ICT for IBD self-management. The primary factor influencing their use of ICT was their affinity for interacting with technology. Distinct differences emerged between individuals who were using ICT and those who were not, particularly regarding their perceived use cases and concerns.

CONCLUSIONS

This study provides valuable insights into the perspectives of individuals with IBD on the use of ICT for self-management. To facilitate wider adoption, addressing privacy concerns, ensuring data security, and establishing reliable ICT integration will be critical.

Neurophysiological patterns reflecting vulnerability to delirium subtypes: a resting-state EEG and event-related potential study

Delirium is a common and acute neurocognitive disorder in older adults associated with increased risk of dementia and death. Understanding the interaction between brain vulnerability and acute stressors is key to delirium pathophysiology, but the neurophysiology of delirium vulnerability is not well defined. This study aimed to identify pre-operative resting-state EEG and event-related potential markers of incident delirium and its subtypes in older adults undergoing elective cardiac procedures. This prospective observational study included 58 older participants (mean age = 75.6 years, SD = 7.1; 46 male/12 female); COVID-19 restrictions limited recruitment. Baseline assessments were conducted in the weeks before elective cardiac procedures and included a 4-min resting-state EEG recording (2-min eyes open and 2-min eyes closed), a 5-min frequency auditory oddball paradigm recording, and cognitive and depression examinations. Periodic peak power, peak frequency and bandwidth measures, and aperiodic offsets and exponents were derived from resting-state EEG data. Event-related potentials were measured as mean component amplitudes (first positive component, first negative component, early third positive component, and mismatch negativity) following standard and deviant auditory stimuli. Incident delirium occurred in 21 participants: 10 hypoactive, 6 mixed, and 5 hyperactive. Incident hyperactive delirium was associated with higher pre-operative eyes open (P = 0.045, d = 1.0) and closed (P = 0.036, d = 1.0) aperiodic offsets. Incident mixed delirium was associated with significantly larger pre-operative first positive component amplitudes to deviants (P = 0.037, d = 1.0) and larger third positive component amplitudes to standards (P = 0.025, d = 1.0) and deviants (P = 0.041, d = 0.9). Other statistically non-significant but moderate-to-large effects were observed in relation to all subtypes. We report evidence of neurophysiological markers of delirium risk weeks prior to elective cardiac procedures in older adults. Despite being underpowered due to COVID-19-related recruitment impacts, these findings indicate pre-operative dysfunction in neural excitation/inhibition balance associated with different delirium subtypes and warrant further investigation on a larger scale.

Designing a resilience-based intervention program for children with cancer and their families: a study protocol

Background

Advances in pediatric oncology have significantly increased survival rates, yet have introduced challenges in managing long-term treatment side effects. This study process introduces an interdisciplinary clinical intervention program rooted in the family resilience framework, aimed at improving well-being across the cancer trajectory for children and their families, especially those in Canadian communities far from specialized oncology centers with limited access to resources.

Methods

Employing an intervention mapping approach, this program collaboratively involves patients, families, professionals, and researchers. It aims to identify vulnerability factors, establish a logic model of change, and devise comprehensive strategies that include professional interventions alongside self-management tools. These strategies, tailored to address biopsychosocial and spiritual challenges, are adapted to the unique contexts of communities distant from specialized cancer treatment centers. A mixed-methods approach will evaluate program effectiveness.

Expected results

Anticipated outcomes include the empowerment of families with self-management tools and professional support, designed to mitigate biopsychosocial and spiritual complications. By addressing the specific needs and limitations of these communities, the program strives to improve the overall health and well-being of both undergoing treatment and survivorship phases.

Discussion

By focusing on comprehensive care that includes both professional interventions and self-management, this initiative marks a significant shift toward a holistic, family-centered approach in pediatric oncology care for remote communities. It underlines the necessity of accessible interventions that confront immediate and long-term challenges, aiming to elevate the standard of care by emphasizing resilience, professional support, and family empowerment in underserved areas.

Imposter phenomenon: recognising and addressing it among nurses

Imposter phenomenon is described as persistently doubting one's accomplishments, leading to an internalised fear of being exposed as a 'fraud'. This article identifies the nature and prevalence of imposter phenomenon among nursing students, newly registered nurses and senior nurses. It also explores the effects of this phenomenon for nurses and healthcare organisations, including its potential association with burnout, suboptimal performance and a lack of career development. Evidence suggests that addressing imposter phenomenon is not something individuals can accomplish by themselves, but that it requires system-level interventions from healthcare organisations and higher education institutions. This could raise awareness, promote recognition and improve resources and training to mitigate the detrimental effects of this phenomenon on healthcare provision.

Delphi Technique on Nursing Competence Studies: A Scoping Review

This scoping review was conducted under the Joanna Briggs Institute (JBI) framework. It included primary studies published until 30 April 2023, obtained through a systematic search across PubMed, Web of Science, CINAHL, and MEDLINE databases. The review focused on primary studies that used the Delphi technique in nursing competence research, especially those related to defining core competency frameworks and developing instruments to assess professional competence. The goal was to analyze the different methodological approaches used by authors, synthesize them, and propose recommendations to enhance methodological rigor, reliability, and validity in the application of the Delphi technique. For this purpose, the following review question was established: "What is the available evidence on the use of the Delphi technique in the study of professional competence in nursing?". The extracted textual elements underwent a content analysis, resulting in dimensions established through an inductive approach. Twenty studies were included, yielding insights into diverse methodological options for conducting Delphi studies, organised around a set of dimensions: (1) preparatory procedures; (2) procedures for accessing and selecting experts; (3) acquisition of expert input; (4) data analysis and consensus; and (5) ethical and legal procedures and guarantees. The study's limitations include the inability to include certain studies due to a lack of response to requests for clarification from corresponding authors. Additionally, the primary studies' methodological quality was not assessed, which is another relevant aspect. The study's results offer valuable insights for researchers intending to utilise the Delphi technique within the context of the research referenced in the included studies. This information encompasses important methodological choices, highlighting their potential benefits and associated risks. The review was prospectively registered on the Open Science Framework (Registration No: osf.io/kp2vw).

Trainee district nurses' understanding and perceptions of the palliative care key worker role: a qualitative study

BACKGROUND

The district nurse is identified as a keyworker in community based palliative care. However, a dearth of research exists on trainees' views and understanding of adopting the role upon qualification.

AIMS

The aim of this study was to explore the understanding and perceptions of district nurse trainees in relation to the palliative care key worker role.

METHODS

Data was gathered via online semi-structured interviews (n=10) and the results were analysed using a thematic model.

FINDINGS

The four evolving themes included: understanding of the palliative care key worker role scope and function; the level of preparation for the role; a juggling act and embedding the role in practice.

CONCLUSION

The themes highlighted various drivers and barriers that reflect a degree of incongruence with policy and practice. Recommendations to standardise the palliative care key worker role, underpinned by formal preparation and clearly defined responsibilities may enhance future development and implementation of the role.

Interaction mechanism of discharge readiness between discharge teaching and post-discharge outcomes in gynecological inpatients: a mediation analysis

BACKGROUND

With the rapid implementation of enhanced recovery after surgery, most gynecological patients are discharged without full recovery. Discharge planning is necessary for patients and their families to transition from hospital to home. Discharge teaching and discharge readiness are two core indicators used to evaluate the quality of discharge planning, which impacts the post-discharge outcomes. To improve post-discharge outcomes, the interaction mechanism of the three variables needs to be determined, but few studies have focused on it.

OBJECTIVES

Explore the mediating effect of discharge readiness between discharge teaching and post-discharge outcomes of gynecological inpatients.

