Systematic reviews: gatekeepers of nursing knowledge

Identity disclosure between donor families and organ transplant recipients: an integrative review of the international literature

Anonymity of deceased organ donation is a legal requirement in many international jurisdictions where legislation prohibits health professionals from disclosing identifiable information about donors, recipients or their families. Written correspondence between donor families and transplant recipients that is coordinated by healthcare professionals must remain anonymous. Internationally, an increasing number of donor families and transplant recipients have advocated for law reform and policy amendment to enable the exchange of identifiable written correspondence and/or face-to-face meetings. This paper aims to synthesise and critically evaluate published, peer-reviewed literature on the perceptions, benefits and challenges of identifiable communication or anonymity between donor families and organ transplant recipients in the international context. Analysis of the findings revealed two major themes: (1) views held by donor families, transplant recipients and healthcare professionals towards identity disclosure in the context of organ donation are diverse across and within groups (2) there are benefits and burdens associated with connecting donor families and transplant recipients through written correspondence. Less is known about the impact of face-to-face meetings between donor families and transplant recipients. However, what is known is that for some donor families, meeting with the transplant recipient(s) may provide a range of positive emotions.

Integrative Review of Exercise at Altitude during Pregnancy

Many competitive and elite athletes continue to train throughout their pregnancies and many visit or live at altitude. The purpose of this integrative review is to synthesize, analyze and critique published studies regarding the safety of serious recreational or elite athletes exercising at altitude while pregnant. Seven databases were searched, and 157 documents were located, which were screened for appropriateness and reduced to seven articles that met the criteria. The studies were analyzed based on maternal and fetal outcomes. Current recommendations for exercising at altitude were based on sedentary individuals who frequently did not have the expected physiological responses based on research on pregnancy and altitude. It is unknown whether competitive and elite athletes would have similar responses to exercise at altitude. More research on exercise at altitude on individuals with a variety of fitness levels is needed.

Recovery e saúde mental: uma revisão da literatura latinoamericana

A abordagem Recovery emergiu nos anos 1970 nos Estados Unidos a partir dos movimentos em defesa dos direitos dos usuários dos serviços de saúde mental, ex-pacientes ou sobreviventes da psiquiatria. A partir da década de 2000 recovery vem orientando serviços de saúde mental em diversos países e muitos acreditam que possa contribuir com os processos de reforma do modelo de atenção em saúde mental em todo o mundo. No campo acadêmico, um número de publicações vem analisando as formas diversas de aplicação da abordagem em níveis nacionais e internacional. O objetivo desta revisão integrativa, realizada em 2019, foi analisar como a abordagem recovery vem sendo tratada na literatura científica na América Latina. A análise gerou categorias temáticas desvelando os principais assuntos abordados nestas publicações, entre eles discussões sobre terminologia, conceito de recovery, práticas, políticas e serviços orientados por recovery e possibilidades da incorporação da abordagem no contexto da Reforma Psiquiátrica Brasileira que, apesar dos obstáculos, ainda pode ser considerada como orientadora da Política Nacional de Saúde Mental no Brasil. A revisão aponta que o número de publicações sobre recovery na América Latina é escasso, comparado com o número de publicações nos Estados Unidos, Canadá, Hong Kong, Europa e Oceania, e são oriundas principalmente do Brasil. Percebe-se, ainda, que os autores brasileiros, em geral, entendem que recovery pode representar uma importante contribuição ao avanço da Reforma Psiquiátrica Brasileira e alguns defendem a necessidade de cautela sobre a incorporação da abordagem sem uma devida adaptação ao contexto social, cultural e econômico local. Também foi apontado que recovery tem sido aplicado em outros contextos sociais. 

Recovery e saúde mental: uma revisão da literatura latinoamericana

A abordagem Recovery emergiu nos anos 1970 nos Estados Unidos a partir dos movimentos em defesa dos direitos dos usuários dos serviços de saúde mental, ex-pacientes ou sobreviventes da psiquiatria. A partir da década de 2000 recovery vem orientando serviços de saúde mental em diversos países e muitos acreditam que possa contribuir com os processos de reforma do modelo de atenção em saúde mental em todo o mundo. No campo acadêmico, um número de publicações vem analisando as formas diversas de aplicação da abordagem em níveis nacionais e internacional. O objetivo desta revisão integrativa, realizada em 2019, foi analisar como a abordagem recovery vem sendo tratada na literatura científica na América Latina. A análise gerou categorias temáticas desvelando os principais assuntos abordados nestas publicações, entre eles discussões sobre terminologia, conceito de recovery, práticas, políticas e serviços orientados por recovery e possibilidades da incorporação da abordagem no contexto da Reforma Psiquiátrica Brasileira que, apesar dos obstáculos, ainda pode ser considerada como orientadora da Política Nacional de Saúde Mental no Brasil. A revisão aponta que o número de publicações sobre recovery na América Latina é escasso, comparado com o número de publicações nos Estados Unidos, Canadá, Hong Kong, Europa e Oceania, e são oriundas principalmente do Brasil. Percebe-se, ainda, que os autores brasileiros, em geral, entendem que recovery pode representar uma importante contribuição ao avanço da Reforma Psiquiátrica Brasileira e alguns defendem a necessidade de cautela sobre a incorporação da abordagem sem uma devida adaptação ao contexto social, cultural e econômico local. Também foi apontado que recovery tem sido aplicado em outros contextos sociais. 

