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Anteayer Journal of Advanced Nursing

The thriving of older people assessment scale: Psychometric evaluation and short‐form development

Abstract

Aim

To evaluate the psychometric properties and performance of the 32‐item Thriving of Older People Assessment Scale (TOPAS) and to explore reduction into a short‐form.

Background

The 32‐item TOPAS has been used in studies of place‐related well‐being as a positive measure in long‐term care to assess nursing home resident thriving; however, item redundancy has not previously been explored.

Design

Cross‐sectional study.

Method

Staff members completed the 32‐item TOPAS as proxy raters for a random sample of Swedish nursing home residents (N = 4,831) between November 2013 ‐ September 2014. Reliability analysis, exploratory factor analysis and item response theory‐based analysis were undertaken. Items were systematically identified for reduction using statistical and theoretical analysis. Correlation testing, means comparison and model fit evaluation confirmed scale equivalence.

Results

Psychometric properties of the 32‐item TOPAS were satisfactory and several items were identified for scale reduction. The proposed short‐form TOPAS exhibited a high level of internal consistency (α = 0.90) and strong correlation (r = 0.98) to the original scale, while also retaining diversity among items in terms of factor structure and item difficulties.

Conclusion

The 32‐item and short‐form TOPAS’ indicated sound validity and reliability to measure resident thriving in the nursing home context.

Impact

There is a lack of positive life‐world measures for use in nursing homes. The short‐form TOPAS indicated sound validity and reliability to measure resident thriving, providing a feasible measure with enhanced functionality for use in aged care research, assessments and care planning for health‐promoting purposes in nursing homes.

Nurses’ perceptions of high‐alert medication administration safety: A qualitative descriptive study

Abstract

Aims

The aim of this study was to determine nurses’ perceptions of supports and barriers to high‐alert medication (HAM) administration safety.

Design

A qualitative descriptive design was used.

Methods

Eighteen acute care nurses were interviewed about HAM administration practices. Registered nurses (RNs) working with acutely ill adults in two hospitals participated in one‐on‐one interviews from July–September, 2017. Content analysis was conducted for data analysis.

Results

Three themes contributed to HAM administration safety: Organizational Culture of Safety, Collaboration, and RN Competence and Engagement. Error factors included distractions, workload and acuity. Work arounds bypassing bar code scanning and independent double check procedures were common. Findings highlighted the importance of intra‐ and interprofessional collaboration, nurse engagement and incorporating the patient in HAM safety.

Conclusions

Current HAM safety strategies are not consistently used. An organizational culture that supports collaboration, education on safe HAM practices, pragmatic HAM policies and enhanced technology are recommended to prevent HAM errors.

Impact

Hospitals incorporating these findings could reduce HAM errors. Research on nurse engagement, intra‐ and interprofessional collaboration and inclusion of patients in HAM safety strategies is needed.

The mental health needs and concerns of older people who identify as LGBTQ+: A narrative review of the international evidence

Abstract

Aims

To synthesize the best available evidence on the experiences and perceptions of older people who identify as LGBTQ+ regarding their mental health needs and concerns.

Design

A narrative review and critical appraisal of qualitative, quantitative and mixed methods studies.

Data sources

A systematic search was undertaken across all of the databases including PsycINFO, MEDLINE, CINAHL and Sociological Abstracts. International studies published in academic journals in the English language, from January 1995 to January 2019 were appraised. Studies had to involve older people identifying as LGBTQ+ and who had experiences mental health issues.

Review Methods

Fourteen papers were selected for inclusion in the systematic review. A narrative analysis of the papers was used by synthesizing the key findings and organizing them into themes and concepts.

Results

Following analysis of the data, the themes that emerged were: (i) LGBTQ+ identity issues (ii) risk and vulnerability factors, (iii) coping strategies and resilience, (iv) interventions and supports.

Conclusion

This review highlights key mental health‐related issues that need to be taken into account in the creation and provision of appropriate, responsive and inclusive supports and services.

This article is protected by copyright. All rights reserved.

