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AnteayerJournal of Clinical Nursing

Design and content validation of a checklist about infection‐prevention performance of intensive care nurses in simulation‐based scenarios

Abstract

Objective

To design, develop and validate a new tool, called NEUMOBACT, to evaluate critical care nurses' knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention through simulation scenarios involving central venous catheter (CVC), endotracheal suctioning (ETS) and mechanically ventilated patient care (PC) stations.

Background

Simulation-based training is an excellent way for nurses to learn prevention measures in VAP and CRB.

Design

Descriptive metric study to develop NEUMOBACT and analyse its content and face validity that followed the COSMIN Study Design checklist for patient-reported outcome measurement instruments.

Methods

The first version was developed with the content of training modules in use at the time (NEUMOBACT-1). Delphi rounds were used to assess item relevance with experts in VAP and CRB prevention measures, resulting in NEUMOBACT-2. Experts in simulation methods then assessed feasibility, resulting in NEUMOBACT-3. Finally, a pilot test was conducted among 30 intensive care unit (ICU) nurses to assess the applicability of the evaluation tool in clinical practice.

Results

Seven national experts in VAP and CRB prevention and seven national simulation experts participated in the analysis to assess the relevance and feasibility of each item, respectively. After two Delphi rounds with infection experts, four Delphi rounds with simulation experts, and pilot testing with 30 ICU nurses, the NEUMOBACT-FINAL tool consisted of 17, 26 and 21 items, respectively, for CVC, ETS and PC.

Conclusion

NEUMOBACT-FINAL is useful and valid for assessing ICU nurses' knowledge and skills in VAP and CRB prevention, acquired through simulation.

Relevance for Clinical Practice

Our validated and clinically tested tool could facilitate the transfer of ICU nurses' knowledge and skills learning in VAP and CRB prevention to critically ill patients, decreasing infection rates and, therefore, improving patient safety.

Patient or Public Contribution

Experts participated in the Delphi rounds and nurses in the pilot test.

Patient safety in surgical settings: A study on the challenges and improvement strategies in adverse event reporting from a nursing perspective

Abstract

Aims

To explore adverse event reporting in the surgical department through the nurses' experiences and perspectives.

Design

An exploratory, descriptive qualitative study was conducted with a theoretical-methodological orientation of phenomenology.

Methods

In-depth interviews were conducted with 15 nurses, followed by an inductive thematic analysis.

Results

Themes include motives for reporting incidents, consequences, feelings and motivational factors. Key facilitators of adverse event reporting were effective communication, knowledge sharing, a non-punitive culture and superior feedback.

Conclusion

The study underscores the importance of supportive organisational culture for reporting, communication and feedback mechanisms, and highlights education and training in enhancing patient safety.

Implications

It suggests the need for strategies that foster incident reporting, enhance patient safety and cultivate a supportive organisational culture.

Impact

This study provides critical insights into adverse event reporting in surgical departments from nurses' lived experience, leading to two primary impacts: It offers specific solutions to improve adverse event reporting, which is crucial for surgical departments to develop more effective and tailored reporting strategies. The research underscores the importance of an open, supportive culture in healthcare, which is vital for transparent communication and effective reporting, ultimately advancing patient safety.

Reporting Method

The study followed the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research guidelines.

Patients or Public Contribution

No patients or public contribution.

Caregiving in the COVID‐19 pandemic: Family adaptations following an intensive care unit hospitalisation

Abstract

Aim and Objective

To identify how family caregivers adapt to the caregiving role following a relative's COVID-19-related intensive care unit (ICU) hospitalisation.

Background

Family caregiving is often associated with poor health amongst caregivers which may limit their capacity to effectively support patients. Though severe COVID-19 infection has necessitated increasing numbers of persons who require caregiver support, little is known about these caregivers, the persons they are caring for, or the strategies used to effectively adjust to the caregiving role.

Design

A qualitative descriptive study design was adopted, and findings are reported using COREQ.

