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Cervical spine can be assessed effectively by emergency department triage nurses

Por: Parker · M.

Commentary on: Stiell IG, Clement CM, Lowe M, et al. A multicenter program to implement the Canadian C-Spine Rule by emergency department triage nurses. Ann Emerg Med. 2018. pii: S0196-0644(18)30300-7.

Implications for practice and research

  • Allowing emergency department (ED) triage nurses to assess and implement the Canadian C-Spine Rule on ambulatory patients who present to the ED complaining of neck pain, and patients who attend the ED via the ambulance service with triple immobilisation in situ (sandbag, collared and tape) will reduce waiting times and improve patient experience.

  • Other guidelines are available for clinicians to consider when ‘clearing’ the c-spine, namely the National Emergency X-Radiography Utilization Study,1 the National Institute for Health and Care Excellence (2016) guidance paper on spinal injuries: initial assessment and management,2 and the Prehospital Trauma Life Support (2014) criteria.3 There is scope for future research to...

  • Professionals need to discuss more effectively the holistic needs of their patients regarding palliative care

    Por: Rodriguez · A.

    Commentary on: Collins A, McLachlan, SA, Philip, J. Communication about palliative care: A phenomenological study exploring patient views and responses to its discussion. Palliative Medicine 32:133–42.

    Implications for practice and research

  • Professionals could be more assertive in leading discussion around palliative care and be clearer about what this means in terms of disease trajectory and well-being for their patients.

  • Professionals need to discuss more effectively the holistic needs of their patients. Where it is appropriate to have open conversations about death and dying, this can be worthwhile for patients to encourage uptake of palliative care services and end-of-life care planning.

  • There is scope to explore further the communication practices and needs of professionals and patients with a range of life-limiting or life-threatening conditions in different care settings.

  • Due to the sensitive and complex nature of palliative care communication, therapeutic interventions are needed to be...

  • Higher rates of depression among women living with Coronary Heart Disease are associated with poorer treatment outcomes and prognosis

    Por: McGuigan · K.

    Commentary on: Buckland SA, Pozehl B, Yates B. Depressive symptoms in women with Coronary Heart Disease: A systematic review of the longitudinal literature. J Cardiovasc Nurs 2018;34:52–9. doi: 10.1097/JCN.0000000000000533.

    Implications for practice and research

  • As women experience significantly higher levels of depression than men particularly in the early stages of CHD, early intervention and support from healthcare professionals would be required to address symptoms and ensure better psychosocial adjustment, treatment adherence and prognosis across time.

  • Longitudinal research is required to map sex-specific psychosocial outcomes among those with CHD and to assess their impact on CHD.

  • Context

    The link between depressive symptomatology, coronary heart disease (CHD) and associated mortality and morbidity is well established.1 However, it is difficult to draw conclusions about the prognosis of women with CHD and depression as women have traditionally been under-represented in related research or trials. In studies...

    Tai Chi: a promising adjunct nursing intervention to reduce risks of cardiovascular disease and improve psychosocial well-being in adults with hypertension

    Por: Smith · G. D.
    Implications for practice and research

  • Nurses play a vital role in reducing the risk of individuals with hypertension developing cardiovascular disease (CVD). Tai Chi, a traditional Chinese exercise intervention, appears to provide a potentially effective form of physical activity for these individuals.

  • Future research of the effect of Tai Chi, a complex form of nursing intervention, should place more emphasis on objective exercise activity measures (accelerometers and pedometers).

  • Context

    The burden of CVD accounts for significant global morbidity and mortality.1 Substantial evidence suggests that physical inactivity is a major modifiable lifestyle factor related to the development of CVD. This experimental study, conducted by Chan et al,2 compared Tai Chi exercise with brisk walking in Hong Kong-based adults with hypertension, a known risk factor for the development of CVD. Tai Chi provides a traditional Chinese form of mind– body exercise, which...

    Home management of heart failure based solely on symptom and fluid management, adherence and knowledge may not fully meet the complex needs of patients

    Por: Collier · L.

