Research has shown sleep problems, elevated fatigue, and high cases of burnout, as well as signs of post-traumatic stress and psychological distress among nurses during the COVID-19 pandemic. Many US hospitals attempted to minimise its impact on staff by providing basic resources, mental health services, and wellness programs. Therefore, it is critical to re-evaluate these well-being indices and guide future administrative efforts.
To determine the long-term impact of the COVID-19 pandemic after 18 months on hospital nurses' insomnia, fatigue, burnout, post-traumatic stress, and psychological distress.
Data were collected online mainly through state board and nursing association listservs between July–September 2021 (N = 2488). The survey had psychometrically tested instruments (Insomnia Severity Index, Occupational Fatigue Exhaustion Recovery Scale, Maslach Burnout Inventory, Short Post-Traumatic Stress Disorder, and Patient Health Questionnaire-4) and sections on demographics, health, and work. The STrengthening the Reporting of Observational studies in Epidemiology checklist was followed for reporting.
Nurses had subthreshold insomnia, moderate-to-high chronic fatigue, high acute fatigue, and low-to-moderate intershift recovery. Regarding burnout, they experienced increased emotional exhaustion and personal accomplishment, and some depersonalisation. Nurses had mild psychological distress but scored high on post-traumatic stress. Nurses who frequently cared for patients with COVID-19 in the past months scored significantly worse in all measures than their co-workers. Factors such as nursing experience, shift length, and frequency of rest breaks were significantly related to all well-being indices.
Nurses' experiences were similar to findings from the early pandemic but with minor improvements in psychological distress. Nurses who frequently provided COVID-19 patient care, worked ≥12 h per shift, and skipped rest breaks scored worse on almost all well-being indices.
Administration can help nurses' recovery by providing psychological support, mental health services, and treatment options for insomnia, as well as re-structure current work schedules and ensure that rest breaks are taken.
Caregivers of lung cancer patients frequently experience psychological distress and high caregiver burden. Previous studies have focused on caregiver burden for patients with advanced lung cancer, while few studies focused on the caregiver burden among informal caregivers of postoperative patients with early-stage non-small cell lung cancer (NSCLC).
This study aimed to (a) examine caregiver burden for caregivers of patients with early-stage NSCLC after surgical treatment and (b) identify predictive factors related to caregiver burden of patients with early-stage NSCLC.
A cross-sectional study was conducted in a university-affiliated hospital in Changsha, China. A total of 385 patients with early-stage NSCLC and postsurgical treatment and their caregivers were included in this study. Caregiver burden was evaluated using the Zarit caregiver burden interview (ZBI). A set of questionnaires was used to assess psychosocial characteristics of participants, including simplified coping style questionnaire, social support rate scale, and hospital anxiety and depression scale. Hierarchical regression analysis was applied to identify factors associated with caregiver burden. We followed STROBE checklist for reporting the study.
The average ZBI score was 29.1 ± 11.4. Most caregivers (62.6%) demonstrated mild to moderate caregiving burden. The duration of caregiving (β = 0.18, p < .001), passive coping of caregiver (β = 0.17, p = .001) and anxiety (β = 0.13, p = .007) were significant predictors of caregiving burden. A variance of 17.6% in caregiving burden was explained by these identified factors.
Caregivers of early-stage NSCLC patients experience a mild to moderate level of caregiver burden. The duration of caregiving, passive coping and anxiety are factors associated with caregiver burden.
Clinicians should provide early care to support new roles of family members as caregivers.
This study examined the changes in patients' parental functioning and the associated factors, including manic, depressive symptoms and social support from before discharge to 6 months post-discharge.
For parents with bipolar disorder and major depression, parenting is a recovery factor for patients, but little research examines the dynamic parental functioning from acute hospitalisation to a remission stage.
A longitudinal design was used. The STROBE Checklist were used in presenting this research.
