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AnteayerEvidence-Based Nursing

Time to treat the climate and nature crisis as one indivisible global health emergency

Over 200 health journals call on the United Nations (UN), political leaders and health professionals to recognise that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe. This overall environmental crisis is now so severe as to be a global health emergency.

The world is currently responding to the climate crisis and the nature crisis as if they were separate challenges. This is a dangerous mistake. The 28th Conference of the Parties (COP) on climate change is about to be held in Dubai while the 16th COP on biodiversity is due to be held in Turkey in 2024. The research communities that provide the evidence for the two COPs are unfortunately largely separate, but they were brought together for a workshop in 2020 when they concluded that: ‘Only by considering climate and biodiversity as parts of the same...

Evidence-informed and community-based strategies are essential to developing affordable and accessible technology-based interventions to prevent social isolation among older adults and promote their well-being and quality of life

Por: Ghassemi · A. E.

Commentary on: Umoh ME, Prichett L, Boyd CM, Cudjoe TKM. Impact of technology on social isolation: Longitudinal analysis from the National Health Aging Trends Study. J Am Geriatr Soc. 2023 Apr;71(4):1117–1123. doi: 10.1111/jgs.18179. Epub 2022 Dec 15.

Implications for practice and research

  • Developing and implementing targeted and integrated community-based interventions that supports steady assessment of technology access and use are required to diminish social isolation among seniors and enhance their overall quality of life.

  • Future research should focus on assessing the efficacy of technology-based interventions and advancing digital technologies to reduce social isolation among older adults.

  • Context

    Social isolation is a fundamental public health problem, and it has significant negative effect on the healthcare system along with surge in ageing population.1–3 Furthermore, social isolation is linked with increased mortality rate, cognitive and functional decline among older adults.

    It is time for healthcare professionals to engage with social media

    Por: Hundley · V. · Marsh · A.

    Commentary on: Chee RM, Capper TS, Muurlink OT. The impact of social media influencers on pregnancy, birth, and early parenting experiences: A systematic review. Midwifery. 2023 May;120:103623. doi: 10.1016/j.midw.2023.103623. Epub 2023 Feb 19.

    Implications for practice and research

  • Social media is one of the fastest growing commercial determinants of health.

  • Healthcare professionals need a better understanding of social media and its impact.

  • Context

    Social media has rapidly become a key source of advice and support for women during childbirth. The growth of influencers, popular users credited with knowledge and expertise, can be seen in the numerous social posts, blogs, podcasts and videos about pregnancy, birth and parenting. Social media influencers provide responsive and relatable content to their network of followers; but there are concerns about the potential to spread misinformation.1

    Methods

    This systematic literature review2 sought to identify...

    Preoperative functional performance is the best predictor for loss of independence after major surgery among older adults

    Por: Johnson · C. E. · Brooke · B. S.

    Commentary on: Goeddel L, Murphy Z, Owodunni O, et al. Domains of Frailty Predict Loss of Independence in Older Adults after Non-Cardiac Surgery. Ann Surg. 2022 Sep 20. doi: 10.1097/SLA.0000000000005720. Epub ahead of print.

    Implications for practice and research

  • Frailty screening with the Edmonton Frailty Scale can be used to identify risk factors for loss of independence after surgery, including a patient’s functional performance, functional dependence, social support and urinary incontinence.

  • Prospective studies are needed to test whether risk factors can be modified before surgery to prevent loss of independence among frail patients.

  • Context

    Frailty is a common syndrome of physiological decline among older adults characterised by vulnerability to adverse outcomes and loss of functional independence after major surgery.1 The study by Goeddel et al2 examined 11 geriatric domains associated with frailty that were collected before surgery using the Edmonton...

    Diffusion of paediatric long-term ventilation as a reflection of changing clinical scenarios and practice

    Por: Meggiolaro · L. · Trevisanuto · D.