METHODS

Discharge teaching and discharge readiness were measured by the Quality of Discharge Teaching Scale (QDTS) and Readiness for Hospital Discharge Scale (RHDS). Post-discharge outcomes on postoperative Day 7 (POF-D7) and postoperative Day 28 (POF-D28) were measured by a self-designed tool. Spearman correlations, Kruskal‒Wallis tests and Mann‒Whitney U tests were conducted to explore the correlation between post-discharge outcomes and other variables. Mediation analysis was used to explore the mediating effect of discharge readiness between discharge teaching and post-discharge outcomes.

RESULTS

QDTS and RHDS showed strong positive correlations with post-discharge outcomes. The mediation analyses verified that RHDS was a full mediator between QDTS and POF-D7, and the indirect effect accounted for 95.6% of the total direct effect. RHDS was a partial mediator between QDTS and POF-D28, and the indirect effect accounted for 50.0% of the total direct effect. RHDS was a full mediator between QDTS and total scores of post-discharge outcomes, and the indirect effect accounted for 88.9% of the total direct effect.

CONCLUSIONS

Discharge teaching can improve the post-discharge outcomes of gynecological inpatients through the intermediary role of discharge readiness. Doctors and nurses should value the quality of discharge teaching and the discharge readiness improving of gynecological inpatients. Future studies should note the interaction mechanism of the three variables to explore more efficient ways of improving post-discharge outcomes of gynecological inpatients.

Functional performance of patients submitted to cardiac surgery with different levels of sleep quality: an observational study

OBJECTIVE

To describe pulmonary function, muscle strength and functional performance in the different qualities of sleep and the impact of this on the number of physiotherapeutic assistances.

METHODS

This is an observational study. In the pre and post operative period, sleep behavior was evaluated using the Pittsburgh questionnaire. Patients were divided into three groups: Good Sleep Quality (GSQ), Poor Sleep Quality (PSQ) and Sleep Disordered (SDB). At this time, other tests were also performed, such as: 6-Minute Walk Test (6MWT), Sit and Stand Test (SST), gait speed test and Timed Up to Go (TUG), Medical Research Council (MRC), maximal inspiratory pressure and maximal expiratory, vital capacity and peak expiratory flow. The functional performance and lung function of each group were compared.

RESULTS

A total of 105 people, undergoing cardiac surgery and admitted to hospital were evaluated, 33 with GSQ, 41 with PSQ and 31 with SD. Patients who were in the SDB group had a lower functional performance than the other groups. 6MWT (meters) in the GSQ was 499 ± 87, versus 487 ± 91 in the PSQ and 430 ± 78 in the SD (p = 0.02). In the SST (seconds) it was 10.4 ± 1.1 in the GQS, 11.1 ± 2.3 in the PSQ and 15.4 ± 2.1 in the SD (p = 0.04). Lung function and muscle strength did not differ between groups. Regarding the refusal to perform physical therapy, the SD group was more incident, the main reason being drowsiness.

CONCLUSION

Based on the results, we found that sleep quality interferes with functional performance and physical therapy assistance during the hospital stay in patients undergoing cardiac surgery.

American Association of Heart failure nurses' knowledge, barriers and facilitators in conducting research

BACKGROUND

To provide high-quality patient care, heart failure (HF) nurses must comprehend/use best evidence; however, HF nurses' ability to do so are unknown.

OBJECTIVES

To describe HF nurses' research interest/involvement, confidence, facilitators/motivators, and barriers to lead/collaborate in research studies.

METHODS

A descriptive design with convenience sampling and online data collection (Qualtrics) were used with American Association of HF Nurses members. Recruited/included nurses (n = 145) needed to be of any educational level and currently practicing in any practice setting in the United States. A 30-item, adapted instrument assessed research interest (one-question), involvement (two-questions), confidence (two-questions), facilitators (one-question), motivators (three-questions), and barriers (21-questions).

RESULTS

Subjects (n = 145) were Caucasian (n = 124, 86.1 %) females (n = 137, 96.5 %) with an average age of 52.5 ± 10.38 years and 26.90±12.06 years of nursing experience. Nurses were interested in conducting nursing research (7.78/10±2.37) but involvement was low. Most frequently (n = 73, 50.3 %) nurses served as principal/co-investigators. Confidence with research participation was moderate (70.28/100±26.92) and in their ability to understand/apply research findings were low (21.68/100±80.07). The most frequently reported facilitator was the ability to control their own schedule/work (n = 30, 20.7 %) and the strongest motivator (n = 107, 73.8 %) was the perception presenting nursing research/EBP impacts HF care. The greatest reported barrier was the authority to seek research funding (2.39/5 ± 1.14). Nursing experience (p=.034), interest in participating in nursing research (p=.01), and how much presenting nursing research/EBP impacted one's performance review (p<.001) added to the prediction (R2=0.499, p<.001).

CONCLUSIONS

The gained knowledge may promote development of innovative programs and educational opportunities to increase HF nurses' research activities.

Interaction between healthcare providers and parents of children or adolescents with epilepsy: A qualitative systematic review and meta-synthesis

AIMS

This study aimed to explore the interactions between healthcare providers and parents of children or adolescents with epilepsy. A qualitative systematic review based on the theory-generating meta-synthesis research approach proposed by Finfgeld-Connett (2018) was applied.

MATERIALS AND METHODS

We searched for empirical qualitative studies in five electronic databases (PubMed, Embase, CINAHL, Cochrane Library, and Web of Science), from January 1, 2003 to February 9, 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to guide the selection process, and two researchers independently assessed the methodological quality of the articles using the Critical Appraisal Skills Programme Qualitative Studies Checklist.

RESULTS

Of the 4,768 studies initially imported for screening, 27 studies were reviewed and synthesized. Only one qualitative study directly focused on the interactions between parents and healthcare providers, but various studies mentioning such interaction as themes or sub-themes of other phenomena allowed us to draw out common attributes. Defining attribute, "journey through the three stages of interaction," were derived as follows: Stage 1: trust vs. mistrust; Stage 2: autonomy vs. doubt; Stage 3: adaptation. The antecedents included encounters with healthcare providers and parent empowerment. A patient-centered approach was found to be the consequence.

CONCLUSION

It is important for parents of children or adolescents with epilepsy to empower themselves and increase their interactions. Considering the stage of interaction, healthcare providers and researchers should explore strategies to promote effective communication. Further research is required to develop strategies aimed at supporting parents and healthcare providers to achieve the tasks at each stage and maintain Stage 3, "adaptation."

Lung transplant recipients' experiences of and attitudes towards self-management: a qualitative systematic review

OBJECTIVE

The objective of this review was to identify lung transplant recipients' experiences of and attitudes towards self-management.

INTRODUCTION

Lung transplantation is an established treatment to improve the survival of patients with end-stage lung diseases and has been performed on more than 40,000 patients worldwide. The current focus of care for lung transplant recipients is long-term management. Patients need to adapt and adhere to complex self-management tasks to prevent complications and to enable them to keep the transplanted graft as long as possible. However, to date, there are no qualitative systematic reviews that identify lung transplant recipients' experiences of and attitudes towards self-management.

INCLUSION CRITERIA

This review included studies of adults over 18 years of age who had received a lung transplant and were able to perform their self-management tasks independently. All studies that investigated lung transplant recipients' experiences of and attitudes towards self-management in any setting were eligible for inclusion. All types of studies that focused on qualitative data, including, but not limited to, phenomenology, grounded theory, ethnography, action research, and feminist research, were considered for inclusion. Mixed methods studies were included only when qualitative data could be extracted separately, and if they reported results relating to the phenomenon of interest. Studies published in English or German were considered for inclusion in this review.