Participants were inpatients with bipolar disorder or major depression (n = 33) recruited within one week before discharge from the acute psychiatric ward in Taiwan. Data on parental functioning was collected four times: before discharge (T1), the 1st (T2), the 3rd (T3) and the 6th (T4) months of post-discharge. Baseline parental functioning before admitting to the acute word was retrospectively assessed at T0. The questionnaires included positive and negative domains of parenting practice, hypomanic/manic symptoms, depressive symptoms and social support. Generalised estimating equations were applied for data analysis.
The negative parenting domains (poor monitoring, inconsistent discipline) decreased during hospitalisation but increased at one month post-discharge, except corporal punishment at 3-months discharge. The positive parenting domains (parental involvement and nurturance/responsiveness) did not recovery to baseline. While clinical symptoms remained stable during 6 months post-discharge, social support decreased at 3 and 6 months post-discharge. Higher depressive symptoms and low social support were associated with positive parenting domains but not related to negative parenting domains. Manic symptoms were not associated with positive or negative parenting domains.
Positive parenting domains did not fully return to the usual situation during 6 months post-discharge.
Parenting functioning recovery program targeting at the impacts of depressive symptoms on the parenting functioning and insufficient social support is needed from hospitalisation to post-discharge.
The importance of family resilience in the recovery of stroke patients has been demonstrated in numerous studies. However, little is known about post-stroke family resilience.
To investigate the family resilience of stroke patients from a patient–caregiver dyadic perspective during the first 6 months after stroke.
A total of 288 dyads of patients diagnosed with a first-episode stroke and their principal caregivers were recruited from neurology departments of 7 tertiary hospitals in Shanghai and Shangqiu, China. Family resilience and family function were assessed during hospitalisation and at 1, 3 and 6 months after stroke. K-means cluster analysis was used to identify different clusters of family resilience based on family resilience of patients and caregivers during hospitalisation. The STROBE guidelines for observational studies were followed.
Three clusters of family resilience were identified with distinct trajectories: cluster of high resilience (HR), cluster of low resilience (LR) and cluster of discrepant resilience (DR). The level of family function was consistently highest in cluster HR and lowest in cluster with LR at four time points. Most (69.8%) families fell into the cluster with low resilience and low family function. Characteristics such as the Rankin scores and education level of patients, education level of caregivers, family monthly income and living district were different among the three clusters.
We concluded that family resilience was linked to the family functioning of patients with a first-episode stroke, however, the levels of resilience in most families were low. Factors, including the education level, family income and stroke severity of patients were revealed to influence the family resilience and its development.
A resilience-focused approach to family-related treatment is beneficial for families. Therefore, understanding family resilience among stroke survivors is needed to inform the development of interventions for enhancing the recovery of stroke families.
To explore culturally and linguistically diverse men's experiences of support after perinatal death, including barriers and facilitators to support and how healthcare providers, systems and policies can best support families.
Many groups of culturally and linguistically diverse families in Australia are at higher risk of experiencing perinatal death. Culturally sensitive bereavement services are essential; however, there has been no previous research specifically examining culturally and linguistically diverse men's experiences of support following perinatal death.
Individual semi-structured interviews were completed with healthcare providers, community leaders and culturally and linguistically diverse men who had experienced a perinatal death in Australia (n = 16). Data were analysed using Thematic Analysis and COREQ guidelines were followed.
Men's need for support following perinatal death was associated with stigma, and shaped by culturally-relevant religion and ritual, and connection to community and family. Significant barriers to men seeking and gaining support included challenges with self-advocacy and navigating the woman-centred nature of perinatal care in Australia.
Culturally and linguistically diverse men's specific needs should be included in the development of policy and practice surrounding perinatal death. While perinatal bereavement care guidelines acknowledge the importance of culturally informed care following perinatal death, there remains a lack of culturally specific supports available, particularly for culturally and linguistically diverse men.
Specific recommendations from this research include increasing community liaison officers or cultural consultants in hospitals and support organisations; providing culturally and linguistically diverse support groups; adopting family-centred and father-inclusive language in all perinatal death support services and ensuring clear communication and targeted assistance for culturally and linguistically diverse men to self-advocate for their baby and access to support.
This study came out of consultation with community members and member checking of results was conducted to ensure adequate representation of participants' views.