    Commentary on: Sevilla-Cazes, J, Ahmad F, Bowles K, et al. Heart failure home management challenges and reasons for readmission: a qualitative study to understand the patient’s perspective. J Gen Intern Med 2018;33(10):1700–7. DOI: 10.1007/s11606-018-4542-3.

    Implications for practice and research

  • Patients reported uncertainty about instructions for self-care after discharge for a heart failure (HF)-related admission.

  • Readmission for HF-related symptoms is viewed as a rationale choice by patients and families seeking a safe place.

  • Further research and evidence is needed into how palliative care should be integrated in to the care of patients with heart failure.

  • Context

    Hospitalisation for HF is common and associated with significant levels of morbidity and mortality.1 There are significant amounts of quantitative and qualitative research focused on home management of HF and reasons for readmission. This study4 aimed to address a perceived limitation in knowledge around potential differences...

    Body sensor providing feedback to bedside staff reduced the prevalence of pressure ulcers in patients with critical illness

    Por: Swift · A.

    Commentary on: Pickham D, Berte N, Pihulic M, et al. Effect of a wearable patient sensor on care delivery for preventing pressure injuries in acutely ill adults: A pragmatic randomized clinical trial (LS-HAPI study). Int J Nurs Stud 2018;80:12–19.

    Implications for practice and research

  • Hospital-acquired pressure injuries (HAPI) vary in prevalence but affect more than 4% of inpatients.

  • HAPIs lead to increased length of stay and are an indicator of poor care quality.

  • Sustained improvement in nursing practice is required to prevent HAPI.

  • Longer term follow-up in studies comparing different ways to reduce risk is required to find a way to sustain improvements in practice.

  • Context

    Hospital-acquired pressure injuries (HAPI) lead to increased length of stay and increased risk of mortality.1 Prevention of pressure ulcers requires careful assessment of the skin and risk factors such as limited mobility, loss of sensation, previous...

    Multidisciplinary disease management programme with or without exercise training may reduce heart failure-related rehospitalisation

    Por: Collier · L.

    Commentary on: Liu M, Wang C, Tung T, et al. Effects of a multidisciplinary disease management programme with or without exercise training for heart failure patients: secondary analysis of a randomized controlled trial. Int J Nursing 2018;8:94–102.

    Implications for practice and research

  • The inclusion of exercise training within a multidisciplinary disease management programme (MDP) may reduce rates of heart failure (HF)-related rehospitalisation.

  • When exercise is contraindicated, an MDP may reduce HF-related rehospitalisation rates for 12 months after discharge for an HF-related hospital stay.

  • Context

    Advances in the management of HF mean survival rates for patients with HF are increasing.1 While management of HF is focused around medicine regimens, lifestyle changes such as weight maintenance, smoking cessation and exercise are encouraged so patients may manage their symptoms more effectively.1 MDPs with structured patient education are effective in reducing HF-related rehospitalisation rates and mortality...

    Patients and nurses have differing views of what is meant by 'compassion

    Por: Green · L.

    Commentary on: Durkin J, Usher K, Jackson D. Embodying compassion: A systematic review of the views of nurses and patients. J Clin Nurs. 2018 Nov 28. doi: 10.1111/jocn.14722.

    Implications for practice and research

  • There is ambiguity regarding how compassion is defined and experienced within nursing.

  • Patients and nurses hold different views on what constitutes compassionate care.

  • Understanding the concept of compassion can help nurses in their clinical practice.

  • Focusing on the nature of compassion—particularly from the point of view of patients—is an important direction in nursing education and research.

  • Context

    Compassion has always been a key concept in nursing.1 2 In the UK, several instances of poor care propelled compassion to the foreground and prompted a series of policy responses that impact directly on the nursing profession. Consequently, compassionate care is increasingly recognised as being just as vital...

    Promoting patient involvement through person-centred handovers in nursing

    Por: Kidd · L.