METHODS

The search strategy aimed to find published studies using the databases Web of Science Core Collection, PsycINFO (Ovid), MEDLINE (Ovid), Embase (Ovid), Emcare (Ovid), and CINAHL (EBSCOhost). The search for unpublished studies included ProQuest Dissertations and Theses Database, EThOS, and OpenGrey. Databases were searched from inception to March 2022. Methodological quality of studies was independently assessed by 2 independent reviewers using the JBI checklist for qualitative research. A standardized data extraction tool from JBI was used by 2 reviewers for data collection. Meta-aggregation was undertaken to synthesize the data, and the final synthesis of the findings was reached through discussion. Results were graded according to ConQual.

RESULTS

Ten studies with a sample size from 8 to 73 participants from North America and Central/Northern Europe were included in the review. The critical appraisal scores of the included studies ranged from 3 to 9 out of 10. A total of 137 findings were extracted and aggregated to form 19 categories and the following 4 aggregated syntheses: i) Changes in routines, beliefs, and sense of responsibility are essential for better adaptation and self-management after lung transplantation; ii) Life after transplantation is characterized by both positive and negative feelings and experiences; iii) Better adjustment and self-management after a lung transplant require dealing with one's own feelings and beliefs; iv) After transplantation, engaging with relatives, friends, medical team, and donors is essential to improve experiences and adapt to being a transplant recipient. Based on the ConQual scores, 2 synthesized findings were graded as moderate and 2 were graded as low.

CONCLUSIONS

Nuanced emotional, social, relational, and psychological adjustment is required of lung transplant recipients to be able to successfully self-manage. Loved ones and health professionals contribute significantly to this process, but psychosocial or peer support may further facilitate this transition.

SUPPLEMENTAL DIGITAL CONTENT

A German-language version of the abstract of this review is available as Supplemental Digital Content [ http://links.lww.com/SRX/A46 ].

Upskill training and preparedness of non-critical-care registered nurses deployed to intensive care units during the COVID-19 pandemic: A scoping review

BACKGROUND

The increase in intensive care unit (ICU) capacity compelled by the COVID-19 pandemic required the rapid deployment of non-critical-care registered nurses to the ICU setting. The upskill training needed to prepare these registered nurses for deployment was rapidly assembled due to the limited timeframe associated with the escalating pandemic. Scoping the literature to identify the content, structure, and effectiveness of the upskill education provided is necessary to identify lessons learnt during the COVID-19 pandemic response so that they may guide workforce preparation for future surge planning.

AIM

The aim of this scoping review was to map the literature to identify the available information regarding upskill training and preparedness of non-critical-care registered nurses deployed to the ICU during the COVID-19 pandemic.

METHODS

This scoping review was conducted in accordance with JBI methodology. A protocol outlined the review questions and used the participants, concept, and context framework to define the inclusion and exclusion criteria. A search of healthcare databases MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane, and Scopus was supplemented with a grey literature search via Google.

RESULTS

Screening and review found 32 manuscripts that met the inclusion criterion for examination. Analysis revealed variation in duration of programs, theoretical versus practical content, face-to-face or online mode of delivery, and duration of preparation time at the bedside in the ICU setting. Data on contributors to preparedness for deployment were sparse but included training, support, peer education, buddy time, and clarity around responsibilities and communication.

DISCUSSION

Evaluation of upskill education was mostly limited to post-training surveys. Few studies explored the preparedness of deployed registered nurses as an outcome of their upskill training or described measures of effectiveness of ICU deployment.

CONCLUSION

There is limited evidence describing preparedness of non-critical-care registered nurses on deployment to the ICU. Further research is needed to identify what elements of upskill education led to preparedness and effective deployment to the ICU setting.

Evaluation of the quality and content of YouTube videos as an educational resource in developing patients' inhaler use skills

BACKGROUND

YouTube has educational videos on inhalers. However, their content and quality are not adequately known.

OBJECTIVES

This study investigated the quality and content of educational YouTube videos on inhalers.

METHODS

This descriptive study analyzed 178 YouTube videos on inhalers between May and July 2022. Two researchers independently evaluated the videos. The Global Quality Score (GQS), Journal of American Medical Association (JAMA) Benchmark Criteria, and Inhaler Application Checklist (IAC) were used to assess the quality and content of the videos. Spearman's correlation, Kruskal-Wallis, Mann-Whitney U, ANOVA, and Post hoc analysis Bonferroni test were used for data analysis.

RESULTS

The videos had a mean GQS score of 3.70 ± 1.24, and JAMA score of 2.22 ± 0.60. A negative correlation was between the quality score of the videos and views, likes, comments, duration, and likes/views (respectively; r = -0.237 p < 0.005, r = -0.217 p < 0.003, r = -0.220 p < 0.005, r = -0.147, p < 0.005). The videos narrated by nurses and doctors had significantly higher mean JAMA and GQS scores than others (p = 0.001). The videos missed some procedural steps [gargling (29.1%), adding no more than five ml of medication and device cleaning (41.9%), and exhaling through the nose (37.5%)]. Videos uploaded by individual missed significantly more procedural steps than professional organizations (p < 0.05).

CONCLUSIONS

YouTube videos about inhaler techniques have a moderate level of quality. Videos uploaded by doctors and nurses as content narrators were of higher quality. The videos missed some procedural steps. Individual video uploaders had higher missed procedural steps. Counseling should be provided to patients regarding the reliability of online information.

Registered nurses' knowledge and interpretation of ECG rhythms: A cross-sectional study

BACKGROUND

Electrocardiographic (ECG) monitoring and recording are seen as the most commonly used non-invasive diagnostic tool to identify cardiac arrhythmia and myocardial damage in the clinical setting. There is an expectation that critical care nurses are ideally trained to interpret abnormalities and morphology in the ECG more proficiently than nurses from general ward areas. However, the ability to interpret and recognise ECG abnormalities is dependent on which critical care area nurses are currently working in and their level of experience.

AIM

The aim of this study was to investigate registered nurses' knowledge in being able to identify and interpret select electrocardiographic rhythms.

STUDY DESIGN

This was a cross-sectional study that evaluated registered nurses' knowledge of electrocardiogram rhythm identification and interpretation. A convenience sample of 105 registered nurses currently enrolled in a 2-year Master's programme leading to critical care specialism and advanced practice nurse award were recruited. A 20-item multiple choice questionnaire that provided examples of electrocardiogram rhythm (n=14) abnormalities and rhythm abnormalities caused by electrolyte disturbances (n=6) RESULTS: The study included registered nurses from critical care and general ward areas. The overall results were poor with only 55% of questions answered correctly. Coronary care nurses scored the highest in identifying ECG rhythms (12/20 ± 1.58; p < .001). When ECG abnormalities associated with electrolyte imbalances were analysed, both groups were unable to identify the effects of hypokalaemia and hypomagnesaemia effectively (p = .748). Length of time as a registered nurse (r = -0.304, p = .002) and length of time in current work environment were weakly correlated (r = -0.328, p = .001). Having a critical care background showed a positive relationship with nursing knowledge of ECG rhythm identification (r = 0.614, p < .001).

CONCLUSION

The results of this study demonstrate that nurses have a poor knowledge of ECG rhythm identification and interpretation, a consistent finding from other work. A possible solution is a revamp of education and training associated with ECG recognition and morphology.

