Nurse-led family-based approach in primary health care for patients with type 2 diabetes mellitus: a qualitative study

PURPOSE

The prevalence of Type 2 diabetes is rapidly increasing, with 537 million people estimated to have diabetes in 2021. The literature suggests that nurses can deliver effective person-centred diabetes care and that families can be essential in supporting patients. Thus, a Nurse-led Family-based (NLFB) approach may be particularly effective. This study aims to explore the perceptions of nurses, adults with type 2 diabetes, and family members regarding the NLFB intervention.

METHODS

Guided by the UK Medical Research Council Framework, this seminal study adopted a qualitative, descriptive approach with content analysis. Data were obtained through 16 semi-structured, in-depth interviews. Themes emerged based on an inductive process using constant comparison (Graneheim and Lundman 2004). The COREQ checklist was used in ensuring rigour.

RESULTS

Three main themes emerged includes: (1) nurses' experiences with current diabetes care practices, (2) stakeholders' views on the development of a NLFB approach, and (3) merging the nurse-led family aspects into the diabetes care. The key challenges are the dominant medical model, lack of specialist nurses, and time. The key facilitators are knowledge and social support.

CONCLUSION

The study recommends stakeholders embrace nursing empowerment strategies and involve families to enhance the nurses' advanced roles and family inclusion in healthcare.

Efficient management of new patient referrals to a breast service: the safe introduction of an advanced nurse practitioner-led telephone breast pain service

INTRODUCTION

There has been an almost 100% increase in referrals to breast cancer diagnostic clinics in the past decade. Breaching of the two-week cancer referral target is now commonplace, potentially delaying diagnoses of breast malignancy in many women. Almost one in five of these referrals are women with mastalgia, not a symptom linked to breast cancer. The objective of the study was the safe introduction of an advanced nurse practitioner-led telephone service for women with mastalgia to improve the service for women and create capacity for those with "red flag" breast symptoms.

METHODS

Referrals to clinic were triaged, women with mastalgia only were directed to a telephone-based assessment clinic and symptoms evaluated using a multidisciplinary created proforma.

RESULTS

Within 23 months, 1,427 women were assessed in the breast pain telephone assessment clinic: 863 (61%) were aged over 40 and 564 (39%) aged under 40. A total of 1,238 underwent telephone assessment. Reassurance and discharge only was needed for 365 (26%). The aetiology of pain was identified as musculoskeletal in 1,104/1,238 (89%) of patients, with only 39/1,238 (3.2%) identified as having true breast pain. Additional symptoms were mentioned by 264 women (18%) during the consultation; all immediately redirected back to a diagnostic clinic. Mammography was undertaken in 609 women (43%). Seven women (0.6%) were diagnosed with a breast malignancy. Patient survey indicated that 93% of patients were satisfied with the care received and 97% said they would recommend the service to a family member or friend.

CONCLUSIONS

Although face-to-face assessments for breast pain remain the standard practice in many breast units, data indicating the safety of a telephone assessment clinic, along with high levels of patient satisfaction, question whether services can be delivered differently.

Intrinsic capacity trajectories, predictors and associations with care dependence in community-dwelling older adults: A social determinant of health perspective

AIMS

To identify intrinsic capacity trajectories, predictors of intrinsic capacity trajectories and associations between intrinsic capacity trajectories and care dependence in community-dwelling older adults in China.

METHODS

A retrospective longitudinal study was conducted, and the data were obtained from a five-year national longitudinal cohort study of older adults in China between 2011 and 2015. The social determinants of health framework informed the data analysis and interpretation.

RESULTS

A total of 3893 older adults met the selection criteria and were included in the study. Three intrinsic capacity trajectories were identified: high trajectory (15.7 %), stable trajectory (52.7 %) and declining trajectory (31.6 %). Social determinants contribute to intrinsic capacity decline in older adults. Decreased cognitive function, psychological status, and locomotion at baseline were associated with care dependence.

CONCLUSION

Approximately thirty percent of the older adults in this cohort study experienced a decline in intrinsic capacity within a 5-year period. Social determinants contributed to this decline in older adults.

Effectiveness of a novel consultant nurse-led breast pain clinic in secondary care

BACKGROUND

Patients with breast pain are usually seen in 'one-stop clinic' (OSC) with breast imaging. In the absence of associated red flag features, the incidence of breast cancer is extremely low. With increase in referrals the OSC capacity is over-stretched. We developed a consultant nurse-led dedicated 'breast pain clinic' in September 2021 without routine breast imaging. After meticulous history and examination, patients obtained detailed counselling and advice regarding breast pain management. If any abnormality was noted then appointment was given for OSC.

AIM

To assess the effectiveness of a consultant nurse-led dedicated 'breast pain clinic'.

METHODS

A prospective study of all consecutive patients seen in 'breast pain clinic' from September 2021 until September 2022. Feedback was sought from all patients.

RESULTS

Altogether 429 patients were seen. The mean age was 48.7 years (range 18-86). 87.6% (n = 376) patients required no breast imaging. Only 12.4% (n = 53) patients needed referral to OSC and subsequently 2 patients (0.46%) were diagnosed with breast cancer. Ninety-eight percent of patients felt reassured and 99.2% patients were extremely likely/likely to recommend this service to family and friends. Out of 376 patients who were discharged from breast pain clinic, 12 patients were referred again over a median follow-up period of 15 months, and 2 out of them were diagnosed with breast cancer.

CONCLUSION

A consultant nurse-led 'breast pain clinic' provides service improvement as it eases the pressure on the OSC. Most patients were managed without breast imaging with high level of patient satisfaction and low rereferral rate.

Supporting Cancer Survivors Following Treatment for Non-Hodgkin's and Hodgkin's Lymphoma: A Pilot Study Assessing the Feasibility and Process Outcomes of a Nurse-Led Intervention

OBJECTIVE

Lymphoma is the sixth most common cancer in Australia and comprises 2.8% of worldwide cancer diagnoses. Research targeting development and evaluation of post-treatment care for debilitating complications resulting from the disease and its treatment is limited. This study aimed to assess the feasibility and acceptability of a nurse-led survivorship intervention, post-treatment in Hodgkin's and non-Hodgkin's lymphoma survivors.

METHODS

A single-center, prospective, 3-arm, pilot, randomized controlled, parallel-group trial was used. People with lymphoma were recruited and randomized to the intervention (ENGAGE), education booklet only, or usual care arm. Participants receiving ENGAGE received an educational booklet and were offered 3 consultations (via various modes) with a cancer nurse to develop a survivorship care plan and healthcare goals. Participant distress and intervention acceptability was measured at baseline and 12-wk. Acceptability was measured via a satisfaction survey using a 11-point scale. Feasibility was measured using participation, retention rates, and process outcomes. Data were analyzed using descriptive statistics.

RESULTS

Thirty-four participants with HL and NHL were recruited to the study (11 = intervention, 11 = information only, 12 = usual care). Twenty-seven participants (79%) completed all time points from baseline to 12 wk. Seven (88%) of the 8 participants receiving ENGAGE completed all consultations using various modes to communicate with the nurse (videoconference 14/23, 61%; phone 5/23, 22%; face-to-face 4/23, 17%). Participants who completed the intervention were highly satisfied with ENGAGE.

CONCLUSION

The ENGAGE intervention is feasible and highly acceptable for lymphoma survivors. These findings will inform a larger trial assessing effectiveness and cost effectiveness of ENGAGE.

Nurse-led ultrasound-guided femoral nerve block: A randomised controlled trial of two different patient flow systems in an emergency department

INTRODUCTION

Elderly with hip fractures present complex challenges. Effective pain management is crucial for recovery and quality of life. However, pain control can be difficult and requires customized care.

METHODS

We conducted an unblinded, randomised controlled trial investigating the effects of ultrasound-guided femoral nerve block in patients with hip fracture performed by specially trained nurses (Group Nurse) compared to anaesthesiologists (Group Anaesthesiologist). The hypothesis was that a single shot ultrasound-guided femoral nerve block would result in a total summarized lower dynamic numeric rating scale score for pain intensity during the first 120 min after admission for patients in Group Nurse compared to Group Anaesthesiologist measured in five timepoints. The primary outcome was measured by a cumulative numeric rating scale score for dynamic pain (with flexion of the hip until maximum 30° from bed surface) during the first 120 min after admission to the emergency department.

RESULTS

From February 2020 to June 2021, 263 patients were screened, of which 42 (16.0%) consented and were randomly allocated; 21 in each arm. The primary outcome was not different between groups (p = 0.24), and displayed no substantial superiority of specially trained nurses over anaesthesiologist. No complications or adverse effects were observed in either group. The use of systemic analgesics and the development of delirium was similar between the two groups. In the Nurse Group, patients were administered their ultrasound-guided femoral nerve block earlier.

CONCLUSION

Our study did not demonstrate a statistically significant beneficial effect of specially trained nurses over anaesthesiologist on cumulative pain in performing ultrasound-guided femoral nerve blocks, while no side-effects/complications or adverse effects were observed in either group.

CLINICALTRIAL

The trial was registered on October 31, 2019 at Clinicaltrials.gov (NCT04145752).

Development and optimisation of a reception testing protocol designed to eliminate HCV in the UK prison population

Background & Aims

Micro-elimination of hepatitis C virus (HCV) in high-risk populations is a feasible approach towards achieving the World Health Organization's targets for viral hepatitis elimination by 2030. Prisons represent an area of high HCV prevalence and so initiatives that improve testing and treatment of residents are needed to eliminate HCV from prisons. This initiative aimed to improve the HCV screening and treatment rates of new residents arriving at prisons in England.

