Competencies of nurses to participate in safe medication management practices for biologics: A scoping review

AIM

To review the existing literature relating to nurse competence in safe medication management practices for biologics, identify evidence, and develop a competency framework to clarify the role of nurses in these practices.

BACKGROUND

With the widespread use of biological agents in disease treatment, ensuring the safe and economical use of high-cost medicines is particularly important. Even though nurses are essential in patient care, detailed knowledge regarding their competence and role in the safe administration of biologics is lacking.

DESIGN AND METHODS

A scoping review was performed following the methodology of Arksey and O'Malley and the PRISMA ScR guidelines. Electronic databases, including PubMed, CINAHL, Embase, Scopus, and Web of Science, were searched using accepted keywords, and relevant articles were identified using inclusion and exclusion criteria.

RESULTS

A total of 3,422 studies were retrieved, 24 of which were eligible for inclusion. The required competencies for nurses were summarized into six areas: clinical specialized knowledge, critical thinking and problem-solving skills, safe medication skills, health education skills, communication and coordination skills, and technological literacy.

CONCLUSION

We provide insights into the competencies of nurses involved in the safe medication management of biologics. These competencies can be used to assess the actual competency level of nurses and facilitate the maximization of biological treatment goals and outcomes. This plays a vital role in optimizing the use of healthcare resources and demonstrating outcomes.

Peer Audit and Feedback: A Documentation-Focused Quality Improvement Project

BACKGROUND AND OBJECTIVES

Nurses' documentation of communication, including notification of critical laboratory results (CLR), is important to ensure safe, high-quality care. Evidence supports peer audit with feedback as a quality improvement (QI) intervention to improve documentation. Nursing compliance with CLR documentation requirements was below goal for several years in an intensive care unit. To address this problem, a peer audit and feedback intervention was implemented and evaluated.

METHODS

Compliance with CLR documentation requirements was evaluated pre- and postintervention, for a total of 12 months. The evaluation also included data from the peer audits and a survey to assess nurses' perceptions. The 5-month intervention was a timely peer audit and feedback of CLR events.

RESULTS

CLR documentation compliance improved from 6.4% to 9.6% (50% improvement), which was clinically meaningful but not statistically significant. Nurses had overall positive perceptions of the peer audit and feedback as a QI tool, perceiving it as nonpunitive and helpful for improving practice.

CONCLUSION

Results support continued examination of peer audit and feedback to improve nursing documentation. Future projects should address the limited time for nurses to engage in QI projects.

The impact of sleep interventions combined with enhanced nutritional support on sleep quality, nutritional status, pain management, psychological well-being, and quality of life in postoperative colon cancer patients

OBJECTIVE

To investigate the synergistic effects of combined sleep interventions and enhanced nutritional support on postoperative recovery in colon cancer patients, with a focus on sleep quality, nutritional status, pain management, psychological well-being, and quality of life.

METHODS

This randomized controlled trial included 290 postoperative colon cancer patients admitted to the First Affiliated Hospital of Soochow University between May 2021 and May 2023. Participants were randomized into two groups: the intervention group, which received standard care supplemented with sleep and nutritional interventions, and the control group, which received standard care alone. Outcomes were assessed pre- and post-intervention, including the Pittsburgh Sleep Quality Index (PSQI), nutritional markers (serum albumin, prealbumin, body weight, etc.), Visual Analog Scale (VAS) for pain, Self-Rating Anxiety and Depression Scales (SAS, SDS), and EORTC QLQ-C30 quality of life scores.

RESULTS

The intervention group demonstrated significantly greater improvements across all assessed domains compared to the control group ( P < 0.005 after Bonferroni correction). Sleep quality (PSQI: 7.81 vs. 10.43, d = 0.81) and nutritional markers (e.g., prealbumin: 230.19 mg/L vs. 188.01 mg/L, d = 1.21 ) improved markedly. Similarly, reductions in pain (VAS: 2.65 vs. 5.19,d = 1.09 ), anxiety (SAS: 42.03 vs. 49.45, d = 0.88), and depression (SDS: 38.17 vs. 49.77,d = 1.02 ) were observed. Quality of life scores significantly increased in the intervention group compared to the control group (EORTC QLQ-C30: 99.29 vs. 88.41, d = 0.92).

CONCLUSION

The combined intervention of sleep enhancement and nutritional support significantly accelerated postoperative recovery in colon cancer patients, demonstrating synergistic effects that improved physical, psychological, and quality-of-life outcomes. These findings underscore the value of integrating multifaceted interventions into standard postoperative care to optimize recovery trajectories and overall well-being.

A Speech-Based Mobile Screening Tool for Mild Cognitive Impairment: Technical Performance and User Engagement Evaluation

Traditional screening methods for Mild Cognitive Impairment (MCI) face limitations in accessibility and scalability. To address this, we developed and validated a speech-based automatic screening app implementing three speech-language tasks with user-centered design and server-client architecture. The app integrates automated speech processing and SVM classifiers for MCI detection. Functionality validation included comparison with manual assessment and testing in real-world settings (n = 12), with user engagement evaluated separately (n = 22). The app showed comparable performance with manual assessment (F1 = 0.93 vs. 0.95) and maintained reliability in real-world settings (F1 = 0.86). Task engagement significantly influenced speech patterns: users rating tasks as "most interesting" produced more speech content (p < 0.05), though behavioral observations showed consistent cognitive processing across perception groups. User engagement analysis revealed high technology acceptance (86%) across educational backgrounds, with daily cognitive exercise habits significantly predicting task benefit perception (H = 9.385, p < 0.01). Notably, perceived task difficulty showed no significant correlation with cognitive performance (p = 0.119), suggesting the system's accessibility to users of varying abilities. While preliminary, the mobile app demonstrated both robust assessment capabilities and sustained user engagement, suggesting the potential viability of widespread cognitive screening in the geriatric population.

Patient Performance of Care Tasks During Acute Hospitalisation: A Scoping Review

BACKGROUND

Patient self-care is established as improving outcomes, yet acute care in hospitals is provided such that patients tend to be passive recipients of care. Little is known about the extent and type of patient participation in treatment care tasks in acute hospital settings.

AIMS

To map and synthesise available literature on self-performance of care tasks in acute hospital settings.

DESIGN

A scoping review was conducted guided by JBI methodology.

METHODS

A literature search was conducted in July 2021 and updated in March 2024 across five databases: Scopus, PubMed, CINAHL, Embase and Web of Science. Studies were screened using predefined eligibility criteria. Full-text screening and data extraction were performed independently by two researchers. Data were collected using a template specifically designed for this review. Reporting followed the PRISMA-ScR guideline.

RESULTS

Of the 31,361 articles identified, 35 were included. Most of the articles were experimental (n = 20) and conducted in Europe (n = 13), North America (n = 10) and Australia (n = 3). Studies were classified according to investigation of the performance of care tasks (n = 6) or of the outcomes of the performance of the self-care task (n = 29). Most tasks performed involved self-administration of medication (n = 31), only 4 articles referred to other care tasks. Most articles focused on acute tasks (n = 18), while 15 articles referred to chronic care tasks. Ostomy self-care (n = 2) was a separate category, being an acute task that continued into chronic self-care.

CONCLUSION

Performance of care tasks by patients in acute care settings are predominantly related to chronic and pain medication administration.

IMPLICATIONS FOR CARE

Patient preferences and competency to self-perform care tasks during hospitalisation should be assessed and monitored and supported accordingly. Utilising hospitalisation time to observe and assess self-care practices could provide additional teaching opportunities to patient self-care and improve overall care continuity.