Absenteísmo de usuários

Introdução: O absenteísmo dos usuários aos serviços de saúde é um fenômeno que vem impactando a atenção à saúde. Objetivo: Identificar a evidência científica disponível sobre as possíveis causas do absenteísmo dos usuários aos serviços de saúde. Métodos: Este estudo analisou 34 publicações, classificadas em três unidades temáticas: barreiras do acesso; impacto dos serviços como determinante da saúde dos usuários; fatores condicionantes e facilitadores do acesso. Resultados: Enfrentar o absenteísmo exige a compreensão das desigualdades sociais, requer conhecimento sobre a organização dos serviços de saúde, dos determinantes sociais e das relações que ocorrem entre os grupos no contexto social. As principais razões para o absenteísmo são evitáveis e pode se beneficiar de intervenções para melhoria dos serviços de saúde. Conclusões: O conhecimento das barreiras e determinantes do acesso permite compreender as possíveis causas do absenteísmo e suas consequências, a fim de fundamentar a tomada de decisões que possibilitem a correção ou minimização de riscos e de prejuízos econômicos, na administração dos serviços públicos de saúde.

Integrative Review of Nursing Practices in Fetal Therapy

OBJECTIVE

To synthesize nursing practices related to fetal therapy (intervention to correct or treat a fetal anomaly).

DATA SOURCES

We searched electronic databases, including PubMed, Embase, OvidSP, and CINAHL, for all relevant published work. We identified additional resources through discussion with experts in the field, hand searches of relevant resources, and examination of the reference lists of articles in our search results.

STUDY SELECTION

Any published literature about fetal therapy in which nursing practices were discussed by nurses.

DATA EXTRACTION

We used Whittemore and Knafl's methodology to guide this integrative review (2005). We completed data extraction using an analytic review template organized to compare results to Kim's (2015) theoretical framework for nursing practice.

DATA SYNTHESIS

We used qualitative techniques described by Miles, Huberman, and Saldaña (2014) to code and thematically interpret the data. Nurses described their contributions to the establishment of fetal therapy programs through the development of entirely new technical and caring skills and their work in relation to care quality, clinician education, ethics, research, and health policy. Data were synthesized under three philosophies of nursing practice: therapy, care, and professional work.

CONCLUSION

Nurses have made important contributions to the evolving practice of fetal therapy, a nuanced practice that is critical to the development and provision of comprehensive patient- and family-centered care. Clinical implications of this review include practical recommendations for enhanced support of nursing practice in fetal therapy, which includes the provision of reliable forums to learn and share feedback about nursing practice in this field. Future work should focus on increasing understanding and visibility of nursing in fetal therapy through interdisciplinary evidence-based practice development.

Exploring Pain Management Among Asian Immigrants with Chronic Pain: Self-Management and Resilience

Asians immigrants (AIs) are one of the fastest growing racial groups in many countries globally. Despite pain prevalence, studies on chronic pain management among AIs is limited in the literature. An integrative review was conducted exploring the current state of science on chronic pain management among AIs. Several databases were used to identify related articles and 15 studies met the inclusion criteria. Two major themes emerged: (a) self-management, pertaining to how AIs take responsibility for their pain, and (b) resilience, their adaptive behaviors indicating low levels of pain-related dysfunction and burden despite chronic pain severity. Resilience plays a significant role in the mechanism by which self-management works in pain among AIs. Chronic pain management is a complex process where challenges to effective treatments exist. Findings have significant implications to healthcare providers and the general pain population. Future research directions include the necessity for increased participation of AIs in studies.

Social media use in adolescents and young adults with serious illnesses: an integrative review

OBJECTIVES

Adolescents and young adults with life-limiting or life-threatening conditions are often socially isolated because of the demands of their illness. Although adolescents and young adults have a noticeable online and social media presence, their motivations for using social media remain unclear. This article aims to summarise empirical research undertaken about how and why social media is used by adolescents and young adults with life-limiting or life-threatening conditions.

METHODS

An integrative literature review was undertaken. Key healthcare research databases including CINHAL, MEDLINE and PSYCHINFO were searched for empirical studies reporting the use of social media by adolescents and young adults with life-limiting or life-threatening conditions. Fifteen articles met the inclusion criteria; included articles were quality appraised and a thematic synthesis undertaken to identify key themes.

RESULTS

The reasons why adolescents and young adults with life-limiting or life-threatening conditions use social media are diverse, with differences relating to age and gender. However, this population in general uses social media to connect with others who have similar lived experiences.

CONCLUSION

Social media platforms can be useful adjuncts to the care of adolescents and young adults with life-limiting or life-threatening conditions. However, current evidence is dominated by studies on social media use by adolescents and young adults with cancer. More research is required to gain a holistic understanding of how and why social media is used by this population and its perceived benefits and limitations.

Dying persons' perspectives on, or experiences of, participating in research: An integrative review

BACKGROUND

Conducting research with dying persons can be controversial and challenging due to concerns for the vulnerability of the dying and the potential burden on those who participate with the possibility of little benefit.