To evaluate the relationship between nurse–patient-initiated participation, nurses' attitudes towards patient's participation, and patients' adherence to treatment. Specifically, to (1) explore nurse–patient participation during haemodialysis and quantify the information into measurable indices; (2) determine the haemodialysis patient's adherence to treatment; (3) describe nurses' attitudes towards patient participation; and (4) establish the relationships between nurse–patient-initiated participation, nurses' attitudes towards patient participation and patients' adherence to treatment.
To improve haemodialysis patients' health, it is crucial to identify nurses' and patients' factors facilitating adherence to treatment.
An exploratory-sequential mixed-methods (quantitative and qualitative) design.
All nurses working at a dialysis ward (n = 30) and their randomly selected patients (n = 102) participated. Qualitative data on nurse–patient-initiated participation were derived from transcribed nurse–patient conversations and quantified for further analyses. Nurses' attitudes towards patient participation were collected via questionnaire, and adherence to treatment via observed reduction in prescribed haemodialysis time. [CONSORT-SPI guidelines].
Content analysis of the conversations indicated that nurse-initiated participation focused on patient's medical condition, treatment plan and education; while patients initiated more small talk. Non-adherence to treatment was significant (Mean = 0.19 h; SD = 0.33). Regression analyses indicated that nurses' attitude towards participation was negatively linked to patient adherence, while patient–nurse-initiated participation was unrelated. Nurses' attitudes towards patient participation moderated the relationship between nurse–patient-initiated participation and patient adherence: the more positive the attitude towards inclusion the more negative the link between patient or nurse-initiated participation and patient adherence.
The findings provided paradoxical insights: Nurses' positive attitudes towards participation lead them to accept the patient's position for shortening haemodialysis treatment, so that adherence to care decreases.
Nurses require education on negotiating methods to help achieve patient adherence while respecting the patient's opinion. Patients should be educated how to approach nurses, seeking the information they need.
The purpose of this study was to examine work-related stress, nurse–physician collaboration and clinical reasoning competence to identify the factors that affected the triage competence of emergency room nurses.
A quick and accurate treatment plan for patients is first determined by a triage nurse. Triage competence is an indispensable requirement for emergency room nurses.
A cross-sectional design was adopted.
The participants comprised 156 emergency room nurses in South Korea who had more than 1 year of experience working in an emergency room. The collected data were analysed using SPSS 28.0. Self-reported data were collected via the Korean Nursing Stress, Nurse–Physician Collaboration, Nurse Clinical Reasoning, Emergency Room Nurse Triage Competence assessing work-related stress, nurse–physician collaboration, clinical reasoning competence and triage competence. In the analyses, multiple regression analysis using the enter method was conducted. We have followed through the STROBE checklist for the preparation of this manuscript.
Triage competence significantly differed according to the age (F = 9.93, p < .001), clinical experience (F = 18.82, p < .001), emergency department experience (F = 12.07, p < .001), triage experience (t = 4.40, p < .001) and if nurses had a triage certificate (t = 4.85, p < .001). The factors that influenced triage competence included clinical reasoning competence (β = .36, p < .001), emergency department experience (β = .21, p = .006), work-related stress (β = .18, p = .007) and nurse–physician collaboration (β = −.17, p = .009); these factors accounted for 38.1% of the variance in triage competence.
The results of this study show that efforts to improve triage competence should be based on clinical reasoning. In addition, an effective plan should be devised to improve nurse–physician collaboration and work-related stress.
Education programmes should be developed to enhance clinical reasoning competence in order to improve triage competence. In addition, a method for managing work-related stress among nurses in emergency departments and programmes to enhance collaborative physician–nurse relations should be developed.
Investigate evidence available on the efficacy, safety and acceptability of devices for the management of female urinary incontinence, in which clinical settings and specific female populations they have been tested. Learn more about healthcare professionals' perspectives and experiences regarding female urinary incontinence devices.
Urinary incontinence is defined as the involuntary leakage of urine, estimated to affect 25%–45% of women. Urinary incontinence predisposes the skin to urinary incontinence dermatitis, it is one of the most common documented causes of inappropriate urinary catheterisation, favouring catheter-associated infection. Several products for managing female urinary incontinence are available, no accurate and systematic data on usability, effectiveness and associated outcomes of these products are available.