REPORTING METHOD

The PRISMA-ScR guideline was followed.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

TRIAL AND PROTOCOL REGISTRATION

This review was registered on Open Science Framework before running the final search: (https://doi.org/10.17605/OSF.IO/D8KS2).

Multimodal strategies for the implementation of infection prevention and control interventions-update of a systematic review for the WHO guidelines on core components of infection prevention and control programmes at the facility level

BACKGROUND

Health care-associated infections (HAIs) remain a significant challenge worldwide, and the use of multimodal strategies is recommended by the WHO to enhance infection prevention.

OBJECTIVES

To update the systematic review on facility level infection prevention and control interventions on the WHO core component of using multimodal strategies.

METHODS

Data sources: Medline (by PubMed), EMBASE, CINAHL, and the Cochrane library.

STUDY ELIGIBILITY CRITERIA

Randomized controlled studies, interrupted time series, and before-after studies in acute care settings, from November 24, 2015 to June 30, 2023.

PARTICIPANTS

Both paediatric and adult populations.

INTERVENTIONS

Infection prevention and control interventions implemented with at least three WHO multimodality elements. Assessment of risk of bias: Effective practice and organisation of care and integrated quality criteria for review of multiple study designs tools. Methods of data synthesis: Descriptive data synthesis.

RESULTS

Of 5678 identified titles and abstracts, 32 publications were eligible for data extraction and analysis. Five non-controlled before-after studies were excluded due to an insufficient integrated quality criteria for review of multiple study designs score. Of the remaining 27 studies, nine reported on the effect of multimodal strategies to reduce device-associated HAIs, four on surgical site infections, eight on infections due to antimicrobial resistance and six on hand hygiene (HH) compliance. Eleven were controlled studies (randomized controlled studies or controlled before-after studies), nine interrupted time series and seven non-controlled before-after studies. Twenty-two of the studies originated from high-income countries, and the overall quality was medium to low. Twenty studies showed either significant HAI reductions or HH improvement.

CONCLUSION

Most studies demonstrate a significant effect on HAI prevention and HH improvement after applying a multimodal strategy. However, the quality of evidence remains low to moderate, with few studies from low-income or middle-income countries. Future research should focus on higher quality studies in resource limited settings.

Clarification and development of advanced practice roles in a Swiss French university hospital: an action research study

BACKGROUND

The evolving healthcare landscape emphasizes the need for health systems to adapt to growing complexities, with new models of care enabling healthcare providers to optimize their scope of practice and coordination of care. Despite increasing interest in advanced practice, confusion persists regarding the roles and scopes of practice of healthcare providers, exacerbated by variations in regulations and titles. We sought to clarify the differences between specialized healthcare professionals, practitioners, and clinical specialists; to describe their roles; and to propose initiatives aimed at supporting the implementation of advanced practice within a university hospital.

METHODS

An action research design was conducted in a Swiss university hospital by the deputy healthcare director, five clinical specialists, one nurse practitioner, one nurse specialist, and six managers. A multimethod approach was used to generate data, which included a literature review, meeting minutes, unstructured interviews, and a questionnaire assessing healthcare providers' perceptions about the clinical specialist role. Semi-structured interviews and a group interview with nursing leaders from Swiss hospitals were conducted to understand their use of clinical roles at the advanced level. Unstructured interviews were reduced and organized into categories. Survey data were analyzed with descriptive statistics, and an inductive content analysis method was used for semi-structured interviews and the group interview.

RESULTS

Managers and healthcare providers shared a vision of clinical specialists' activities but emphasized the lack of clarity surrounding these functions. Role clarity was emphasized as crucial for sustainability of advanced practice. A model that defined healthcare specialist, practitioner, and clinical specialist roles was developed. It included title standardization, use of an implementation strategy, creation of a tool to facilitate profile selection, and implementation of a communication plan. Further initiatives aimed to enhance training funding, establish regulations, and optimize advanced practice implementation and governance within the hospital.

CONCLUSIONS

The study results encourage clarification of clinical roles to facilitate their implementation and optimize resources. They also suggest initiatives to support advanced practice implementation, such as a communication plan and an implementation strategy, reflection on the current governance model, and integration of advanced practice providers. Ongoing efforts involve collaboration with academics, managers, and discussions at the political level.

Intermittent documentation of blood pressure values does not provide comprehensive evaluation of the hemodynamic response during continuous intravenous medication administration

Blood pressure (BP) is a dynamic measure that is frequently discussed in static terms. There exist many limitations in current documentation systems whereby documented BP values may not be reflective of the dynamic variability of BP. This study used an observational, prospective, non-randomized study design to examine the variability in BP response during intravenous vasoactive medication administration in an intensive care unit setting. Subjects admitted to a neuroscience intensive care unit were monitored continuously during a 12-hour period. The BP values include systolic BP, diastolic BP, and mean arterial pressure. Intermittent values from an intra-arterial figurecatheter (a-line) and continuously sampled values from an a-line obtained using continuous data acquisition (CDA) software, were compared to intermittently sampling of cuff-based BP measurements documented in the medical record. The 30 patients provided 1,220,511 BP observations from CDA, 944 from a-line documentation, and 416 from cuff-based BP documentation. The systolic BP was used as a goal parameter for 23 (77%) of the patients. Repeated measures models demonstrated that on average cuff-based differed from intermittent a-line and from CDA (p < .005) for all BP values. No differences between a-line and CDA were observed. Concordance correlation coefficients ranged from 0.56 to 0.72 for a-line, cuff-based BP, and CDA, indicating moderate agreement. Using intermittently documented BP values does not fully represent the dynamic nature of BP over time.

Translation and Validation for the Portuguese Population of the Bedside Handover Attitudes and Behaviors Questionnaire

Purpose

The Bedside Handover Attitudes and Behaviors questionnaire is a 32-item instrument originally developed in English that enables nurse managers to monitor the consistency of nurses' practice during the implementation of the Nursing Bedside Handover. We aimed to cross-culturally validate this questionnaire for the Portuguese population and to examine its psychometric properties.

Methods

An exploratory-descriptive, quantitative, cross-sectional, and validation study was conducted. A sample of 241 nurses from a Portuguese acute care hospital participated in the field test. The questionnaire was cross-culturally adapted through translation, translation synthesis, and back-translation procedures, an expert committee harmonization, and two pre-tests.

Results

We obtained one factorial solution through exploratory factor analysis that explained 53.5% of the total variance, with 18 items distributed by four components: Direct Engagement, Personal Interaction, Information Sharing, and Individualized Approach. Confirmatory factor analysis supported the four-factor factorial structure of the questionnaire X2/df = 1.440; CFI = 0.0953; GFI = 0.926; RMSEA = 0.043; P[rmsea] < 0.001; MECVI = 1.175). Cronbach's α indicated acceptable reliability for the total questionnaire (α = 0.790). The refinement of the instrument led to the proposal of a new Conceptual Model for Patient Participation in Nursing Bedside Handover.

Conclusion

The questionnaire is valid and reliable for use by Portuguese nurse managers. This adapted version of the BHAB questionnaire can be applied by nurse managers to facilitate the implementation of Nursing Bedside Handover.

PD-L1 expression in recurrent or metastatic head and neck squamous cell carcinoma in China (EXCEED study): a multicentre retrospective study

AIMS

Programmed death-ligand 1 (PD-L1) is known to be highly expressed in various malignancies, including head and neck squamous cell carcinoma (HNSCC). We aimed to determine the prevalence of PD-L1 expression in recurrent or metastatic HNSCC (R/M HNSCC) among Chinese patients.