Methods

A rapid test and treat pathway was developed and implemented in 47 prisons in England between May 2019 and October 2021 as a healthcare service improvement initiative. Prison healthcare staff performed opt-out HCV testing for all new residents at each prison within 7 days of arrival, and those who were positive for HCV RNA were offered treatment with direct-acting antivirals (DAAs). The Hepatitis C Trust provided peer support for all residents on treatment and those who were released into the community.

Results

Of 107,260 new arrivals, 98,882 (92.2%) were offered HCV antibody testing, 63,137 (63.9%) were tested and 1,848 were treated. Testing rates increased from 53.7% in Year 1 to 86.0% in Year 3. Between May 2020 and October 2021, 40,727 residents were tested, 2,286 residents were positive for HCV antibodies and 940 residents were HCV RNA positive, giving an antibody prevalence of 5.6% and an RNA prevalence of 2.3%. A total of 921 residents were referred for treatment and 915 initiated DAA treatment (97.3% of whom were HCV RNA positive).

Conclusions

This initiative showed that an opt-out HCV test and treat initiative in prison receptions is feasible and can be adapted to the needs of individual prisons as a viable way to achieve HCV micro-elimination.

Impact and implications

Prisons represent an area of high HCV prevalence and so initiatives that improve testing and treatment of residents are needed to eliminate HCV from prisons. The reception testing protocol improved HCV screening in new arrivals across 47 prisons in England and could be a viable way for countries to achieve HCV micro-elimination in their prison systems. The reception testing protocol presented here can be adapted to the individual needs of prisons, globally, to improve HCV screening and treatment in this setting.

Effectiveness of a nurse-led decision counselling programme on hepatocellular carcinoma screening uptake among patients with hepatitis B: A randomised controlled trial

BACKGROUND

The globally endemic hepatocellular carcinoma induced by hepatitis B highlights the need for an ultrasonography-based screening strategy to reduce the tumour burden. However, patient non-adherence due to unawareness and complex decisions in weighting uncertainties of hepatocellular carcinoma screening has continuously challenged its continuum.

OBJECTIVE

To examine the effectiveness and process of a nurse-led decision counselling programme for improving hepatocellular carcinoma screening among patients with hepatitis B.

DESIGN

Single-blind randomised controlled trial.

SETTING AND PARTICIPANTS

Between 12 March and 19 July 2021, 178 patients with hepatitis B were recruited from six inpatient wards of a university-affiliated hospital in northern China.

METHODS

Participants were randomly allocated to receive usual care (n = 89) or usual care plus a nurse-led decision counselling programme (n = 89). Underpinned by the preventive health model, the programme consisted of health education, tailored information, and values clarification exercises to elicit informed and value-based preferences for hepatocellular carcinoma screening. Screening barriers were explored and addressed through procedural problem-solving. Hepatocellular carcinoma screening rate at six months post-baseline was the primary outcome. Secondary outcomes (knowledge, perceptions, and decision conflicts regarding hepatocellular carcinoma screening) were measured at baseline (T0), immediately after the intervention (T1), and the six-month follow-up (T2). A Medical Research Council framework-guided process evaluation was conducted by drawing on data from intervention documentation, WeChat discussions, and interviews with stakeholders (n = 13).

RESULTS

With a mean age of 47.32 (8.78) years, participants mostly occupied rural residences (63.5 %). Compared with the control group, the intervention group had significantly higher hepatocellular carcinoma screening rates (75.6 % vs. 42.1 %, p < 0.001) and displayed greater improvements in the scores of hepatocellular carcinoma screening knowledge (β = 3.643, 95 % confidence interval [CI] = 3.030, 4.255), salience and coherence (β = 0.410, 95 % CI = 0.234, 0.586), response efficacy (β = 0.327, 95 % CI = 0.181, 0.473), and perceived susceptibility (β = 0.214, 95 % CI = 0.040, 0.388) at T1. Improvement in perceived susceptibility was not maintained, whereas a higher decrease of the decision conflict score was found at T2 (β = -4.156, 95 % CI = -7.851, -0.461). The process evaluation revealed potential intervention mechanisms and contextual factors affecting intervention effectiveness, such as living status and natural disasters.

CONCLUSION

The programme was effective in improving hepatocellular carcinoma screening and showed that nurses could play a decision counselling role in optimising the screening among patients with hepatitis B.

TRIAL REGISTRATION

ClinicalTrials.govNCT04659005. Registration date: 9 December, 2020.

TWEETABLE ABSTRACT

Nurse-led decision counselling improves hepatocellular carcinoma screening in patients with hepatitis B.

The characteristics and efficacy of educational nurse-led interventions in the management of children with atopic dermatitis - An integrative review

OBJECTIVE

This integrative review investigates the modalities, characteristics, and efficacy of educational nurse-led interventions for parents of children with atopic dermatitis (AD).

METHODS

We conducted an integrative review with the following inclusion criteria: Quantitative, qualitative and mixed-method studies written in English or German and published between 1 January 2000 and 31 December 2021. We searched for entirely nurse-led interventions.

RESULTS

Four RCTs, three pre-post studies without control groups, and one post-test study without control group met the inclusion criteria. Nurse-led interventions were found to have medium to large positive effect sizes on disease severity, and none to large positive effects on quality of life. There was significant heterogeneity across study designs with a wide variety in educational interventions and outcome measures used. The quality of most included studies was low.

CONCLUSION

Nurse-led educational interventions for parents of children with AD are beneficial in reducing disease severity. However, it remains unclear, which main components of the nurse-led intervention are most effective.

PRACTICE IMPLICATIONS

Based on the results of this review, we think that trained and qualified nurses who are part of the entire treatment of children with AD and do as well educational interventions have the greatest potential to improve outcomes.

The effectiveness of nurse-led interventions to manage frailty in community-dwelling older people: a systematic review

BACKGROUND

The global increase in the number of frail older people and the accompanying increase in chronic conditions underline the need to develop effective health promotion and preventive interventions for these population groups. Wide ranging of physical, psychological, and social health factors influence frailty in older people and leads to increased vulnerability to many adverse outcomes. To reverse or reduce the progression of frailty, nurses play a pivotal role in delivering health promotion and preventive interventions. The purpose of the review is to determine the effectiveness of nurse-led interventions in reducing frailty in community-dwelling older people.

METHODS

The following electronic databases: PubMed, MEDLINE, Web of Science, SCOPUS, CINAHL, PsychInfo, and WHO Global Index Medicus were searched until June 2022. Nurse-led, "nurse led", education, training, intervention, program, teaching, frail*, fragile*, "frailty syndrome", debility, infirmity, elder*, aged*, old*, geriatric, "community based settings", "community-based", "community setting", community were the search terms. Before data extraction, eligible articles were assessed for their methodological quality. The JBI critical appraisal checklist for reporting experimental studies was utilised to appraise the methodological quality of the studies. Data were systematically examined using a narrative review to determine the effectiveness of the intervention.

RESULTS

Of the 156 studies identified, from the search, six studies with samples ranging from 40 to 1387 older people were eligible for inclusion in the review. Two quasi-experimental studies and one Randomised Controlled Trial (RCT) showed a moderate risk of bias. The Nurse-led frailty interventions used a multi-component intervention approach across the studies. The interventions reversed frailty progression, improve physical functioning, nutritional status, and quality of life, enhance perceptions of social support, improve mental health, and reduce depression.

CONCLUSIONS

Few studies have explored the effectiveness of a nurse-led intervention to decrease frailty in older people. Evaluating physical functioning, nutritional status, mental health, and quality of life in community-dwelling frail older people can contribute to developing appropriate interventions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO ID of CRD42022348064.

Experience of coronary heart disease patients with a nurse-led eHealth cardiac rehabilitation: Qualitative process evaluation of a randomized controlled trial

BACKGROUND

A previous randomized controlled trial (NeCR) has indicated the effectiveness of nurse-led eHealth cardiac rehabilitation (CR) on modifying the behaviors of patients with coronary heart disease. However, limited qualitative studies explore the experiences of using eHealth CR that led to such benefits.

OBJECTIVE

The study aimed to explore the experiences of patients who participated in the NeCR program.

METHODS

A descriptive qualitative study was employed among 20 intervention group patients who used the eHealth CR website and ranked differently (0-35th percentile, >35th percentile, and > 70% percentile) in the improvement of health-promoting behaviors.

RESULTS

Five themes emerged: the NeCR program has promoted behavior change and mitigated emotional distress post-CHD. Patients described how the NeCR influenced cognitive determinants (knowledge and skill acquisition, having a roadmap, self-monitoring, and self-evaluation and resolution) and offered social support (professional counseling and peer interaction via multimedia chat) toward such change. Patients also appreciated the high affordability, accessibility, reliability of the NeCR, and expressed psychological, contextual, and technical barriers.

CONCLUSIONS

Providing eHealth CR during patient discharge is warranted as an affordable, accessible, and reliable alternative to obtain health benefits. Extensive behavior change techniques, actionable CR guidance, and increased awareness are widely perceived enablers. Offering professional support and moderation is critical for early post-discharge consultation and for introducing direct peer interaction to reassure patients.