    Commentary on: Barker N, Sinha A, Jesson C, Doctor T, Narayan O, Elphick HE. Changes in UK paediatric long-term ventilation practice over 10 years. Arch Dis Child. 2023 Mar;108(3):218-224. doi: 10.1136/archdischild-2021-323562. Epub 2022 Nov 29.

    Implications for practice and research

  • Up-to-date information on the use of long-term ventilation (LTV) in the UK paediatric population helps LTV centres to plan services and support healthcare needs.

  • The future development of a national LTV children database could advise clinical guidelines and assist resource allocation planning.

  • Context

    LTV consists in the delivery of respiratory support provided on a daily basis for a minimum period of 3 months through various mechanical interventions.1 LTV, particularly long-term non-invasive ventilation (NIV), is an increasing practice in children as there has been evidence of improving survival and quality of life in several clinical scenarios characterised by respiratory failure. Moreover, it is...

    Understanding staff perceptions on adolescent seclusions

    Por: Vidal · C. · Reynolds · E. K.

    Commentary on: Yurtbasi MK, Melvin G, Pavlou C, Gordon M. Staff perspectives on the effects of seclusion in adolescent psychiatric inpatient care. Int J Ment Health Nurs. 2023 Apr;32(2):567–578. doi: 10.1111/inm.13102. Epub 2022 Dec 15.

    Implications for clinical practice and research

  • Nursing staff find adolescent seclusions necessary but also experience related guilt and self-doubt.

  • Seclusion protocols in adolescent psychiatric units should include alternatives to seclusion and debriefing processes.

  • Context

    Seclusions cause distress in patients and lead to negative outcomes, including death. Growing research demonstrates that seclusion rates vary by age, sex, race, diagnosis and personal history of adverse events.1 In fact, seclusion rates among youth are higher than among adults. While research involving staff in adult inpatient psychiatric units demonstrates that staff and patients experience negative reactions,2 more specific research is needed related to staff in adolescent inpatient units, given...

    Enhancing behavioural support through telehealth for family carers and professionals

    Por: Leyser · M.

    Commentary on: Tomlinson SRL, Gore N, McGill P. Family carer and professional perceptions of the potential use of telehealth for behavioural support. J Intellect Disabil Res. 2023;67:531–46. doi: 10.1111/jir.13026.

    Implications for practice and research

  • Telehealth is valuable for behavioural support, especially for family carers facing challenges in accessing in-person services.

  • Healthcare professionals need training to effectively use telehealth platforms for behavioural interventions.

  • Further research is required to explore diverse populations’ perspectives and experiences and evaluate technical barriers, long-term effectiveness and cost-effectiveness of telehealth for behavioural support.

  • Context

    Tomlinson et al1 explored the use of telehealth for behavioural support in individuals with intellectual and developmental disabilities (IDD). They examined the perspectives of family carers and professionals on this approach, considering the need for accessible interventions and the impact of the COVID-19 pandemic.2 3 Telehealth, using digital communication technologies...

    Nurse identity: the misrepresentation of nursing in the media

    Por: Garcia · R. · Qureshi · I.

    Since 2019, the nursing profession has been frequently represented in mainstream media in the UK through the lenses of the COVID-19 pandemic and more recently, industrial action. In 2020, during COVID, we saw the nursing profession praised, with weekly neighbourhood applause and thanks to the National Health Service (NHS) staff schemes. In 2023, when, for the first time in history nurses voted to strike (fair pay for nursing), nurses again received media attention. Conversely, the media chose to report how striking nurses (and other health professional staff) contributed to long waiting lists in the NHS and unhelpfully, demonstrated how 64% of poll voters (n=7955) did not think nurses should have a better pay deal.1 The reality is that nursing is central to the delivery of quality, evidence-based, and person-centred care in our health sector in the UK and represents the largest clinical professional group with approximately 334 690...

    Induction, deduction and abduction

    Por: Barrett · D. · Younas · A.