METHODS

This multicentre, retrospective analysis of data from six centres in China included patients with R/M HNSCC treated from 9 August 2021 to 28 February 2022. PD-L1 expression in tumour tissue was assessed and represented using a combined positive score (CPS). The χ2 and Cochran-Mantel-Haenszel χ2 tests were used to compare the prevalence of different PD-L1 expression statuses according to related co-variables.

RESULTS

For all 402 examined patients with R/M HNSCC, 168 cases (41.8%) had PD-L1 expression with a CPS ≥20, and 337 cases (83.8%) had PD-L1 expression with a CPS ≥1. Between the PD-L1 CPS ≥20 group and PD-L1 CPS <20 group, statistically significant differences were observed for variables of sex (p<0.001), smoking habit (p=0.0138 for non-smokers vs current smokers) and primary tumour site (p<0.001 for hypopharynx vs oral cavity and p=0.0304 for larynx vs oral cavity, respectively).

CONCLUSION

PD-L1 with CPS ≥20 was expressed in about 41.8% of cases with R/M HNSCC among Chinese patients, and PD-L1 expression was significantly associated with sex, smoking history and primary tumour site. Our findings regarding the variables related to PD-L1 expression level provide insight for clinical practice and a solid basis for future research on immunotherapy in HNSCC.

TRIAL REGISTRATION NUMBER

ISRCTN10570964.

Enhancing HIV Cognitive Abilities and Self-Management Through Information Technology-Assisted Interventions: Scoping Review

BACKGROUND

HIV/AIDS remains a significant global challenge, and with the rapid advancement of technology, there has been an increasing number of interventions aimed at improving HIV/AIDS cognition and self-management behaviors among patients. However, there is still a lack of detailed literature integrating relevant evidence.

OBJECTIVE

This study aims to comprehensively review existing research on interventions using modern information methods to improve HIV/AIDS cognition and enhance self-management behaviors among patients. It systematically reports the theoretical frameworks and specific intervention strategies used in current research, providing a comprehensive overview of the development status of relevant studies. We aim to compile existing evidence through this scoping review to identify potential avenues for future research.

METHODS

We followed the scoping review framework proposed by the Joanna Briggs Institute for the synthesis and reporting of evidence. Relevant literature was searched using electronic databases, including PubMed, Web of Science, Embase, CINAHL, and Cochrane Library. The time frame for inclusion was from 2018 to December 1, 2023. Inclusion criteria were (1) interventions using modern information technology or new digital media, (2) studies focusing on improving HIV awareness or self-management behaviors among people living with HIV, (3) intervention studies or evaluations of intervention effects, and (4) studies published within the last five years. Two reviewers (HH and MX) independently assessed each study at both the title and abstract screening stage and the full-text review stage, resolving any disagreements through discussion.

RESULTS

A total of 55 studies that met the inclusion criteria were included. The Information-Motivation-Behavioral Skills model, Social Cognitive Theory, Health Belief Model, Theory of Planned Behavior, and Information Systems Research Framework are among the most commonly used theoretical frameworks. Modern information technology interventions are mainly constructed using smartphone apps, SMS text messaging, internet-based platforms, audiovisual materials, and digital health education platforms, with smartphone apps and SMS text messaging being the most widely used intervention media.

CONCLUSIONS

Modern information technology is becoming an important tool for health interventions among people living with HIV/AIDS. However, future research should focus on integrating theoretical framework guidance with intervention design, further exploring the diversity of intervention implementations, the applicability of different technological methods, their long-term effects, and how to more effectively combine traditional intervention strategies to maximize intervention outcomes.

Construction of a bundle for the safety of patients with mental disorders during hospitalization

OBJECTIVE

to develop a bundle for the safety of psychiatric patients during hospitalization.

METHODS

a methodological study conducted in two stages. In the first, a comprehensive literature review was developed through a scoping review and conducted to examine evidence on the safety of psychiatric patients during hospitalization. In the second, based on the evidence listed, a set of actions was developed for the safety of psychiatric patients during hospitalization.

RESULTS

twenty-six articles published between 2012 and 2022 were used, making it possible to categorize recommendations and build a bundle through four axes: safety culture; clinical decision-making; intervention planning; and interpersonal violence.

CONCLUSIONS

the scientific evidence provided clear guidance on actions to improve the safety of psychiatric patients during hospitalization. This evidence also highlighted gaps in research, indicating the need for future studies in this area.

Enhancing work environments and reducing turnover intention: a multicenter longitudinal cohort study on differentiated nursing practices in Dutch hospitals

BACKGROUND

Addressing the growing challenge of nurse retention requires coordinated actions at national and global levels to improve recruitment, retention policies, and investments in the nursing work environment. The nursing work environment, defined as the "organizational characteristics of a work setting that facilitate or constrain professional nursing practice", is critical in influencing whether nurses decide to leave their jobs. This study investigates the impact of differentiated nursing practices - which involved tailoring roles and responsibilities based on nurses' training, skills, and experience in Dutch hospitals - and investigated their impact on the nursing work environment and turnover intention (i.e., nurses' intentions to leave their organization). We also explored whether the work environment mediates this relationship.

METHODS

A multicenter longitudinal cohort study was conducted across 19 Dutch hospitals between 2019 and 2023. Nursing professionals participated via digital surveys administered before (T0) and after (T1) differentiated nursing practices were introduced. The nursing work environment was assessed using the Practice Environment Scale of the Nursing Work Index. A multilevel analysis with a random intercept and fixed slope was used to evaluate the impact of differentiated nursing practices on the work environment and on nurses' turnover intentions.

RESULTS

We received 5411 responses to our questionnaire - 4259 at T0 and 1152 at T1. Results showed that, while the overall work environment improved, particularly in the dimensions of staffing and resource adequacy, collegial nurse-physician relationships, and participation in hospital affairs, there were no significant improvements in nursing foundation for quality of care or nurse managers' ability, leadership, and support of nurses. Additionally, differentiated nursing practices did not significantly impact turnover intention, nor did the work environment mediate this relationship.

CONCLUSIONS

This study is the first to explore the unique effects of practice differentiation on turnover intention mediated by the work environment. The findings suggest that, while differentiated practices can enhance certain aspects of the work environment, a more systemic and integrated approach is required for sustained improvements. Future research should include longer term studies to fully understand the complex relationship and accompanying mechanisms between differentiated nursing practices, the nursing work environment, and turnover intention.

TRIAL REGISTRATION

Clinical trial number not applicable.

Systems Leadership: a qualitative systematic review of advice for policymakers

Background

'Systems leadership' research rejects the idea that complex policy problems can be solved by a few heroic leaders in the centre of government or at the top of organisations. Many people need to contribute to systems leadership by collaborating to harness the skills of actors across government and outside of government. At times, this proposition is vague and it is difficult to know who should change or what to do. We searched the academic and grey literature for further advice on how to foster effective systems leadership.

Methods

We conducted a qualitative systematic review (2024) of peer reviewed journal articles (Web of Science) and grey literature reports (Policy Commons, Overton). Each text had to inform advice on systems leadership. We used an immersive inductive approach to identify key sources of ideas, highlight common themes, and relate the results to insights from policy theories.

Results

84 texts met the inclusion criteria (39 Web of Science, 34 Policy Commons, 11 Overton), then we included 80 snowballed academic and grey references (total 164). Some relate leadership to complexity theory, but most provide broad accounts of systems leadership that emphasise decentralisation and collaboration. These accounts describe high aspirations and essential skills but limited evidence from activity. Nevertheless, this literature helps us produce a coherent synthesis of common insights and advice on how to foster systems leadership.