AIM

To conduct an integrative review to answer the question 'What are dying persons' perspectives or experiences of participating in research?

DESIGN

A structured integrative review of the empirical literature was undertaken.

DATA SOURCES

Cumulative Index Nursing and Allied Health Complete, PsycINFO, MEDLINE, Informit and Embase databases were searched for the empirical literature published since inception of the databases until February 2017.

RESULTS

From 2369 references, 10 papers were included in the review. Six were qualitative studies, and the remaining four were quantitative. Analysis revealed four themes: value of research, desire to help, expression of self and participation preferences. Dying persons value research participation, regarding their contribution as important, particularly if it provides an opportunity to help others. Participants perceived that the potential benefits of research can and should be measured in ways other than life prolongation or cure. Willingness to participate is influenced by study type or feature and degree of inconvenience.

CONCLUSION

Understanding dying persons' perspectives of research participation will enhance future care of dying persons. It is essential that researchers do not exclude dying persons from clinically relevant research due to their prognosis, fear or burden or perceived vulnerability. The dying should be afforded the opportunity to participate in research with the knowledge it may contribute to science and understanding and improve the care and treatment of others.

Recent Research Trends in Meta-analysis

The use of meta-analysis (MA), which is placed on top of the evidence hierarchy, in studies has been increasing exponentially. MA has three effect size families. Using the category of effect size families, this paper introduces the important points in the MA process and highlights the recent research trends in this field, such as network MA, meta-analytic structural equation modeling, and diagnostic test accuracy MA. Several reporting standards were established for primary studies and MA. The critical assessment reviews demonstrated that the current quality of nursing MA reporting was low. The problematic areas of the current nursing MA include study search, study selection, risk of bias, publication bias, and additional analysis based on quality assessment. Directions for future research are also presented in this paper.

A critical review of published research literature reviews on nursing and healthcare ageism

AIMS AND OBJECTIVES

To establish how common and impactful nursing and healthcare ageism is and whether proven interventions or prevention methods exist.

BACKGROUND

Ageism has been a concern since 1969 when it was first introduced as a concept for social reform. As ageism has been linked to lower quality health services and reduced health care access, it is imperative that healthcare and nursing ageism is prevented or identified and reduced or eliminated.

DESIGN

A qualitative narrative review of published research literature reviews using a scoping design to map all published reviews was undertaken. The EBSCO Discovery Service (providing access to articles in 271 databases, including MEDLINE and CINAHL) and Directory of Open Access Journals (providing access to over 9,000 open access journals) were used to find review articles. Using predetermined inclusion and exclusion criteria, and limited by English language and peer-review publications, 12 eligible reviews were identified and information from them was systematically identified, assessed and synthesised.

RESULTS

The 12 reviews did not provide clear and convincing information to determine how common and impactful nursing or healthcare ageism is, nor what can best be done to prevent or address it. Although each review had value since research literature was collected and discussed on nursing or healthcare ageism, the array of literature search and analysis methods, and diversity in conclusions reached about the evidence is highly problematic.

CONCLUSION

Research literature reviews offering a more balanced perspective and demonstrating greater care in finding and using quality evidence are needed.

RELEVANCE TO CLINICAL PRACTICE

At this point in time, there is no clear understanding of how widespread and impactful nursing or healthcare ageism is, and what can best be done to prevent or address it. Nurses need to be aware that ageism may be common and impactful, and guard against it.

Humanização na formação e no trabalho em saúde: uma análise da literatura

Resumo Este estudo teve como objetivo investigar as concepções de humanização presentes em artigos publicados no Brasil no campo da formação em saúde no período de janeiro de 2000 a junho de 2012. Como processo metodológico, optou-se pela revisão de literatura e utilizaram-se os seguintes descritores: ‘humanização’, ‘humanismo’ e ‘humanização na formação’. Foram selecionados 23 artigos, e a análise dos dados abrangeu caracterização das publicações e discussão das concepções de humanização constantes nos documentos analisados. As concepções presentes nos artigos apontaram para a questão da polissemia do termo humanização, apreendendo-se outros sentidos: capacidade de comunicação, respeito à vida humana, ética nos relacionamentos, bom convívio social, um conceito que orienta práticas. Humanização revelou-se como um processo complexo e amplo que envolve condições institucionais e pessoais. Os desafios evidenciados abrangem a implantação de mudanças nas graduações em saúde, tornando o tema humanização nos currículos um eixo transversal, o que potencializa um diferencial na graduação e na educação permanente em saúde.

Navigating in an unpredictable daily life: a metasynthesis on children's experiences living with a parent with severe mental illness

A large group of individuals suffering from mental illness are parents living with their children. These children are invisible in the health care even though at risk for illhealth. The aim of this metasynthesis was to advance knowledge of how children of parents with mental illness experience their lives, thus contributing to the evidence of this phenomenon. The metasynthesis is following Sandelowski and Barroso's guidelines. Literature searches covering the years 2000 to 2013 resulted in 22 reports which were synthesised into the theme 'navigating in an unpredictable everyday life' and the metaphor compass. Children of parents with mental illness irrespective of age are responsible, loving and worrying children who want to do everything to help and support. Children feel shame when the parent behaves differently, and they conceal their family life being afraid of stigmatisation and bullying. When their parent becomes ill, they distance to protect themselves. The children cope through information, knowledge, frankness and trustful relationships. These children need support from healthcare services because they subjugate own needs in favour of the parental needs, they should be encouraged to talk about their family situation, and especially, young children should to be child-like, playing and seeing friends.