Methods

A secondary analysis of transcripts from semi-structured interviews conducted with recently discharged ICU patients who had COVID-19 (n = 16) and their family caregivers (n = 16) was completed using thematic analysis. MAXQDA 2020 and Miro were used to organise data and complete coding. Analysis involved a structured process of open and closed coding to identify and confirm themes that elucidated adaptation to family caregiving.

Results

Six themes highlight how family caregivers adapt to the caregiving role following an ICU COVID-19-related hospitalisation including (1) engaging the support of family and friends, (2) increased responsibilities to accommodate caregiving, (3) managing emotions, (4) managing infection control, (5) addressing patient independence and (6) engaging support services. These themes were found to be congruent with the Roy adaptation model.

Conclusions

Family caregiving is a stressful transition following a patient's acute hospitalisation. Effective adaptation requires flexibility and sufficient support, beginning with the care team who can adequately prepare the family for the anticipated challenges of recovery.

Relevance to Clinical Practice

Clinical teams may improve post-hospitalisation care outcomes of patients by preparing families to effectively adjust to the caregiver role—particularly in identifying sufficient support resources.

Patient or Public Contribution

Participation of patients/caregivers in this study was limited to the data provided through participant interviews.

Experiences of improvement of everyday life following a rehabilitation programme for people with long‐term cognitive effects of COVID‐19: Qualitative study

Abstract

Aim and Objectives

To explore challenges in everyday life for people with long-term cognitive effects of COVID-19 and whether a rehabilitation programme contributed to the remedy thereof.

Background

Healthcare systems around the world need knowledge about acute COVID-19 treatment, long-term effects exerting an impact on peoples' everyday lives, and how to remedy these.

Design

This is a qualitative study with a phenomenological approach.

Methods

Twelve people with long-term cognitive effects of COVID-19 participated in a multidisciplinary rehabilitation programme. Individual semi-structured interviews were made. Data were analysed thematically.

Results

Three themes and eight sub-themes emerged with respect to everyday life challenges and experiences of the rehabilitation programme. The themes were (1) Personal insight and knowledge, (2) Changed daily routines at home and (3) Coping with working life.

Conclusion

Participants experienced long-term effects of COVID-19 as cognitive challenges, fatigue and headaches, which affected their everyday lives, that is inability to overcome daily tasks at home and at work, maintaining family roles and relations with relatives. The rehabilitation programme contributed to a vocabulary and insights related to the long-term effects of COVID-19 and the experience of being a different person. The programme contributed to changes in daily routines, organising breaks in everyday life and explaining challenges to family/relatives and the way in which they affected daily routines and their role in the family. In addition, the programme supported several of the participants in finding the right workload and working hours.

Relevance to Clinical Practice

We recommend multidisciplinary rehabilitation programmes inspired by cognitive remediation of long-term COVID-19 cognitive effects. Municipalities and organisations could collaborate in the development and completion of such programmes, possibly comprising both virtual and physical elements. This could facilitate access and reduce costs.

Patient or Public Contribution

Patients contributed to the conduct of the study by participating in the data collection via interviews.

Clinical Trial Registration Number

Data collection and processing of data are approved by the Region of Southern Denmark (journal number: 20/46585).

Factors influencing fatigue in UK nurses working in respiratory clinical areas during the second wave of the Covid‐19 pandemic: An online survey

Abstract

Aims and objectives

This study explores UK nurses' experiences of working in a respiratory clinical area during the COVID-19 pandemic over winter 2020.

Background

During the first wave of the pandemic, nurses working in respiratory clinical areas experienced significant levels of anxiety and depression. As the pandemic has progressed, levels of fatigue in nurses have not been assessed.

Methods

A cross-sectional e-survey was distributed via professional respiratory societies and social media. The survey included Generalised Anxiety Disorder Assessment (GAD7), Patient Health Questionnaire (PHQ9, depression), a resilience scale (RS-14) and Chalder mental and physical fatigue tools. The STROBE checklist was followed as guidance to write the manuscript.

Results

Despite reporting anxiety and depression, few nurses reported having time off work with stress, most were maintaining training and felt prepared for COVID challenges in their current role. Nurses reported concerns over safety and patient feedback was both positive and negative. A quarter of respondents reported wanting to leave nursing. Nurses experiencing greater physical fatigue reported higher levels of anxiety and depression.