Conclusions

We identify key features of systems leadership: reject heroic top-down leadership and central control in favour of collaboration across boundaries; develop attributes (e.g. humility), mindsets (e.g. big picture), and skills (e.g. facilitation) to act in complex systems (albeit without a common view on what a complex system is); and, seek organisational and political support for this approach. Some accounts identify barriers to systems leadership and negative experiences, while others redefine such obstacles as learning opportunities.

Advancing Quality and Safety Culture in Healthcare: Insights From the Evaluation of an Improvement Science Program for Nurses and Midwives

AIMS

This paper presents the outcomes and insights gained from the implementation of an Improvement Science program tailored for nursing and midwifery staff within a large local health district in New South Wales. The programme aimed to enhance frontline clinicians' confidence and capability in quality improvement, ultimately improving patient outcomes and safety culture.

DESIGN

Through an explanatory sequential mixed-methods evaluation study, we assessed the programme's effectiveness in building capacity, sustaining practice changes and fostering a culture of continuous improvement.

METHODS

Quantitative data were collected through pre-post knowledge surveys, post workshop feedback and programme participation rates. Qualitative data were then collected via nine interviews with programme participants. Simple descriptive statistical analysis for quantitative data and a thematic analysis of qualitative data was undertaken. Data were then integrated from these multiple sources to gain a deeper understanding of the outcomes of the Improvement Science Program.

RESULTS

Key findings indicate that coaching and mentoring support significantly contributed to project completion and sustained practice changes. Structured coaching sessions, collaborative team meetings, and executive sponsorship were vital components that facilitated successful outcomes. Notably, effective leadership, often demonstrated by Clinical Nurse Educators and Consultants, played a crucial role in fostering staff collaboration and participation. Insights from qualitative interviews highlight the transformative impact of the programme on participants' skills, confidence and practice.

CONCLUSION

The paper concludes with recommendations for future Improvement Science programs, emphasising the importance of structured coaching, accountability mechanisms, and the identification and support of future coaches. Overall, this study underscores the value of ongoing training initiatives in promoting a culture of safety, quality improvement and enhanced patient outcomes in healthcare settings.

PATIENT OR PUBLIC CONTRIBUTION

This study had no patient or public contribution.

REPORTING METHOD

Adherence to Standards for Reporting Qualitative Research (SRQR) EQUATOR guidelines (see Supplementary file).

Impact of nursing interventions on hemodialysis patients using the integrated theory of health behavior change

This study investigated the impact of nursing interventions based on the Integrated Theory of Health Behavior Change on hemodialysis patients. A retrospective analysis of 713 hemodialysis patients' electronic medical records from June 2020 to November 2023 was conducted. Patients were divided into an experimental group, receiving nursing interventions based on the theory, and a control group, receiving regular nursing care. After 1 month, dialysis indices and hospitalization rates were compared. Subgroup analyses based on education level were performed. After basic information matching, the spKt/V values of the experimental group and the control group were 1.62 ± 0.27 and 1.41 ± 0.25, with 198 and 176 individuals meeting the standard, respectively. The urea reduction ratio of the experimental group was 78.26 ± 8.72, with 187 individuals meeting the standard. From the 2 indicators, the dialysis indices of the experimental group were significantly better than those of the control group (P < .05). The numbers of readmissions in the 2 groups were 41 and 61, respectively, with a statistically significant difference (P = .024). We also compared the reasons for readmission between the 2 groups and found significant differences in the reasons. Particularly, the numbers of readmissions due to fluid overload were 13 and 32 in the experimental and control groups, respectively, with significantly fewer in the experimental group than in the control group (P = .033). The education level did not affect the readmission rate of patients, with readmission rates of 12 and 11 in the 2 groups, respectively, with P > .05. The dialysis indices spKt/V and urea reduction ratio increased with increasing BMI, and there was a correlation between the 2, with values of 0.61 and 0.51, respectively, which were statistically significant (P < .05). The extremely satisfied rates were 46% in the experimental group and 36% in the control group, with dissatisfaction rates of 2% and 3% in the 2 groups, respectively, showing a significant statistical difference (P < .01). Nursing interventions based on the Integrated Theory of Health Behavior Change improved dialysis outcomes and patient satisfaction, providing insights for chronic disease management.

Construction of a nursing management program for early fluid resuscitation in patients with acute pancreatitis: a Delphi study in China

AIM AND OBJECTIVES

To construct a set of scientific and feasible nursing management protocols for early fluid resuscitation in acute pancreatitis (AP) patients that can be used to guide clinical practice and enhance the treatment efficacy in these patients.

BACKGROUND

Fluid resuscitation is a key means of early treatment for AP patients and has become a clinical consensus. Nurses are important practitioners of fluid resuscitation, and there is a lack of specific enforceable nursing management programs.

METHODS

Through literature research, on-site research, semi-structured interviews, and other preliminary preparations of the first draft of the nursing management program for early fluid resuscitation in acute pancreatitis, the Delphi method was used to conduct two rounds of correspondence with medical and nursing experts, and then statistically analyzed.

RESULTS

Fifteen and 14 questionnaires were distributed in two rounds, respectively, and 15 and 14 questionnaires were recovered, respectively. The positive coefficient of experts was 100%, the authority coefficient was 0.970 and 0.975, respectively; the coefficient of variation coefficient was 0.05-0.21 and 0.00-0.20, respectively; the expert coordination coefficients of all levels of indices in this study are 0.166-0.335 and 0.189-0.364, respectively. The P values of the first, second, and third level indices are < 0.05 according to the test of Kendall's harmony coefficient. A total of 5 primary indicators, 11 secondary indicators, and 36 tertiary indicators were used to construct the Nursing Management Program for Early Fluid Resuscitation in Acute Pancreatitis.

CONCLUSIONS

The constructed nursing management plan for early fluid resuscitation in acute pancreatitis patients puts forward clear requirements and standards for nursing care in the early stage of AP treatment. This plan is scientific, represent good clinical practice, are feasible for nurses to follow, and construct a standardized protocol for the management of early fluid resuscitation in patients with acute pancreatitis.

A genomics learning framework for undergraduates

Genomics is an increasingly important part of biology research. However, educating undergraduates in genomics is not yet a standard part of life sciences curricula. We believe this is, in part, due to a lack of standard concepts for the teaching of genomics. To address this deficit, the members of the Genomics Education Alliance created a set of genomics concepts that was then further refined by input from a community of undergraduate educators who engage in genomics instruction. The final genomics concepts list was compared to existing learning frameworks, including the Vision and Change initiative (V&C), as well as ones for genetics, biochemistry and molecular biology, and bioinformatics. Our results demonstrate that the new genomics framework fills a niche not addressed by previous inventories. This new framework should be useful to educators seeking to design stand-alone courses in genomics as well as those seeking to incorporate genomics into existing coursework. Future work will involve designing curriculum and assessments to go along with this genomics learning framework.

Research protocol for a systematic review and meta-analysis of the effects of music on anxiety and physiological outcomes in patients undergoing bronchoscopy

INTRODUCTION

Bronchoscopy is a routine clinical examination that can cause discomfort and anxiety in patients. This paper presents a protocol for a systematic review and meta-analysis aiming to assess the effect of music on anxiety and physiological outcomes in patients undergoing bronchoscopy.

METHODS

The protocol adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines and has been registered in PROSPERO (CRD42024567398). Our documentary research strategy will involve four databases: PubMed, Google Scholar, Scopus, and the Cochrane Library. In addition, manual searches will be conducted through related articles and references. We will include randomized controlled trials that evaluate the effect of music on patients undergoing bronchoscopy. The primary outcome will be the anxiety level and the secondary outcome will include physiological outcomes. Study selection, data extraction, and quality assessment will be carried out independently by two reviewers. Any discrepancies will be resolved through consultation with a third reviewer. The quality and the risk of bias in the studies will be evaluated using The Joanna Briggs Institute critical appraisal tool. The results of this systematic review will be synthesized to provide an overview on the effectiveness of music on anxiety and physiological parameters in patients during bronchoscopy. If the results are considered acceptable and sufficiently homogeneous, a meta-analysis will be performed to synthesize the findings.