RELEVANCE TO CLINICAL PRACTICE

Monitoring and assessing ECG morphology provide important details about cardio-electroconductive stability, especially with fluctuations in serum electrolyte levels seen in critical illness or trauma. For this, critical nurses must improve their proficiency through education/training or internal quality improvement activities in detecting abnormalities associated with ECG changes beyond those most easily recognizable rhythms such as atrial fibrillation or ventricular tachycardia.

Changes in the Professional Identity and Self-Efficacy of Nursing Students Engaged in the Objective Structured Clinical Examination Using Simulation Learning

BACKGROUND

The Objective Structured Clinical Examination (OSCE) is widely adopted in nursing education to enhance clinical skills and professionalism. With OSCE, the learning process is important, and students who underwent OSCE felt more confident and better prepared for their next clinical training.

OBJECTIVES

This study aims to clarify how the self-efficacy and professional identity of nursing students change after learning through simulation education and OSCE. Clarification of these issues will allow an OSCE design utilizing simulation-based education as will be discussed.

METHODS

This study used a pre-post study design, and the participants were 74 nursing university students at one university in Japan who agreed to participate in the study. The total scores and subscale scores for professional identity and self-efficacy were compared before and after the OSCE using the Wilcoxon signed-rank test. Spearman's rank correlation coefficient was calculated to examine the relationship between professional identity and self-efficacy.

RESULTS

There were significant increases in self-efficacy scores (p<0.05) after OSCE, but there were no significant changes in the total scores of professional identities before and after the OSCE. Professional identity scores, such as choosing nursing again and desire to improve nursing skills, increased.

CONCLUSIONS

Simulation-based OSCE effectively enhances nursing students' self-efficacy and certain aspects of professional identity, indicating its potential for nursing education.

Pathway to Excellence: One Institution's Experience Obtaining the Joint Commission's Advanced Total Hip and Total Knee Replacement Certification

As the prevalence of total hip and total knee arthroplasty procedures increase over the next decades, hospitals seek opportunities to improve quality outcomes while simultaneously limiting costs and mitigating risks of complications. The Joint Commission's Advanced Total Hip and Total Knee Replacement (THKR) certification is one of the highest quality standard certification programs in the nation and is the only one that collaborates with the American Academy of Orthopedic Surgeons. To obtain THKR certification, several requirements based on evidence-based clinical practice guidelines must be met. The process is described from initial identification of stakeholders to ongoing efforts to retain certification. Joint Commission THKR certification was awarded after rigorous review and on-site visit. Compliance with advanced care standards from the time of orthopedic consultation through postsurgical follow-up was reviewed. Joint Commission THKR certification provides supporting evidence of the institutions journey in processes toward delivering high quality clinical care. A multidisciplinary team with ongoing collaboration is necessary to obtain and retain certification.

Clinical Faculty Orientation Practices in the United States: A Descriptive Study

BACKGROUND

Due to the nursing faculty shortage, expert clinical nurses are working as novice clinical instructors (CIs). Orientation is needed to prepare these nurses to teach; however, lack of evidence-based guidelines for orientation programs can lead to variability among institutions.

PURPOSE

The purpose of this study was to describe clinical nursing faculty orientation practices in the United States.

METHODS

A descriptive convergent mixed methods design was used.

RESULTS

One hundred thirteen CIs participated. Of these, 70.8% were not provided with a formal orientation to their role. Duration, modality, and content varied widely among orientations. Four themes were derived from the qualitative data: Administrative Requirements, Transition to Clinical Educator, Mentorship, and Resilience.

CONCLUSIONS

Clinical faculty orientation practices vary widely in the United States. Evidence-based guidelines are needed to streamline orientations to provide CIs with the requisite knowledge and skills to support clinical students.

Subjective Cognitive Dysfunction in Chronic Illness: A Systematic Review and Meta-Synthesis

BACKGROUND

Qualitative studies have examined the experiences of subjective cognitive dysfunction in specific populations or specific disease stages, but there has not yet been a systematic synthesis and evaluation of findings related to perceptions of subjective cognitive dysfunction in nondementia-related chronic illnesses.

OBJECTIVE

The aim of this study was 2-fold: (1) to undertake a systematic review of experiences of subjective cognitive dysfunction in people with nondementia-related chronic disease and (2) to develop an explanatory framework to describe the experiences of living with subjective cognitive dysfunction.

METHODS

Four databases were systematically searched for studies on subjective cognitive dysfunction up to June 2023. Qualitative synthesis was conducted on the final sample (N = 25) using Sandelowski's adaptation of Nobilt and Hare's reciprocal transactional analysis method. Critical appraisal was completed using the Critical Appraisal Skills Programme checklist.

RESULTS

Through constant comparison of key concepts, findings were organized within 4 interrelated themes that informed a conceptual explanatory model of adapting to living with subjective cognitive dysfunction: (1) symptoms, (2) health care, (3) perceptions of self, and (4) relationships. Participants highlighted how subjective cognitive dysfunction affected interactions in health care settings and involved other symptoms that in turn complicated meaning, self-enhancement, and mastery.

CONCLUSIONS

Our model of the process of adapting provides a new way to conceptualize cognitive dysfunction in chronic illness and suggests opportunities for health care professionals to support patients and their families. The results highlight the need for more research to better understand the role of subjective cognitive dysfunction in nondementia-related chronic illnesses.The review protocol was registered in PROSPERO (CRD42021231410).

Harm reduction nursing and the path toward developing best practice: Lessons from caring for people with xylazine-associated wounds in Philadelphia, PA

Xylazine-associated wounds are a distinct, novel clinical entity characterized by co-occurrence with substance use, progressive necrosis of skin, muscle, tendon, and bone, and slow healing. In Philadelphia, the specter of limb loss, stigma, and shame has hung over hospital-based care for xylazine-associated wounds among people who use drugs (PWUD) and kept many people away from engaging in care. Continued engagement in harm reduction wound care nursing, however, offers an opportunity for PWUD to address their wounds and their fears with members of the medical world. In the absence of established best practices, harm reduction's model of risk-reductive care offers a way forward for patients and practitioners alike. Here, "harm reduction" describes an ethic of practical, trauma-informed, patient-centered care. It is this integration of harm reduction into medicine and public health that effectively promotes the safety, survival, and recovery of PWUD across all spectrums of drug use habits and housing stability.

Nurses' Experiences of the Prerequisites for Implementing Family-Centered Care to Prevent Pediatric Delirium

PURPOSE

The aim of this study was to describe nurses' experiences of the prerequisites for implementing family-centered care to prevent pediatric delirium.

DESIGN

The research employed a qualitative, descriptive study design.

METHODS

A total of 10 nurses working in the pediatric intensive care unit at 1 university hospital participated in the study. The quality data were collected using individual semistructured interviews, and the data were then analyzed by inductive content analysis.

RESULTS

The prerequisites for implementing family-centered care to prevent delirium among pediatric patients consisted of 30 subcategories that were grouped into 11 generic categories. The generic categories were further grouped into 5 main categories: (1) an environment that supports family presence, (2) psychosocial support for the family, (3) individual family involvement, (4) family participation in shared decision-making, and (5) nurses' professional competence.

CONCLUSIONS

According to the nurses' experiences, the implementation of a family-centered approach to preventing delirium in pediatric patients requires creating a supportive environment for families, providing psychosocial support, encouraging family involvement in decision-making, and ensuring that all nurses have the necessary skills.

Non-pharmacological interventions to reduce thirst in patients with heart failure or hemodialysis: A systematic review and meta-analysis

BACKGROUND

Thirst is a frequent and burdening symptom in many patients, especially in patients with chronic heart failure (CHF) and/or receiving hemodialysis (HD). As drug therapies are not feasible, non-pharmacological strategies are needed to reduce thirst and thirst-related burden.