    Researchers often refer to the type of ‘reasoning’ that they have used to support their analysis and reach conclusions within their study. For example, Krick and colleagues completed a study that supported the development of an outcome framework for measuring the effectiveness of digital nursing technologies.1 They reported completing the analysis through combining ‘an inductive and deductive approach’ (p1), but what do these terms mean? How can these methods of reasoning support nursing practice, and guide the development and appraisal of research evidence?

    This article will explore inductive and deductive reasoning and their place in nursing research. We will also explore a third approach to reasoning—abductive reasoning—which is arguably less well-known than induction and deduction, but just as prevalent and important in nursing practice and nursing research.

    Inductive reasoning

    Induction, or inductive reasoning, involves the identification of cues and the collection of data to develop general...

    Minimum Unit Pricing in Scotland 32 months on: evidence demonstrates a significant reduction in alcohol related deaths

    Por: Avades · T. · Dhanda · A.

    Commentary on: Wyper GMA, Mackay DF, Fraser C, Lewsey J, Robinson M, Beeston C, Giles L. Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study. Lancet. 2023 Apr 22;401(10385):1361-1370. doi: 10.1016/S0140-6736(23)00497-X. Epub 2023 Mar 20.

    Implications for practice and research

  • Data will inform the decision of the Scottish Parliament whether to keep the minimum unit pricing (MUP) policy, which expires on 30 April 2024.

  • Further study is needed exploring the enduring effects of MUP on chronic alcohol conditions, including alcohol-related cancer deaths.

  • Context

    In 2021, the rate of alcohol-related deaths in the UK increased by 7.4% from 2020 (14.8/100 000), with the highest rate (22.4/100 000) in Scotland.1 There are inequalities in those affected by alcohol with more admissions and deaths in males and people from lower socioeconomic groups.

    MUP is...

    Home fall hazard assessments effective in high-risk fallers but more information needed on effects of assistive technologies

    Por: Sharma · Y. · Iaboni · A.

    Commentary on: Clemson L, Stark S, Pighills AC, Fairhall NJ, Lamb SE, Ali J, Sherrington C. Environmental interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2023 Mar 10;3(3):CD013258. doi: 10.1002/14651858.CD013258.pub2

    Implications for practice and research

  • Home fall hazard assessments are shown to be effective in fall prevention among community-dwelling older adults at higher risk of falls. Future work should investigate the feasibility of implementing these interventions in practice settings.

  • It is uncertain whether assistive technologies can prevent falls in community-dwelling older adults, thus further research is needed.

  • Context

    Nearly 30% of older adults aged 65 years and older fall each year.1 While falls are multifactorial and include both intrinsic and environmental factors, ‘accidental’ falls, such as trips and slips related to environmental hazards, are very common reasons provided for a fall.2 Identifying effective...

    Vigorous exercise in pragmatic settings leads to antidepressive, metabolic and cardiovascular health benefits in adult outpatients with major depression or anxiety disorders

    Por: Morres · I. D. · Metsios · G. S.

    Commentary on: Verhoeven JE, Han LKM, Lever-van Milligen BA, et al. Antidepressants or running therapy: comparing effects on mental and physical health in patients with depression and anxiety disorders. J Affect Disord 2023;329:19–29. doi: 10.1016/j.jad.2023.02.064.

    Implications for practice and research

  • Supervised outdoor running at vigorous intensity leads to antidepressant and physical health benefits in outpatients with major depression or anxiety disorders.

  • More pragmatic exercise trials for mental health outpatients with heterogeneous symptomatology are needed.

  • Context

    Exercise is associated with antidepressant effects in clinical settings but relevant research in pragmatic (real-life) settings is scarce.1–3 Hence, Verhoeven et al4 in their pragmatic trial compared the mental and physical health benefits of running therapy versus antidepressant medication.

    Methods

    Participants were physically inactive adult outpatients with a current major depression or an anxiety disorder and were treated with...

    Communication between families and hospital staff is important in understanding nutrition and hydration problems in dementia patients

    Por: Ontan · M. S. · Isik · A. T.