CONCLUSION

The systematic review produced from this protocol will provide evidence on the effectiveness of music for patients undergoing bronchoscopy and will contribute to strengthening the existing body of knowledge on non-pharmacological interventions for anxiety management during medical procedures.

Exploring the experiences of children's palliative care for forced migrant families in the United Kingdom: an interpretative phenomenological study

Introduction

This study focused on understanding the experiences of forced migrant families and the health care professionals who care for them within palliative care. Palliative care for children requires an active, holistic approach to care, with a focus upon improving quality of life. Forced migrant families encounter a range of additional challenges including the loss of family, belongings, and all sources of familiarity and support. The difficulties of navigating complex bureaucratic systems can confound access and communication difficulties.

Methods

Interpretative Phenomenological Analysis methodology was used in this study to privilege participant perspectives and apply an active in-depth cyclical process of reflection and reflexivity. Advisory group members provided expertise in childhood illness, palliative care and forced migration, throughout the study. The Silences Framework offered novel theoretical and philosophical concepts, which helped to situate and prioritise the "silences" within the marginalised discourses of forced migration and palliative care. Seven family members and seven health care professional participants were interviewed from hospital, hospice and community palliative care settings in the UK.

Results

Four overarching themes were identified related to experiences of loss and grief, communication, faith and coping strategies and alienation and discrimination. Compassionate, empathetic, family-centred care which valued family belief systems and coping strategies, optimised care. Learning with and from families was described by all participants, which enhanced understanding and fostered mutual respect. However, barriers included poor access to services and resources, protocol-led care, limited time with families, communication barriers and staff burnout.

Discussion

The findings suggest the need for a specific educational pathway for palliative care professionals to include spiritual care provision, cultural humility, and moral reasoning. Interdisciplinary education including the use of lived-experience expert insights is also advocated. Sufficient time to build relationships, the importance of interpreter support and the need for better access to hospice care for forced migrant families is also recommended.

Reducing catheter-associated urinary tract infections with sterile, continuously closed drainage systems does not have to be costly

INTRODUCTION

Catheter-associated urinary tract infections (CAUTIs) cause significant morbidity and financial strain in the pediatric intensive care unit (PICU). There is a significant incentive to reduce the rate of CAUTIs through multimodal quality improvement initiatives; however, these initiatives are often costly to implement.

OBJECTIVE

This article examines the cost-savings associated with a novel "two-part, two-person" catheter insertion protocol implemented at a pediatric quaternary care center PICU which replaced costly pre-packaged, closed system urinary catheter kits with their individually packaged components, along with its impact on CAUTI rates and nursing satisfaction.

STUDY DESIGN

The "two-part, two-person" insertion protocol involved two nurses placing an appropriate size indwelling catheter using an individually packaged sterile insertion kit, urine meter bag, and Foley catheter. All patients with Foley catheters placed in the PICU between April 2021 and March 2022 were included in this study. Endpoints included the cost of each insertion, CAUTI rates per 1000 Foley days, and nursing satisfaction.

RESULTS

The "two-part, two-person" insertion protocol resulted in a projected 12-month cost savings of $38 521 while CAUTI rates over this period (3.8 per 1000 Foley days) did not significantly deviate from the 6 months prior to program initiation (5.65 per 1000 Foley days, p = 0.06). This protocol garnered an approval rating of 87 % by PICU nurses.

CONCLUSIONS

Catheter expenditures can be reduced and quality standards can be maintained by eliminating costly pre-packaged, closed system urinary catheter kits in favor of their individual components. This protocol demonstrates an acceptable and sustainable intervention to improve value of care within the PICU.

Enhancing interprofessional ward rounds by identifying factors associated with low satisfaction and efficiency: a quantitative and qualitative national survey of Swiss healthcare professionals

AIMS OF THE STUDY

Interprofessional ward rounds are a cornerstone of patient-centred care for medical inpatients and offer opportunities to discuss and coordinate patient treatment and further management. We aimed to identify factors associated with lower satisfaction and efficiency of interprofessional ward rounds, as reported by physicians and nurses.

METHODS

An anonymous Swiss nationwide online survey of physicians and nurses was conducted in 28 Swiss internal medicine inpatient departments between 9 August and 19 October 2023. Analyses were conducted from November to December 2023. The primary outcome was physicians' and nurses' perceived lower satisfaction with ward rounds, which was assessed using visual analogue scales ranging from 0 to 10, with lower satisfaction defined as scores below the median. The main secondary outcome was perceived lower efficiency using a similar definition. Qualitative analysis was performed through inductive thematic analysis.

RESULTS

The survey had a response rate of 21.6% (547/2530). Of the 547 physicians and nurses included in the final analysis, the median satisfaction was 7 points (interquartile range [IQR] 6-8). A total of 61% of physicians (156/254) and 76% of nurses (224/293) reported lower satisfaction. Lower satisfaction was reported significantly more frequently by nurses (adjusted odds ratio [OR] 2.33, 95% confidence interval [CI] 1.58-3.43; p ≤0.001) and female team members (adjusted OR 1.95, 95% CI 1.32-2.9; p <0.01). The median perceived efficiency of ward rounds was 7 points (IQR 5-8), and the nursing profession was associated with lower perceived efficiency (adjusted OR 1.95, 95% CI 1.3-2.93; p <0.01). Adherence to in-house guidelines for ward rounds was associated with satisfaction (adjusted OR for lower satisfaction 0.25, 95% CI 0.16-0.39; p <0.001) and perceived efficiency (adjusted OR for lower efficiency 0.27, 95% CI 0.17-0.43; p <0.001). Both physicians and nurses preferred to perform ward rounds as part of an interprofessional team. The qualitative analysis of the data revealed a preference for structured interprofessional ward rounds and the active involvement of nurses.

CONCLUSIONS

This survey revealed an overall high preference for interprofessional ward rounds. In addition, we identified several factors that were associated with lower satisfaction and efficiency. Structured in-house protocols for ward rounds may increase the satisfaction and efficiency of interprofessional collaboration during ward rounds.

Effects of Animal-Assisted Therapy for Anxiety Reduction in Children and Adolescents: A Systematic Review

Background: Animal-Assisted Therapy (AAT) is a clinical approach aimed at building valuable human-animal relationships with both preventive and therapeutic goals. It is provided by a healthcare professional and involves animals (meeting certain criteria) as an integral part of the treatment process. This type of therapy has been shown to have multiple benefits in several areas, such as reducing anxiety in a variety of different groups of people. However, few studies have specifically investigated the benefits of AAT in reducing anxiety in children and adolescents. This systematic review aimed to comprehensively assess the evidence regarding the effectiveness of AAT in reducing anxiety among children and adolescents while also identifying research gaps in this field. Methods: Studies focusing on the relationship of these two variables were obtained from multiple databases (EBSCO, PubMed, and Web of Science). Results: AAT has grown and the literature demonstrates several benefits of this approach. However, few studies have demonstrated the benefits of AAT for reducing anxiety in children and adolescents. Conclusions: Most of these few studies show that this type of intervention can help reduce anxiety levels.