The impact of nurse-led nonpharmacological multidisciplinary holistic nursing care on fatigue patients receiving hemodialysis: a randomized, parallel-group, controlled trial

BACKGROUND

Fatigue is a symptom characterized by an elevated prevalence in patients undergoing hemodialysis, which may cause extreme mental and muscular debilitation, significantly influencing social interaction, life quality and well-being. However, the significance of fatigue to patients undergoing hemodialysis has not been recognized yet, and prevention and management of fatigue in this population have not been thoroughly investigated. Additionally, previous studies mainly focused on muscular fatigue, while mental fatigue has been seldom discussed. This study aims to investigate the interaction between nurses and multidisciplinary of nonpharmacological integrated care interventions (NICIs) and assess the impact of fatigue on patients undergoing hemodialysis.

METHODS

The integrative nonpharmacological care interventions in this study included walking, motivational interviewing (MI) and health education regarding behavioral self-management. A single-center randomized controlled trial was conducted in the dialysis center of the nephrological department in a tertiary affiliated hospital of medical university from January to June 2019. A total of 118 patients were selected and randomly divided into the intervention group (IG) and the control group (CG). Four patients dropped out during the study, and 114 patients were enrolled for the eventual analysis. The 60 patients in the IG received routine nursing combined with integrated care interventions, while the 54 patients in the CG received routine nursing only. This study lasted for six months.

RESULTS

The experimental group exhibited significant reductions of overall fatigue (2.26 vs. 0.48), mental fatigue (1.41 vs. 0.54), muscular fatigue (2.13 vs. 0.75), and some biochemical indicators (e.g., serum urea) (P<0.05), compared with the CG.

CONCLUSIONS

Nurses and multidisciplinary teams have been demonstrated to play a key role and interplay function in chronic disease management. Hence, the nurse-led multidisciplinary NICIs significantly alleviated total fatigue (muscular fatigue and mental fatigue) and improved other parameters.

TRIAL REGISTRATION

ChiCTR-IOR-16008621 (March 18, 2016).

The Women's Health Initiative cancer survivorship clinic incorporating electronic patient-reported outcomes: a study protocol for the Linking You to Support and Advice (LYSA) randomized controlled trial

BACKGROUND

The improved survival rate for many cancers in high-income countries demands a coordinated multidisciplinary approach to survivorship care and service provision to ensure optimal patient outcomes and quality of life. This study assesses the feasibility of introducing a Women's Health Initiative cancer survivorship clinic in Ireland.

METHODS

The trial https://spcare.bmj.com/content/9/2/209.short comprises an intervention and control arm. Two hundred participants will be recruited. Key eligibility (1) women with early-stage hormone receptor-positive breast or gynecologic cancer (cervix or endometrial), within 12 months of completion of primary curative therapy, and (2) access to the Internet. The complex intervention comprises a nurse-led clinic targeting symptom management through a trigger alert system, utilizing electronic patient-reported outcome (ePRO) assessments at baseline, and 2, 4, 6, 8, 10, and 12 months. It also includes input from a dietitian monitoring diet and nutritional status. The control group will receive their usual care pathway standard of care and attend the cancer survivorship clinic and complete ePRO assessments at the start and end of the study. The primary endpoint (feasibility) includes the proportion of enrolled participants who complete baseline and follow-up ePRO surveys and partake in health professional consultations after ePRO data triggers. Secondary endpoints include changes in cancer-related symptom scores assessed by ePROs, health-related Quality of Life Questionnaire (QLQ) scores, Appraisal Self-Care Agency-R scores, and adjuvant endocrine therapy medication adherence. A process evaluation will capture the experiences of participation in the study, and the healthcare costs will be examined as part of the economic analysis. Ethical approval was granted in December 2020, with accrual commencing in March 2021.

DISCUSSION

This protocol describes the implementation of a parallel arm randomized controlled trial (RCT) which examines the feasibility of delivering a Cancer Survivorship Clinic. The ePRO is an innovative symptom monitoring system which detects the treatment-related effects and provides individualized support for cancer survivors. The findings will provide direction for the implementation of future survivorship care.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT05035173 . Retrospectively registered on September 5, 2021.

A qualitative descriptive study of a novel nurse-led skin cancer screening model in rural Australia

Background

People residing in rural areas have higher rates of skin cancer and face barriers to accessing care. Models of skin cancer care addressing the specific needs of rural communities and overcoming specific challenges are required, but literature is scarce. This study aimed to describe the elements of a nurse-led skin cancer model in rural Victoria using qualitative methodology and programme logic to inform implementation and ongoing sustainability.

Methods

Qualitative descriptive design. Semi-structured interviews were conducted with key stakeholders involved in the skin cancer model, namely health service executive management, clinical staff, and administration staff. Interviews were audio-recorded and transcribed verbatim. Transcripts were thematically analysed independently by two researchers before themes were compared and refined. A programme logic model was developed to organise themes into contextual elements, inputs, activities and anticipated outcomes; it was also used as a visual tool to aid discussions with key stakeholders. Member checking of the logic model occurred to verify interpretation. This programme logic model will be refined throughout the implementation phase, and again after three years of service delivery.

Results

Eight stakeholders participated in interviews. Thematic analysis identified three major themes: the influence of the local rural context, the elements of the model, and “making it happen’. These major themes and accompanying sub-themes were mapped to the programme logic model by contextual elements (rural locale, health service access barriers, burden of disease), key inputs (promotion, human resources including appropriate nurse training and leadership) and ‘making it happen’ (governance including referral pathways, flexible and sustained funding, and partnerships). The anticipated outcomes identified include skin cancer care delivered locally, timely access, career development for nurses, and decreased skin cancer burden.

Conclusion

An initiative that is place-based and community driven in response to consumer demand addresses key system barriers to earlier detection of skin cancers. It is anticipated to result in flow-on reductions in skin cancer disease burden. Programme logic was useful to both describe the initiative and as a visual tool for discussions, with the potential to inform wider health service efforts to address system barriers and bottlenecks.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08411-6.

Effects of Nurse-Led Fall Prevention Programs for Older Adults: A Systematic Review

Falls among older adults are preventable events and fall prevention programs led by nursing staff are promising and viable programs for preventing falls. This systematic review aimed to gain insight into the effects of nurse-led fall prevention programs for older adults. The Preferred Reporting Items for Systemic Reviews and Meta-Analysis was used as a guideline in reporting this literature search conducted through CINAHL, MEDLINE, Eric, Science Direct, and Google Scholar databases. The Johns Hopkins Nursing Evidence-Based Practice was used to determine the level of evidence and quality rating of the articles, while data extraction was done by a matrix review method. The review included six randomized controlled trials, two non-randomized controlled trials, and three quasi-experimental designs. Six studies directed their education component of the intervention on the nursing staff, while three focused on the older participants. Nurses' roles were patient assessment, patient education, administration of exercise programs, and follow-up post interventions. Fall rates and fall incidents were reduced in five studies, while three studies changed patients' behavior. Fall prevention programs with education components specific for older adults and nursing staff resulted in positive outcomes. Nursing staff make a significant contribution to improving patients' outcomes, and a fall prevention program that focuses on reducing injurious fall rates and enhancing participants' behavior could maximize its effects.

Developing a Medication Self-management Program to Enhance Medication Adherence among Older Adults with Multimorbidity Using Intervention Mapping

BACKGROUND AND OBJECTIVES

Suboptimal medication adherence is prevalent in older adults with multimorbidity. However, intervention programs for enhancing adherence in this population are limited. This study describes the development process of a medication self-management program for older adults with multimorbidity.

RESEARCH DESIGN AND METHODS

We adopted the first four steps of the Intervention Mapping to develop the program: (1) needs assessment, including a literature review, a systematic review, and a cross-sectional study, (2) development of program outcomes and objectives, (3) selection of theory-based intervention methods and practical applications, and (4) development of the program.

RESULTS

We conducted a needs assessment to identify factors affecting medication adherence among older adults with multimorbidity and created a logic model of the adherence problem in Step 1. In Step 2, we developed the specific program outcomes and objectives and then selected adherence information, personal motivation, social motivation, behavioral skills, and treatment experiences as modifiable and important targets that needed to change in this program. In Step 3, we chose several theory-based methods and strategies for practical applications. We finally created a nurse-led medication self-management program in Step 4. Feedback from relevant stakeholders refined the intervention protocol and materials.

DISCUSSION AND IMPLICATIONS

The newly developed medication self-management program incorporated theory and evidence from literature and empirical studies with the engagement of multiple stakeholders, making it a contextually and culturally appropriate intervention. This study provides insights into strategies for geriatrics healthcare professionals to support medication self-management among older adults with multimorbidity.

The effects of a nurse-led couples intervention on marital quality of couples with gynecological cancer: A clinical randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of a nurse-led couples intervention on the marital quality of couples coping with gynecological cancer.

METHODS

Couples coping with gynecological cancer were randomly allocated to the intervention (n = 51) and the control (n = 53) group. The intervention group received the nurse-led couples intervention developed based on the Preliminary Live with Love Conceptual Framework plus routine nursing care. The control group received only routine nursing care. Marital quality, including marital satisfaction, marital communication, and sexual life, were measured using Olson Marital Quality Questionnaire at 3 timepoints (baseline, 2- and 3-months following baseline). Generalized estimating equation was used to examine the effectiveness of the intervention in improving marital quality.

RESULTS

Patients and husbands in the intervention group had significantly improved marital satisfaction scores (Waldχ² = 11.109, P = 0.001; Waldχ² = 4.849, P = 0.028); the interaction between intervention and time had a significant effect on the marital communication of both patients and their husbands (Waldχ² = 6.214, P = 0.045; Waldχ² = 15.460, P < 0.001). Patient-reported and husband-reported sexual life was not significantly influenced by the intervention (Waldχ² = 0.167, P = 0.683; Waldχ² = 3.215, P = 0.073).