    Commentary on: Anantapong K, Davies N, Sampson EL. Communication between the multidisciplinary team and families regarding nutrition and hydration for people with severe dementia in acute hospitals: a qualitative study. Age Ageing 2022;51:afac230. doi: 10.1093/ageing/afac230.

    Implications for practice and research

  • Hydration and nutrition issues in dementia should be discussed primarily by experienced health professionals, considering the beliefs, culture and expectations of the patient and her family, from the diagnosis. Moreover, these problems may show different characteristics in the acute hospital and at the end of life.

  • Further studies with larger and interrelated study groups may emphasise more on the importance of communication in hydration and nutrition problems in dementia.

  • Context

    Eating and drinking difficulties are known sources of health problems in people with dementia. It is essential to increase the awareness of patients and family carers for these problems. Healthy communication with family carers...

    Innovative and evidence-informed technology-based assessment can facilitate comprehensive cancer rehabilitation by improving cancer care outcomes through personalised nurse-led follow-up interventions

    Por: Ghassemi · A. E.

    Commentary on: Skorstad M, Vistad I, Fegran L, et al. Nurse-led consultation reinforced with eHealth technology: a qualitative study of the experiences of the patients with gynecological cancer. BMC Nurs 2022;21:326. doi: 10.1186/s12912-022-01104-9.

    Implications for practice and research

  • To improve continuity and quality of cancer care (QoCC) and patients’ adherence to the oncological treatments, it is necessary to develop innovative, digitalised, personalised and evidence-informed follow-up interventions that enhances patients’ quality of life (QoL).

  • Future research should focus on developing clear guidance and efficient technology-based assessment measures that are necessary for providing individualised early palliative care and post-treatment interventions.

  • Context

    A surge in the ageing population and the rising incidence of cancer risk factors have resulted in the increase in the occurrence of cancer in women worldwide, which requires careful treatment planning and innovations in post-treatment follow-up interventions.1–3 Several...

    Cardiomyopathy and pregnancy: a high-risk combination

    Por: Ntiloudi · D. · Giannakoulas · G.

    Commentary on: Eggleton EJ, McMurrugh KJ, Aiken CE. Maternal pregnancy outcomes in women with cardiomyopathy: a systematic review and meta-analysis. Am J Obstet Gynecol. 2022 Oct;227(4):582–592. doi: 10.1016/j.ajog.2022.05.039. Epub 2022 May 2021

    Implications for practice and research

  • Pregnant patients with cardiomyopathy have a risk of complications and should be advised accordingly.

  • Prospective data focusing on pregnancy outcomes in patients with various subtypes of cardiomyopathies are warranted to ensure proper counselling of these patients.

  • Context

    Haemodynamic changes, especially blood volume, heart rate and cardiac output augmentation, during pregnancy can exacerbate symptoms in patients with cardiomyopathy or unmask a preexisting asymptomatic condition.1 Peripartum cardiomyopathy, which also belongs in the cardiomyopathy group, presents with left ventricular (LV) dysfunction towards the end of pregnancy and in the postpartum period, when no other cause of heart failure is evident.1 All these patients are at high...

    Mental state, well-being and coping are affected by a high-risk pregnancy

    Por: Holness · N. · Barfield · L.

    Commentary on: Williamson SP, Moffitt RL, Broadbent J, Neumann DL, Hamblin PS. Coping, wellbeing, and psychopathology during high-risk pregnancy: A systematic review. Midwifery. 2023 Jan;116:103556. doi: 10.1016/j.midw.2022.103556. Epub 2022 Nov 14.

    Implications for practice

  • Awareness of negative impacts of high-risk pregnancies on mental health will help to identify women in need of support.

  • Strategies can be created to improve coping and well-being for high-risk pregnant women.

  • Context

    Pregnancy is a period of major physiological changes. Psychological adjustments occur, more so with a high-risk diagnosis in pregnancy. In their systematic review, the authors outlined the state of the science of pregnant women’s psychopathology, coping and well-being when high-risk conditions including hypertension, diabetes and kidney disease develop during pregnancy. Pregnant women with these conditions can experience ineffective coping, poor well-being, anxiety and depression among other negative symptoms. Provider’s awareness, culturally appropriate education and support can reduce...