Conclusions

Nurses working in respiratory clinical areas were closely involved in caring for COVID-19 patients. Nurses continued to experience similar levels of anxiety and depression to those found in the first wave and reported symptoms of fatigue (physical and mental). A significant proportion of respondents reported considering leaving nursing. Retention of nurses is vital to ensure the safe functioning of already overstretched health services. Nurses would benefit from regular mental health check-ups to ensure they are fit to practice and receive the support they need to work effectively.

Relevance to clinical practice

A high proportion of nurses working in respiratory clinical areas have been identified as experiencing fatigue in addition to continued levels of anxiety, depression over winter 2020. Interventions need to be implemented to help provide mental health support and improve workplace conditions to minimise PTSD and burnout.

Factors associated with satisfaction and depressed mood among nursing home workers during the covid‐19 pandemic

Abstract

Aims and Objectives

This paper aims to examine the satisfaction and depressed mood experienced by nursing home workers during the COVID-19 pandemic and associated variables. Specifically, to analyse the factors that may contribute to nursing home workers developing adaptive behaviours that promote satisfaction or, on the contrary, show characteristics associated with a negative mood.

Background

Nursing homes have faced unprecedented pressures to provide appropriately skills to meet the demands of the coronavirus outbreak.

Design

A cross-sectional survey design using the STROBE checklist.

Methods

Professionals working in nursing homes (n = 165) completed an online survey measuring sociodemographic and professional characteristics, burnout, resilience, experiential avoidance, satisfaction with life and depression. Data were collected online from April to July 2021, the time in which Spain was experiencing its fifth wave of COVID-19. Two multiple linear regression models were performed to identify salient variables associated with depressive mood and satisfaction.

Results

Resilience, personal accomplishment and satisfaction had a significant and negative relationship with depression and emotional exhaustion, depersonalisation and experiential avoidance had a positive relationship with depression. However, emotional exhaustion, depersonalisation and experiential avoidance had a negative and significant relationship with satisfaction and personal accomplishment, and resilience had a positive and significant relationship with satisfaction. In addition, it was found that accepting thoughts and emotions when they occur is beneficial for developing positive outcomes such as satisfaction.

Conclusions

Experiential avoidance was an important predictor of the effects that the COVID-19 pandemic can have on nursing home workers.

Relevance to Clinical Practice

Interventions focusing on resources that represent personal strengths, such as acceptance, resilience and personal accomplishment, should be developed.

No Patient or Public Contribution

The complex and unpredictable circumstances of COVID's strict confinement in the nursing home prohibited access to the centres for external personnel and family members. Contact with the professionals involved could not be made in person but exclusively through online systems. However, professionals related to the work environment have subsequently valued this research positively as it analyses ‘How they felt during this complicated process’.

Perceived quality of life and associated factors in long COVID syndrome among older Brazilians: A cross‐sectional study

Abstract

Aims and objectives

This paper aims to: (a) determine the personal, sociodemographic, clinical, behavioural, and social characteristics of older Brazilians with clinical evidence of long COVID; (b) evaluate perceived quality of life and determine its association with personal, sociodemographic, behavioural, clinical and social variables; and (c) assess significant predictors of high perceived QoL.

Background

Given the inherent vulnerabilities of the ageing process, the older people are an at-risk group for both contagion of SARS-CoV-2 and the perpetuation of residual symptoms after infection, the so-called long COVID or post-COVID syndrome.

Design

A cross-sectional survey design using the STROBE checklist.

Methods

Brazilian older people with long COVID syndrome (n = 403) completed a phone survey measuring personal, sociodemographic, behavioural, clinical, and social characteristics, and perceived Quality of Life (QoL). Data were collected from June 2021–March 2022. A multiple linear regression model was performed to identify salient variables associated with high perceived QoL.

Results

The mean age of participants was 67.7 ± 6.6 years old. The results of the multivariate regression model showed that race, home ownership, daily screen time, musculoskeletal and anxiety symptoms, and work situation were the significant predictors of QoL among COVID-19 survivors.