CONCLUSIONS

The nurse-led couples intervention based on the Preliminary Live with Love Conceptual Framework improved marital satisfaction and marital communication, but not sexual life, of couples coping with gynecological cancer. The provision of professional sexual health psychology training for nurses may be crucial if nurse-led models are to truly support the sexual health of couples coping with gynecological cancer.

REGISTRATION

Registered with www.chictr.org.cn (ChiCTR2000034232).

The development of a home-based therapeutic platform for multiple myeloma

BACKGROUND

Multiple Myeloma (MM) accounts for 1-2% of all malignancies but is the second commonest haematological malignancy. It is characterized by a proliferation of malignant plasma cells. The treatment paradigm of MM in Australia is traditionally hospital-based, complex and costly. While MM comprises 1-2% of cancer diagnoses, it appears in the top ten cancer diagnoses requiring hospital admission. The cumulative time spent receiving treatment is a significant burden for patients. The ability to receive treatment at home and maximize time away from hospital-based settings is a key preference for patients receiving anticancer therapies over a prolonged period of time.

METHODS

The Peter MacCallum Cancer Centre and Royal Melbourne Hospital's combined Clinical Hematology Unit has collaborated with their Hospital in the Home departments to develop several innovative programs to address this.

RESULTS

We describe our current active programs and potential developments in home-based MM therapy.

CONCLUSION

We have enabled large numbers of patients to receive complex therapies in their own home and the COVID-19 pandemic has increased the pace of the roll out without any compromise in safety. We anticipate that the next raft of immunotherapies will be able to transition into the @Home treatment setting in the coming years.

Effect of nurse-led hospital-to-home transitional care interventions on mortality and psychosocial outcomes in adults with heart failure: a meta-analysis

AIMS

To determine the effectiveness and dose-response of nurse-led hospital-to-home transitional care interventions (TCIs) on patient mortality and psychosocial outcomes of health-related quality of life (HRQoL), self-care behaviours, and emotional well-being in adults hospitalized with heart failure (HF) and to recognize pertinent characteristics that potentially affect the overall effectiveness.

METHODS AND RESULTS

Relevant studies were identified through electronic database searches, including MEDLINE, Embase, CINAHL, and Cochrane Library from January 2000 until January 2021. Two independent authors performed study selection, data abstraction, and risk-of-bias assessment. When appropriate, we used random-effects meta-analysis to derive pooled effect estimates, investigated dose-response relationships, and ran meta-regressions to locate the source of heterogeneity. A total of 27 studies with 7635 participants were included. Our findings revealed that nurse-led hospital-to-home TCIs reduced the risk of all-cause mortality by 21% [risk ratio = 0.79; 95% confidence interval (CI) 0.68-0.92; P = 0.003] and improved HRQoL (mean difference = -3.29; 95% CI -6.51 to -0.07; P = 0.04) compared to usual care, but non-significant effects were found for emotional well-being. The narrative summary of evidence for self-care behaviours showed positive intervention effects. Meta-regression did not find any covariates that were significantly related to mortality or HRQoL. Dose-response analysis showed that mortality risk was reduced with increased intensity and complexity of the nurse-led TCIs.

CONCLUSION

Generally, nurse-led hospital-to-home TCIs may play a beneficial role in decreasing mortality, and improving HRQoL and self-care behaviours for adults with HF. Additional studies are warranted to characterize the optimal nurse-led TCIs for HF management.

A randomized trial on the application of a nurse-led early rehabilitation program after minimally invasive lumbar internal fixation

BACKGROUND

Lumbar degenerative disease (LDD) is a narrowing of the spinal canal and intervertebral foramina caused by aging and degeneration of lumbar spine tissue. Minimally invasive internal lumbar spine fixation is emerging in the treatment of LDD. However, no standard early rehabilitation protocol for orthopedic robot-assisted minimally invasive internal lumbar spine fixation exits. To investigate the effect of a nurse-led early rehabilitation program in the postoperative recovery of patients with lumbar degenerative lesions undergoing orthopedic robot-assisted minimally invasive lumbar internal fixation.

METHODS

Eighty patients with minimally invasive orthopedic robot-assisted lumbar degenerative lesions admitted to our hospital between January 2019 and January 2021 were recruited to this study. The patients were randomly allocated to a control group (n=40), involving conventional care, and an observation group (n=38; 40 initially and 2 later excluded) including a nurse-led early rehabilitation program added on the basis of the control group. The primary outcomes were the general postoperative conditions, scores of daily living ability, the degree of low back pain and functional recovery. Participants were also compared in terms of their compliance with the care regimen and the incidence of complications.

RESULTS

Participants in the observation group had a significantly shorter first time on the floor after surgery (P<0.001) and shorter hospital stay (P=0.003). Meanwhile, participants in the observation group had higher Barthel index (BI) scores (P=0.039), lower visual analogue scale (VAS) scores (P=0.028), and Oswestry disability index (ODI) scores (P=0.002) at 3 days postoperatively, and there was no difference in the three scores between the two groups at 1 month postoperatively (all P>0.05). The compliance of participants in the observation group was significantly higher than that of the control group (P<0.001). Participants in the observation group were less likely to experience constipation (P=0.043) and bloating (P=0.012) within 1 month after surgery.

CONCLUSIONS

Implementation of a nurse-led early rehabilitation program in patients undergoing orthopedic robotic-assisted minimally invasive treatment of lumbar degenerative lesions can significantly improve patient compliance, significantly shorten postoperative flooring and hospitalization time, reduce the incidence of gastrointestinal adverse events, and accelerate postoperative recovery.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2100048698.

The effectiveness of a nurse-led home-based heart failure self-management programme (the HOM-HEMP) for patients with chronic heart failure: A three-arm stratified randomized controlled trial

BACKGROUND

Although important, heart failure self-care remains a challenge for many patients. This study aimed to evaluate the effect of a nurse-led, home-based self-management psychosocial education intervention (HOM-HEMP). The primary outcome was patient's HF self-care in terms of maintenance, management and confidence. The secondary outcomes were cardiac self-efficacy, psychological wellbeing in terms of perceived social support, health related quality of life and levels of anxiety and depression. The clinical outcomes included New York Heart Association (NYHA) functional class and numbers of unplanned health service visits due to cardiac-related reasons.

DESIGN

A three-arm stratified randomized controlled trial was conducted (Clinical trial registration number: NCT03108235).

METHODS

A total of 213 participants admitted for heart failure were recruited from the inpatient wards of a tertiary public hospital in Singapore. They were randomly allocated to the control group, the experimental group A or the experimental group B. All participants received the usual care provided by the hospital. Participants in experimental groups A and B received the HOM-HEMP intervention, and those in experimental group B received an additional supplemental smartphone application. Data were collected at baseline, 6 weeks, 3 months and 6 months from baseline.

RESULTS

Compared to the control groups, participants in either of the experimental group had significantly higher levels of heart failure self-care maintenance (F = 4.222, p = 0.001), self-care confidence (F = 5.796, p < 0.001) and self-care management (p < 0.05) at 6-week, 3-month and 6-month follow-ups. In addition, both experimental groups had significantly higher levels of cardiac self-efficacy, better health related quality of life and lower depression levels than the control group after the study intervention. A higher proportion of participants in both experimental groups had a better New York Heart Association functional class at 6-week and 3-month follow-ups. Participants in the experimental group B also had significantly fewer cardiac-related unplanned hospital admissions and emergency room visits than the control group at 6-month follow-up. Results on perceived social support were not significant. The study outcomes in experimental group A and B were not significantly different at any of the post intervention follow-up.

CONCLUSION

The findings suggested that HOM-HEMP is an effective intervention for patients with heart failure in Singapore.

Examining the Effects of Music-Based Interventions on Pain and Anxiety in Hospitalized Children: An Integrative Review

PROBLEM

Children often experience pain and anxiety during a hospital stay. Effective pain and anxiety management plays a crucial role in healing. However, recent literature has highlighted multiple barriers to managing pain and anxiety in children, such as parent and provider fears of the adverse effects of pain and anxiety medications.

ELIGIBILITY CRITERIA

A database search was conducted for articles published between 2009 and 2019 to evaluate the impact of nurse-led, music-based interventions as an adjunct method of pain and anxiety management in hospitalized children. Articles were included if study subjects were ages 0-21 years old, the study used live or recorded music as an intervention, and occurred in an inpatient setting.

SAMPLE

A total of seven randomized control trials and one quasi-experimental study were included for analysis.

RESULTS

There is consistent and significant evidence that music can reduce anxiety in hospitalized children before and during procedures. Results with respect to pain and vital signs, often viewed as the physiologic analogs to pain, were mixed.

CONCLUSIONS

Music-based interventions are safe for hospitalized children. Several studies highlighted the importance of patient preference in selecting music for children. A heavy reliance on pre-recorded audio, delivered via headphones illustrates the feasibility and cost-effectiveness of music-based interventions.

IMPLICATIONS

Nurse-led, music-based interventions have been shown to be an affordable, safe, effective, and feasible alternative for managing anxiety in hospitalized children. Music should be considered as an adjunct therapy to traditional anxiety treatment. Further research is needed to determine the effects of music on pain.

