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To synthesise evidence from the literature on hospital nurses' perceived challenges and opportunities in the care of people with dementia.
People with dementia often have longer lengths of hospital stay and poorer health outcomes compared to those without dementia. Nurses play a pivotal role in the care of people with dementia. However, there is a scarcity of systematic reviews that synthesise the challenges and opportunities they perceive.
A mixed-methods systematic review was conducted with a database search covering Ageline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emcare, Embase, Medline, PsycINFO, ProQuest, Scopus and Web of Science in April 2022. In total, 27 articles that met the selection criteria were critically reviewed and included in this systematic review. Data from the selected articles were extracted and synthesised using a convergent segregated approach.
Three main themes and eight subthemes were identified. Theme 1 described nurse-related factors consisting of the lack of capability in dementia care, experiencing multiple sources of stress and opportunities for nurses to improve dementia care. Theme 2 revealed people living with dementia-related factors including complex care needs and the need to engage family carers in care. Theme 3 explained organisation-related factors comprising the lack of organisational support for nurses and people with dementia and opportunities for quality dementia care.
Hospital nurses experience multidimensional challenges in the care of people with dementia. Opportunities to overcome those challenges include organisational support for nurses to develop dementia care capability, reduce their stress and partner with the family caregivers.
Hospitals will need to build an enabling environment for nurses to develop their capabilities in the care of people with dementia. Further research in empowering nurses and facilitating quality dementia care in acute care hospitals is needed.
The review followed the PRISMA 2020 checklist.
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To investigate evidence-based practices and examine the influence of individual and social system factors on evidence-based practices among nurses in general hospitals.
Evidence-based practice is essential for improving healthcare quality. However, a challenge for nursing worldwide is nurses' limited use of evidence-based practices. It is crucial to determine the individual and social system factors affecting nurses' use of evidence-based practices.
This study employs a multi-institutional cross-sectional design.
With a multistage random sampling method, 336 registered nurses were recruited from 17 general hospitals in the Republic of the Union of Myanmar. Data were collected through a seven-part questionnaire, including the Evidence-Based Practice Implementation Scale and individual and social system factors. Data were analyzed using descriptive statistics and multiple linear regression.
Nurses in general hospitals perceived low levels of evidence-based practices. Individual factors, such as perceived barriers (p < .001), knowledge (p < .001) and attitudes (p = .001), were related to EBP as well as social system factors, including the work environment (p < .001) which influence nurses' practice, explaining 34% variance among nurses.
Nurses perceived the work environment as the most influencing factor related to evidence-based practices. Individual characteristics, including perceived knowledge, attitudes and barriers, were critical factors in performing evidence-based practices in Myanmar.
Nurse administrators and policymakers can develop strategies and interventions for improving knowledge, attitudes and work environment towards evidence-based practice. Minimizing the barriers to evidence-based practice will promote evidence-based practices in Myanmar general hospitals.
In addressing the individual and social system factors influencing the evidence-based practices of nurses, this study contributes to enhancing healthcare quality and outcomes.
This study adhered to the STROBE checklist.
There was no patient or public contribution.
To compare the effectiveness of non-pharmacological interventions in enhancing sleep quality in older people.
Sleep problems in older adults have become increasingly prominent. Sleep problems not only affect the health and quality of life of older people, but also the range of chronic diseases caused by sleep problems also impose a huge burden on social services and health care. Non-pharmacological interventions are an effective alternative to pharmacological therapies, but it is unclear which non-pharmacological therapies are most effective in enhancing sleep quality in older adults.
A systematic review and network meta-analysis based on PRISMA-NMA.
A total of seven databases were searched from the establishment of the database to March 2023. After literature screening and data extraction, the Cochrane Bias assessment tool 2.0 version of randomised controlled trials (RCTs) was used to evaluate literature quality. A network meta-analysis was performed to evaluate the relative efficacy of the non-pharmacological interventions on sleep quality.
A total of 71 RCTs involving nine non-pharmacological interventions were included. The results of the network meta-analysis showed that the joint intervention may be the most effective non-pharmacological intervention to enhance sleep quality in older adults.
This study confirms that non-pharmacological interventions can improve sleep quality in older adults. The use of non-pharmacological interventions can be promoted by healthcare professionals in the future to improve the quality of sleep and thus the physical and mental health of older people.