The acceptability of care provided by dental auxiliaries: A systematic review

BACKGROUND

Dental auxiliaries undertaking a limited range of intraoral clinical procedures normally performed by dentists could increase access to care and control costs, yet their acceptability to patients has been questioned. The aim of this study was to assess data on the social acceptability and patient satisfaction of dental auxiliaries performing intraoral clinical procedures.

METHODS

The authors searched 14 electronic databases and 2 trial registries for studies of any design (from inception to November 2013). They searched gray literature databases (from inception to July 2014), reference lists of included studies, and high-yield journals (from January 2000 to December 2014). Risk of bias was assessed, and data were extracted.

RESULTS

The authors identified 29 studies: 25 considered experiential and 4 on social acceptability. Twenty-three were cross-sectional, 2 were qualitative, 1 was mixed-methods, and 3 had unclear methods. The authors found that patients reported high acceptability of care, comparable or better than that from dentists. Social acceptability varied, with care for children being less acceptable. One-fifth of people were unwilling to receive any treatment from a dental auxiliary. All studies were at high risk of bias, and quality of the evidence was low.

CONCLUSIONS

Experiential acceptability of dental auxiliaries by patients appeared high in this study, but their social acceptability varied.

PRACTICAL IMPLICATIONS

Given the age of the studies, their settings, and their quality, generalizability to dental practices is limited. Additional high-quality, methodologically rigorous studies are needed.

Quality of healthcare services provided in disaster shelters: An integrative literature review

BACKGROUND

Globally, shelters are a resource to promote critical health and safety in disasters, particularly for vulnerable populations (e.g., children, elderly, chronically ill). This study examines the nature and quality of healthcare services rendered in disaster and emergency shelters.

OBJECTIVES

To determine based upon systematic and accurate measurement the scope and quality of health care services rendered in disaster shelters and to describe the health outcomes experienced by shelter residents.

METHODS

An integrative review of English-language literature pertaining to the assessment, evaluation, and systematic measurement of healthcare quality and client outcomes in disaster and emergency shelters was undertaken. Articles were identified using a structured search strategy of six databases and indexing services (PubMed, CINAHL, EMBase, Scopus, Web of Science, and Google Scholar).

RESULTS

Limited literature exists pertaining specifically to metrics for quality of health care in acute disaster and emergency shelters, and the literature that does exist is predominately U.S. based. Analysis of the existing evidence suggests that nurse staffing levels and staff preparedness, access to medications/medication management, infection control, referrals, communication, and mental health may be important concepts related to quality of disaster health care services.

CONCLUSIONS

A small number of population-based and smaller, ad hoc outcomes-based evaluation efforts exist; however the existing literature regarding systematic outcomes-based quality assessment of disaster sheltering healthcare services is notably sparse.

Evidence synthesis and its role in evidence-based health care

The central role of evidence synthesis (or the systematic review of evidence) in evidence-based health care is often poorly understood. There are numerous examples in the literature of poorly conceived and/or executed systematic reviews and of a lack of awareness of the international standards developed by the international leaders in systematic reviews. The Cochrane Collaboration has played a critical global role in developing and refining systematic review methods in relation to evidence of effects and of diagnostic accuracy.

What is known about the experiences of using CPAP for OSA from the users' perspective? A systematic integrative literature review

Economic, social and personal costs of untreated obstructive sleep apnoea (OSA) are high. Continuous positive airway pressure (CPAP) is recommended and cost effective. Increasing OSA prevalence may accompany predicted globally increasing obesity.

OBJECTIVE

To synthesise international evidence regarding personal experiences using CPAP for OSA.

METHODS

A systematic integrative literature review was conducted and quality assessment criteria applied.

RESULTS

22, of 538, identified papers met inclusion criteria. Thematic analysis identified three themes: 1) users' beliefs about CPAP influence users' experiences of CPAP; 2) CPAP users are primed to reflect negatively on experiences of CPAP; and 3) spouse and family influence users' experiences of CPAP. Personality and attitude impact expectations about CPAP prior to use, whilst engagement of spouse and family also influence experiences. Analysis highlighted that users' reporting of CPAP experiences is constrained by investigator defined assessment methods. Overall, research relating to experiences using CPAP is limited.

CONCLUSION

Users' perspectives of CPAP are constrained by researchers' concern with non-compliance. Typically experiences are not defined by the user, but from an 'expert' healthcare perspective, using words which frame CPAP as problematic. Family and social support is a significant, but neglected area of experiencing CPAP warranting further investigation. More information from users is required to determine how CPAP can be managed successfully.