Effects of a nurse-led eHealth cardiac rehabilitation programme on health outcomes of patients with coronary heart disease: A randomised controlled trial

BACKGROUND

The uptake of and adherence to cardiac rehabilitation remain suboptimal despite its apparent health benefits in modifying risk factors and slowing disease progression. eHealth refers to the use of information and communication technologies for health-related purposes. It is a promising approach for improving participation in cardiac rehabilitation by enabling instant contact, hypermedia information delivery, technology-monitored functionalities and individualised progress monitoring.

AIMS

To evaluate the effects of a nurse-led eHealth cardiac rehabilitation (NeCR) system on health behaviours, cardiac self-efficacy, anxiety and depression, health-related quality of life, risk parameters and unplanned use of care services for people with coronary heart disease.

DESIGN

A single-blinded randomised controlled trial design was used.

METHODS

The study randomly assigned 146 patients hospitalised for coronary heart disease to receive either the NeCR intervention or the usual care. Underpinned by social cognitive theory, the intervention commenced before hospital discharge with an in-person session by the nurse to identify individualised self-care needs, set goals and develop an action plan to enhance behavioural risk factor modification and orientate the patient to the use of the information and communication technology platform for cardiac rehabilitation. After discharge, the e-platform helped patients gain knowledge of disease management and monitor goal attainment for health behavioural changes. The nurse provided feedback on the patients' goal attainment and lifestyle modifications on a weekly basis in a small group format through the WeChat platform, thus also mobilising peer influence. Data for lifestyle behaviours, physiological risk parameters and clinical outcomes were collected at baseline and at 6 and 12 weeks post-intervention.

RESULTS

At 6 weeks post-intervention, participants in the intervention group showed significant improvement in the number of steps/day (β = 2628.48, p = .022), the number of minutes/week sitting (β = -640.30, p = .006) and their health-promoting lifestyle profile (β = 25.17, p < .001) compared with the control group. Improvements in the number of steps/day (β = 2520.00, p = .006), the number of minutes/week sitting (β = -719.73, p = .004) and health-promoting lifestyle (β = 16.09, p < .001) were sustained until the 12-week post-intervention endpoint. Moreover, participants showed significantly greater improvement in self-efficacy (β = 0.61, p = .005) and health-related quality of life (mean difference = 0.56, p < .001) than the control group at the study endpoint.

CONCLUSIONS

The findings of this study demonstrate the effectiveness of the NeCR intervention in modifying behavioural risk factors and improving health-related quality of life. These findings also provide insights into the application of eHealth nursing interventions to enhance the rehabilitation of patients with coronary heart disease.

TRIAL REGISTRATION

ChiCTR1800020411.

Implementation of a nurse-led lower urinary tract symptoms (LUTS) clinic reduces general urology clinic workload in a Model 4 Hospital: a pilot study in Tallaght University Hospital

Background

With among the lowest urologist per population ratios in Europe, the demand for urology specialist review in Ireland far exceeds supply. Lower urinary tract symptoms (LUTS) account for a significant number of referrals. The traditional paradigm of every patient being reviewed in a consultant-led clinic is unsustainable. New models of care with nurse-led clinics represent an opportunity to optimise limited resources.

Methods

Existing long-waiting male LUTS referrals were triaged to a specialist nurse-led LUTS clinic. After urology CNS assessment, charts were reviewed by a consultant urologist and a plan formulated. Relevant data were prospectively collected and analysed.

Results

Fifty-eight new male patients with LUTS were seen over a 6-month period with an average waiting time of 15.8 months. Patients were assessed with uroflowmetry, IPSS and DRE. Mean age was 64, IPSS 14.5, Qmax 18.3 ml/s and PVR 89 ml. Thirty patients (52%) were discharged directly with lifestyle modification and medical therapy.

Twenty-eight patients (48%) required one or more further investigations and subsequent review; 11 had flexible cystoscopy, 4 had urodynamics, 5 had prostate MRI, and 2 patients were listed for surgery (TURP and circumcision). The remaining 10 patients were for review post trial of lifestyle modifications and/or medical treatment. After review/investigations, 4 more patients were discharged. A total of 32 patients (55%) were discharged or listed for surgery after initial assessment. This total increased to 62% after a second review/investigations.

Conclusion

Introduction of a CNS-led LUTS clinic has significantly reduced the number of patients requiring follow-up in general urology clinics, representing a quality improvement in service provision.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11845-020-02428-8.

Effects of nurse-led sedation protocols on mechanically ventilated intensive care adults: A systematic review and meta-analysis

OBJECTIVES

The objective of the study was to compare nurse-led sedation protocols with physician-led usual care in intensive care units (ICUs) in treating mechanically ventilated adult patients.

REVIEW METHOD USED

This is a systematic review and meta-analysis.

DATA SOURCES

PubMed, Cochrane Library, EMBASE, CINAHL, China National Knowledge Infrastructure, and China Wanfang databases were interrogated for articles published before May 2020.

REVIEW METHOD

As per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, eight randomised controlled trials (RCTs) and six preintervention and postintervention studies published in English and Chinese met the inclusion criteria for the meta-analysis. Two reviewers independently extracted data into a tabular format using predefined data fields. Disagreements were resolved by consensus. The quality of the included RCTs and preintervention and postintervention studies was assessed using the Cochrane Quality Assessment Tool and Risk Of Bias In Non-randomised Studies of Interventions assessment tool.

RESULTS

Eight RCTs were of intermediate methodological quality, and six preintervention and postintervention studies exhibited a low to moderate risk of bias. Compared with usual care, nurse-led sedation protocols resulted in significantly decreased durations of mechanical ventilation (days) (standardised mean difference = -1.765; 95% confidence interval [CI] = -2.461, -1.068); P < 0.001; I² = 97.7%); decreased length of ICU stay (days) (standardised mean difference = -1.463; 95% CI = -2.181, -0.745; P < 0.001; I² = 97.3%); reduced ICU mortality (relative risk [RR] = 0.854; 95% CI = 0.747, 0.983; P = 0.027), I² = 0%); and decreased incidence of ventilator-associated pneumonia (RR = 0.438; 95% CI = 0.292, 0.657; P < 0.001; I² = 41.4%), delirium (RR = 0.522; 95% CI = 0.338, 0.807; P = 0.003; I² = 26.6%), and extubation failure (RR = 0.498; 95% CI = 0.266, 0.932; P = 0.029; I² = 45.1%).

CONCLUSIONS

Although pre-post intervention study design cannot establish causality, the present findings raise the considerable possibility that a sedation protocol can be safely implemented by nurses to reduce mortality in ICUs and sedation-related adverse events in patients on mechanical ventilation compared with physician-led usual care.

Bridging the Needs of Adolescent Diabetes Care During COVID-19: A Nurse-Led Telehealth Initiative

Amidst the unprecedented global pandemic of COVID-19, attending to the needs of adolescents with diabetes mellitus became more challenging. They faced the uncertainty of access to care and the attendant problems of a lockdown. We present the nurse-led telehealth initiative for adolescents with diabetes mellitus, leveraging on existing infrastructure and resources with the aim of addressing the anticipated challenges that many of the adolescents might face. The initiative was well received among those who participated, and there were no significant adverse effects noted.

Developing and testing a nurse-led intervention to support bereavement in relatives in the intensive care (BRIC study): a protocol of a pre-post intervention study

BACKGROUND

When a patient is approaching death in the intensive care unit (ICU), patients' relatives must make a rapid transition from focusing on their beloved one's recovery to preparation for their unavoidable death. Bereaved relatives may develop complicated grief as a consequence of this burdensome situation; however, little is known about appropriate options in quality care supporting bereaved relatives and the prevalence and predictors of complicated grief in bereaved relatives of deceased ICU patients in the Netherlands. The aim of this study is to develop and implement a multicomponent bereavement support intervention for relatives of deceased ICU patients and to evaluate the effectiveness of this intervention on complicated grief, anxiety, depression and posttraumatic stress in bereaved relatives.

METHODS

The study will use a cross-sectional pre-post design in a 38-bed ICU in a university hospital in the Netherlands. Cohort 1 includes all reported first and second contact persons of patients who died in the ICU in 2018, which will serve as a pre-intervention baseline measurement. Based on existing policies, facilities and evidence-based practices, a nurse-led intervention will be developed and implemented during the study period. This intervention is expected to use 1) communication strategies, 2) materials to make a keepsake, and 3) a nurse-led follow-up service. Cohort 2, including all bereaved relatives in the ICU from October 2019 until March 2020, will serve as a post-intervention follow-up measurement. Both cohorts will be performed in study samples of 200 relatives per group, all participants will be invited to complete questionnaires measuring complicated grief, anxiety, depression and posttraumatic stress. Differences between the baseline and follow-up measurements will be calculated and adjusted using regression analyses. Exploratory subgroup analyses (e.g., gender, ethnicity, risk profiles, relationship with patient, length of stay) and exploratory dose response analyses will be conducted.

DISCUSSION

The newly developed intervention has the potential to improve the bereavement process of the relatives of deceased ICU patients. Therefore, symptoms of grief and mental health problems such as depression, anxiety and posttraumatic stress, might decrease.

TRIAL REGISTRATION

Netherlands Trial Register Registered on 27/07/2019 as NL 7875, www.trialregister.nl.

Effects of nurse-led interventions on early detection of cancer: A systematic review and meta-analysis

BACKGROUND

Early detection of cancer serves an important strategy for cancer control, but its uptake rate remains relatively limited. Nurse-led interventions may have potential benefits for the early detection of cancer, but the evidence remains unclear.