Fuzzy cognitive mapping: an old tool with new uses in nursing research

Abstract

Aims

Describe the implementation and uses of fuzzy cognitive mapping as a constructive method for meeting the unique and rapidly evolving needs of nursing inquiry and practice.

Design

Discussion paper.

Data Sources

Drawing on published scholarship of cognitive mapping from the fields of ecological management, information technology, economics, organizational behavior and health development, we consider how fuzzy cognitive mapping can contribute to contemporary challenges and aspirations of nursing research.

Implications for nursing

Fuzzy cognitive mapping can generate theory, describe knowledge systems in comparable terms and inform questionnaire design and dialogue. It can help build participant‐researcher partnerships, elevate marginalized voices and facilitate intercultural dialogue. As a relatively culturally safe and foundational approach in participatory research, we suggest fuzzy cognitive mapping should be used in settings of transcultural nursing, patient engagement, person and family centered care and research with marginalized populations. Fuzzy cognitive mapping is amenable to rigorous analysis and simultaneously allows for greater participation of stakeholders.

Conclusion

In highly complex healthcare contexts, fuzzy cognitive mapping can act as a common language for defining challenges and articulating solutions identified within the nursing discipline.

Impact

There is a need to reconcile diverse sources of knowledge to meeting the needs of nursing inquiry. Fuzzy cognitive mapping can generate theory, describe knowledge systems, facilitate dialogue and support questionnaire design. In its capacity to engage multiple perspectives in defining problems and identifying solutions, fuzzy cognitive mapping can contribute to advancing nursing research and practice.

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How Career Facilitators and Barriers Influence Nurses' Professional Turnover Intention

Abstract

Aims

Our study investigates the influence of career facilitators and barriers on nurses' improvement of their professional capabilities and their professional turnover intention.

Background

Reducing nurses' professional turnover intention could help alleviate the global nursing shortage. Nevertheless, little research has addressed how career facilitators and barriers, nurses' improvement of their professional capabilities and professional turnover intention are related, indicating a gap.

Design

This study used a cross‐sectional design.

Methods

We surveyed 502 out of 2,660 full‐time nurses who worked for a medical centre in Taiwan between January and March 2018. Our items were adapted from Cunningham et al. and Teng et al. and had adequate reliability and validity. Structural equation modeling was used to test the study hypotheses.

Results

Human capital, social capital and discrimination were positively related to intention to improve professional capabilities. Moreover, intention to improve professional capabilities was positively related to action to improve professional capabilities, which was negatively related to professional turnover intention.

Conclusion

Most of the career facilitators and even barriers, boost the improvement of professional capabilities and are useful for retaining nurses in the nursing profession.

Impact

Findings of this study should have an impact on nursing managers by offering them means to retain nurses, e.g., enhancing human capital and social capital among nurses to reduce their turnover intention.

This article is protected by copyright. All rights reserved.

A Quantitative Systematic Review of the association between nurse skill mix and nursing‐sensitive patient outcomes in the acute care setting

Abstract

Aims

To examine the association between nurse skill mix (the proportion of total hours provided by Registered Nurses) and patient outcomes in acute care hospitals.

Design

A quantitative systematic review included studies published in English between January 2000 and September 2018.

Data sources

Cochrane Library, CINAHL Plus with Full Text, MEDLINE, Scopus, Web of Science and Joanna Briggs Institute were searched. Observational and experimental study designs were included. Mix‐methods designs were included if the quantitative component met the criteria.

Review methods

The Systematic Review guidelines of the Joanna Briggs Institute and its critical appraisal instrument was used. An inverse association was determined when seventy‐five percent or more of studies with significant results found this association.

Results

Sixty‐three articles were included. Twelve patient outcomes were inversely associated with nursing skill mix (i.e. higher nursing skill mix was significantly associated with improved patient outcomes). These were length of stay; ulcer, gastritis and upper gastrointestinal bleeds; acute myocardial infarction; restraint use; failure‐ to‐ rescue; pneumonia; sepsis; urinary tract infection; mortality/30‐day mortality; pressure injury; infections and shock/cardiac arrest/ heart failure.