    Commentary on: Kullberg A, Sharp L, Dahl O, et al. Nurse perceptions of person-centered handovers in the oncological inpatient setting - A qualitative study. Int J Nurs Stud 2018;86:44–51.

    Implications for practice and research

  • Person-centred handovers can enhance patient participation in healthcare decision-making, supporting the provision of high quality, safe person-centred care.

  • Consideration is needed to how person-centred handovers are understood and implemented in clinical practice to ensure that they foster genuine participation and partnership working between nursing teams and patients.

  • Context

    Nurse handovers are a routine form of communication and information exchange that occurs when one nurse hands over the responsibility of care for a patient to another nurse, for example at the end of a nursing shift.1 In daily practice, different models of handover are used.1 Evidence on nurses’ perspectives of person-centred handover (PCH) models, which incorporate and...

    Opioid users reflect on their experiences responding to suspected opioid overdoses using take-home naloxone

    Por: Donaghy · J.

    Commentary on: Neale J, Brown C, Campbell ANC, et al. How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies. Addiction. 2018 Nov 26. doi: 10.1111/add.14510.

    Implications for practice and research

  • Opioid users described using take-home naloxone (THN) to deliver emergency treatment to victims of opioid overdose.

  • Insights from opioid users who have responded to overdoses could improve THN.

  • This study provides a foundation for research exploring the competency of individuals delivering first-line treatment to opioid overdose victims.

  • Context

    In the USA, opioid overdose accounted for 42 249 deaths during 2016. Respiratory depression caused by opioid overdose can be reversed by the timely administration of naloxone. THN programmes supply naloxone and advice in responding to opioid overdose crisis to non-medical professionals.1 Current provision does not appear to meet the clinical need.

    Harm-benefit analysis: treatment of mild hypertension in low-risk individuals

    Por: Kean · T.

    Commentary on: Sheppard et al. Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension. JAMA Internal Medicine

    Implications for practice and research

  • A risk-based approach that includes tailored targets and comorbidity may be optimal in the management of hypertension.1

  • Research to examine risk-over-time as a prognostic indicator in the development of cardiovascular disease (CVD) in low-risk patients may provide greater insight into the benefit of treating mild hypertension in these individuals.1

  • Context

    Hypertension, a growing global burden, affects one-quarter of the world’s population.1–3 Uncontrolled hypertension can lead to life-threatening sequelae, decreased quality of life and increased expenditures by health systems.1–3 Evidence-based guidelines, a mainstay of modern practice, feature prominently in clinical decision-making.3 4 Yet, some guidelines can spur controversy.

    Sheppard et...

    Select groups of older adults may benefit from emergency-based short-stay unit admission, as compared to standard medical admission

    Por: Kerin · U.

    Commentary on: Strøm C, Rasmussen LS, Löwe AS, et al. Short-stay unit hospitalisation vs. standard care outcomes in older internal medicine patients-a randomised clinical trial. Age Ageing 2018;47:810-817. doi: 10.1093/ageing/afy090.

    Implications

  • Preliminary data suggests emergency-based, short-stay units reduced: functional decline, adverse events, readmission rates and hospital stays.

  • Short-stay units reported similar 90-day mortality rates to standard medical admissions.

  • Multicentre international studies are required.

  • Future research should include a cost-analysis and powered studies to detect minimal differences in 90-day mortality.

  • Context

    In most countries, demand exceeds availability of acute healthcare resources.1 An aged population with complex biopsychosocial needs are an increasing healthcare challenge.2 Older adults regularly require extended periods of hospitalisation, and are more at risk of developing adverse, hospital-acquired sequelae.2 3

    Short-stay units (SSU) are speculated to be cost-effective facilities with the potential to...

    Patient-reported improvement in pain with pregabalin for painful diabetic neuropathy and postherpetic neuralgia is promising but needs further investigation

    Por: Cox · F.

    Commentary on: Derry S, Bell RF, Straube S, et al. Pregabalin for neuropathic pain in adults. Cochrane Database Syst Rev 2019:CD007076. doi: 10.1002/14651858.CD007076.pub3.