OBJECTIVES

Synthesise the evidence on the impact of nurse-led interventions on early cancer detection. The primary outcome was early cancer detection uptake rate. Secondary outcomes were cancer knowledge, early detection beliefs, diagnosed precancerous lesions and early-stage cancers.

DESIGN

A systematic review and meta-analysis of randomised controlled trails.

DATA SOURCES

Eight English language databases (British Nursing Index, Cochrane Central Register of Controlled Trials, CINAHL Complete, EMBASE, Ovid Emcare, Medline, Scopus, Web of Science Core Collection) and three Chinese language databases (Chinese Biomedical Literature Databases, China Journal Net, and Wanfang Data) were searched from inception date to September 2019. Grey literature and reference lists of included studies were also examined.

REVIEW METHODS

Two reviewers independently assessed eligibility, extracted data and evaluated methodological quality using the Cochrane risk of bias (RoB 2.0) tool. Meta-analyses and descriptive analyses were used. Subgroup analyses were conducted for study settings and intervention types.

RESULTS

Ten studies examined the effects of nurse-led interventions, including education, patient reminders, counselling, and patient navigation, on early detection of breast or cervical cancer, colorectal cancer, and lung cancer. Nurse-led interventions improved the uptake rates of mammography [risk ratio (RR) = 1.97; 95% confidence interval (CI): 1.17-3.33; p = 0.01], clinical breast examination (RR = 2.16; 95% CI: 1.02-4.59; p = 0.05), regular breast self-examination (RR = 2.01; 95% CI: 1.54-2.63; p < 0.001), and colonoscopy (RR = 1.90; 95% CI: 1.57-2.30; p < 0.001), but not of faecal blood occult tests. Subgroup analyses showed significantly improved mammography and clinical breast examination uptake rates for interventions conducted at health centres, and that patient navigation had better effects on improving colonoscopy uptake rates than did counselling. The intervention also improved cancer knowledge, early detection beliefs, and cases of detected precancerous lesions.

CONCLUSIONS

Nurse-led interventions may improve early cancer detection uptake rates, cancer knowledge, early detection beliefs, and cases of detected precancerous lesions. The effects of nurse-led interventions conducted in home settings on improving mammography and clinical breast examination uptake rates may need further exploration. Patient navigation may be superior to counselling in improving colonoscopy uptake rates. Social media may be an option for delivering early cancer detection guidance, but needs to be further explored. Tweetable abstract: Nurse-led interventions have potential effects on promoting early detection of cancer.

Advanced practice nurses led clinic in a psychiatric hospital: An outcome evaluation in Singapore

BACKGROUND

Ageing population and rising patients' expectations, coupled with the shortage of physicians and the increasing pressure to contain health care costs, have resulted in rapid growth of advanced practice nurses (APNs), and the gradual shift of care from physicians to them. Though it was reported that APNs can provide safe, effective and quality care for patients, the evidence in mental health is lacking both locally and internationally.

OBJECTIVES

This study evaluated the effectiveness of mental health APN-led clinic through examining the participants' clinical outcomes, satisfaction and perceived recovery.

METHODS

Pre-post test study design was used, whereby 100 participants were surveyed by questionnaires, in addition to retrospective review of participants' medical records. Comparison was made from data obtained two years prior to and two years after participant's first consultation with APNs.

RESULTS

Participants had their psychiatric symptoms well-controlled (M = 24.71, SD = 1.18). There was no significant difference in readmissions (p = 0.320) and the emergency room visits (p = 0.320) over two years before and two years after participants' first consultation with APNs. However, there was a significant difference in default rates (p = 0.020). Participants seen by APNs had better attendance for their appointments than those seen by doctors. Participants reported being satisfied with APNs (M = 121.07, SD = 10.82), had good adherence to medications (M = 7.26, SD = 2.42), good perception of mental health recovery (M = 94.43, SD = 12.53) and had confidence in achieving their goals (M = 31.44, SD = 5.78). Characteristics of participants were not correlated with outcomes, with exception that age was correlated to drug adherence (p < 0.001). Satisfaction with APNs was also noted to correlate with mental health recovery (p < 0.001) and general self-efficacy (p < 0.001).

CONCLUSION

This study supported the evidence that mental health advanced practice nurses can provide safe, effective and quality care for patients.

Setting up a nurse-led model of care for management of hypertension and diabetes mellitus in a high HIV prevalence context in rural Zimbabwe: a descriptive study

Background

In the light of the increasing burden of non-communicable diseases (NCDs) on health systems in low- and middle-income countries, particularly in Sub-Saharan Africa, context-adapted, cost-effective service delivery models are now required as a matter of urgency. We describe the experience of setting up and organising a nurse-led Diabetes Mellitus (DM) and Hypertension (HTN) model of care in rural Zimbabwe, a low-income country with unique socio-economic challenges and a dual disease burden of HIV and NCDs.

Methods

Mirroring the HIV experience, we designed a conceptual framework with 9 key enablers: decentralization of services, integration of care, simplification of management guidelines, mentoring and task-sharing, provision of affordable medicines, quality assured laboratory support, patient empowerment, a dedicated monitoring and evaluation system, and a robust referral system. We selected 9 primary health care clinics (PHC) and two hospitals in Chipinge district and integrated DM and HTN either into the general out-patient department, pre-existing HIV clinics, or an integrated chronic care clinic (ICCC). We provided structured intensive mentoring for staff, using simplified protocols, and disease-specific education for patients. Free medication with differentiated periodic refills and regular monitoring with point of care (POC) glycosylated haemoglobin (HbA1c) were provided.

Results

Nurses in 7 PHC facilities and one hospital developed sufficient knowledge and skills to diagnose, initiate treatment and monitor DM and HTN patients, and 3094 patients were registered in the programme (188 with DM only, 2473 with HTN only, 433 with both DM and HTN). Major lessons learned from our experience include: the value of POC devices in the management of diabetes; the pressure on services of the added caseload, exacerbated by the availability of free medications in supported health facilities; and the importance of leadership in the successful implementation of care in health facilities.

Conclusion

Our experience demonstrates a model for nurse-led decentralized integrated DM and HTN care in a high HIV prevalence rural, low-income context. Developing a context-adapted efficient model of care is a dynamic process. We present our lessons learned with the intention of sharing experience which may be of value to other public health programme managers.

Evaluation of a nurse-led education program to improve cross-cultural care for older people in aged care

BACKGROUND

Cultural diversity is significant in aged care facilities. Registered nurses play a leading role in the care setting. Nurse-led education interventions to improve the cultural competence of aged care workers are in high demand.

AIM

The aims of the study were to evaluate the effect of a nurse-led cross-cultural care program on cultural competence of Australian and overseas-born care workers.

DESIGN

A pre- and post-evaluation design and a sub-group analysis.

SETTINGS AND PARTICIPANTS

This study was undertaken in four large-sized aged care facilities in Australia. Direct care workers were invited to participate in the study.

METHODS

The intervention lasted 12 months. Data were collected at baseline, 6 months and 12 months using the Clinical Cultural Competency Questionnaire and site champion reports. One-way ANOVA was applied to determine the changes of outcomes over time for the whole group. A mixed effect linear regression model was applied in the sub-group analyses to compare the differences of outcomes between the Australian-born and overseas-born groups.

RESULTS

One hundred and thirteen staff participated in the study including Australian-born (n = 62) and overseas-born (n = 51). Registered nurses were trained as site champions to lead the program. The results showed a statistically significant increase in participants' scores in Knowledge (p = .000), Skills (p = .000), Comfort Level (p = .000), Importance of awareness (p = .01) and Self-Awareness (p = .000) in a 12-month follow-up. The increased scores in the Skills (p = .02) and Comfort Level (p = .001) were higher in the Australian-born group compared to the overseas-born group. The results also showed a statistically significant increase in participants' overall satisfaction scores with the program at 12 months (p = .009). The overseas-born group demonstrated a higher score in Desire to Learn More (p = .016) and Impact of the Program on Practice (p = .014) compared to the Australian-born group.

CONCLUSION

A nurse-led cross-cultural care program can improve aged care workers' cultural competence.

A service evaluation of specialist nurse telephone follow-up of bowel cancer patients after surgery

INTRODUCTION

the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery.

METHODS

the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients.

RESULTS

feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff.

DISCUSSION

this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.

Feasibility of a guided participation discharge program for very preterm infants in a neonatal intensive care unit: a randomized controlled trial

Background

Previous studies showed that parents of very preterm infants expressed feelings of incompetence and experienced high levels of stress upon the discharge of their infants. We conducted a systematic review of seven studies and observed potential benefits for parental outcomes when using discharge interventions that adopted guided participation (GP). More evidence is needed on the effective doses of discharge interventions underpinned by the principles of GP.

Aim

To investigate the feasibility and preliminarily estimate the effects on parental competence and stress outcomes of a newly developed, nurse-led, GP discharge program for mothers of very preterm infants.

Methods

A two-arm randomized controlled trial was conducted in a neonatal intensive care unit (NICU). Mothers of infants with gestational ages of ≤32 weeks who had no congenital malformations and did not need to undergo major surgeries were recruited. All mothers were the primary caregivers to their infants. The intervention group received a nurse-led GP discharge intervention (three structured 30- to 60-min GP sessions and one follow-up phone call). The control group received usual care. The parental outcomes were measured using the Parenting Sense of Competence Scale (C-PSOC) and Perceived Stress Scale (C-PSS) at baseline (T0), on the day of discharge (T1), after the follow-up phone call (within 72 h after discharge) (T2), and 1 month after discharge (T3). The outcomes were analyzed using generalized estimating equations based on intention-to-treat principles.

