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AnteayerEvidence-Based Nursing

Patient-centered perspectives in diabetic retinopathy care: phenomenology and practice

Por: Raman · R. · Kumar · S.

Commentary on: Zhang M, Zhang C, Chen C, et al. The experience of diabetic retinopathy patients during hospital-to-home full-cycle care: a qualitative study. BMC Nurs. 2023 Mar 3;22(1):58. doi: 10.1186/s12912-023-01206-y.

Implications for practice and research

  • Consideration of patients' life experiences, which aids in examining their feelings and patient’ experiences.

  • Future research should further investigate the phenomenological approach in diverse healthcare contexts.

  • Context

    The transition from hospital to home treatment for patients with diabetic retinopathy (DR) is the subject of a study by Zhang and colleagues. The authors attempt to comprehend the substance of this phenomenon a shift towards patient-centric healthcare research by using a phenomenological method.1 Such first-hand experiences may help to close the gap between patient demands and medical practise, laying the groundwork for personalised and emphathetic care strategies.

    Methods

    The descriptive phenomenology method was used to implement this...

    Cultural competence in nursing education: examining the nexus of cultural sensitivity and effectiveness among nursing students

    Por: Tosun · B.

    Commentary on: Kardas U, Yilmaz Sahin S. Investigation of the relationship between cultural sensitivity and effectiveness levels among nursing students. Nurse Educ Pract. 2023 Oct;72:103773. doi: 10.1016/j.nepr.2023.103773. Epub 2023 Aug 29 .

    Implications for practice and research

  • Nurse educators and policymakers can draw valuable insights from these findings to shape evidence-based strategies for enhancing cultural competence in nursing education, ultimately contributing to the provision of culturally sensitive and effective healthcare services.

  • The unexpected decline in cultural sensitivity and effectiveness levels as students approach graduation raises intriguing questions about the factors influencing these dynamics. Longitudinal studies are recommended to provide a comprehensive understanding of how cultural competence evolves over the course of nursing education.

  • Context

    When intercultural competence is comprehensively addressed in providing healthcare services, it positively influences patients’ satisfaction levels, participation in care and safety.1 To achieve this, cultural sensitivity and cultural...

    Literature suggests gaps in evidence-based PRN medication practices in acute mental healthcare

    Por: Hipp · K.

    Commentary on: Wong S, Müller A. Nurses' use of pro re nata medication in adult acute mental healthcare settings: An integrative review. Int J Ment Health Nurs. 2023 Apr 6. doi: 10.1111/inm.13148. Epub ahead of print.

    Implications for practice and research

  • This literature review provides synthesised evidence to evaluate and improve the clinical practice of pro re nata (PRN) medication in mental healthcare organisations.

  • Further research focused on exploring grey literature would offer additional perspectives and broaden the current clinical practices of PRN utilisation.

  • Context

    PRN refers to unscheduled medication used to manage acute symptoms. PRN is commonly used in mental healthcare, but literature suggests that its use is not always based on evidence. This review offers knowledge for developing evidence-based PRN practice. The nurses play a crucial role in PRN administration, including assessing patients’ needs for medication, following prescribed indications and instructions, as...

    Better cardiovascular health for a longer life without major diseases

    Por: Lopez-Bueno · R.

    Commentary on: Wang X, Ma H, Li X, et al. Association of Cardiovascular Health With Life Expectancy Free of Cardiovascular Disease, Diabetes, Cancer, and Dementia in UK Adults. JAMA Intern Med. 2023 Apr 1;183(4):340-9. doi: 10.1001/jamainternmed.2023.0015. Erratum in: JAMA Intern Med. 2023 Apr 1;183(4):394. Erratum in: JAMA Intern Med. 2023 May 15.

    Implications for practice and research

  • Improving cardiovascular health may contribute to a higher and healthier life expectancy.

  • Healthcare professionals may prioritise cardiovascular health promotion and support patients in adopting healthy behaviours.