    Implications for practice and research

  • There is moderate quality evidence that pregabalin is more effective than placebo for postherpetic neuralgia, painful diabetic neuropathy and post-traumatic neuropathic pain.

  • There is no evidence to support its use in HIV neuropathy nor central neuropathic pain.

  • Future studies require greater sample sizes and clearer methodology.

  • There is a need to identify patients who would benefit from pregabalin therapy.

  • Context

    Pregabalin is licensed to treat neuropathic pain which is defined as pain caused by a lesion or disease of the somatosensory nervous system.1 Neuropathic pain effects up to 10% of the population2 and includes postherpetic neuralgia (PHN) and painful diabetic neuropathy (PDN). The impact can be disabling and lead to higher healthcare...

    Supporting family in their search for meaning and purpose during unexpected ICU admission improves coping, resilience and psychological outcomes

    Commentary on: Wong, P, Liamputtong P, Koch S, et al. Searching for meaning: a grounded theory of family resilience in adult ICU. J Clin Nurs 2018;28:781–91. Doi: 10.111/jocn.14673

    Implications for practice and research

  • To be resilient, families of intensive care unit (ICU) patients must be supported to seek and understand information, advocate for their loved one and find personal meaning and purpose in the admission.

  • Future research is needed to understand the best psychosocial interventions for family during ICU admission.

  • Context

    Intensive care units (ICUs) are evolving to function with increased family involvement. However, unchecked family involvement in the ICU can place a family at risk for psychological problems including anxiety, depression and if severe enough, postintensive care syndrome family (PICS-F). These risk factors may be lessened if a patient and family-centred care (PFCC) model is used. The foundation for PFCC involves dignity and respect, collaboration, information sharing...

    Tele-health-monitoring may decrease emergency room visits and hospitalisation in patients with COPD

    Por: OConnor · S.

    Commentary on: Hong Y and Lee SH. Effectiveness of tele-monitoring by patient severity and intervention type in chronic obstructive pulmonary disease patients: a systematic review and meta-analysis. Int J Nurs Stud 2019;92:1–15.

    Implications for practice and research

  • Monitoring patients’ health remotely at home using technology has been gaining in popularity for a number of years.

  • Evidence suggests that tele-monitoring may have the potential to reduce emergency room visits and hospitalisation for patients with chronic obstructive pulmonary disease (COPD), particularly those with high disease severity.

  • More rigorously conducted trials of tele-monitoring in patients with  COPD are required to determine clinical and cost-effectiveness.

  • Context

    COPD is a long-term, debilitating, respiratory condition that impacts the lives of millions of people worldwide. Poor management of COPD can lead to hospital admissions, increased healthcare costs and poorer outcomes for patients and their families.1 A range of interventions are...

    Over-confidence in cardiac devices can create a barrier in engaging patients in advance care planning and discussions around device deactivation

    Por: Elliott · K.

    Commentary on: Hadler RA, Goldstein NE, Bekelman DB, et al. "Why Would I Choose Death?": A Qualitative Study of Patient Understanding of the Role and Limitations of Cardiac Devices. J Cardiovasc Nurs 2019;34:275–82. doi: 10.1097/JCN.0000000000000565.

    Implications for practice and research

  • Stage II-IV heart failure patients with cardiac devices may overestimate their device’s ability to prevent further deterioration and death. This may become a barrier to engaging in advance care planning.

  • Further research is required to evaluate best methods of engaging these patients in discussions around advance care planning and device deactivation.

  • Context

    Guidelines for managing patients with heart failure indicate that discussions about the condition, treatment options and advance care planning should be discussed at an early stage of the disease.1 Prior to implanting a cardiac device, clinicians should be discussing when device deactivation might become appropriate.2–4...

    Womens experiences of breast cancer reveal the need for a holistic person-centred approach to breast cancer care

    Por: Kerin · U.