Patient education outcomes in surgery: a systematic review from 2004 to 2010

RATIONALE AND OBJECTIVES

In 2004, Johansson and colleagues, in their systematic review covering the years 1990-2003, documented education interventions and their effectiveness in the treatment of surgical patients. While they provide a review of the state of knowledge until 2003, recent trends in preoperative education and its effects on postoperative patients' outcomes have not been documented in a systematic review. The aim of this study was to describe preoperative educational interventions (including content and delivery time) and postoperative outcomes as considered in studies evaluating the effectiveness for patients undergoing major surgery published from 2004 to 2010.

METHODS

A systematic review of preoperative education and its effects on postoperative patient outcomes was undertaken. A search was conducted of the PubMed, CINAHL and EBMR databases, including the Cochrane Central Register of Controlled Trials. Randomised controlled trials, or at least clinical trials including pre-/post-test evaluations, with educational interventions performed by nurses preoperatively and outcomes evaluated postoperatively, and written in English, were included.

RESULTS

A total of 19 studies involving 3944 patients were retrieved. Of these, 12 were randomised controlled trials. Interventions were based on verbal education, on written/visual education, or both. The content of interventions varied widely. Frequent outcomes evaluated were anxiety, knowledge, pain and length of stay. Objective knowledge (what a patient retains from education) was the only positive outcome influenced by education.

CONCLUSIONS

Current trends in preoperative education are: scheduling education early; increased frequency of message exposure through several interventions and/or reinforcements; content frequently addressing postoperative management; the measurement of outcomes such as patients' cognitive, experiential and biophysiological aspects. Both the clinical and research implications that emerged from the findings are discussed.

Effect of Pre-warming on Reducing the Incidence of Inadvertent Peri-operative Hypothermia for Patients Undergoing General Anaesthesia: A Mini-review

Objective:

This mini-review aims to assess the effect pre-warming has on reducing the incidence of inadvertent peri-operative hypothermia for patients undergoing general anaesthesia.

Method:

A search of the MEDLINE and EMBASE databases, as well as hand-searching through the reference lists of key articles, was undertaken. Articles were included on the basis that the studies were randomised controlled trials, undertaken on patients who were undergoing surgery under general anaesthesia and were pre-warmed for 60 minutes using forced-air warming systems. This resulted in two articles being critically appraised and reviewed using guidelines based on those given in Greenhalgh and Donald (2000).

Findings:

The results for both of these studies showed that statistically significant differences were seen in core body temperature, with analysis of variance used to test for the significant differences between the sample means. The findings were also clinically significant, as a small drop in temperature as a result of anaesthesia and surgery can lead to IPH, and with pre-warming this can be avoided.

Conclusion:

The studies that were used in this review both reported that pre-warming patients for 60 minutes pre-operatively had both a statistically significant and clinically significant effect. This means that patients should receive a period of pre-warming before surgery in addition to being warmed peri-operatively, in order to reduce any drop in potential temperature that can lead to IPH.

Evidence-based dialectics

‘Evidence-based policy’ and ‘evidence-based management’ are increasingly popular ways of describing the relationship between research and practice. The majority discussing the evidence-based approach have tended to be in favour: here, ‘believers’. Yet this approach has also attracted critics: ‘heretics’. Understanding of such a division can be enhanced by dialectics: a process which tries to destabilize, reconcile or transcend apparent opposites. This divide is not simply a consequence of differences relating to epistemology, but also aesthetics: a set of reactions to the world seen as art. So, to analyse this divide requires a correspondingly rich model of dialectic. Nietzsche’s Birth of Tragedy offers this in its account of Apolline and Dionysian responses to the world. Dialectics supports a move beyond synchronous critique, and allows speculation as to the future development of the evidence-based approach.

Systematic review and its relationship with evidence-based practice in health

Systematic reviews (SR) have gained relevance in the world and Latin America because of their credibility in the search, compilation, arranging and analysis of the information obtained from research about health interventions, during a period of time. Consequently, evidence-based practice uses SR as a way to capture the best evidence of clinical effectiveness. This article reviews SR methodology, process, and its usefulness in health professions like nursing and medicine.

The research evidence published in high impact nursing journals between 2000 and 2006: a quantitative content analysis

BACKGROUND

Evidence-based practice has become an imperative for efficient, effective and safe practice. Furthermore, evidences emerging from published research are considered as valid knowledge sources to guiding practice.

OBJECTIVES

The aim of this paper is to review all research articles published in the top 10 general nursing journals for the years 2000-2006 to identify the methodologies used, the types of evidence these studies produced and the issues upon which they endeavored.

DESIGN

Quantitative content analysis was implemented to study all published research papers of the top 10 general nursing journals for the years 2000-2006.

METHODS

The top 10 general nursing journals were included in the study. The abstracts of all research articles were analysed with regards the methodologies of enquiry, the types of evidence produced and the issues of study they endeavored upon. Percentages were developed as to enable conclusions to be drawn.

RESULTS

The results for the category methodologies used were 7% experimental, 6% quasi-experimental, 39% non-experimental, 2% ethnographical studies, 7% phenomenological, 4% grounded theory, 1% action research, 1% case study, 15% unspecified, 5.5% other, 0.5% meta-synthesis, 2% meta-analysis, 5% literature reviews and 3% secondary analysis. For the category types of evidence were 4% hypothesis/theory testing, 11% evaluative, 5% comparative, 2% correlational, 46% descriptive, 5% interpretative and 27% exploratory. For the category issues of study were 45% practice/clinical, 8% educational, 11% professional, 3% spiritual/ethical/metaphysical, 26% health promotion and 7% managerial/policy.