  • Context

    The problem addressed in this study is the contribution of cardiovascular risk factors to a healthier life expectancy.1 Life expectancy has been boosted in recent decades in developed countries, but not all of the increased life expectancy elapses in good health.2 This study aims to investigate the associations between levels of cardiovascular health through Life’s Essential...

    Are we ready for prehospital troponin testing by paramedics?

    Por: Vrints · C. J. M.

    Commentary on: Dawson LP, Nehme E, Nehme Z, Zomer E, Bloom J, Cox S, Anderson D, Stephenson M, Ball J, Zhou J, Lefkovits J, Taylor AJ, Horrigan M, Chew DP, Kaye D, Cullen L, Mihalopoulos C, Smith K, Stub D. Chest Pain Management Using Prehospital Point-of-Care Troponin and Paramedic Risk Assessment. JAMA Intern Med. 2023 Mar 1;183(3):203-211. doi: 10.1001/jamainternmed.2022.6409.

    Implications for practice and research

  • In patients calling the emergency medical system for acute chest pain without ST-segment elevation, prehospital risk stratification using validated risk scores and point-of-care (POC) cardiac troponin measurement by emergency nurses or paramedics can result in substantial cost savings.

  • The safety of this strategy needs confirmation by sufficiently powered prospective randomised clinical trials.

  • Context

    Acute chest pain is one of the most common reasons for emergency system activation and transfer to the emergency department (ED).1 Only a minority of...

    Non-English speakers are not adequately represented in paediatric research

    Por: Paquette · E. · Pilarz · M.

    Commentary on: Chen A, Demaestri S, Schweiberger K, Sidani J, et al. Inclusion of non-English-speaking participants in pediatric health research: a review. JAMA Pediatr. 2023;177(1):81–88. doi: 10.1001/jamapediatrics.2022.3828.

    Implications for practice and research

  • In a review of inclusion of non-English speaking (NES) participants, 9% of research articles included NES participants, which may impact study generalisability.

  • Research teams, research networks/databases, regulatory authorities and journals that disseminate study findings share responsibility for adequate inclusion of NES participants in research.

  • Context

    Non-English speakers (NES) and limited English proficiency (LEP) populations are growing.1 Children from NES/LEP families are vulnerable to health disparities and experience poorer health.2 It is important to provide equitable care to NES/LEP populations. Generating applicable evidence requires inclusion of NES/LEP populations in research. However, inclusion of NES/LEP populations in research is understudied. Additionally, unlike requirements to justify exclusion of other populations, inclusion...

    Factors that enable or hinder the rebuilding of the therapeutic relationship following an episode of physical restraint in acute forensic services

    Por: Askola · R. · Lantta · T.

    Commentary on: Moyles J, Hunter A, Grealish A. Forensic mental health nurses’ experiences of rebuilding the therapeutic relationship after an episode of physical restraint in forensic services in Ireland: A qualitative study. Int J Ment Health Nurs. 2023 May 26. doi: 10.1111/inm.13176. Epub ahead of print.

    Implications for practice and research

  • Ensuring routine postrestraint-focused clinical supervision, experiential training for forensic mental health nurses involved in rebuilding therapeutic relationships postphysical restraint, effective debriefing and positive role modelling from senior staff is needed.

  • Studies on models to combine goals of the therapeutic relationship and maintain safety are needed, besides establishing the effectiveness of different methods to facilitate a therapeutic relationship.

  • Context

    Forensic mental health nurses (FMHNs) are expected to manage potentially serious levels of risk while maintaining a proportionate balance between therapeutic care and potentially restrictive security.1 The use of coercion in mental health...

    Contribution of cultural behavioural patterns and family-informed interventions in cancer-related fatigue

    Por: Ozel · A.