OBJECTIVES

To identify non-pharmacological interventions aiming to reduce thirst in patients with CHF and/ or HD, to describe intervention components, and to evaluate the effectiveness of these interventions.

METHODS

In February 2024, we completed a systematic search in MEDLINE via PubMed, Livivo, CINAHL, Cochrane Library and Web of Science. Two reviewers independently screened titles, abstracts, and full texts, performed critical appraisal and data extraction. We checked risk of bias with the checklists of the Joanna Briggs Institute and the Cochrane Risk of Bias tool and calculated meta-analyses for sufficiently homogeneous studies using fixed-effects models.

RESULTS

We included 15 intervention studies applying non-pharmacological interventions including chewing gum (n = 8), low-sodium diet (n = 2), acupressure (n = 1), frozen strawberries (n = 1), fluid timetables (n = 1), ice cubes and mouthwash (n = 1), and a psychological intervention (n = 1). Sample sizes varied between 11 and 88 participants. Eleven intervention studies showed a reduction of thirst as intervention effect. Meta-analyses for chewing gum showed no significant effect on thirst using a visual analogue scale (IV: -2,32 [-10.37,5.73]; p = 0.57) or the dialysis thirst inventory (IV: -0.26 [- 1.83, 1.30]; p = 0.74). Quality of studies was moderate to low.

CONCLUSION

Results indicate that various non-pharmacological interventions could be helpful to reduce thirst in patients with CHF or HD, but important uncertainty remains.

Environmental impact of a blood test reduction intervention in adult intensive care units: A before and after quality improvement project

BACKGROUND

Pathology testing is a very common investigation in the intensive care unit (ICU). Many tests are ordered on a routine basis rather than for a specific clinical indication, resulting in potential patient harm and unnecessary financial and environmental costs.

OBJECTIVE

The objective of this study was to determine whether a multifaceted intervention based on the principles of education, audit, and feedback can result in a decrease in unnecessary pathology tests without a commensurate increase in adverse patient outcomes and to measure this decrease in terms of the associated reduction in environmental and financial costs.

METHODS

A before and after quality improvement project was conducted between 2017 and 2019 across four ICUs in three 12-month phases, divided according to baseline, intervention implementation, and follow-up. Local clinician champions from each site partnered with the project coordinating centre to develop and implement a range of interventions based on the principles of education, audit, and feedback. Data were collected for the number of pathology tests performed and the clinical characteristics of patients admitted to a participating ICU across the three phases.

RESULTS

A total of 196 323 arterial blood gases and 460 258 other tests across eight categories were performed on the 22 210 patients admitted to participating ICUs during the project. A decrease in testing was observed across all but one category, with the greatest reduction seen in arterial blood gases (31.2% reduction in tests per bed-day). Across all categories, this equated to a mean reduction of 1.8 tCO2e (tonnes of carbon dioxide equivalent), a potential estimated total saving of Australian dollar $918 497.50. No increase in adverse clinical outcomes was observed.

CONCLUSION

A multifaceted intervention based on the principles of education, audit, and feedback can produce a significant decrease in the number of unnecessary pathology tests performed. This reduction translates to substantial environmental and financial savings without any associated increase in adverse patient outcomes.

Comparison of laboratory results between central venous access devices and venipuncture: A systematic review and meta-analysis

OBJECTIVES

To compare the hematologic, blood chemistry, and coagulation test results between two blood sampling methods via central venous access devices (CVADs) and venipuncture.

METHOD

The authors searched PubMed, Embase, Cochrane, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for controlled studies that compared the differences in hematologic, blood chemistry, and coagulation test results between venipuncture and CVADs from the date of database establishment to July 2022. Two researchers independently performed the literature screening, data extraction, and quality assessment. The standardized mean difference was used as the effect size for continuous variables and a 95% confidence interval was provided. The random-effects model was used for an I2 > 50%, otherwise the fixed-effects model was used. Sources of heterogeneity were determined by subgroup analysis or sensitivity analysis, as indicated.

RESULTS

This review ultimately identified 17 studies for systematic review, of which 12 were selected for meta-analysis. A total of 541 adult participants were included in the meta-analysis. With the exception of the activated partial thromboplastin time, there were no significant differences in hematologic, blood chemistry, and coagulation test results between blood sampling via venipuncture and CVADs.

CONCLUSIONS

The results of this study provide substantial evidence that blood sampling via venipuncture and CVADs had equal reliability in most laboratory tests. Serial blood sampling via CVADs will reduce the risk of bleeding episodes and pain at the blood collection site, and safety for healthcare professionals.

Prevalence of Impostor Phenomenon Among Final-Semester Baccalaureate Nursing Students

BACKGROUND

Impostor phenomenon (IP) is characterized as an internal sense of intellectual fraudulence and the inability to internalize success. It was identified by Clance and Imes in 1978 in a study with high-achieving women and has since been found among other professionals. Studies regarding IP are limited in nursing and among nursing students.

PURPOSE

The purpose of the study was to evaluate the prevalence of IP among senior baccalaureate nursing (BSN) students at a public central Texas university immediately prior to graduation.

METHODS

Senior BSN students were given an anonymous survey utilizing the Clance Impostor Phenomenon Scale.

RESULTS

Of the 86 senior BSN students, 82.5% completed the anonymous survey. Among students, 45.1% experienced moderate IP, 46.5% experienced frequent IP, and 8.5% experienced intense IP.

CONCLUSIONS

The incidence of IP was higher than expected. This study has implications for the future of nursing, including academic retention and postgraduation performance.

The Arcus Experience: Bridging the Data Science Gap for Nurse Researchers

BACKGROUND

For years, nurse researchers have been called upon to engage with "big data" in the electronic health record (EHR) by leading studies focusing on nurse-centric patient outcomes and providing clinical analysis of potential outcome indicators. However, the current gap in nurses' data science education and training poses a significant barrier.

OBJECTIVES

We aimed to evaluate the viability of conducting nurse-led, big-data research projects within a custom-designed computational laboratory and examine the support required by a team of researchers with little to no big-data experience.

METHODS

Four nurse-led research teams developed a research question reliant on existing EHR data. Each team was given its own virtual computational laboratory populated with raw data. A data science education team provided instruction in coding languages-primarily structured query language and R-and data science techniques to organize and analyze the data.

RESULTS

Three research teams have completed studies, resulting in one manuscript currently undergoing peer review and two manuscripts in progress. The final team is performing data analysis. Five barriers and five facilitators to big-data projects were identified.

DISCUSSION

As the data science learning curve is steep, organizations need to help bridge the gap between what is currently taught in doctoral nursing programs and what is required of clinical nurse researchers to successfully engage in big-data methods. In addition, clinical nurse researchers require protected research time and a data science infrastructure that supports novice efforts with education, mentorship, and computational laboratory resources.

Filling Gaps in Practice Leadership: Succession Planning for Clinical Nurse Specialist Positions

PURPOSE

To create a succession plan for clinical nurse specialist positions across multiple clinical settings.

DESCRIPTION OF THE PROJECT

Mayo Clinic (Rochester, Minnesota) had multiple clinical nurse specialist position vacancies. However, standard recruitment methods and a collaboration between human resources and nursing managers to expand the applicant pool yielded few applicants. A work group was subsequently commissioned to identify innovative ways to fill the vacant clinical nurse specialist positions. Guiding principles for hiring and implementing the role were developed.