Results

Thirty infant–mother dyads were recruited. Greater improvements in the C-PSOC score were observed in the intervention group than in the control group at T1 and T2, although these differences were statistically insignificant. The intervention group exhibited greater improvements than the control group in the C-PSS scores at T1, T2, and T3, although these differences were also not statistically significant.

Conclusions

The findings suggest that a GP discharge intervention could improve parenting competence and stress among mothers with very preterm infants. The absence of adverse events suggests that the GP discharge intervention could be feasibly implemented in NICU settings. This feasibility study was not powered to determine the effectiveness of the intervention but is anticipated to lay the foundation for a future full-scale study.

Trial registration

ClinicalTrials.gov Identifier: NCT03668912. Date of registration: 13 September 2018 (retrospectively registered).

A service evaluation of specialist nurse telephone follow-up of bowel cancer patients after surgery

INTRODUCTION

the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery.

METHODS

the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients.

RESULTS

feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff.

DISCUSSION

this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.

Unplanned readmission prevention by a geriatric emergency network for transitional care (URGENT): a prospective before-after study

BACKGROUND

URGENT is a comprehensive geriatric assessment (CGA) based nurse-led care model in the emergency department (ED) with geriatric follow-up after ED discharge aiming to prevent unplanned ED readmissions.

METHODS

A quasi-experimental study (sequential design with two cohorts) was conducted in the ED of University Hospitals Leuven (Belgium). Dutch-speaking, community-dwelling ED patients aged 70 years or older were eligible for enrolment. Patients in the control cohort received usual care. Patient in the intervention cohort received the URGENT care model. A geriatric emergency nurse conducted CGA and interdisciplinary care planning among older patients identified as at risk for adverse events (e.g. unplanned ED readmission, functional decline) with the interRAI ED Screener© and clinical judgement of ED staff. Case manager follow-up was offered to at risk patients without hospitalization after index ED visit. For inpatients, geriatric follow-up was guaranteed on an acute geriatric ward or by the inpatient geriatric consultation team on a non-geriatric ward if considered necessary. Primary outcome was unplanned 90-day ED readmission. Secondary outcomes were ED length of stay (LOS), hospitalization rate, in-hospital LOS, 90-day higher level of care, 90-day functional decline and 90-day post-hospitalization mortality.

RESULTS

Almost half of intervention patients (404/886 = 45.6%) were categorized at risk. These received on average seven advices. Adherence rate to advices on the ED, during hospitalization and in community care was 86.1, 74.6 and 34.1%, respectively. One out of four at risk patients without hospitalization after index ED visit accepted case manager follow-up. Unplanned ED readmission occurred in 170 of 768 (22.1%) control patients and in 205 of 857 (23.9%) intervention patients (p = .11). The intervention group had shorter ED LOS (12.7 h versus 19.1 h in the control group; p < .001), but higher rate of hospitalization (70.0% versus 67.0% in the control group; p = .003).

CONCLUSIONS

The URGENT care model shortened ED LOS and increased the hospitalization rate, but did not prevent unplanned ED readmissions. A geriatric emergency nurse could improve in-hospital patient management, but failed to introduce substantial out-hospital case-management.

TRIAL REGISTRATION

The protocol of this study was registered retrospectively with ISRCTN ( ISRCTN91449949 ; registered 20 June 2017).

Standard vs. intensified management of heart failure to reduce healthcare costs: results of a multicentre, randomized controlled trial

Aims

To determine if an intensified form of heart failure management programme (INT-HF-MP) based on individual profiling is superior to standard management (SM) in reducing health care costs during 12-month follow-up (primary endpoint).

Methods and results

A multicentre randomized trial involving 787 patients (full analysis set) discharged from four tertiary hospitals with chronic HF who were randomized to SM (n = 391) or INT-HF-MP (n = 396). Mean age was 74 ± 12 years, 65% had HF with a reduced ejection fraction (31.4 ± 8.9%) and 14% were remote-dwelling. Study groups were well matched. According to Green, Amber, Red Delineation of rIsk And Need in HF (GARDIAN-HF) profiling, regardless of location, patients in the INT-HF-MP received a combination of face-to-face (home visits) and structured telephone support (STS); only 9% (`low risk') were designated to receive the same level of management as the SM group. The median cost in 2017 Australian dollars (A$1 equivalent to ∼EUR €0.7) of applying INT-HF-MP was significantly greater than SM ($152 vs. $121 per patient per month; P < 0.001), However, at 12 months, there was no difference in total health care costs for the INT-HF-MP vs. SM group (median $1579, IQR $644 to $3717 vs. $1450, IQR $564 to $3615 per patient per month, respectively). This reflected minimal differences in all-cause mortality (17.7% vs. 18.4%; P = 0.848) and recurrent hospital stay (18.6 ± 26.5 vs. 16.6 ± 24.8 days; P = 0.199) between the INT-HF-MP and SM groups, respectively.

Conclusion

During 12-months follow-up, an INT-HF-MP did not reduce healthcare costs or improve health outcomes relative to SM.

A systematic review

OBJECTIVE

The purpose of this systematic review was to highlight the effect of nurse-led 1:1 patient education sessions on Quality of Life (QoL), readmission rates and healthcare costs for adults with heart failure (HF) living independently in the community.

METHOD

A systematic review of randomised control trials was undertaken. Using the search terms nurse, education, heart failure, hospitalisation, readmission, rehospitalisation, economic burden, cost, expenditure and quality of life in PubMed, CINAHL and Google Scholar databases were searched. Papers pertaining to nurse-led 1:1 HF disease management of education of adults in the community with a history of HF were reviewed.

RESULT

The results of this review identified nurse-led education sessions for adults with HF contribute to reduction in hospital readmissions, reduction in hospitalisation and a cost benefit. Additionally, higher functioning and improved QoL were also identified.

CONCLUSION

These results suggest that nurse-led patient education for adults with HF improves QoL and reduces hospital admissions and readmissions.

PRACTICE IMPLICATIONS

Nurse-led education can be delivered utilising diverse methods and impact to reduce readmission as well as hospitalisation.

Follow-up care after treatment for prostate cancer: protocol for an evaluation of a nurse-led supported self-management and remote surveillance programme

BACKGROUND

As more men survive a diagnosis of prostate cancer, alternative models of follow-up care that address men's enduring unmet needs and are economical to deliver are needed. This paper describes the protocol for an ongoing evaluation of a nurse-led supported self-management and remote surveillance programme implemented within the secondary care setting.

METHODS/DESIGN

The evaluation is taking place within a real clinical setting, comparing the outcomes of men enrolled in the Programme with the outcomes of a pre-service change cohort of men, using a repeated measures design. Men are followed up at four and 8 months post recruitment on a number of outcomes, including quality of life, unmet need, psychological wellbeing and activation for self-management. An embedded health economic analysis and qualitative evaluation of implementation processes are being undertaken.

DISCUSSION

The evaluation will provide important information regarding the effectiveness, cost effectiveness and implementation of an integrated supported self-management follow-up care pathway within secondary care.

Unravelling effectiveness of a nurse-led behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: study protocol for a cluster randomised controlled trial

Background

Self-management interventions are considered effective in patients with chronic disease, but trials have shown inconsistent results, and it is unknown which patients benefit most. Adequate self-management requires behaviour change in both patients and health care providers. Therefore, the Activate intervention was developed with a focus on behaviour change in both patients and nurses. The intervention aims for change in a single self-management behaviour, namely physical activity, in primary care patients at risk for cardiovascular disease. The aim of this study is to evaluate the effectiveness of the Activate intervention.

Methods/design

A two-arm cluster randomised controlled trial will be conducted to compare the Activate intervention with care as usual at 31 general practices in the Netherlands. Approximately 279 patients at risk for cardiovascular disease will participate. The Activate intervention is developed using the Behaviour Change Wheel and consists of 4 nurse-led consultations in a 3-month period, integrating 17 behaviour change techniques. The Behaviour Change Wheel was also applied to analyse what behaviour change is needed in nurses to deliver the intervention adequately. This resulted in 1-day training and coaching sessions (including 21 behaviour change techniques). The primary outcome is physical activity, measured as the number of minutes of moderate to vigorous physical activity using an accelerometer. Potential effect modifiers are age, body mass index, level of education, social support, depression, patient-provider relationship and baseline number of minutes of physical activity. Data will be collected at baseline and at 3 months and 6 months of follow-up. A process evaluation will be conducted to evaluate the training of nurses, treatment fidelity, and to identify barriers to and facilitators of implementation as well as to assess participants’ satisfaction.

Discussion

To increase physical activity in patients and to support nurses in delivering the intervention, behaviour change techniques are applied to change behaviours of the patients and nurses. Evaluation of the effectiveness of the intervention, exploration of which patients benefit most, and evaluation of our theory-based training for primary care nurses will enhance understanding of what works and for whom, which is essential for further implementation of self-management in clinical practice.

Trial registration

ClinicalTrials.gov identifier: NCT02725203. Registered on 25 March 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-1823-9) contains supplementary material, which is available to authorized users.