This evidence suggests that joint interventions may be most effective. Therefore, in the future, a combination of non-pharmacological interventions could be used to maximise their effectiveness in improving sleep quality in older people and promoting healthy aging.
No patient or public contribution is not applicable to this study.
The clinical significance of cancer-related stigma on patients' well-being has been widely established. Stigma can be perceived and internalised by cancer patients or implemented by the general population and healthcare workers. Various interventions have been carried out to reduce cancer-related stigma, but their effectiveness is not well-understood. This review aims to synthesise evidence on the effectiveness of interventions to reduce cancer-related stigma.
An integrative review.
This integrative review combined both qualitative and quantitative studies and followed five steps to identify problems, search for the literature, appraise the literature quality, analyse data, and present data. Mixed Methods Appraisal Tool (version 2018) was applied to evaluate the quality of the included studies.
Databases included Web of Science, MEDLINE, SpringerLink, Wiley Online Journals, Cochrane Library, ScienceDirect, OVID, and China National Knowledge Infrastructure (from the inception of each database to 30 April 2021).
Eighteen quantitative, six qualitative, and five mixed-methods studies were included in this review. Cultural factors should be considered when conducting interventions to reduce cancer-related stigma. For cancer patients, multi-component interventions have demonstrated a positive effect on their perceived stigma. For general population, interactive interventions show promise to reduce their implemented stigma towards cancer patients. For healthcare workers, there is a paucity of studies to reduce their implemented stigma. Existing studies reported inconclusive evidence, partially due to the lack of a robust study design with an adequate sample size.
Multi-component and interactive interventions show promise to relieve cancer-related stigma. More methodologically robust studies should be conducted in different cultures to elucidate the most appropriate interventions for different populations to reduce cancer-related stigma.
These findings will facilitate healthcare workers to design and implement interventions to reduce cancer-related stigma, thus improving the quality of life for cancer patients.
No patient and public contribution.
To develop a Delirium Care Critical-Thinking Scale for nurses caring for patients in the intensive care unit and examine the scale's psychometric properties.
There is a tool to evaluate nurses' critical thinking skills to determine nursing competency when delirium care is required.
This cross-sectional, mixed-methods study.
The Delphi method was applied for collection and analysis of data during conceptualization and item generation of the tool (Phase I). Item analysis, assessment of validity and reliability of the scale (Phase II) involved 318 nurses recruited by convenience sampling from nine adult intensive care units in medicine and surgery at one medical centre. Confirmatory factor analysis assessed construct validity. Internal consistency and 2-week test–retest stability measured reliability. A Critical Thinking Disposition Inventory Scale examined concurrent validity.
After three rounds, the Delphi method resulted in 31 scale items. Item analysis demonstrated construct reliability ranged from 9.23 to 16.18. Confirmatory factor analysis eliminated one item and extracted five factors: applying knowledge, confirming the problem and accuracy of information, reasoning logically, choosing appropriate strategies and remaining open-minded. Average variance extracted values of all factors indicated good convergent validity. Cronbach's α for internal consistency was .96 with good test-retest reliability. The correlation coefficient for concurrent validity was .301.
The new Delirium Care Critical-Thinking Scale for intensive care nurses was demonstrated to be a reliable and valid tool for evaluating their ability to assess patients with delirium.
This new scale could be used to assess outcomes of education interventions and the effectiveness of nursing care quality involving patients with delirium in intensive and critical care units.
The COSMIN checklist was used as the reporting guideline for this study.
None.
To describe how family members of critically ill patients experienced the COVID-19 visiting restrictions in Sweden.
In Sweden, the response to COVID-19 was less invasive than in many other countries. However, some visiting restrictions were introduced for intensive care units, with local variations. Although there is a growing body of literature regarding healthcare professionals' and family caregivers' perspectives on visiting restriction policies, there may be inter-country differences, which remain to be elucidated.
This study has a qualitative descriptive design. Focus group interviews with 14 family members of patients treated for severe COVID-19 infection were conducted. The interviews took place via digital meetings during the months after the patients' hospital discharge. Qualitative content analysis was used to interpret the interview transcripts. Reporting of the study followed the COREQ checklist.
Two categories—dealing with uncertainty and being involved at a distance—described family members' experiences of coping with visiting restrictions during the COVID-19 pandemic. These restrictions were found to reduce family members' ability to cope with the situation. Communication via telephone or video calls to maintain contact was appreciated but could not replace the importance of personal contact.