    Commentary on: Li H, Ng MSN, Jin X, et al. ‘Life became slow down’: a descriptive qualitative study of the experiences of cancer-related fatigue amongst people with advanced lung cancer. Palliat Med 2023; Sep;37 (8):1168–1182. doi: 10.1177/02692163231184926. Epub 2023 Jul 3.

    Implications for practice and research

  • Multidimensional measurement of cancer-related fatigue in clinical practice may contribute to coping strategies based on the assumption that it affects physical, emotional and cognitive domains.

  • More effective and family-informed interventions are needed in future research to improve cancer-related fatigue management.

  • Context

    Most types of fatigue cannot be directly observed; therefore, its importance and treatment are often overlooked. Cancer-related fatigue (CRF) and its treatment differs greatly from the fatigue experienced by the general population. Previous studies have shown that comprehensive support tailored to the individual’s priorities can positively encourage appropriate management of CRF. Planning CRF self-management interventions is crucial...

    Impact of moral distress on early career nurses: an integrative review

    Por: Finch · N.

    This is a summary of Loyd et al.1

    Background and purpose

  • ‘Moral distress’ is described by Jameton as ‘...aris[ing] when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’ (p. 6).2

  • Moral distress may cause nurses to question their career choice, and to feel disempowered and unhappy in their work. This may have a negative impact on the physical and mental well-being of nursing staff, leading to burnout and high staff turnover.

  • Nurses in the first 5 years of their career (early career nurses) may be particularly at risk of experiencing moral distress as they make the stressful and challenging transition from student to qualified practice.

  • The purpose of the review is to synthesise the literature regarding moral distress in the first 5 years of qualified practice.

  • ...

    Nurturing healthy futures: unveiling promising policy avenues to tackle root causes of poor health in early years

    Por: Ospina · M. B. · Bailleux · M.

    Commentary on: Stewart E, Pearce A, Given J, Gilbert R, Brophy S, Cookson R, Hardelid P, Harron KL, Leyland A, Wood R, Dundas R. Identifying opportunities for upstream evaluations relevant to child and maternal health: a UK policy-mapping review. Arch Dis Child. 2023 Jul;108(7):556-562. doi: 10.1136/archdischild-2022-325219. Epub 2023 Mar 31.

    Implications for practice and research

  • Prioritising policies targeting social determinants of health is crucial for improving early-life health outcomes. Public involvement in policy prioritisation is vital for equitable and effective policies.

  • Investing in comprehensive evaluations using harmonised and accessible administrative data is necessary to understand long-term effects of policy effectiveness.

  • Context

    Reducing early-life health inequalities is a critical challenge amid the COVID-19 socioeconomic impact.1 Sociostructural policies addressing upstream determinants are important, but evidence is limited compared with individual interventions—a discrepancy known as the inverse evidence law.2 3 To...

    Trajectory patterns of self-care behaviour over 1 year provide nurses insights to tailor individualised care for patients with heart failure

    Por: Chang · W.-T. · Chen · H.-M.

    Commentary on: Son YJ, Jang I. One-year trajectories of self-care behaviours and unplanned hospital readmissions among patients with heart failure: A prospective longitudinal study. J Clin Nurs. 2023 Sep;32(17-18):6427-6440. doi: 10.1111/jocn.16658. Epub 2023 Feb 23.

    Implications for practice and research

  • Timely identifying self­care behaviour patterns over time may reduce the risk of hospital readmissions in patients with heart failure (HF).

  • Further research studies are required to examine the effects of every 3–6 months self-care intervention on hospital readmissions among patients with HF.

  • Context

    Unplanned readmissions within 30 days and 6 months postdischarge are notably common in patients with HF.1 2 Effective self-care behaviours are essential to lower readmissions. However, the trajectories of self-care behaviours throughout the HF progression can vary among patients.3 Limited research studies have examined the relationships among the influencing variables, self-care behaviours and readmissions over...

    Death education: the importance of terror management theory and of the active methods

    Por: Testoni · I.