Triage, treatment and transfer of patients with stroke in emergency department trial (the T3 Trial): a cluster randomised trial protocol

BACKGROUND

Internationally recognised evidence-based guidelines recommend appropriate triage of patients with stroke in emergency departments (EDs), administration of tissue plasminogen activator (tPA), and proactive management of fever, hyperglycaemia and swallowing before prompt transfer to a stroke unit to maximise outcomes. We aim to evaluate the effectiveness in EDs of a theory-informed, nurse-initiated, intervention to improve multidisciplinary triage, treatment and transfer (T3) of patients with acute stroke to improve 90-day death and dependency. Organisational and contextual factors associated with intervention uptake also will be evaluated.

METHODS

This prospective, multicentre, parallel group, cluster randomised trial with blinded outcome assessment will be conducted in EDs of hospitals with stroke units in three Australian states and one territory. EDs will be randomised 1:1 within strata defined by state and tPA volume to receive either the T3 intervention or no additional support (control EDs). Our T3 intervention comprises an evidence-based care bundle targeting: (1) triage: routine assignment of patients with suspected stroke to Australian Triage Scale category 1 or 2; (2) treatment: screening for tPA eligibility and administration of tPA where applicable; instigation of protocols for management of fever, hyperglycaemia and swallowing; and (3) transfer: prompt admission to the stroke unit. We will use implementation science behaviour change methods informed by the Theoretical Domains Framework [1, 2] consisting of (i) workshops to determine barriers and local solutions; (ii) mixed interactive and didactic education; (iii) local clinical opinion leaders; and (iv) reminders in the form of email, telephone and site visits. Our primary outcome measure is 90 days post-admission death or dependency (modified Rankin Scale >2). Secondary outcomes are health status (SF-36), functional dependency (Barthel Index), quality of life (EQ-5D); and quality of care outcomes, namely, monitoring and management practices for thrombolysis, fever, hyperglycaemia, swallowing and prompt transfer. Outcomes will be assessed at the patient level. A separate process evaluation will examine contextual factors to successful intervention uptake. At the time of publication, EDs have been randomised and the intervention is being implemented.

DISCUSSION

This theoretically informed intervention is aimed at addressing important gaps in care to maximise 90-day health outcomes for patients with stroke.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ACTRN12614000939695 . Registered 2 September 2014.

A nurse-led protocol improves the time to first dose intravenous antibiotics in septic patients post chemotherapy

PURPOSE

Neutropenic sepsis is a time-dependent emergency with early interventions shown to improve outcomes. Broad spectrum intravenous antibiotic administration is the initial therapy in patients with suspected neutropenic sepsis. Compliance with early antibiotic administration in febrile neutropenia patients is poor. Innovations have been trialled to improve the time to first dose intravenous antibiotics in patients with suspected neutropenic sepsis. Consideration of extending first dose intravenous antibiotic prescribing to trained nursing staff may improve performance in this key standard.

METHODS

A retrospective analysis was performed at a specialist oncology hospital in the North West of England from January 1st 2015 to January 31st 2016. The nurses on the Medical Admissions Unit (MAU) have been given the responsibility of assessing patients presenting with fever post chemotherapy including prescribing and administering the first dose of intravenous antibiotics with the aim of improving the speed of this intervention.

RESULTS

During the study period, 697 patients presented to the MAU with suspected sepsis post chemotherapy. Six hundred seventy-two (96.4 %) patients received their first dose of intravenous antibiotics within 60 min of presentation to the MAU. Of this group, 323 (48.1 %) were administered antibiotics within 15 min of arrival. Of the 25 (3.6 %) patients who did not receive antibiotics within 1 h, root cause analysis revealed the reason in 23 (92 %) patients was an inability to ascertain intravenous access.

CONCLUSION

Nurse-led protocols are an effective, safe, and sustainable method for achieving early antibiotic administration in patients with suspected febrile neutropenia. This is a key component of ensuring improved outcomes for this cohort of patients.

Transition journey from hospital to home in patients with cancer and their caregivers: a qualitative study

BACKGROUND

The National Cancer Institute Singapore initiated the NUH2 Home program in January 2014, referred to as "Caring Across the Cancer Continuum," a nurse-led cancer transitional care service (CTCS) that provides home care to patients with cancer and their caregivers. The study aimed to explore the transition experiences of patients with cancer and their caregivers.

METHOD

Using a purposive sampling, 12 patients with cancer and 12 caregivers were recruited. Audiotape interviews were conducted until data saturation was achieved. Each interview was transcribed verbatim, and thematic analyses were performed to extract significant themes and subthemes.

RESULTS

Four themes emerged from the data including (1) ongoing concerns, (2) needing timely help, (3) resuming control and normality of life, and (4) appreciating the transition care. The transition journey of patients and caregivers provided them with an ability to regain control and normality in their lives, be reassured and confident in being able to care for themselves and manage the physiological and psychological strains associated with the multiple vicissitudes associated with having cancer and its treatment while at home.

CONCLUSION

Our study addressed the nature, patterns, conditions, and responses to transition care. Our findings provided relevant contextual knowledge to further improve the transition care service based on the recommendations of the patients with cancer and their caregivers who first experienced the new service.

Factors Associated With Efficacy of Nurse-led Bowel Training of Patients With Chronic Constipation

BACKGROUND & AIMS

It is not clear whether nurse-led bowel training (NBT), an individually tailored biofeedback strategy designed to improve the physiological process of defecation by operant conditioning and trial and error learning, is effective for patients with chronic constipation. We assessed the ability of NBT to reduce symptoms and increase quality of life in patients with constipation at a large tertiary medical center.

METHODS

We performed a retrospective analysis of data from 347 patients (median age, 50 years) who underwent a median 3 sessions of NBT for chronic constipation from January 2011 through December 2013 at St Marks Hospital in the United Kingdom. The NBT comprised a combination of sensory retraining, pelvic floor conditioning, and advice on diet and toileting behavior. Data on patient demographics (age, sex, type of constipation) were collected alongside their assessments of constipation, which were based on Patient Assessment of Constipation Quality of Life (PAC-QoL) and patient satisfaction scores. We performed binary logistic regression analysis. Each variable was tested first at the univariate level; those with significance (P < .10) were included in a multivariate model.

RESULTS

At the end of NBT, 62.5% of the patients (217/347) reported reduced symptoms, and 40.2% of the patients (41/102) reported a reduction of at least 1 point on the PAC-QoL score. The mean PAC-QoL scores before and after NBT were 2.42 and 1.41, respectively (P = .001). Multivariate analysis demonstrated that increasing age (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.02-2.87; P = .042), greater number of sessions (OR, 4.14; 95% CI, 2.09-8.20; P < .001), and non-irrigation (OR, 4.39; 95% CI, 1.89-10.19; P = .001) were independent predictors of patient satisfaction.

CONCLUSIONS

Data collected immediately after patients with chronic constipation received NBT indicate that it is an effective treatment for most patients. Older patients with dyssynergic defecation benefit most from at least 4 sessions.

Patients' Experiences of Nurse-Led Screening for Cardiovascular Risk in Rheumatoid Arthritis

BACKGROUND

Patients with rheumatoid arthritis (RA) have increased morbidity and mortality due to cardiovascular disease (CVD). Screening for cardiovascular risk is recommended by the European League Against Rheumatism (EULAR). There is a lack of evidence of the experiences of RA patients who are screened for CVD. Such information is important in order to organize and further develop screening programmes for CVD in patients with RA. The aim of the present study was to explore RA patients' experiences of participation in nurse-led screening for CVD and to identify key issues for the future organization of screening programmes.

METHODS

Three qualitative focus group interviews were carried out with 14 outpatients diagnosed with RA. The participants were stratified into groups, depending on whether they had a low-to-moderate or high ten-year risk of cardiovascular death according to the European Systematic Coronary Risk Evaluation (SCORE) system. Data were analysed using meaning condensation to identify key themes.

RESULTS

Five themes were identified: reactions to receiving the invitation to the screening consultation; screening consultation adapted to needs and RA; duration reflected needs; screening consultation brought a sense of relief; and motivation and sense of control. Regardless of their CV risk, the participants found it important that the screening consultation was adapted to their needs and their illness as RA had a major impact on their daily life.

CONCLUSIONS

When planning future screening programmes for CVD for patients with RA, it is important that the screening consultation is individualized and tailored to patients' needs and their RA. Copyright © 2015 John Wiley & Sons, Ltd.

Evaluating the angina plan in patients admitted to hospital with angina: a randomized controlled trial

The aim of this trial was to evaluate the Angina Plan (AP), a cognitive-behavioral nurse-facilitated self-help intervention against standard care (SC). A randomized controlled trial of 218 patients hospitalized with angina assessed participants predischarge and 6 months later. Data were collected during a structured interview using validated questionnaires, self-report, and physiological measurement to assess between group changes in mood, knowledge and misconceptions, cardiovascular risk, symptoms, quality of life, and health service utilization. The intention-to-treat (ITT) analysis found no reliable effects on anxiety and depression at 6 months. AP participants reported increased knowledge, less misconceptions, reduced body mass index (BMI), an increase in self-reported exercise, less functional limitation, and improvements in general health perceptions and social and leisure activities compared to those receiving SC. Sensitivity analysis excluding participants with high baseline depression revealed a statistical significant reduction in depression levels in AP compared to the SC participants. Analysis excluding participants receiving cardiac surgery or angioplasty removed the ITT effects on physical limitation, self-reported exercise and general health perceptions and the improvements seen in social and leisure activities, while adaptive effects on knowledge, misconceptions and BMI remained and between-group changes in depression approached significance. Initiating the AP in a secondary care setting for patients with new and existing angina produces similar benefits to those reported in newly diagnosed primary care patients. Further evaluation is required to examine the extent of observed effects in the longer term.