CONCLUSIONS

Published studies can provide adequate evidences for practice if nursing journals conceptualise evidence emerging from non-experimental and qualitative studies as relevant types of evidences for practice and develop appropriate mechanisms for assessing their validity. Also, nursing journals need to increase and encourage the publication of studies that implement RCT methodology, systematic reviews, meta-synthesis and meta-analysis methodologies. Finally, nursing journals need to encourage more high quality research evidence that derive from interpretative, theory testing and evaluative types of studies that are practice relevant.

The efficacy of nurse implemented non-pharmacological strategies for the symptom management of agitation in persons with advanced dementia living in residential aged care facilities: a systematic review

AIM

Agitation is a common symptom of dementia which becomes exacerbated in the advanced stages of the disease. The negative effects of this symptom are numerous and often result in institutionalisation. Given it is the registered nurse, with the cooperation of the enrolled nurse/ assistant in nursing, who provide the majority of face-to-face care in residential aged care facilities, there is a clear need to identify effective management strategies for agitated behaviours which nursing staff can easily access and implement.This review identifies the best available evidence regarding the efficacy of nurse implemented non-pharmacological strategies for the symptom management of agitation in persons with advanced dementia living in residential aged care facilities METHOD: A systematic literature search of MEDLINE, CINAHL, PsycINFO, Cochrane Library, SCOPUS, EMBASE, and AgeLine databases was undertaken. Additionally, the reference lists of relevant papers were examined for additional trials.This review considered any English language randomised trial that investigated strategies implemented by a nurse for the symptom management of agitation in persons with advanced dementia living in residential aged care facilities. Outcomes measured included frequency and severity of agitation.

RESULTS

Seven trials were included in this review. Five of the seven strategies investigated were shown to be effective in the symptom management of agitation when compared to alternate strategies. Effective strategies include: behavioural therapy, balancing arousal states, therapeutic touch, multi-sensory stimulation and person-centred bathing.

CONCLUSIONS

The heterogeneity of the included trials made it difficult to draw definitive conclusion. However, the results of this systematic review reveal that some non-pharmacological strategies are effective when implemented by a nurse for the symptom management of agitation in pesons with advanced dementia living in residential aged care facilities. Despite this finding, there is currently insufficient evidence to develop practice guidelines.

Revisão sistemática de literatura e metassíntese qualitativa: considerações sobre sua aplicação na pesquisa em enfermagem

Trata-se de uma reflexão sobre a condução de metassíntese qualitativa, que aborda características da revisão bibliográfica sistemática, como uma tendência emergente da necessidade de reunir dados para a tomada de decisão em saúde, comparando as diversas modalidades de revisão, metanálise e metassíntese. Aborda também a pesquisa qualitativa, suas definições, variedade de disciplinas, métodos e peculiaridades, destacando a vasta produção em pesquisa qualitativa no âmbito da enfermagem, e a necessidade de dar visibilidade e impacto aos seus resultados, visando a sua aplicação na prática. Apresenta a definição de metassíntese qualitativa e suas características, discutindo aspectos relacionados à complexidade da metodologia e à sua condução prática. Conclui que a metassíntese qualitativa pode ser uma ferramenta a ser pesquisada no âmbito da Enfermagem, aperfeiçoando a metodologia e validando-a, através da inclusão da grande produção de pesquisa qualitativa com aspectos importantes do ofício de cuidar e ser cuidado.

Accident and emergency staff opinion on the effects of family presence during adult resuscitation: critical literature review

AIM

This paper is a report of a critical literature review to identify the positive and negative effects of family presence during adult resuscitation, as perceived by accident and emergency healthcare staff based in primary (out-of-hospital) and secondary (in-hospital) environments of care.

BACKGROUND

The controversial practice of family presence during resuscitation of adults has stimulated debate over the past two decades, giving rise to a growing body of literature and the development of clinical guidelines for practice.

METHODS

A search was carried out for the period 1987-2007 using the Science Direct, CINAHL, Medline, EMBASE, psychINFO and BNI databases and the search terms resuscitation, witnessed resuscitation, family presence, relatives' presence, attitudes and opinions and accident and emergency.

RESULTS

Eighteen studies were included in the critical review, primarily comprising retrospective survey research. The majority of studies were descriptive in design. A standardized approach to the appraisal process was achieved through the utilization of guidelines for critiquing self-reports. The findings revealed that accident and emergency healthcare staff perceive both positive and negative effects as a consequence of family presence during adult resuscitation and their opinions suggest that there are more risks than benefit.

CONCLUSION

Further research is essential if family presence during resuscitation of adults is to be better defined and understood. Qualitative methods of enquiry are recommended as a way of gaining a deeper insight into and understanding of this practice.

Strategic collaborative model for evidence-based nursing practice

PURPOSE

To describe a model that has been developed to guide nurses and other health professionals in collaborative efforts toward evidence-based nursing practice.

METHOD

A review of literature was conducted using MEDLINE and CINAHL to search for articles on research utilization for evidence-based practice in health care delivery. Empirical studies; reviews; and theoretical, opinion, and information articles were included in the review in order to provide a more comprehensive view of the state of evidence-based nursing internationally.