    Commentary on: Wu Q, Zhu P, Ji Q, et al. The effect of death education course utilizing constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death: A mixed study design. Nurse Educ Today. 2023 Jul;126:105809. doi: 10.1016/j.nedt.2023.105809. Epub 2023 Apr 6.

    Implications for practice and research

  • Death education courses (DECs) prepare healthcare students to manage future relationships with end-of-life (EOL) patients and their relatives. It would be better for DECs to use active methodologies, for example, creative arts therapies and constructivist and narrative techniques.

  • Research should longitudinally monitor students who have completed a DEC to check their levels of willingness to work in palliative care and their levels of work satisfaction versus burn-out in both the EOL and other hospital wards after they become healthcare professionals.

  • Context

    Many healthcare practitioners suffer from a lack of competence in death...

    Trust and confidence of clinical staff and patients is crucial for the successful introduction of artificial intelligence (AI) in mental healthcare

    Por: Barrera · A.

    Commentary on: Higgins O, Short BL, Chalup SK, et al. Artificial intelligence (AI) and machine learning (ML) based decision support systems in mental health: an integrative review. Int J Ment Health Nurs 2023 [Epub ahead of print 6 Feb 2023]. doi: 10.1111/inm.13114.

    Implications for practice and research

  • The introduction of artificial intelligence (AI)-based decision support systems (DSS) in mental healthcare is at a very early stage.

  • For DSS to be relevant and cost-effective, clinicians must participate at all stages of development, from project specification to evaluation.

  • Context

    This integrative review1 investigates the evidence for incorporating AI-based DSS in mental healthcare as a partial solution to an escalating care demand which can lead to staff’s burnout and potentially unfinished or missed care. Rightly, the authors of this review mention wider systemic problems such as under-resourcing and staff shortages. A DSS is an information...

    Can falls as a behavioural marker indicate development of dementia down-line?

    Commentary on: Zhang L, Wang J, Dove A, Yang W, Qi X, Xu W. Injurious falls before, during and after dementia diagnosis: a population-based study. Age Ageing. 2022 Dec 5;51(12):afac299. doi: 10.1093/ageing/afac299.

    Implications for practice and research

  • People with dementia show a higher incidence of falls four years before diagnosis.

  • There is a growing evidence of life-style risk factors for developing dementia in later life.

  • Further research is needed of the behavioural risks to developing dementia and interventions to mitigate those risks.

  • Context

    The incidence of falls increases with age with approximately a third of people over the age of 65 years experiencing one or more falls a year. These falls can result in significant injuries, such as a fracture or even death. Dementia is largely a condition associated with age and there is a growing interest and body of research that explores the...

    Smoking cessation interventions are cost-effective in people affected by stroke

    Por: Suner-Soler · R.

    Commentary on: Wechsler PM, Liberman AL, Restifo D, Abramson EL, Navi BB, Kamel H, Parikh NS. Cost-Effectiveness of Smoking Cessation Interventions in Patients With Ischemic Stroke and Transient Ischemic Attack. Stroke. 2023 Apr;54(4):992-1000. doi: 10.1161/STROKEAHA.122.040356. Epub 2023 Mar 3.

    Implications for practice and research

  • Measures to promote smoking cessation should go beyond brief counselling to include intensive counselling with pharmacotherapeutic support, such as varenicline, which are cost-effective.

  • Future research is needed to study to what extent the results obtained here are reproducible in other healthcare settings.

  • Context

    Smoking cessation in stroke survivors is associated with a reduction in vascular events and death.1 Despite this, less than half of stroke survivors stop smoking2 although if the stroke affects the insular cortex, cessation is easier.3 Clinical practice often fails to go beyond brief counselling to encourage people to stop smoking...

    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...

    Impact of the COVID-19 pandemic on eating disorder-related hospital and programme admissions in youth

    Por: Devoe · D. J. · Holland · K. M. G.