A scoping review was conducted, using a methodological framework including the following five steps: identification of the research question; identification of relevant documents; selection of documents included in the review; tracking of information and data; synthesis and reporting of results. Twenty-one articles were selected. PRISMA-ScR Checklist was followed.
The devices explored in the studies were as follows: female external urinary catheter; disposable sanitary pads, diapers or sanitary pads used to manage urinary incontinence in women; mechanical devices; a new prototype of underwear that tracks where pads lose; reusable underwear for light incontinence; a new intelligent system pad.
New smart pads, urine suction systems and female external catheters appear to be effective in preventing and reducing urinary incontinence dermatitis. The female external catheter reduces the days of indwelling catheterisation and could reduce the incidence of catheter associated urinary tract infection; therefore, it should be recommended.
The number of people with chronic and long-term conditions has increased during recent decades; this has been addressed by leveraging information and communication technology (ICT) to develop new self-care solutions. However, many of the developed technological solutions have not been tested in terms of impact(s) on patients' quality of care.
This systematic review aimed to identify the current best evidence on the types of interventions that have been developed to improve the quality of patient care through the clinical application of ICT in primary, tertiary or home care.
A systematic review, including a meta-analysis, was conducted according to the JBI Manual for Evidence Synthesis guidelines.
Relevant data were identified from four electronic databases: CINAHL, PUBMED, SCOPUS and MEDIC.
The eligibility criteria were formatted according to PICOS inclusion and exclusion criteria. At least two researchers performed the screening process separately, after which they agreed upon the results. The Cochrane Risk of Bias Assessment and JBI Critical Appraisal tool for randomised controlled studies (RCTs) were used to assess research quality. Data were extracted, and a meta-analysis was performed if the research met quantitative requirements.
Of the 528 initially identified studies, 11 studies were chosen for final data synthesis. All of the interventions integrated ICT solutions into patient care to improve the quality of care. Patients across all of the RCTs were educated through direct training, the provision of information relevant to their disease or one-to-one educational coaching. The interventions included various interactions, e.g. nurse expert visits and support, and support provided by peers, groups or family members. These interactions occurred through face-to-face coaching, virtual human coaching or virtual coaching that relied on an algorithm. The performed meta-analysis included 6 of the 11 identified studies. The overall effect was nonsignificant, with three studies demonstrating a significant postintervention effect on patients' quality of care and quality of life and three studies a nonsignificant effect.
The presented results suggest that ICT-based care should be developed in collaboration with nurses and other health care professionals, involve patients in decision-making and combine ICT solutions with human interaction and coaching. ICT education was found to be essential to the success of an intervention.
To describe the quality of information coming from previous care units to palliative care.
Information quality is an interconnected concept that includes different dimensions and can be viewed from different perspectives. More knowledge is needed from a multi-professional perspective on the information quality coming to palliative care.
Descriptive qualitative study.
Altogether 33 registered nurses, practical nurses, social workers and physicians working in palliative care were purposively selected to participate in thematic interviews. The research was carried out in six palliative care units in three hospital districts. The data were analysed by using deductive and inductive content analysis. The COREQ checklist was used.
Three main categories with thirteen categories were identified in connection with the deductive analysis based on the Clinical Information Quality framework: (1). Informativeness of information coming from previous care units to palliative care included accuracy, completeness, interpretability, plausibility, provenance and relevance. (2). Availability of information coming from previous care units to palliative care included accessibility, portability, security and timeliness. (3). Usability of information coming from previous care units to palliative care included conformance, consistency and maintainability. Each category is divided into sub-categories followed by narratives of their content.
This study provides new knowledge on the quality of information coming to palliative care from a multi-professional perspective. Professionals working in palliative care units highlight issues describing good information quality, but also point out quality issues and areas for improvement.
The results can guide the development of documentation practices and Health Information System development as well as be used in the generation of a new audit instrument of information quality.