Nurse-Led Self-Management Support After Organ Transplantation - A Multicenter, Stepped-Wedge Randomized Controlled Trial

In this unblinded multi-center stepped-wedge randomized controlled trial the effectiveness of the nurse-led ZENN-intervention was tested in promoting self-management skills in comparison to standard care among heart, lung and kidney transplant recipients. This intervention is based on behaviour change theories and was conducted in four sessions over 6 months at the outpatient clinic. The experimental group received standard care, plus the ZENN-intervention, while the control group received only standard care. Both groups completed questionnaires at baseline, at 6 months and 1 year follow-up. At baseline, the experimental group (n = 69) scored significantly lower than the control group (n = 106) on the primary outcome Skills and Technique Acquisition (STA). No significant between-group differences were found on the secondary outcomes self-management, self-regulation, quality of life and medication adherence at T1 and T2. There was a significant increase on the self-management scale STA between T0 and T1 in the experimental group. Therefore, participants included in the experimental group had lower self-management skills at baseline and reported significant improvement after completing the intervention. No significant intervention effect was found in the primary analysis, however, for recipients with reduced self-management skills the intervention may be beneficial.

Clinical Trial Registration

https://onderzoekmetmensen.nl/en/trial/24150, Netherlands Trial Register NL8469.

War-related continuous traumatic stress as a potential mediator of associations between moral distress and professional quality of life in nurses: a cross-sectional study in Ukraine

BACKGROUND

At the beginning of 2022, Central Europe entered a state of emergency due to the Russian invasion of Ukraine. Nurses were particularly vulnerable to a decline in their professional quality of life, facing repeated exposure to military trauma, ethical dilemmas, prolonged working hours, and increased stress and fatigue. This study aimed to contribute to our understanding of the potential mediating effect of war-related continuous traumatic stress on the association between moral distress and professional quality of life, including compassion satisfaction and compassion fatigue, represented by burnout and secondary traumatic stress.

METHODS

This study used the Professional Quality of Life (ProQOL) Scale to assess compassion fatigue, including burnout, secondary traumatic stress, and compassion satisfaction; the Moral Distress Questionnaire for Nurses to examine everyday moral distress in healthcare facilities and everyday ethical dilemmas of nurses; and the Continuous Traumatic Stress Response (CTSR) Scale to assess ongoing threats, resulting in exhaustion/rage, and fear/betrayal. The sample consisted of 130 female nurses (mean age 40.20 ± 12.15 years) from general surgery, neurosurgery, trauma and orthopaedic surgery, and urgent care who had been undergoing advanced training to work with injured military personnel at the Volyn Medical Institute (Ukraine) from March to May 2023. All nurses had experienced direct and indirect exposure to military trauma, and 105 participants were working with injured military personnel.

RESULTS

The results of the mediation analysis indicated that war-related continuous traumatic stress fully mediated the relationship between moral distress and different components of professional quality of life, namely, compassion fatigue, including burnout and secondary traumatic stress, and compassion satisfaction.

CONCLUSION

Research has shown that continuous traumatic stress has a significant effect on the relationship between moral distress and various aspects of professional quality of life, underscoring the need for targeted interventions for nurses facing war-related trauma.

Efficacy of electroacupuncture in the treatment of insomnia in cancer patients: A meta-analysis

BACKGROUND

The purpose of this meta-analysis of current studies was to assess the efficacy of electroacupuncture for cancer-related insomnia.

METHODS

A comprehensive search was conducted encompassing randomized controlled trials examining the efficacy of electroacupuncture in treating cancer-related insomnia across CNKI, VIP, Wang Fang, PubMed, Embase, Cochrane library, and Web of Science, with a search deadline of December 26, 2023. The Cochrane manual's risk-of-bias evaluation was used for quality assessment, while Stata 15.0 was used for the data analysis.

RESULTS

Eight randomized controlled studies involving 537 individuals were finally included. Meta-analysis results suggested that electroacupuncture improved total sleep time [SMD = 0.68, 95% CI (0.31, 1.06)], sleep efficiency [SMD = 1.26, 95% CI (0.02, 2.50)], and reduced Pittsburgh sleep quality index [SMD = -0.44, 95% CI (-0.63, -0.25)], insomnia severity index [SMD = -1.23, 95% CI (-1.88, -0.58)], and sleep onset latency [SMD = -0.76, 95% CI (-1.36, -0.15)] in cancer patients.

CONCLUSION

Based on the current study, we found that electroacupuncture may have a better effect on insomnia in cancer patients.

IMPACT-ICU feasibility study: pragmatic mixed-methods randomised controlled trial of a follow-up care intervention for survivors of critical illness and caregivers

INTRODUCTION

Survivors of critical illness and their caregivers are at risk for long-term cognitive, physical and psychiatric impairments known as post-intensive care syndrome (PICS) and PICS-family, respectively. This study will assess the feasibility of a randomised controlled trial (RCT) evaluating an intensive care unit (ICU) follow-up care bundle versus standard-of-care for ICU patients and their caregivers.

METHODS AND ANALYSIS

This is a single-centre feasibility study. Survivors of critical illness will be eligible if: age ≥18 years, life expectancy ≥6 months and high risk for PICS. We define high risk as ICU stay ≥4 days or involving 1+ of mechanical ventilation, tracheostomy, delirium or lack of access to a primary care physician (PCP). 20 ICU survivor-primary caregiver dyads will be enrolled (n=10 dyads per group) and randomised 1:1 to the intervention versus control group. The intervention will be: (1) diaries to journal patient experiences, (2) information packages on expectations post-discharge and (3) specialised follow-up care at 1 and 3 months post-discharge. The control group will receive standard of care in the ICU and follow-up with their PCP. The primary outcome is feasibility, defined as: (1) consent rate >80%, (2) enrolment rate of 4 participants/month, (3) follow-up rate>70% and (4) data capture rate >80%. Our secondary objective is to explore the perspectives of survivors of critical illness and their families about the intervention and their participation in the study. Tertiary outcomes will be a battery of cognitive, physical functioning and psychiatric outcomes.

IMPLICATIONS

Survivorship from critical illness extends beyond surviving an ICU stay. This project will lay the foundation for performing a large, multicentre pragmatic RCT with survivors of critical illness and their caregivers, paving the way for improved long-term healthcare.

ETHICS AND DISSEMINATION

This study has received approval (6039808) from the Queen's University Health Sciences/Affiliated Teaching Hospitals Research Ethics Board. Results will be presented at critical care conferences. A lay summary co-designed with ICU survivor participants will be provided to patients.

TRIAL REGISTRATION NUMBER

NCT06681649.

Poly-skilling and advanced practice roles in perioperative care: protocol for a realist synthesis of evidence

INTRODUCTION

An ageing population and a workforce crisis have triggered an ambitious UK strategy for sustained delivery of healthcare. In perioperative care (the management of patients from contemplation of surgery until full recovery), it is recognised that interventions are needed to place the workforce on a more sustainable footing through cross-functionality and skill-shifting, namely with advanced practice roles. However, despite some reports and reviews in the literature, it is unclear how skills development efforts may potentially support workforce transformation for an effective and resilient perioperative care workforce. Thus, drawing causal inferences for policy-making that is both evidence based and rooted in theory is challenging. A scoping review, reported within this protocol, confirmed that 'poly-skilling' and 'advanced practice roles' are critical to this workforce transformation, but the mechanisms through which interventions in this area may work are not understood. A synthesis of evidence is, therefore, proposed in this protocol, to understand what works for whom and under what circumstances, in relation to poly-skilling and advanced practice roles in workforce transformation for sustained healthcare delivery.