OUTCOME

During the 4-year project period (2016 through 2019), the time to fill positions decreased from 174 days to 83 days. Nurse managers and clinical nurse specialists reported an increased number of registered nurses seeking information about the profession. Twenty-eight clinical nurse specialist interns, titled clinical resource nurses, were hired, and 14 completed their graduate degree, obtained state licensure, and transitioned to clinical nurse specialist roles. Twelve clinical resource nurses were on schedule to transition to clinical nurse specialist positions, and 2 left their positions.

CONCLUSION

A succession plan that used clinical nurse specialists to mentor clinical resource nurses to fill gaps in practice priorities while completing graduate education was a successful strategy to fill vacant clinical nurse specialist positions.

Characterization of kratom use and knowledge at a rural, Oregon community health center

BACKGROUND

Kratom is an herbal supplement that has drawn attention for its use in the self-treatment of opioid withdrawal, and its widespread availability with minimal restrictions. Past Web-based research has attempted to determine patterns and trends of use, but generalizability to underserved populations is unclear.

OBJECTIVE

The purpose of this study was to characterize behavior related to kratom, attitudes toward kratom, and knowledge of kratom in a rural, underserved population.

METHODS

We developed, refined, and administered a cross-sectional, 36-item survey to examine use, attitudes, and knowledge of kratom. We recruited participants and administered the survey alongside medical office appointments between January and April 2023. Data were summarized using descriptive statistics.

RESULTS

A convenient sample of 186 patients (of the 907-patient clinic panel) were invited to participate and 150 returned the survey. Most patients were female (52.0%) and white (86.6%), and approximately half had an income below the federal poverty level (48.5%). Seventeen participants reported previous experience with kratom use, with one actively using kratom. The most commonly reported reasons for use were pain (47.1%) and mental health (41.2%). Kratom knowledge was low regardless of kratom use history, with most respondents correctly answering between 1 and 3 questions (n = 71 of 86; 82.3%) of the 5 knowledge-focused items.

CONCLUSION

Results suggest that although active kratom use is uncommon in this Oregon population, 1 in 10 surveyed had used kratom. Regardless of past use, respondents had limited knowledge of kratom. Future research should focus on understanding trends in kratom use behaviors in underserved populations, addressing patient knowledge gaps, and evaluating patient safety and health equity implications.

Evaluating health literacy from an organizational perspective: A cross-sectional study of community health centers

OBJECTIVES

To investigate community health centers' (CHCs) health literacy.

DESIGN

A cross-sectional study.

SAMPLE

A total of 374 CHCs were surveyed and 258 CHCs responded, with an effective questionnaire response rate of 69.0%.

MEASUREMENTS

Data were collected by using a self-developed health literacy assessment tool to survey CHCs' health literacy throughout Taiwan from January to December 2019.

RESULTS

The item of organizational health literacy (OHL) with the highest proportion of CHCs not implementing them was "Design of easy-to-use computer applications and new media" (47.3% not yet achieved), followed by "Involving target audiences in document and service development" (34.9% not yet achieved). CHCs located in northern Taiwan had higher health literacy achievement scores than those in other regions, and those in urban areas had higher health literacy achievement scores than those in general and remote areas.

CONCLUSIONS

This study identified items with poor implementation of OHL and found regional differences in health literacy among CHCs. The findings can inform the development of targeted interventions to improve health literacy in underperforming CHCs and guide policymakers in allocating resources to regions and areas in need of.

An "ethics of strangers"? On knowing the patient in clinical ethics

The shape and function of ethical imperatives may vary if the context is an interaction between strangers, or those who are well acquainted. This idea, taken up from Stephen Toulmin's distinction between an "ethics of strangers" and an "ethics of intimacy", can be applied to encounters in healthcare. There are situations where healthcare personnel (HCP) know their patients (corresponding to an "ethics of intimacy") and situations where HCP do not know their patients (corresponding to "an ethics of strangers"). Does it make a difference for normative imperatives that follow from central concepts and principles in medical ethics whether HCP know their patients or not? In our view, this question has not yet been answered satisfactorily. Once we have clarified what is meant by "knowing the patient", we will show that the distinction is particularly relevant with regard to some thorny questions of autonomy in healthcare (e.g., regarding advance directives or paternalism in the name of autonomy), whereas the differences with regard to imperatives following from the principles of justice and beneficence seem to be smaller. We provide a detailed argument for why knowing the patient is ethically valuable in encounters in healthcare. Consequently, healthcare systems should provide fertile ground for HCP to get to know their patients, and structures that foster therapeutic continuity. For this to succeed, a number of questions still need to be clarified, which is an important task for medical ethics.

Longitudinal linkages between strength use and depressive symptoms in Chinese nurses: A two wave, cross-lagged study

Nurses are at increased risk for developing depressive symptoms. While previous research has suggested that strength use may be inversely related to these symptoms, the longitudinal impact of strength use on nurses' depressive symptoms remains under-explored. This study sought to examine the longitudinal relationship between strength use and depressive symptoms among Chinese nurses. Using a two-wave cross-lagged design from 2020 to 2023, 321 nurses participated in an online questionnaire survey. Using structural equation modeling, our results supported the hypothesized reciprocal model, indicating that strength use can significantly predict a reduction in depressive symptoms and vice versa. Given these findings, there's an urgent need for nurse leaders to emphasize the importance of using nurses' strengths as a strategy to alleviate depressive symptoms.

Capability as a concept in advanced practice nursing and education: a scoping review

OBJECTIVE

The objective of this review was to map the literature about the concept of capability in advanced practice nursing education and practice to achieve greater clarity on the concept and its application.

INTRODUCTION

Advanced practice nursing roles make up a growing segment of the global nursing workforce. Capability has been proposed as an overarching description of the attributes of advanced practice nursing roles within complex workplace environments. Capability includes knowing how to learn, and the ability to creatively integrate prior knowledge, skills, judgment, and experience in both new and familiar situations.

INCLUSION CRITERIA

This review looked at the literature about capability applied to advanced practice nursing in any setting globally. We were guided by the International Council of Nurses' definition of advanced practice nursing, which includes nurses with both graduate education and an expanded scope of practice. Drawing from an initial review of the literature, we used a working definition of capability, which was a combination of knowledge, skills, experience, and competencies that enables advanced practice nurses to provide appropriate care for patients in both known and unfamiliar clinical settings. We included literature about individual capability as a concept in any setting related to advanced practice nursing and education.

METHODS

We searched 18 electronic databases and included qualitative, quantitative, and mixed methods study design methodologies, reviews, and reports. The gray literature search included policy and practice documents from the World Health Organization, the International Council of Nurses, and websites of 48 nursing and health organizations. Two reviewers independently completed title and abstract screening prior to full-text review and data extraction. Conflicts were resolved via discussion or with a third reviewer. Extraction was completed by 2 reviewers using a piloted data extraction tool. Articles published in English from 1975 to the present were included. Sources in languages other than English were not included in the review due to the difficulties in accurately translating the concept of capability.

RESULTS

Thirty-five sources were included in the review with publication dates from 2000 to 2023. Most sources originated from Australia, the United Kingdom, and the United States. Sources included frameworks and clinical guidelines, peer-reviewed articles, and gray literature. Capability was discussed in a range of settings, including specialized clinical roles. Applications of capability in educational settings included the use of capability frameworks to guide nurse practitioner education, nursing practice doctorates, and postgraduate nurse practitioner training. Definitions of capability, where provided, were relatively consistent. Capability was proposed as a distinguishing characteristic of advanced practice nursing, as a descriptor of clinical proficiency that moved beyond competency, and as a framework that accounted for complexity in health care settings.