Conclusions

Knowledge about the persistence of physical, emotional, and social symptoms of COVID-19 can help nurses and other healthcare providers to improve the management of survivors, bringing benefits to the whole society.

Relevance to clinical practice

Given the novelty of long-COVID and its heterogeneous trajectory, interventions focusing on the repercussions and requirements unique to more vulnerable older persons should be developed and these aspects should be included in public health recommendations and policymakers' concerns.

Patient or Public Contribution

No patient or public contribution was required to design, to outcome measures or undertake this research. Patients/members of the public contributed only to the data collection.

Family members' experiences of COVID‐19 visiting restrictions in the intensive care unit—A qualitative study

Abstract

Objective

To describe how family members of critically ill patients experienced the COVID-19 visiting restrictions in Sweden.

Background

In Sweden, the response to COVID-19 was less invasive than in many other countries. However, some visiting restrictions were introduced for intensive care units, with local variations. Although there is a growing body of literature regarding healthcare professionals' and family caregivers' perspectives on visiting restriction policies, there may be inter-country differences, which remain to be elucidated.

Design

This study has a qualitative descriptive design. Focus group interviews with 14 family members of patients treated for severe COVID-19 infection were conducted. The interviews took place via digital meetings during the months after the patients' hospital discharge. Qualitative content analysis was used to interpret the interview transcripts. Reporting of the study followed the COREQ checklist.

Results

Two categories—dealing with uncertainty and being involved at a distance—described family members' experiences of coping with visiting restrictions during the COVID-19 pandemic. These restrictions were found to reduce family members' ability to cope with the situation. Communication via telephone or video calls to maintain contact was appreciated but could not replace the importance of personal contact.

Conclusions

Family members perceived that the visiting restriction routines in place during the COVID-19 pandemic negatively influenced their ability to cope with the situation and to achieve realistic expectations of the patients' needs when they returned home.

Relevance to Clinical Practice

This study suggests that, during the COVID-19 pandemic, the visiting restrictions were experienced negatively by family members and specific family-centred care guidelines need to be developed for use during crises, including the possibility of regular family visits to the ICU.

Patient and Public Contribution

None in the conceptualisation or design of the study.

A mixed methods study: The grief experience of registered nurses working on the frontlines during the COVID‐19 pandemic

Abstract

Aim and Objective

The purpose of this study was to generate a conceptual definition and theory of grief for nurses working on the frontlines during the COVID-19 pandemic using grounded theory methodology.

Background

The COVID-19 pandemic has had a negative impact on nurses working on the frontlines. The increasing flow of diagnosed COVID-19 cases, diverse unknowns and demands in the treatment of patients with COVID-19, and depression related to countless deaths can trigger grief experiences.

Design

A mixed methods approach, including the qualitative method of grounded theory and a quantitative 30-question survey, was used in this study.

Methods

Eight focus group sessions were conducted with registered nurses working on the frontlines during the pandemic. Sessions were audio recorded and analysed using constant comparative data analysis. Following the interviews, a survey including demographics and self-report inventories was completed by participants. The COREQ checklist was used to assess study quality.

Results

Major concepts that emerged include ‘facing a new reality’, ‘frustrations’, ‘stress’ and ‘coping’. Core concepts were combined into a conceptual definition of grief and a grounded theory of the experience of nurses working on the frontlines during the pandemic. Cross comparisons of qualitative and quantitative findings were made and compared with the literature.

Conclusions

This study provides a better understanding of the grief experience of nurses working on the frontlines during the COVID-19 pandemic. It is necessary to recognise professional grief and develop intervention strategies that lead to grief reconciliation.

Relevance to Clinical Practice

Findings provide useful insights for healthcare administrators to provide support and develop interventions to reduce frustrations and stress of frontline registered nurses.

Patient or Public Contribution

This study design involved registered nurses participating in focus group sessions. Participants detailed their experience working on the frontlines of the COVID-19 pandemic with patients, family and hospital administration.