    Becoming unable to afford adequate home heating is associated with increased risk of severe mental distress

    Por: O'Sullivan · K. C.

    Commentary on: Clair A, Baker E. Cold homes and mental health harm: Evidence from the UK Household Longitudinal Study. Soc Sci Med. 2022 Dec;314:115461. doi: 10.1016/j.socscimed.2022.115461. Epub 2022 Oct 22 .

    Implications for practice and research

  • Supporting people to live in warm housing during a period of increasing living and energy costs in many countries will avoid social, economic and mental health harm.

  • Further research to understand the pathways between cold housing and increased mental health distress is needed.

  • Context

    Cold housing, driven by poor housing quality and energy poverty, is a significant public health issue in many countries.1 2 Cold housing is known to contribute to many negative physiological health outcomes including: increased risk of cardiovascular events, stroke and myocardial infarction; increased negative effects from chronic and acute respiratory disease; increased colds and influenza; exacerbation of chronic conditions for...

    Improved grief and symptoms of depression in bereaved siblings: promising findings from an online intervention

    Por: Andriessen · K.

    Commentary on: Wagner B, Hofmann L, Maaß U. A therapist-supported internet-based intervention for bereaved siblings: a randomized controlled trial. Palliat Med. 2022 Dec;36(10):1532–1543. doi: 10.1177/02692163221122344. Epub 2022 Oct 20.

    Implications for practice and research

  • An online 6-weeks 12-session CBT-based writing intervention can improve grief and depression in bereaved siblings up to 1 year postintervention.

  • Further research may examine the potentially effective components and the effectiveness of the intervention in populations such as males and people bereaved by suicide.

  • Context

    Bereaved siblings have an increased risk of developing long-term health-related problems after loss. A population-wide study revealed higher risks of depression, substance use and a twofold risk of attempted suicide compared to non-bereaved siblings.1 Other research reported a 71% increase of all-cause mortality during a 37-year follow-up period.2 The risk was two-fold when the siblings died by the same cause.

    Digital mental health interventions with individual support may complement mental health services for adults with intellectual disabilities

    Por: Desroches · M. L.

    Commentary on: MacHale R, Ffrench C, McGuire B. The experiences and views of adults with intellectual disabilities accessing digital mental health interventions: A qualitative systematic review and thematic synthesis. J Appl Res Intellect Disabil. 2023 May;36(3):448-457. doi: 10.1111/jar.13082. Epub 2023 Feb 13.

    Implications for practice and research

  • Digital mental health interventions may be useful to complement in-person mental health services, with sufficient supports for meaningful use.

  • User-centred design research with adults with intellectual disabilities and supporters is needed at all phases of digital mental health intervention development and evaluation.

  • Context

    Providers report that digital interventions are effectively being delivered to adults with intellectual disabilities; there is less research about how digital health interventions are received and experienced by people with intellectual disabilities.1 This study by MacHale et al synthesises the experiences of adults with intellectual disabilities using digital mental health interventions, mental...

    NHS England long-term workforce plan: Can this deliver the workforce transformation so urgently needed or is it just more rhetoric?

    Por: Twycross · A. · Wray · J.

    The long-awaited NHS England workforce plan1 (the plan) was launched in June 2023 by the Prime Minister (Rishi Sunak) and NHS England CEO (Amanda Pritchard) and heralded as:

    The first comprehensive workforce plan for the NHS, putting staffing on a sustainable footing and improving patient care. It focuses on retaining existing talent and making the best use of new technology alongside the biggest recruitment drive in health service history.1

    This is a laudable aim, but can this ambitious plan really deliver the actions needed to transform the long-term future of this critical workforce?

    Workforce planning is crucial to the success of the National Health Service (NHS) and has been notable by its absence in recent decades. The publication of this plan could be seen as a step in the right direction. Workforce planning requires2:

  • Data analysis of the current workforce and...

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