CONCLUSION

Capability was used as a concept and framework to describe advanced practice nursing within complex practice environments that necessitate flexible approaches. Capability frameworks were applied holistically and to specific areas of practice or education, including in pregraduate and postgraduate advanced practice nursing education. Strategies for teaching and learning capability focused on flexibility, student-directed learning, and development of flexible learning pathways.

SUPPLEMENTAL DIGITAL CONTENT

A Norwegian-language version of the abstract of this review is available: http://links.lww.com/SRX/A58.

Is a Picture Worth a Thousand Words? A Scoping Review of the Impact of Visual Aids on Patients Undergoing Surgery

OBJECTIVE

While graphics are commonly used by clinicians to communicate information to patients, the impact of using visual media on surgical patients is not understood. This review seeks to understand the current landscape of research analyzing impact of using visual aids to communicate with patients undergoing surgery, as well as gaps in the present literature.

DESIGN

A comprehensive literature search was performed across 4 databases. Search terms included: visual aids, diagrams, graphics, surgery, patient education, informed consent, and decision making. Inclusion criteria were (i) full-text, peer-reviewed articles in English; (ii) evaluation of a nonelectronic visual aid(s); and (iii) surgical patient population.

RESULTS

There were 1402 articles identified; 21 met study criteria. Fifteen were randomized control trials and 6 were prospective cohort studies. Visual media assessed comprised of diagrams as informed consent adjuncts (n = 6), graphics for shared decision-making conversations (n = 3), other preoperative educational graphics (n = 8), and postoperative educational materials (n = 4). There was statistically significant improvement in patient comprehension, with an increase in objective knowledge recall (7.8%-29.6%) using illustrated educational materials (n = 10 of 15). Other studies noted increased satisfaction (n = 4 of 6), improvement in shared decision-making (n = 2 of 4), and reduction in patient anxiety (n = 3 of 6). For behavioral outcomes, visual aids improved postoperative medication compliance (n = 2) and lowered postoperative analgesia requirements (n = 2).

CONCLUSIONS

The use of visual aids to enhance the surgical patient experience is promising in improving knowledge retention, satisfaction, and reducing anxiety. Future studies ought to consider visual aid format, and readability, as well as patient language, race, and healthcare literacy.

BONE Break: A Hot Debrief Tool to Reduce Second Victim Syndrome for Nurses

The pandemic has intensified clinicians' workloads, leading to an increased incidence of adverse events and subsequent second victim syndrome, with almost half of health care clinicians experiencing its symptoms. However, following a literature review, no tools were found that addressed second victim syndrome in nurses. To address these issues and the gap in the literature, the authors developed the BONE Break hot debriefing tool. BONE Break is designed to be facilitated by charge nurses or other unit leaders as a means of offering peer support to other nurses who went through an adverse event. During its initial implementation, BONE Break was employed in 43 of 46 events adverse events (93.5%), and 41 of 43 sessions (95.3%) were deemed helpful. The research team has continued to gain stakeholder buy-in and implement BONE Break across multiple sites. Future work will determine BONE Break's efficacy in enhancing long-term nursing retention and reducing second victim symptoms.

Vascular complications in extremities of physically restrained intensive care unit patients: A prospective, observational study

BACKGROUND

Physical restraint is used to prevent agitation, to continue treatments and to ensure safety in intensive care patients. Physical restraint has negative effects on physical and psychological health, and physical restraint should not be used unless necessary.

AIMS

The purpose of this study was to evaluate the development of vascular complications in extremities of physically restrained patients hospitalized in the intensive care unit (ICU) and the associated factors.

STUDY DESIGN

A prospective, observational study. The study was conducted between September 1, 2022, and March 31, 2023 in eight ICUs of a hospital located in the inner regions of Türkiye. The development of vascular complications (discolouration, distemperature, variations in capillary refill time, fluctuations in peripheral pulse, skin ulceration and oedema in the area of physical restraint) rate in patients hospitalized in the ICUs who were physically restrained. Independent sample t test, Mann-Whitney U test and Pearson-χ2 test were used to analyse the data.

RESULTS

During the study, 2409 patients were admitted to ICUs. Physical restraint was applied to 209 of these patients. Of the 209 patients, 112 patients who met the inclusion criteria were included in the study. The physical restraint site of the patients was evaluated an average of 230.12 times and physical restraint was terminated in 9.8% of the patients (n = 112) because of vascular complications that developed in the physical restraint site. The rate of vascular complications at the site of physical restraint was higher in patients with endotracheal tubes (p < .05), lower GCS scores (p < .05) and higher INR values (p < .05). Patients with skin ulceration at the restraint site received more massages and cream applications (%95CL = 1. 1.692-34.734, OR = 7.667, p = .032). It was determined that more massage was applied to patients with changes in skin temperature at the restraint site (%95Cl = 1.062-11.599, OR = 3.510, p = .032).

CONCLUSIONS

Vascular complications may develop at the restraint site in patients hospitalized in the ICU. This may be more common in ICU patients with endotracheal tube, lower GCS score and higher INR values.

RELEVANCE TO CLINICAL PRACTICE

Nurses should closely monitor ICUs patients with endotracheal tube, lower GCS score and higher INR values, and implement care interventions to prevent the development of vascular complications.

Barriers to effective clinical preceptorship in nurse anesthesiology

BACKGROUND

Clinical preceptorship is an effective teaching tool for Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs). Strategies for success and barriers to effective clinical preceptorship have been explored across the literature to improve learning experiences for SRNAs.

PURPOSE

The purpose of this literature review was to identify barriers to effective clinical preceptorship in the field of nurse anesthesiology.

METHOD

A rapid review of the literature utilizing PubMed, Embase, CINAHL, Scopus, and Cochrane Library ultimately yielded 14 relevant articles.

RESULTS

Clinical preceptorship in the discipline of nurse anesthesiology has a significant impact on both student experiences and preceptor satisfaction. Barriers within the clinical preceptorship model have been identified across the literature from both the preceptor and student perspectives.

CONCLUSIONS

The overarching theme is that development of clinical preceptor workshops and specific guidelines would enhance the experiences of both clinical preceptors and students and allow goals and objectives to be more easily met.

The effects of Iranian traditional music on cervical dilation and labor progress in the active stage of term pregnancy: A nonrandomized controlled trial

Background and Aims

Childbirth is a multifaceted and distressing event that can profoundly affect mothers' psychological and physical well-being. Noninvasive interventions like music therapy have been explored to improve labor outcomes by decreasing pain and anxiety levels, promoting relaxation, and enhancing maternal-fetal health. This study aimed to investigate the effect of Iranian traditional music on cervical dilation and labor progress in the active stage of term pregnancy.

Methods

This study was a nonrandomized controlled trial that included pregnant women between 20 and 35, with a gravidity of two or three. Participants were assigned to either the intervention group, which received traditional Iranian music therapy during labor, or the control group, which received routine care without the music intervention. The primary outcome was the effect of music therapy on cervical dilation from 4 cm to full dilation (10 cm) during term pregnancy. The secondary outcomes included changes in fetal heart rate, maternal anxiety, and pain scores before and after the intervention. Statistical analyses were performed using appropriate methods, and the results were reported using descriptive and inferential statistics.

Results

The mean age of the intervention group was 28.32 ± 6.13 years, and that of the control group was 28.31 ± 3.47 years (p = 0.890). The median duration of labor was not significantly different during the active stage, with 120 min in the intervention group and 137 min in the control group (p = 0.505). However, significant differences were observed in fetal heart rate, anxiety score, and pain score changes before and after the intervention between the two groups (p < 0.05).