Predictors of professional burnout and fulfilment in a longitudinal analysis on nurses and healthcare workers in the COVID‐19 pandemic

Abstract

Aims and objectives

(1) To investigate the vulnerability of nurses to experiencing professional burnout and low fulfilment across 5 months of the COVID-19 pandemic. (2) To identify modifiable variables in hospital leadership and individual vulnerabilities that may mitigate these effects.

Background

Nurses were at increased risk for burnout and low fulfilment prior to the COVID-19 pandemic. Hospital leadership factors such as organisational structure and open communication and consideration of employee opinions are known to have positive impacts on work attitudes. Personal risk factors for burnout include symptoms of depression and anxiety.

Methods

Healthcare workers (n = 406 at baseline, n = 234 longitudinal), including doctors (n = 102), nurses (n = 94), technicians (n = 90) and non-clinical administrative staff (n = 120), completed 5 online questionnaires, once per month, for 5 months. Participants completed self-report questionnaires on professional fulfilment and burnout, perceptions of healthcare leadership, and symptoms of anxiety and depression. Participants were recruited from various healthcare settings in the southeastern United States. The STROBE checklist was used to report the present study.

Results

Both at baseline and across the 5 months, nurses working during the COVID-19 pandemic reported increased burnout and decreased fulfilment relative to doctors. For all participants, burnout remained largely steady and fulfilment decreased slightly. The strongest predictors of both burnout and fulfilment were organisational structure and depressive symptoms. Leadership consideration and anxiety symptoms had smaller, yet significant, relationships to burnout and fulfilment in longitudinal analyses.

Conclusions

Burnout and reduced fulfilment remain a problem for healthcare workers, especially nurses. Leadership styles and employee symptoms of depression and anxiety are appropriate targets for intervention.

Relevance to clinical practice

Leadership wishing to reduce burnout and increase fulfilment among employees should increase levels of organisational support and consideration and expand supports to employees seeking treatment for depression and anxiety.

The important factors nurses consider when choosing shift patterns: A cross‐sectional study

Abstract

Aim

To gain a deeper understanding of what is important to nurses when thinking about shift patterns and the organisation of working time.

Design

A cross-sectional survey of nursing staff working across the UK and Ireland collected quantitative and qualitative responses.

Methods

We recruited from two National Health Service Trusts and through an open call via trade union membership, online/print nursing profession magazines and social media. Worked versus preferred shift length/pattern, satisfaction and choice over shift patterns and nurses' views on aspects related to work and life (when working short, long, rotating shifts) were analysed with comparisons of proportions of agreement and crosstabulation. Qualitative responses on important factors related to shift preferences were analysed with inductive thematic analysis.

Results

Eight hundred and seventy-three survey responses were collected. When nurses worked long shifts and rotating shifts, lower proportions reported being satisfied with their shifts and working their preferred shift length and pattern. Limited advantages were realised when comparing different shift types; however, respondents more frequently associated ‘low travel costs’ and ‘better ability to do paid overtime’ with long shifts and ‘healthy diet/exercise’ with short shifts; aspects related to rotating shifts often had the lowest proportions of agreement. In the qualitative analysis, three themes were developed: ‘When I want to work’, ‘Impacts to my life outside work’ and ‘Improving my work environment’. Reasons for nurses' shift preferences were frequently related to nurses' priorities outside of work, highlighting the importance of organising schedules that support a good work-life balance.

Relevance to Clinical Practice

General scheduling practices like adhering to existing shift work guidelines, using consistent and predictable shift patterns and facilitating flexibility over working time were identified by nurses as enablers for their preferences and priorities. These practices warrant meaningful consideration when establishing safe and efficient nurse rosters.

Patient or Public Contribution

This survey was developed and tested with a diverse group of stakeholders, including nursing staff, patients, union leads and ward managers.

Reporting Method

The Strengthening the Reporting of Observational Studies (STROBE) checklist for cross-sectional studies was used to guide reporting.

Leadership practices that enable healthful cultures in clinical practice: A realist evaluation

Abstract

Aim

To generate, test and refine programme theories that emerged from a rapid realist review investigating practising UK Nurses' and Midwives' experiences of effective leadership strategies during the COVID-19 pandemic.