    Commentary on: Smit A, Coetzee BJ, Roomaney R, et al. Women’s stories of living with breast cancer: a systematic review and meta-synthesis of qualitative evidence. Soc Sci Med 2019; 222:231–45. doi: 10.1016/j.socscimed.2019.01.020

    Implications for practice and research

  • Findings illustrate the physical, psychosocial and emotional impact of breast cancer on women.

  • A holistic, person-centred approach to breast cancer care is required before, during and after active cancer treatment has been terminated.

  • The proposed trajectory of breast cancer framework will enable future researchers to consider breast cancer experiences relative to particular breast cancer time-points.

  • Context

    Breast cancer is reported to be the most common type of cancer in women.1 There are distinct histological subtypes; luminal A, luminal B, basal-like and human epidermal growth factor receptor 2 (HER2) enriched.2 Improved molecular understanding has facilitated the development of targeted treatments. Disease stage and...

    Best practice for peripheral intravenous catheter replacement

    Por: Hacker Bravo · P.

    Commentary on: Webster J, Osborne S, Rickard CM, et al. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev 2019;1:CD007798.

    Implications for practice and research

  • No difference was found in rates of catheter-related bloodstream infections (CRBSI), thrombophlebitis, pain or mortality between routine and clinically indicated peripheral intravenous catheter (PIVC) removal and replacement.

  • Routine PIVC change does decrease infiltration and catheter occlusion.

  • Clinically indicated catheter exchange may be a cost-saving measure for healthcare systems.

  • Context

    PIVCs are the most common invasive procedure with each patient receiving an average of two PIVCs during their admission.1 This common device, however, increases risk for BSI/CRBSI with a mortality rate of 12%–25%.2 Many institutions disagree on what best practice recommendations should be. Many institutions including the Centers for Disease Control support the routine removal of PIVCs as a method to decrease the risk...

    Increased knowledge of oral anticoagulants and treatment satisfaction leads to better adherence to oral anticoagulants in patients with atrial fibrillation

    Por: Schwanda · M. · Gruber · R.

    Commentary on: Smet L, Heggermont WA, Goossens E, et al. Adherence, knowledge, and perception about oral anticoagulants in patients with atrial fibrillation at high risk for thromboembolic events after radiofrequency ablation. J Adv Nurs 2018;74:2577–87.

    Implications for practice and research

  • Increased knowledge about oral anticoagulants (OACs) and treatment satisfaction may increase the adherence to OAC in patients with atrial fibrillation (AF).

  • There is a need for long-term effects of educational interventions regarding adherence and the intake of OAC in patients with AF.

  • Context

    AF occurs frequently and leads to a higher incidence of thromboembolic events and stroke. Therefore, OACs are crucial and recommended. This therapy can be carried out with vitamin K antagonists (VKAs) or non-VKA OAC (NOACs). Both have demonstrated a significant reduction in the risk of thromboembolic events. Additionally, an effective rhythm control strategy, the catheter ablation, is useful and reduces the...

    ITU patients with delirium did not benefit from electronic and pharmacist support encouraging the deprescribing of benzodiazepines and anticholinergics

    Por: Donaghy · J.

    Commentary on: D. Campbell, N. L. Perkins, A.J. Khan, et al. Deprescribing in the Pharmacologic Management of Delirium: A Randomized Trial in the Intensive Care Unit. J Am Geriatr Soc 2019;67(4):695–702.

    Implications for practice and research

  • Electronic alerts were used with pharmacist support to suggest alternative medications to benzodiazepines and anticholinergics. This had no effect on the use of these medications or the short-term patient outcomes.

  • Deprescribing interventions can have little influence where prescribing levels are already very low.

  • Context

    Delirium is a syndrome characterised by an acute onset of disturbed consciousness, cognitive function or perception. It is associated with higher mortality, increased rates of dementia and longer hospital stays.1 Consequently, establishing methods of prevention has been identified as an important goal.1 Delirium is a common issue, affecting one-third of hospitalised general medical patients aged 70 and over.2 Campbell et...

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