FINDINGS

Findings revealed a number of barriers to evidence-based nursing practice, which have persisted over the last two decades, including inadequate knowledge of research among practicing nurses, lack of administrative support for research activities in clinical settings, lack of empowerment of nurses, and lack of needed mentoring from nursing research consultants.

CONCLUSIONS

Barriers in the areas of nursing education and administrative support appear to be major. A need was identified for a pragmatic model that encourages cooperation and collaboration between educators/researchers in academia and the administrative leaders in the clinical facilities if evidence-based nursing practice is to become the norm. FRAMEWORK OF MODEL: The Tyler Collaborative Model is based on an eclectic approach to planned change for creating evidence-based practice. This model identifies a step-by-step process for change, while allowing for the opportunity to integrate any of the previously available methods of critical appraisal to determine the best evidence for practice in each clinical setting.

Challenges in approaching metasynthesis research

The overall aim of this study was to contribute to the development of metasynthesis through an analysis of the challenges involved. The study grew out of the critique of qualitative metaresearch raised by current developers of metamethodologies. Different views on the application of methodologies have emerged in the literature, contributing to confusion and ambiguity concerning the challenging questions of what, why, how, and who in metasynthesis research, which might increase the risk of misunderstanding. The roots of metasynthesis research are seen as multifaceted and influencing the development of the methods in different directions. The primary worth of metasynthesis is theoretical and/or methodological development (synthesis) combined with the potential for reflection: going beyond and behind the studies (meta). Metasynthesis research has also the potential to raise questions of research collaboration, culture, and language.

Systematic Review of Studies of Staffing and Quality in Nursing Homes

PURPOSE

To evaluate a range of staffing measures and data sources for long-term use in public reporting of staffing as a quality measure in nursing homes.

METHOD

Eighty-seven research articles and government documents published from 1975 to 2003 were reviewed and summarized. Relevant content was extracted and organized around 3 themes: staffing measures, quality measures, and risk adjustment variables. Data sources for staffing information were also identified.

RESULTS

There is a proven association between higher total staffing levels (especially licensed staff) and improved quality of care. Studies also indicate a significant relationship between high turnover and poor resident outcomes. Functional ability, pressure ulcers, and weight loss are the most sensitive quality indicators linked to staffing. The best national data sources for staffing and quality include the Minimum Data Set (MDS) and On-line Survey and Certification Automated Records (OSCAR). However, the accuracy of this self-reported information requires further reliability and validity testing.

CONCLUSIONS

A nationwide instrument needs to be developed to accurately measure staff turnover. Large-scale studies using payroll data to measure staff retention and its impact on resident outcomes are recommended. Future research should use the most nurse-sensitive quality indicators such as pressure ulcers, functional status, and weight loss.

Adult surgical patients and the information provided to them by nurses: a literature review

OBJECTIVE

A literature review was conducted to explore what is already known of surgical patients' informational needs, their opinions about the provision of information and the effect of individualised information.

METHODS

Computerised searches from 1994 to March 2004 were conducted on MEDLINE, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials using the keywords information, surgical patient adult and nursing.

RESULTS

Findings about the provision of information and important areas for surgical patients vary from study to study. Surgical patients have specific informational needs during the peri-operative period. However, some studies showed that the patients were not given the information that they need. This is a concern because patients have to take care of themselves after discharge. Individually tailored learning and teaching strategies are needed for patients to ensure the quality and usefulness of information for patients post-discharge.

CONCLUSIONS

The results of this review confirm that information, which is tailored to individual patient needs, has an important role for surgical patients. At present there is a poor understanding of the processes that describe the detailed experiences of surgical patients in clinical care and the possibilities of empowerment through learning.

PRACTICE IMPLICATIONS

As surgical patients differ individually in their learning needs and benefit from different content and quantity of information, more emphasis should be put into evaluating and assessing these individual needs.

The integrative review: updated methodology

AIM

The aim of this paper is to distinguish the integrative review method from other review methods and to propose methodological strategies specific to the integrative review method to enhance the rigour of the process.

BACKGROUND

Recent evidence-based practice initiatives have increased the need for and the production of all types of reviews of the literature (integrative reviews, systematic reviews, meta-analyses, and qualitative reviews). The integrative review method is the only approach that allows for the combination of diverse methodologies (for example, experimental and non-experimental research), and has the potential to play a greater role in evidence-based practice for nursing. With respect to the integrative review method, strategies to enhance data collection and extraction have been developed; however, methods of analysis, synthesis, and conclusion drawing remain poorly formulated.

DISCUSSION

A modified framework for research reviews is presented to address issues specific to the integrative review method. Issues related to specifying the review purpose, searching the literature, evaluating data from primary sources, analysing data, and presenting the results are discussed. Data analysis methods of qualitative research are proposed as strategies that enhance the rigour of combining diverse methodologies as well as empirical and theoretical sources in an integrative review.

CONCLUSION

An updated integrative review method has the potential to allow for diverse primary research methods to become a greater part of evidence-based practice initiatives.