Background

The realist review of literature generated six tentative theories of healthful leadership practices reflecting, working with people's beliefs and values; being facilitative; multiple means of communication and; practical support. The review yielded little insight into the actual impact of the leadership approaches advocated.

Methods

A realist study, informed by person-centredness using mixed-methods. Online survey (n = 328) and semi-structured interviews (n = 14) of nurses and midwives across the UK in different career positions/specialities. Quantitative data analysed using descriptive statistics and exploratory factor analysis. Framework analysis for qualitative data using context (C), mechanism (M), outcome (O) configurations of the tentative theories.

Results

Three refined theories were identified concerning: Visibility and availability; embodying values and; knowing self. Healthful leadership practices are only achievable within organisational cultures that privilege well-being.

Conclusions

Leaders should intentionally adopt practices that promote well-being. ‘Knowing self’ as a leader, coaching and mentoring practice development is important for leadership development.

Implications for Clinical Practice

Nurses who feel valued, heard, cared for and safe are more likely to remain in clinical practice. Job satisfaction and being motivated to practice with confidence and competence will impact positively on patient outcomes.

Impact

The study addresses the role of leadership in developing healthful workplace cultures. The main findings were six leadership practices that promote healthful cultures. The research will have an impact on strategic and clinical leaders, nurses and midwives.

Reporting Method

This study used EQUATOR checklist, RAMASES II as reporting standards for realist evaluations.

Patient or Public Contribution

No patient or public contribution.

Older adults' lived experiences of physical rehabilitation for acquired brain injury and their perceptions of well‐being: A qualitative phenomenological study

Abstract

Aim

To explore the experiences of older adults (65+) living with acquired brain injury regarding their sense of well-being during physical rehabilitation within the Greek Healthcare System.

Background

With the increasing ageing population and the life-changing effects of acquired brain injury, there is a need to focus on care for older people and their potential to live well. Rehabilitation systems deserve greater attention, especially in improving the well-being of those who are using them.

Design

A qualitative study design with a hermeneutic phenomenological approach was used.

Methods

Fourteen older adults living with acquired brain injury and undergoing physical rehabilitation in Greece were purposively sampled. Semi-structured interviews were conducted to collect data and were thematically analysed using van Manen's and Clarke and Braun's methods. The COREQ checklist was followed.

Results

Four themes emerged from the analysis: (1) Challenges of new life situation, (2) Seeking emotional and practical support through social interaction, (3) Identifying contextual processes of rehabilitation, (4) Realising the new self.

Conclusions

The subjective experiences, intersubjective relations and contextual conditions influence the sense of well-being among older adults living with acquired brain injury, thus impacting the realisation of their new self. The study makes the notion of well-being a more tangible concept by relating it to the degree of adaptation to the new situation and the potential for older adults to create a future whilst living with acquired brain injury.

Relevance for Clinical Practice

Identifying the factors that impact older adults' sense of well-being during rehabilitation can guide healthcare professionals in enhancing the quality of care offered and providing more dignified and humanising care.

Patient or Public Contribution

Older adults living with acquired brain injury were involved in the study as participants providing the research data.

Clinical deterioration as a nurse sensitive indicator in the out‐of‐hospital context: A scoping review

Abstract

Aims

To explore and summarise the literature on the concept of ‘clinical deterioration’ as a nurse-sensitive indicator of quality of care in the out-of-hospital context.

Design

The scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review and the JBI best practice guidelines for scoping reviews.

Methods

Studies focusing on clinical deterioration, errors of omission, nurse sensitive indicators and the quality of nursing and midwifery care for all categories of registered, enrolled, or licensed practice nurses and midwives in the out-of-hospital context were included regardless of methodology. Text and opinion papers were also considered. Study protocols were excluded.

Data Sources

Data bases were searched from inception to June 2022 and included CINAHL, PsychINFO, MEDLINE, The Allied and Complementary Medicine Database, EmCare, Maternity and Infant Care Database, Australian Indigenous HealthInfoNet, Informit Health and Society Database, JSTOR, Nursing and Allied Health Database, RURAL, Cochrane Library and Joanna Briggs Institute.