METHODS AND ANALYSIS

This protocol sets out the plan to undertake a realist synthesis of the related literature, with theory elicitation (step 1), search for empirical evidence (step 2), selection and appraisal of evidence (step 3) and programme theory refinement (step 4). Exploratory reviews of the literature and key informants' inputs will produce initial hypotheses as to what it is about interventions in poly-skilling and advanced practice roles that work and why. Data from the literature will then be collected based on relevance, rigour and richness. The iterative analysis and synthesis of these data will produce causal links between contexts, mechanisms and outcomes. The results will inform a realist evaluation, to be undertaken as part of doctoral research, to better understand the mechanisms that support workforce transformation through poly-skilling and advanced practice roles.

ETHICS AND DISSEMINATION

As a review of previously published literature, the evidence synthesis proposed in this protocol does not require formal ethical approval. Recommended ethical considerations regarding the involvement of key informants, who are not study participants but a consultative group, are presented in this protocol. A formal ethics approval will be sought ahead of the later empirical stage of the research. The results of the realist synthesis proposed in this protocol will be fed back to the local National Health Service organisation and Integrated Care Board and disseminated to the research community via presentations at conferences and a peer-reviewed journal article.

PROSPERO REGISTRATION NUMBER

CRD42024512164.

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

INTRODUCTION

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

METHOD

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

RESULTS

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

DISCUSSION

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

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Advancing Telemedicine: Virtual Rounding and Care in an Emergency Department Observation Unit

Patient overcrowding in emergency departments (ED) impact quality of care by increasing length of stay which often leads to delayed patient dispositions. Emergency Department Observation Units (EDOUs) are protocol driven units staffed by ED providers that can alleviate overcrowding concerns and accommodate patients that require further diagnostics for a final disposition. Virtual rounding on EDOUs can be leveraged to maximize provider shortages and increase access to quality care. We present a case report of a patient who arrived at an ED for abdominal pain and was eventually admitted to an EDOU that practiced virtual rounds. This case report demonstrates the benefits of utilizing a clinical hybrid model that combines telemedicine and observation medicine to achieve quality care while improving ED operational flow.

Prospective Trial of a Passive Diversion Device to Reduce Blood Culture Contamination

Background

Blood culture contaminants can lead to inappropriate antibiotic use, prolonged length of stay, and additional hospital costs. Several devices have been developed to reduce the risk of blood culture contamination by diverting a portion of the initial blood sample from the blood culture bottle. We assessed the effectiveness of 1 blood diversion device (BDD) in a prospective trial performed at the 2 separate emergency departments (EDs) of an academic medical center.

Methods

A multiphase prospective crossover trial was performed with the BDD in use at 1 ED and standard equipment at the other ED for 10 weeks, and a second 10-week study phase was conducted with the use of the BDD and standard equipment in the EDs reversed. Contaminants were identified both by standard clinical microbiology lab criteria and by independent retrospective review by 3 infectious disease (ID) physicians. The primary analysis was performed based on intention-to-use data using the physician review of positive blood cultures.

Results

A total of 5637 blood samples were obtained, with 5625 samples analyzed after 12 blood culture results were deemed inconclusive by the ID physician review. The University ED had a higher blood culture contamination rate of 2.9% compared with the Memorial ED at 1.4%. In an intention-to-use analysis, the overall contamination rates were 2.0% and 2.9% in the BDD and standard equipment periods, respectively (P = .03), and in an actual-use analysis the contamination rates were 1.2% and 3.0% for the BDD and standard equipment, respectively (P < .001).

Conclusions

The BDD was associated with significantly lower blood culture contamination rates at the institution's 2 EDs, with a stronger effect noted at the campus caring for higher acuity patients.

Psychological Safety in Medical Education, Another Challenge to Tackle?

Psychological safety is the feeling that one can take interpersonal risks without fear of negative consequences including retaliation, intimidation, or rejection. The literature base on psychological safety in medical education is increasing. Despite increasing recognition in the medical literature, many medical practitioners and educators are uncertain about the background and effects of psychological safety on medical education. For learners (students and residents), having an environment with high psychological safety means being able to admit knowledge gaps and skill deficits. Psychological safety is recognized as an essential attribute for a positive learning environment and is associated with several positive behaviors. To benefit medical educators, we contextualize the benefits of improved psychological safety in medical education and highlight the limited data substantiating what interventions are known to enhance psychological safety in graduate medical education. While it is recognized that higher psychological safety is important, creating better psychological safety is a complex challenge analogous to patient safety, well-being, and healthcare disparity. The challenges for environments with lower psychological safety are understanding what to fix and how to fix it, and recognition that quick fixes are elusive. Moving forward, medical educators must have a better understanding of how to enhance psychological safety.

Optimizing triage education for emergency room nurses: A scoping review

AIMS

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

DESIGN

A scoping review.

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

Emotional safety in maternity care: An evolutionary concept analysis

BACKGROUND

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

AIM

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

METHODS

The evolutionary approach was used for this concept analysis.

DATA SOURCES

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

RESULTS

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

CONCLUSION

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

Presentation suitability and readability of ChatGPT's medical responses to patient questions about on knee osteoarthritis

Objective: This study aimed to evaluate the presentation suitability and readability of ChatGPT's responses to common patient questions, as well as its potential to enhance readability. Methods: We initially analyzed 30 ChatGPT responses related to knee osteoarthritis (OA) on March 20, 2023, using readability and presentation suitability metrics. Subsequently, we assessed the impact of detailed and simplified instructions provided to ChatGPT for same responses, focusing on readability improvement. Results: The readability scores for responses related to knee OA significantly exceeded the recommended sixth-grade reading level (p < .001). While the presentation of information was rated as "adequate," the content lacked high-quality, reliable details. After the intervention, readability improved slightly for responses related to knee OA; however, there was no significant difference in readability between the groups receiving detailed versus simplified instructions. Conclusions: Although ChatGPT provides informative responses, they are often difficult to read and lack sufficient quality. Current capabilities do not effectively simplify medical information for the general public. Technological advancements are needed to improve user-friendliness and practical utility.

Aged smart-care application program for promoting quality of life among older adults in the community: Study protocol of a three-arm randomized controlled trial

Objectives

To describe a study protocol for a three-arm randomized controlled trial that will evaluate the effectiveness of an Aged Smart-Care (ASC) application program intervention for community-dwelling older adults in China.

Methods

This randomized controlled trial with three arms will be conducted at eight community health service centers. Participants will be randomly assigned to one of three groups: the interactive ASC (ASC + I) group, the regular ASC group, or the control group. The ASC + I group will receive management from a multidisciplinary medical team, while the regular ASC group will only utilize the ASC. The primary outcome will be assessed using the Medical Outcomes Study Short Form 36 (SF-36) Health Survey. The secondary outcomes include general self-efficacy, medication adherence, effectiveness of health behavior interventions, BMI, number of outpatient visits, and number of hospitalizations. Data will be collected at baseline, immediately post-intervention, 3 months, 6 months, and 1 year after the intervention. Generalized estimating equations model will be employed for data analysis.

Conclusions

This study clarifies the development process of the ASC and designs a three-arm randomized controlled trial to examine the efficacy of the ASC for older adults in the community. The results of the study will compare differences in the quality of life of participants in different groups. This will help community healthcare workers to choose appropriate interventions regarding the ASC. Furthermore, this provides scientific guidance for the Integrated Theory of Health Behavior Change theory in the field of mobile health tool development.

A Theory of Transitions Influencing Diabetes Self-management Among Emerging Adults With Type 1 Diabetes

Emerging adults with type 1 diabetes are experiencing numerous transitions, potentially affecting diabetes self-management. For example, when transitioning to college, these emerging adults may experience changes in their daily routines and usual reminders or triggers for habitual behavior such as checking blood glucose levels. In turn, these emerging adults may omit checking glucose levels, impacting decisional and adaptational diabetes self-management behavior associated with their insulin dose or bolus. Thus, we propose a theory on transitions influencing daily routines, diabetes self-management habitual behavior triggers, and, in turn, diabetes self-management habitual and decisional/adaptational behaviors for emerging adults with type 1 diabetes.