    Commentary on: Hartman-Munick SM, Lin JA, Milliren CE, et al. Association of the COVID-19 pandemic with adolescent and young adult eating disorder care volume. JAMA Pediatr. 2022 Dec 1;176(12):1225-1232. doi: 10.1001/jamapediatrics.2022.4346.

    Implications for practice and research

  • The current research demonstrates the need to increase staffing and programme capacity for those working with patients with eating disorders (EDs) to ensure adequate care.

  • Future research into how the relationship between ED-related hospitalisations and individual external factors, such as social isolation are needed.

  • Context

    Research has shown that the pandemic greatly impacted worldwide mental health1 and disproportionality impacted those with EDs.2 Those with EDs such as anorexia nervosa, bulimia nervosa and binge ED have seen an increase in hospital admissions and programmes due to the COVID-19 pandemic.2 3 However, there is a lack of nationwide research investigating the increase...

    Sibling carers of adults with intellectual disabilities in Ireland report high levels of health but feel overwhelmed by care responsibilities

    Por: Leane · M.

    Commentary on: Brennan, D., D'Eath, M., McCallion, P., & McCarron, M. (2023). Health and well-being of sibling carers of adults with an intellectual disability in Ireland: Four waves of data. British Journal of Learning Disabilities, 1–10. https://doi.org/10.1111/bld.12532

    Implications for practice and research

  • Formal protocols for engaging with sibling carers of people with intellectual disability about their support needs are required.

  • Future research should explore the experiences of sibling carers and their support needs.

  • Context

    Increased life expectancy of people with intellectual disability (ID) means that sibling caring is more likely to occur. Planning around sibling carer roles is often absent and the needs of this cohort are not well documented.1

    Methods

    Family carers of people with ID aged 40 years and older were surveyed between 2011 and 2020.2 Four waves of data were collected through a...

    We need more evidence to inform community-based health services for women, and transgender and nonbinary people who experience incarceration

    Por: McLeod · K. · Kouyoumdjian · F. G.

    Commentary on: Paynter M, Heggie C, Low C, McKibbon S, Martin-Misener R. Community-based models of health care for women, trans and nonbinary people released from prisons: An international scoping review with implications for Canada. J Clin Nurs. 2023 Jul;32(13-14):3277-3294. doi: 10.1111/jocn.16464. Epub 2022 Aug 8.

    Implications for practice and research

  • Women, transgender and non-binary people who experience incarceration often have complex healthcare needs and require dynamic, trauma-informed care in the community.

  • Research is needed to understand how to address the diverse health needs of women, transgender and non-binary people leaving prison.

  • Context

    On any given day, approximately 740 000 women and girls1 and an unknown number of transgender, non-binary and gender diverse people are incarcerated globally. Intersecting social and structural factors impact incarceration and healthcare experiences, requiring community-based interventions that address the specific needs of women, transgender and non-binary people leaving prison.

    ...

    Step your way to a longer life: examining the relation between step counts, morbidity and mortality

    Por: Blond · K. · Grontved · A.

    Commentary on: del Pozo Cruz B, Ahmadi MN, Lee IM, Stamatakis E. Prospective Associations of Daily Step Counts and Intensity With Cancer and Cardiovascular Disease Incidence and Mortality and All-Cause Mortality. JAMA Intern Med. 2022 Nov 1;182(11):1139-1148. doi: 10.1001/jamainternmed.2022.4000.

    Implications for practice and research

  • Encouraging daily steps and increasing the daily time with high cadence steps may be important means to prevent morbidity and prolong lifespan.

  • Assessment of daily steps over a longer period may further elucidate the shape of the dose–response relationship and better quantify the benefits of increasing daily step counts.

  • Context

    Physical activity is widely recommended due to the extensive evidence supporting its numerous health benefits, including lower risks of morbidity and mortality. While current physical activity guidelines quantify their recommendations in terms of minutes of physical activity, step count has emerged as another popular metric for quantifying physical activity. However,...

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