Results

Thirty-four studies were included. Workloads, education and training opportunities, access to technology, home visits, clinical assessments and use of screening tools or guidelines impacted the ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting.

Conclusions

Little is known about the work of nurses or midwives in out-of-hospital settings and their recognition, reaction to and relay of information about patient deterioration. The complex and subtle nature of non-acute deterioration creates challenges in defining and subsequently evaluating the role and impact of nurses in these settings.

Implications for the profession and/or patient care

Further research is needed to clarify outcome measures and nurse contribution to the care of the deteriorating patient in the out-of-hospital setting to reduce the rate of avoidable hospitalisation and articulate the contribution of nurses and midwives to patient care.

Impact

What Problem Did the Study Address?

Factors that impact a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting are not examined to date.

What Were the Main Findings?

A range of factors were identified that impacted a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting including workloads, education and training opportunities, access to technology, home visits, clinical assessments, use of screening tools or guidelines, and avoidable hospitalisation.

Where and on whom will the research have an impact?

Nurses and nursing management will benefit from understanding the factors that act as barriers and facilitators for effective recognition of, and responding to, a deteriorating patient in the out-of-hospital setting. This in turn will impact patient survival and satisfaction.

Reporting Method

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines guided this review. The PRISMA-Scr Checklist (Tricco et al., 2018) is included as (supplementary file 1).Data sharing is not applicable to this article as no new data were created or analysed in this study.”

No Patient or Public Contribution

Not required as the Scoping Review used publicly available information.

Needs, barriers and facilitators for a healthier lifestyle in haemodialysis patients: The GoodRENal project

Abstract

Background

Malnutrition, sedentary lifestyle, cognitive dysfunction and poor psychological well-being are often reported in patients on haemodialysis (HD).

Aims

We aimed to explore needs, barriers and facilitators—as perceived by patients, their carers, and healthcare professionals (HCPs) for increasing the adherence to the diet, to physical activity and cognition and psychological well-being.

Methods

This is an observational cross-sectional study following the STROBE statement. This study is part of an ERASMUS+ project, GoodRENal—aiming to develop digital tools as an educational approach to patients on HD. For that, the GoodRENal comprises HD centers located in four Belgium, Greece, Spain and Sweden. Exploratory questionnaires were developed regarding the perceived needs, barriers and facilitators regarding the diet, physical activity, cognition and psychological well-being from the perspective of patients, their carers and HCPs.

Results

In total, 38 patients, 34 carers and 38 HCPs were included. Nutrition: For patients and carers, the main needs to adhere to the diet included learning more about nutrients and minerals. For patients, the main barrier was not being able to eat what they like. Physical activity: As needs it was reported information about type of appropriate physical activity, while fatigue was listed as the main barrier. For Cognitive and emotional state, it was perceived as positive for patients and carers perception but not for HCPs. The HCPs identified as needs working as a team, having access to specialised HCP and being able to talk to patients in private.

Conclusions

Patients and their carers listed as needs guidance regarding nutrition and physical activity but were positive with their cognitive and emotional state. The HCPs corroborated these needs and emphasised the importance of teamwork and expert support.

Patients' and caregivers' perceptions of the quality of hospital‐at‐home service: A scoping review

Abstract

Aim

This scoping review aims to provide an overview of patients and caregivers perceptions of hospital-at-home (HaH) services.

Background

HaH services provide patients with hospital-level care at home and are central to integrated healthcare systems. Despite favourable data from individual studies in the literature, in-depth analysis from patient and caregivers perspectives is lacking. This understanding is essential for the dissemination and scaling of HaH services.

Design

The scoping review was performed using the PRISMA-ScR checklist and PAGER framework for the findings report and research recommendations.

Method

Literature from PubMed, Web of Science, Ovid, CINAHL, Cochrane and Mednar databases were searched. Relevant studies published between 1st January 2005 and 31st December 2022 were identified. The conceptual model of the development of patient perceptions of quality was used for data extraction and tabulation.