Conclusion

Using traditional Iranian music therapy as a noninvasive intervention during labor can potentially improve maternal and fetal outcomes by reducing anxiety and pain perception. Further research is needed to explore the potential benefits of traditional music therapy in clinical settings.

Effectiveness of the 5As Model-Based Transitional Care Program among Chinese Patients with Type B Aortic Dissection Post-TEVAR: A Randomized Controlled Trial

Background

Thoracic aortic endovascular repair (TEVAR) is the primary treatment for Stanford type B aortic dissection (type B AD). However, patients often encounter significant difficulties post-TEVAR that endanger their safety when transitioning from hospital- to home-based care. Moreover, information on the ideal transitional care for patients with type B AD post-TEVAR is scarce in China. This single-masked randomized clinical trial aimed to assess the effectiveness of the Assess, Advise, Agree, Assist, and Arrange (5As) model-based transitional care in improving discharge preparation level and transitional care quality post-TEVAR among patients with type B AD in China.

Methods

This study was conducted at a hospital in China between January 2021 and October 2021. Patients with type B AD were randomly divided into intervention and control groups. Participants in the intervention group received the 5As model-based transitional nursing care. The 5As model is an evidence-based intervention strategy comprising: (1) Assess: assessing the preoperative cardiovascular risk behavior of patients with AD. (2) Advise: making suggestions according to the risk behaviors of the patients. (3) Agree: reaching a consensus on goals and action plans by making decisions with the patients and their families. (4) Assist: assisting patients in solving obstacles to implementing health plans. (5) Arrange: arranging follow-up visits according to the actual situation of the patients and guiding them in adhering to a schedule. The control group received the usual nursing care for the same duration and number of follow-up visits. A trained research nurse collected all the baseline data of the patients on admission, assessed discharge readiness level (using the Readiness for Hospital Discharge Scale) on the day of discharge, and collected transitional quality of care (by the Care Transition Measure-15) data on day 30 after discharge.

Results

Overall, 72 patients with type B AD were recruited. Discharge readiness level and transitional care quality in the intervention group were significantly superior to those in the control group.

Conclusions

This study showed that the 5As model-based transitional care program can effectively promote discharge readiness and transitional care quality of patients with type B AD post-TEVAR.

Clinical Trial Registration

The Chinese Clinical Trial Registry Center: ChiCTR2200060797 (https://www.chictr.org.cn/showproj.html?proj=167403).

Clinical nurse specialists in nutrition: A systematic review of roles and clinical experiences

BACKGROUND/SCOPE

The Clinical Nurse Specialist in Nutrition is a professional capable of providing specialist clinical assistance and leadership-related clinical nutrition. To date, although their role has already been identified, there is still uncertainty about how this figure can actually fit into the various global health systems. The purpose of this review is to clarify and define the role of this professional aimed at analysing clinical experiences and data from nutrition scientific societies.

METHODOLOGY

A systematic literature review was conducted using the Prisma Statement in the Cochrane Library databases and subsequently in PubMed, Embase, CINAHL, Scopus and Web of Science. In addition, a manual search of studies published in Google Scholar was conducted for the analysis of 'grey literature'. Out of 3,320 identified records, 20 studies were included in the present review. [Correction added on 06 June 2024, after first online publication: The preceding sentence has been corrected from "Out of 2,348 identified records, 21 studies were included in the present review." to "Out of 3,320 identified records, 20 studies were included in the present review" in this version.] RESULTS: The development of specific training, certification and qualification protection courses is contributing to the development of this professional in various hospital and community clinical contexts. The clinical experiences identified have shown that this figure is able to provide specialist assistance by offering high levels of safety, efficacy and quality of the care provided.

CONCLUSIONS/ IMPLICATIONS FOR NURSING

The implementation of nurse nutrition specialist, to date, is still limited at the global level, and training programmes coordinated between scientific societies and nursing universities could be the basis for the development of this specialization in countries where today this figure is not yet present.

Catheter-associated urinary tract infections in critical care: Understanding incidence, risk factors, and pathogenic causes in Palestine

Catheter-associated urinary tract infections (CAUTI) are the most common secondary cause of bloodstream infection. CAUTI is particularly prevalent in critical care departments and developing countries, where the duration of catheterization remains the most significant risk factor. This study focused on the characteristics, risk factors, and outcomes of CAUTI patients in a tertiary care hospital setting. It also provides the incidence rate of CAUTI in an ICU setting in Palestine. The study adopted a retrospective observational design at a tertiary care hospital in Palestine. The data were collected from patient records as well as from nursing flow charts. Variables are reported as frequencies, percentages and means + standard deviations. Independent t-tests was used for numerical variables, while Pearson's chi-square or Fisher's exact test were used for categorical variables. Multivariate analysis was performed to adjust for confounders using binary logistic regression. Mortality risk factors were assessed using the proportional Cox regression model. Of the 377 patients included in the study, 33 (9%) developed CAUTI. Among CAUTI patients, 75% had Candida species isolated, with non-albicans Candida predominating (72%) fungal isolates. On the other hand, 25% of the patients had bacterial isolates in their urine, with a predominance of Escherichia coli growing in 36% of bacterial cultures. Multivariate regression analysis revealed that female gender, longer catheterization days, and corticosteroid use were associated with an increased risk of CAUTI. On the other hand, developing CAUTI, having a malignant disease, developing kidney injury, and developing shock were associated with increased mortality. This study highlighted the emerging presence of fungal and resistant bacterial CAUTI. It also emphasized that the risk of CAUTI was associated with a longer duration of urinary catheterization. The findings of this study may help formulate antimicrobial management and stewardship plans as well as emphasize the risk of urinary catheterizations.

Mediating Role of Evidence-Based Nursing Competence Between Specialist Nurses' Information Literacy and Innovative Behaviour: A Multicentre Cross-Sectional Study

AIM

To investigate the levels of information literacy, evidence-based nursing competence and innovative behaviour in specialist nurses, determine the impact of information literacy and evidence-based nursing competence on the innovative behaviour of specialist nurses and to analyse the mediating role of evidence-based nursing competence between information literacy and innovative behaviour among specialist nurses.

DESIGN

A multicenter cross-sectional design.

METHODS

In March 2024, a survey was conducted on 313 specialist nurses in four tertiary Grade A comprehensive hospitals in China. Data collection involved the utilization of general demographic questionnaire, the Information Literacy Questionnaire, the Evidence-Based Nursing Competence Scale and the Nurse Innovation Behaviour Scale. The data were analysed using IBM SPSS26 and Amos28 software.

RESULTS

Specialist nurses scored above average in information literacy, evidence-based nursing competence and innovative behaviour. Information literacy significantly positively correlated with innovative behaviour. Evidence-based nursing competence also positively affected innovative behaviour and partially mediated the relationship between information literacy and innovative behaviour.

CONCLUSION

This research indicated that specialist nurses exhibited above-average levels of evidence-based nursing competence, information literacy and innovative behaviour. Both information literacy and evidence-based nursing competence positively impacted innovative behaviour, with evidence-based nursing competence playing a significant mediating role between information literacy and innovative behaviour.

IMPACT

The findings suggest that nursing managers should focus on enhancing information literacy and evidence-based nursing competence in specialist nurses. Improving these abilities will support the implementation of innovative practices and advance the nursing field.

REPORTING METHOD

The research findings were presented in strict accordance with the STROBE statement.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY

It provides reference guidance and theoretical basis for global nursing managers to formulate targeted interventions, so as to effectively enhance the innovative behaviour of specialist nurses.