To assess the results of a nursing-led program to treatment of minor health issues from Catalan health institute primary care teams during 2019 and 2020.
In 2009, the Catalan health institute implemented a nursing program to deal with minor health problems. This nursing-led program includes an algorithm for each of the minor health problems and arose as a strategy to reorganise the flow of demand for care in primary care.
A cross-sectional design.
Multicentric cross-sectional study. 392 primary care teams from the Catalan health institute participated in the study. STROBE guideline was followed in reporting this study. Patients attending any of the participating centres requesting a same-day consultation for minor health issues were registered.
A total of 21,215,278 consultations were recorded: 18,284,105 for adult and 2,931,173 for paediatric patients. Minor health issue resolved by the nurse was achieved in 50.9% of adult patients and 55.4% of paediatric patients. The highest rates of resolution in adults (>85%) were as follows: burns, emergency contraception and injuries. The highest resolution rates (>84%) were as follows: burns, breastfeeding difficulties and infant colic. 87.7% of prescriptions issued by nurses were accepted by the family physician.
The nursing-led program to treat minor health issues has been shown to present acceptable resolution for nurses in a large primary care setting. Nurses have been carrying out prescription activities with very favourable results.
This study demonstrates that care provided to patients by nurses for minor health issues requiring preferential resolution is effective. Our results are useful in that they confirm both the effectiveness of the nursing-led program for minor health issues and the pharmacological prescriptions produced during patient appointments.
Patient's data were obtained through a program records system after the minor health issues appointments.
Telehealth-assisted interventions have been used as secondary prevention measures in cardiac rehabilitation, especially for the delivery of information between healthcare service providers and patients. However, as the application of this intervention modality broadens, investigation of its effects in secondary prevention of cardiovascular disease (CVD) is necessary.
To identify the effectiveness of telehealth-assisted interventions for secondary prevention of CVD.
Systematic review and meta-analysis.
The PRISMA protocol was used to conduct a systematic review and meta-analysis of randomised controlled trials. The full text of articles was obtained from six databases for the period from database establishment to 25 November 2021. To assess the methodological quality of the studies reviewed, the updated Cochrane risk-of-bias checklist for randomised trials was employed. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for secondary CVD prevention.
The final analysis included 4012 individuals from 18 different trials. Telehealth-assisted interventions were shown to improve medication adherence (standardised mean difference [SMD]: 0.31; 95% confidence interval [CI]: 0.33–0.59) and reduce depression (SMD: −0.28; 95% CI: −0.46 to −0.10).
Telehealth-assisted interventions appear to improve adherence to medication and reduce depression of individuals with CVD. These intervention strategies could be offered to both healthcare providers and individuals with CVD as an option in delivering and facilitating the use of health services to improve health behaviours and overall outcomes. Furthermore, this study may be used as guidance for future research to provide an appropriate plan of care for this population.
The findings imply that the delivery of care remotely via telehealth-assisted interventions for secondary prevention of CVD is beneficial in improving CVD survivors' health and access to healthcare services.
The International Prospective Register of Systematic Review: (PROSPERO): CRD 42021290111.
To explore differences in nurses' attitudes regarding the importance of family in nursing care and factors associated with nurses' attitudes across 11 European countries.
Family involvement in healthcare has received attention in many European healthcare systems. Nurses have a unique opportunity to promote family involvement in healthcare; however, their attitudes and beliefs may facilitate or impede this practice.
A cross-sectional survey across European countries.
A broad convenience sample of 8112 nurses across 11 European countries was recruited from October 2017 to December 2019. Data were collected using the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire. We used the STROBE checklist to report the results.
There were significant differences in nurses' attitudes about families' importance in nursing care across Europe. Country was the factor with the strongest association with the total scores of the FINC-NA. Older age, higher level of education, increased years since graduation, having a strategy for the care of families in the workplace, and having experience of illness within one's own family were associated with a higher total FINC-NA score. Being male and working in a hospital or other clinical settings were associated with a lower total FINC-NA score.