Results

The review included 24 articles. Expectation attributions were identified as needs, types of service, hospitalisation experiences, family care preferences, social-demographics and coping skills. From patient's and caregiver's perspectives, HaH was safe, effective and viewed positively. Perceived concerns/barriers and enablers/facilitators were associated with individual, caregiver and system factors, but demonstrated an overall satisfaction in the HaH service.

Conclusion

HaH provides an excellent service according to patients' and caregivers' perceptions. However, gaps in care were identified such as prioritising patient-centred care, along with improved multidisciplinary continuity of care and future studies should incorporate these into their research of HaH.

Relevance to Clinical Practice

Patients' and caregivers' HaH needs should be embedded in the design, development and implementation of HaH services.

Patient and Public Contribution

Not applicable for the study design of this scoping review.

Changes in the diagnosis of depression among nursing professionals during the COVID‐19 pandemic: A longitudinal study

Abstract

Aims

To identify changes in mental health status among nursing professionals in a Brazilian municipality during the COVID-19 pandemic.

Design

An observational and longitudinal study.

Methods

Using the Patient Health Questionnaire-9, the presence of depressive symptoms was evaluated among 690 nursing professionals in the city of Pelotas, Brazil, at two moments: June/July 2020 and June/July 2021.

Results

13.0% incidence of depressive symptoms was identified; as well as 12.2% remission; 24.1% persistence and 50.7% absence. Among the factors associated with the worst prognoses we can mention female gender, greater workload, feeling of overload, illness of family members or friends due to COVID-19 and use of psychotropic drugs

Conclusions

There was significant mobility in the diagnosis of depression among the professionals studied during the period analysed, with incidence of new cases of significant depression and greater than the number of remissions. In addition to sociodemographic aspects, traumatic experiences and exposure to continuous overload were associated with persistence and incidence of new cases.

Implications for the profession and/or patient care

With the advent of the COVID-19 pandemic, several studies have shown an increase in depressive symptoms among nursing professionals; however, understanding the long-term effects of this scenario is still a challenge.

Impact

What problem did the study address? This study investigates changes in the mental health status of nursing professionals working at different care levels, taking the prevalence of screening for depression as a proxy, during a period of a year during the COVID-19 pandemic.

What were the main findings? Between both data collection moments, 2020 e 2021, there was a significant percentage of professionals with persistent depression, in addition to a significant proportion of incident cases that slightly exceeded the number of remissions and the factors associated with the worst prognoses were sociodemographic aspects such as gender and emotional stressors like illness of family members or close friends due to COVID-19, in addition to those related to the organisation and support provided by the services, such as workload and feeling of overload.

Where and on whom will the research have an impact? This study will impact the nursing professionals and in role of the health services in order to establishing actions that contribute to minimising the deleterious effects of the pandemic on the mental health of their Nursing teams.

Reporting method

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study.

Patient or public contribution

No Patient or Public Contribution.

Investigation of social support as a mediator of the relationship between physical and psychological health among hospitalised patients

Abstract

Aim

To investigate the self-reported levels of social support from friends and family and from nurses as mediators of the relationship between self-rated physical and psychological condition in hospitalised patients.

Design

Cross-sectional study of adult inpatients at a large tertiary-care hospital in the northeast United States.

Methods

Multiple mediation analysis of survey data.

Results

In surveys received from 324 inpatients, one fourth of the variation in patients' self-rated psychological condition was explained by self-rated physical condition. Social support from family and friends mediated a significant proportion (11.0%) of the relationship between self-rated physical and psychological condition, however social support from nurses did not.

Conclusion

Social support from family and friends can positively influence the psychological health of inpatients, but nurses are not an adequate replacement for the social support provided by family and friends.

Implications for Nursing

Although nurses cannot replace the social support provided by family and friends, the assessment of social isolation and care planning of interventions to support patients is a fundamental nursing role. Technology to connect patients with friends and family should be used to mitigate isolation for hospitalised patients unable to receive in-person visits from loved ones.

Impact

The influence of social support from family and friends and nurses was addressed. The study found social support from family and friends, but not nurses, to influence the relationship between physical and psychological ratings. This finding has implications for the role of nurses in the hospital setting.

Reporting Method

Strengthening the Reporting of Observational Studies in Epidemiology guidelines were followed.

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