Preoperative education for orthopaedic patients: systematic review

AIMS

This paper presents a systematic review whose aim was to describe the scope and methods of the current literature on preoperative patient education and to identify the effects of this education.

BACKGROUND

Preoperative patient education is a common and important intervention in surgical nursing, yet there is very limited systematic evidence on its precise role.

METHODS

The Medline, CINAHL, Eric, Psycinfo and Social Sciences Index databases and the Cochrane Library were searched, covering the period from the beginning of each database to April 2003. Studies were included if they concerned adult orthopaedic patients, preoperative nursing patient education and were based on randomized controlled or clinical trials. Meta-analysis was carried out where appropriate.

RESULTS

We identified 11 articles involving 1044 participants. Most studies included one experimental and one control group; only two had more than one experimental and control group. The educational interventions varied widely, but the majority were based on written materials alone, or written materials in combination with other teaching methods. The most common outcome measures related to pain, knowledge, anxiety, exercises and length of stay, and the least common to self-efficacy and empowerment. The methodological quality of the studies varied. Almost all reported one or more statistically significant effects. Based on the findings of the meta-analysis, preoperative education appears to have some impacts on patients' anxiety and knowledge levels.

CONCLUSIONS

The review clearly highlights the need for well-designed, methodologically sound research into the outcomes of patient education. It also points to the need to study patient education from the point of view of empowerment.

Examining the evidence for The International Confederation of Midwives’ essential competencies for midwifery practice

OBJECTIVE

to present the evidence for inclusion of selected midwifery tasks (skills) as essential practice competencies for midwives throughout the world. The tasks addressed are those presented to the International Confederation of Midwives (ICM) Council of Delegates in 2002 for discussion and adoption, based on the fact that during field-testing, notable variance was encountered.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

evidence-based practice should be characterised by the use of best practices derived from rigorous research, combined with and balanced by client perspectives and the expert judgement based on the critical thinking of the clinician. Much of midwifery practice is considered an art based on common sense, tradition, and woman-centred approaches to caring, as most of the women who seek midwifery care are healthy and require a health-promotion model of care that may not easily lend itself to examination by scientists or clinicians. However, when intervention is indicated to save the lives of mother, baby, or both, those interventions must be based on the best available evidence from a variety of sources leading to the most effective choices for action. The ICM Essential Competencies for Midwifery Practice (2002) are based on evidence derived from a variety of quantitative and qualitative methodologies. Expert clinical consensus may serve as to the best form of evidence at certain points in the evolution of knowledge. Every midwife needs to understand where the gaps exist in supporting traditional practices that have yet to be fully examined in a scientific manner. In summary, a multi-matrix or triangulated approach may be most appropriate to the delineation of evidence underpinning best midwifery practice.

Family member presence during resuscitation in the emergency department: An Australian perspective

OBJECTIVE

The practice of family member presence during resuscitation in the ED has attracted widespread attention over the last few decades. Despite the recommendations of international organizations, clinical staff remain reluctant to engage in this practice in many EDs. This paper separates the evidence from opinion to determine the current state of knowledge about this practice.

METHODS

A search strategy was developed and used to locate research based publications, which were subsequently reviewed for the strength of evidence providing the basis for recommendations.

RESULTS

The literature was examined to reveal what patients and their family members want; the outcomes of family presence during resuscitation for patients and their family members; staff views and practices regarding family presence during resuscitation. Findings suggest that providing the opportunity to be with their critically ill family member is both important to and beneficial for families, however, disparity in staff views has been identified as a major obstacle to family presence during resuscitation. Examination of published guidelines and staff practices described in the literature revealed consistent elements.

CONCLUSION

Although critics point to the lack of rigour in this body of literature, the current state of knowledge suggests merit in pursuing future research to examine and measure effects of family member presence during resuscitation on patients, family members and healthcare providers.

[Systematic review: a resource that allows for the incorporation of evidence into nursing practice]

Systematic review is an important resource in evidence-based practice, which consists in a form of synthesizing the research results related to a specific problem. This article aimed to offer subsidies for reflections with a view to the construction and/or application of systematic reviews in the nursing environment. Based on the literature, authors presented the phases comprising a systematic review and the relevant aspects that must be considered for using this resource.

Accompanying critically ill relatives in emergency departments

BACKGROUND

Family members are a crucial part of the holistic approach to care in emergency departments. In particular, they are a group who are vulnerable, yet have been overlooked when considering care options.

AIM

The primary aim of this systematic review was to appraise research relevant to identifying and meeting the needs of family members who accompany a critically ill person into the Emergency Department (ED). The information was intended to inform future research into the care of these people.

METHOD

A quality assessment strategy was specifically developed to evaluate the various research designs used. The outcomes of the highest quality studies were used to develop evidence-based clinical practice guidelines to inform clinicians caring for family members who accompany a critically ill person into the ED.

RESULTS

Recommendations for family care drawn from this review provide the foundation for more rigorous methodologies in future research into this topic. Key findings concern family needs for communication, proximity, support, comfort, assurance and to locate meaning in the event.

CONCLUSION

The review has revealed current knowledge about the care of family members who accompany a critically ill person into the ED that provides guidelines for practice. Despite significant limitations, the knowledge can lead to recommendation to guide and inform future intervention research.