Family members perceived that the visiting restriction routines in place during the COVID-19 pandemic negatively influenced their ability to cope with the situation and to achieve realistic expectations of the patients' needs when they returned home.
This study suggests that, during the COVID-19 pandemic, the visiting restrictions were experienced negatively by family members and specific family-centred care guidelines need to be developed for use during crises, including the possibility of regular family visits to the ICU.
None in the conceptualisation or design of the study.
To develop a Chinese version of a chronic wound health-related quality of life (QoL) instrument and to examine the psychometric properties of this instrument.
Existing QoL instruments are not tailored to the linguistic and cultural characteristics of Chinese-speaking patients; a version addressing this gap will increase clinical understanding of their healthcare experience and may help guide chronic wound care.
A methodological study.
The method advanced by DeVellis (2017) was used to develop the instrument. An initial pool of 38 items was created. To optimize scale length and test reliability and validity, exploratory and confirmatory factor analyses were conducted. A total of 23 items formed the final pool. After two rounds of expert discussions, the average content validity index of the final 23 items was .89.
A total of 226 patients completed the instrument and were divided into two groups for further analysis. Exploratory factor analysis revealed that 15 items remained in four factors (social activity restrictions, physical and psychological disturbance, wound burden and daily life limitation), which accounted for 64.87% of the variance. Confirmatory factor analysis revealed an acceptable fit of the hypothesized factor structure and the convergent and discriminant validities were achieved. Cronbach's α coefficients for each factor were .807, .773, .799 and .713, respectively.
The Chinese version of a chronic wound health-related QoL instrument consists of 15 items in four subscales and demonstrates good reliability and validity.
This instrument can be used intermittently or continuously to evaluate the treatment effect of chronic wounds by assessing health-related QoL. Scholars in Chinese-speaking regions may find this culturally compatible instrument useful when conducting studies related to chronic wounds.
Two hundred twenty-six participants provided their perspectives on health-related QoL.
To examine the multidimensional properties of caregiver burden among family caregivers of patients with advanced cancer in a palliative context.
A sequential, explanatory, mixed-method study was performed.
Family caregivers of patients diagnosed with advanced cancer were recruited from a palliative care department of a third-level hospital in Sichuan Province, China. The Caregiver Burden Inventory, Social Support Rating Scale and Connor–Davidson Resilience Scale were used to collect quantitative data, and a total of 150 caregivers were recruited from January 2022 to September 2022. Qualitative data were collected through semi-structured interviews, and a total of 22 caregivers were interviewed from October 2022 to November 2022. Survey data were analysed using descriptive statistics, and the factors of caregiver burden were identified using the Mann–Whitney U test, Kruskal–Wallis H test and Spearman correlations. Interpretative phenomenological analysis was performed to analyse the interview data to initially explore the multidimensions of caregiver burden. The following-a-thread method and convergence coding matrix were used for triangulation to examine the multidimensional properties of caregiver burden.
The participants experienced a moderate level of caregiver burden (32.97 ± 13.09). Through triangulation, six meta-themes and nine meta-subthemes were identified as multidimensional properties of caregiver burden, including physical (too many caring tasks and poor health condition), emotional (strong negative emotions resulting from patients' suffering and insufficient and ineffective family communication), social (less social interaction and social role conflict) and economic burdens, factors that aggravate burden (prevention and control of COVID-19 and spousal relationship with patients) and factors that mitigate burden (social support).
Multiple dimensions of caregiver burden were experienced by family caregivers of patients with advanced cancer in the palliative context. Family-centred palliative care must be further developed.
It is important to develop family-centred palliative care. Therefore, the focus must be on developing a rational understanding of palliative care in public and a culture-oriented death education in palliative units.
This study adopted a mixed-method approach to comprehensively understand the phenomenon of and factors in caregiver burden in the Chinese palliative oncology context. Our findings suggest that family caregivers in palliative oncology experience a moderate level of caregiver burden, with dimensions including physical, emotional, social and economic burdens, among which emotional burden is the most prominent. The findings of this study provide policy makers and nurse practitioners with targets to be addressed in family-centred care in Chinese palliative units.
The results of this study are reported based on the guidelines of the Mixed-Methods Article Reporting Standards.
Eligible caregivers were invited to participate in the study and semi-structured interviews. Nurse managers of the palliative unit helped us access the patient-management system.
FreshRSS 