Nurses' attitudes regarding the importance of family in nursing care vary across 11 European countries. This study highlights multiple factors associated with nurses' attitudes. Further research is necessary to gain a deeper understanding of the reasons for nurses' different attitudes and to develop a strong theoretical framework across Europe to support family involvement in patient care. The inclusion of family healthcare programs in the baccalaureate curriculum may improve nurses' attitudes.
In clinical practice, the focus should be on identifying influencing factors on nurses' attitudes to enhance families' importance in nursing care across Europe.
The aim of this study was to evaluate the clinical features of children with tracheostomy and the predictors of psychological status of their primary caregivers in order to determine the associations between the children's clinical course with their caregivers' psychological status.
The caregivers of children with tracheostomy are responsible for providing basic tracheostomy care at home. All these responsibilities may be associated with significant changes in family members' lifestyles, daily routines and family dynamics.
This study is a cross sectional study.
Data of the family's socioeconomic status and clinical status of children with tracheostomy were noted in four paediatric pulmonology centers. The Beck Depression Inventory, Maslach Burnout Inventory, Zarit Caregiver Burden Scale, and Rosenberg Self-esteem Scale were used for psychological measurements of the caregivers. The STROBE checklist was used for this study.
Eighty-five children and their primary caregivers were enrolled in the study. The children's median age was 4.1 years. Thirty-eight of them were dependent on home ventilators. Twenty-one had bacterial colonisation. All children's primary caregivers were their mothers. Beck Depression Inventory scores of mothers of children with colonisation were higher. Number of hospitalizations in previous 6 months was related to mothers' emotional exhaustion and depersonalization scores. Duration of children's hospitalizations in previous 6 months was positively correlated to mothers' emotional exhaustion, depersonalization, and Beck Depression Inventory scores.
Mothers of children with tracheostomy may experience psychological conditions, such as high levels of depression, burnout, burden and low levels of self-esteem. Frequent and long-term hospitalizations of children correlated with mother's depression and burnout. Therefore, primary caregivers should be evaluated and supported psychologically.
Preventing mothers of children with tracheostomy from experiencing psychological conditions such as depression, burnout, burden and low self-esteem can also increase the quality of care for children.
To synthesise evidence on the effectiveness of radiofrequency (RF) scanning technology as an adjunct to manual counting protocols in preventing retained surgical items (RSIs) in the operating room.
Despite the implementation of rigorous manual counting protocols, RSIs remain one of the most common reported sentinel events in operating theatres that lead to adverse patient outcomes.
An integrative review.
This review was guided by the Whittemore and Knafl (2005) framework. A literature search using CINAHL, MEDLINE, ProQuest, PubMed, and Scopus with key search terms related to RSIs and RF was applied to select English articles from January 2011 till August 2021. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was utilised for study quality assessment while reporting of review was guided using the PRISMA checklist.
A total of 15 peer-reviewed articles were included, enabling the knowledge on the RF scanning technology to be grouped into four themes, namely: detection accuracy of RF scanning technology, real-time detection of surgical items using RF identification, the impact of the RF scanning technology for detecting RSIs on patient safety, and cost-analysis of integrating the RF scanning technology in operating theatres.
Radiofrequency scanning technology is effective in preventing RSIs with significant cost-savings. Perioperative leaders should develop a multidisciplinary process to evaluate and select the most appropriate RF scanning technology as part of their patient safety programs. However, future studies with a larger sample size and robust research design, such as randomised controlled trial, should be considered to enhance the generalisability and rigour of evidence.
This review contributes to perioperative personnel's education/training of staff on using RF scanning technology to prevent RSIs. The cost-effectiveness analysis enables the healthcare leaders to decide on the selection of appropriate RF technology.
The aim of this study was to describe the basis for choosing a cannulation technique for arteriovenous fistula.
Four cannulation techniques are relevant to cannulating an arteriovenous fistula: rope ladder, area puncture and buttonhole using blunt or sharp needles. The chosen technique may affect both the patency and number of complications.
The study used a convergent mixed methods design and inductive approach.