Risk of drug-induced delirium in older patients- a pharmacovigilance study of FDA adverse event reporting system database

BACKGROUND

Drug-induced delirium is known risk factors associated with increased morbidity and mortality in older patients. The objective was to evaluate the risk of drug-related delirium in older patients based on the FDA Adverse Event Reporting System (FAERS).

RESEARCH DESIGN AND METHODS

Delirium reports in older patients (age ≥65) extracted from the FAERS database using Open Vigil 2.1. The reported odds ratio and the proportional reported ratio were calculated to detect the adverse reaction signal of delirium. Combined with published evidence, suspected drugs were categorized as known, possible, or new potential delirium-risk-increasing drugs.

RESULTS

Of the 130,885 reports (including 28,850 delirium events and 1,857 drugs) analyzed for this study, 314 positive signal drugs were detected. Positive signal drugs are mainly concentrated on the drug of nervous system, cardiovascular system , alimentary tract and metabolism and anti-infectives for systemic use. Of the positive signal drugs, 26.11% (82/314) were known delirium-risk increasing drugs, 44.90% (141/314) were possible and 28.98% (91/314) were new potential.

CONCLUSION

Drug-induced delirium risk is prevalent in older patients, according to the FAERS. The risk level of drug-induced delirium should be taken into account to optimize drug therapy in clinical practice.

Hemodynamic Impact of the Trendelenburg Position: A Systematic Review and Meta-analysis

OBJECTIVE

To systematically evaluate the impact of the Trendelenburg position on hemodynamic parameters in adult patients.

DESIGN

Systematic literature review and meta-analysis using PubMed and Medline.

SETTING

All prospective interventional studies comparing the hemodynamic characteristics of patients in the horizontal supine position and Trendelenburg position.

MEASUREMENTS AND MAIN RESULTS

A total of 16 studies including 333 patients were found. The Trendelenburg position led to a statistically significant 11% increase in stroke volume compared with the supine position (mean difference [MD] = 8.27, 95% confidence interval [CI]: 1.79; 14.76, p = 0.012). A decrease in stroke volume variation (MD = -1.36, 95% CI: 2.26; -0.46, p = 0.003) and heart rate (MD = -1.65, 95% CI: -2.86; -0.44, p = 0.008) and an increase in cardiac output (MD = 0.33, 95% CI: 0.1; 0.57, p = 0.006), mean arterial pressure (standardized MD, = 0.42, 95% CI: 0.1; 0.74, p = 0.011), central venous pressure (MD = 4.13, 95% CI: 2.42; 5.84, p < 0.001), mean pulmonary artery pressure (MD = 4.25, 95% CI: 2.69; 5.81, p < 0.001), and left ventricular end-diastolic volume (MD = 16.89, 95% CI: 3.17; 30.61, p = 0.016) were found.

CONCLUSIONS

The Trendelenburg position significantly increases stroke volume and improves multiple hemodynamic parameters in adult patients. These results confirm the position's potential clinical relevance in hemodynamic management and suggest the possibility of a tailored application in selected clinical settings. The duration of the beneficial effects of the Trendelenburg position and the possible side effects should be the focus of further investigation.

ED Nurse-Led Code Sepsis to Reduce Time to Antibiotics

BACKGROUND

Delays in sepsis recognition contribute to delays in antibiotic administration, which lead to increased morbidity and mortality in patients with sepsis. Our objective was to create an Emergency Department (ED) Code Sepsis Nurse-led team to reduce the time to antibiotics and mortality in patients with sepsis.

METHODS

This initiative was implemented at a community hospital in Southern California in response to previous undesirable sepsis outcomes. In fiscal year 2021, the ED Sepsis Nursing Team was launched with the goal of improving sepsis-related outcomes. The following interventions were implemented: First, a group of dedicated Sepsis Nurses with training specific to sepsis recognition was created, and an electronic ED-sepsis screening tool was developed and implemented. Next, the dedicated sepsis nurses designed and educated to a "Code Sepsis" activation process. The code triggered a multidisciplinary response and implementation of standing orders for blood cultures, lactate, complete blood count, complete metabolic panel, and chest x-ray or urinalysis if indicated. Finally, the Sepsis Team Registered Nurse (RN) Captain led house-wide monthly Sepsis Task Force meetings to improve unit-level engagement and to allow the team to have ownership over sharing wins and losses.

RESULTS

By Quarter 4 (Q4) of Fiscal Year 2021, door-to-antibiotic time for sepsis patients dropped from 196.7 min (Q1) to 144.7 (Q4). Additionally, mortality dropped below the health system average (10.4% vs. 13.5%), and Fiscal Year 2021 surpassed the readmissions benchmark of <1.0 at a rate of 0.5.

CONCLUSION

An RN-led, interprofessional response to accepted sepsis identification criteria enhanced staff and physician engagement and improved sepsis outcomes for patient mortality and hospital reporting outcomes. The process was adopted with very few obstacles that were easily overcome as the understanding of the role and its significance was realized.

Educational games in nursing education: A bibliometric and content analysis

AIM

To conduct a bibliometric and content analysis of publications on educational games in the field of nursing education.

BACKGROUND

Educational games are an innovative active teaching method. Its use in nursing education has advantages; it has the potential to support students' active participation in the educational process.

DESIGN

Bibliometric and content analysis.

METHODS

The data for this study were screened from the Web of Science database. Bibliometric analysis and data visualization were performed using VOSviewer and Bibliometrix software, employing techniques such as scientific mapping and performance analysis. For content analysis, a synthetic knowledge synthesis approach based on bibliometric mapping was adopted.

RESULTS

A total of 223 publications involving 819 authors were analyzed. These publications appeared in 87 different journals, with an average of 1.67 citations per publication. The journals "Nurse Education Today" and "Clinical Simulation in Nursing" featured the highest number of articles. The USA and Spain were leading countries in terms of total link strength, connections and the number of articles and citations. The most frequently cited author was Gómez-Urquiza (n = 308). Commonly used keywords included "nursing education," "gamification," "serious games," and "nursing students." The content analysis revealed five primary themes: 1) technology in nursing education, 2) effects of educational games, 3) applications of educational games in nursing education, 4) types of educational games used in nursing education and 5) gamification in the learning-teaching process.

CONCLUSIONS

Research on educational games in nursing education is on the rise. The findings of this study provide new insights for researchers interested in the application of educational games in nursing education.

Post-Intensive Care Syndrome Family

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

COASTing Through Bedside Report: An Innovative Approach to Safe Transitions of Care

BACKGROUND

Bedside shift report improves patient satisfaction, peer accountability, communication, and decreases safety events.

LOCAL PROBLEM

Clinical practice of bedside report varied prior to the pandemic. Due to limited personal protective equipment and exposure risk, bedside report was halted during the pandemic.

APPROACH

The Iowa Model of Evidence-Based Practice was used to guide this project. To standardize communication during bedside report, safety data and literature were reviewed and grouped by themes. The acronym COAST was developed, consisting of code status, oxygen, access, safety, and tubes/drains. These elements were to be discussed at the bedside during handoff.

RESULTS

Compliance with completing elements of COAST increased during the pilot, 9- and 12-month sustainment periods. Additional safety-related outcomes of cardiopulmonary resuscitation wristband application, falls, and good catches improved. Notably, overtime declined.

CONCLUSIONS

A bedside report with standardized communication focusing on safety elements can improve compliance with adoption and patient safety outcomes.

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.

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

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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