A questionnaire and an inquiry of local guidelines were sent to nurses in all dialysis units in Sweden. Questionnaires were answered by nurses from 37 units, and 29 units included their local guidelines. The questionnaires were analysed using descriptive statistics and qualitative content analysis, and the guidelines were analysed using qualitative content analysis. The different analyses were combined in a final result. The study is based on GRAMMS guidelines.
Local guidelines, patients' and nurses' own judgement, and consultation with colleagues were found to greatly influence the choice of cannulation technique. Buttonhole was the most preferred cannulation technique in the participating units and was favoured by nurses when choosing a cannulation technique. The process of choosing a cannulation technique was found to be influenced by the dedication to good cannulation technique and healthy arteriovenous fistulas, whether the technique is perceived as being easy to use and is expected to prevent complications and based on the experienced-based knowledge of each dialysis unit.
Choosing a cannulation technique is a process based on the nurse, local guidelines and the patient. Most dialysis nurses and units in Sweden consider buttonhole to be a good cannulation technique and use it as their standard technique.
The results provide insight into why cannulation techniques are chosen differently in different units. The results also show the importance of evidence in making decisions on cannulation technique.
Spasticity is a frequent symptom of multiple sclerosis (MS), which may negatively influence daily living activities (ADL).
To (1) explore the feasibility to conduct a structured interview by specialist nurses about limitations in ADL; (2) determine the percentage of people with MS (PwMS) with limitations in ADL related to spasticity; (3) to assess the knowledge about spasticity and describe its clinical features.
Observational, cross-sectional, multicentre study in 16 MS units of Catalonia (Spain). Participants were recruited from the outpatient facility and day-care hospital between July 2018 and June 2019 and met the following criteria: (1) age 18 or older, (2) diagnosis of MS according to McDonald criteria 2010 and (3) no clinical relapse in previous 30 days.
Specialist nurses conducted a structured interview divided in two parts: the assessment of (1) limitations in the ADL and (2) the presence of spasticity and associated symptoms. The usefulness of this intervention was requested. This study met the STROBE reporting guidelines checklist for observational studies.
Three hundred sixty eight pwMS (244 women) with a mean age of 46 years and a median Expanded Disability Status Scale score of 2.5 (range, 0–8.5) were included. 262 (71%) pwMS had limitations in the ADL, and spasticity was reported as the most limiting symptom in 59 (23%). As a result of the interview, spasticity was observed in 199 (76%) participants; 47 (24%) of them were unaware that they had spasticity and 102 (51%) would not have reported it spontaneously. The level of the interview satisfaction was high (90%).
Spasticity is a complex and limiting symptom in MS. The structured interview conducted by specialist nurses is feasible and has good acceptance.
Specialist nurses can be proactive in MS clinical assessment, which may help to detect symptoms with negative impact on quality of life.
This paper investigates the feasibility and the perception of the nurse's role as the palliative care coordinator.
Integrated care is a global imperative in all healthcare improvement processes. Due to Andrija Štampar's success in the organisation of public health services, Croatia today has more than hundred years of experience in care integration. The palliative care system has been continuously developing since 2014 as an integrated care model, with nurses as care coordinators.
The study used a mixed methodology based on pragmatic research principles, including an analysis of strategic and policy documents and reports, and thematic analysis of focus group conducted with palliative care coordinators, following COREQ checklist.
Although a legal, professional and financial regulation of nurse coordinators has been achieved, a number of implementation challenges remain. These challenges arise as a result of long-term fragmentation of the health and social care, and can be found in both horizontal and vertical integration of care, that is in the dimensions of functional, clinical, cultural and social integration.
Nurses play a central role in care coordination. Coordination and integration promote professionalisation with clear roles and tasks. However, even with the legal, professional and financial implementation of the nurse coordinator model, it has to be further promoted as an equally important job in the healthcare system, with nurses as competent professionals in charge of care coordination.
Palliative care provides a range of individualised, coordinated services that meet the medical and non-medical needs of seriously ill patients. Described model of palliative care in Croatia is particularly important because it was developed as an integrated part of health care (and partly social welfare) system, indicating with the nurse's role as palliative care coordinator that coordination is a continuous process that requires a dedicated professional role.