Conclusion

Nursing skill mix affected twelve patient outcomes. However, further investigation using experimental or longitudinal study designs are required to establish causal relationships. Consensus on the definition of skill mix is required to enable more robust evaluation of the impact of changes in skill mix on patient outcomes.

Impact

Skill mix is perhaps more important than the number of nurses in reducing adverse patient outcomes such as mortality and failure to rescue, albeit the optimal staffing profile remains elusive in workforce planning.

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Patient safety culture among European cancer nurses—An exploratory, cross‐sectional survey comparing data from Estonia, Germany, Netherlands, and United Kingdom

Abstract

Aim

To explore the differences in perceived patient safety culture in cancer nurses working in Estonia, Germany, the Netherlands, and the United Kingdom.

Design

An exploratory cross‐sectional survey.

Methods

In 2018, 393 cancer nurses completed the 12 dimensions of the Hospital Survey on Patient Safety Culture.

Results

The mean score for the overall patient safety grade was 61.3. The highest rated dimension was “teamwork within units” while “staffing” was the lowest in all four countries. Nurses in the Netherlands and in the United Kingdom, scored higher on “communication openness”, the “frequency of events reported”, and “non‐punitive response to errors”, than nurses from Estonia or Germany. We found statistically significant differences between the countries for the association between five of the 12 dimensions with the overall patient safety grade: overall perception of patient safety, communication openness, staffing, handoffs and transitions and non‐punitive response to errors.

Conclusion

Patient safety culture, as reported by cancer nurses, varies between European countries and contextual factors, such as recognition of the nursing role and education have an impact on it. Cancer nurses’ role in promoting patient safety is a key concern and requires better recognition on a European and global level.

Impact

Cancer Nursing Societies in any country can use these data as an indication on how to improve patient care in their country. Recognition of cancer nursing as a distinct specialty in nursing will help to improve patient safety.

Reasons for choosing or refusing care from a nurse practitioner: Results from a national population‐based survey

Abstract

Aim

To understand the public's willingness or lack thereof, to be seen and treated by a nurse practitioner (NP) as the first point of contact when accessing healthcare services.

Design

This cross‐sectional, population‐based survey study used computer assisted telephone interviewing to elicit public opinions on the topic.

Methods

Data were collected in July and August 2015 from calls randomly placed to Australian households. Survey questions were developed from previous surveys and pilot tested. Summative content analysis was used to analyse open‐ended responses.

Results

Most respondents were always, or in some situations, willing to receive care from a nurse practitioner. The main themes identified from those willing to be seen by a nurse practitioner in any situation were, (a) appropriately qualified nurse practitioners, (b) the knowledge and experience to refer on if necessary. Description of situations from those unwilling to be seen by a nurse practitioner related to concern about appropriate care in a life‐threatening condition.

Conclusion

Respondents unwilling to consider any care from a nurse practitioner or care in an emergency situation, reveal a lack of understanding of their role in the wider healthcare team. As the number of nurse practitioners increase, professional groups and community awareness programmes should be focused on explaining and promoting their essential role.

Impact

This study addresses the increasing healthcare requirements of ageing populations through understanding acceptance by society to the provision of care from health professionals other than medical practitioners.

Most respondents were willing to be seen by a nurse practitioner for all or most of their healthcare needs. Lack of understanding of their scope of practice and role in the wider healthcare team, particularly in emergency situations, was reflected in responses. Those who would refuse care from a NP were in the minority. Appropriateness and acceptability of the roles of health professionals to provide quality care collaboration need consideration by policy makers.

Involving caregivers in self‐management interventions for patients with heart failure and chronic obstructive pulmonary disease. A systematic review and meta‐analysis

Abstract

Aim

To quantify the impact of involving caregivers in self‐management interventions on health‐related quality of life of patients with heart failure or chronic obstructive pulmonary disease.

Design

Systematic review, meta‐analysis.

Data sources

Searched: Medline Ebsco, PsycINFO, CINAHL, Embase, Web of Science, The British Library and ProQuest. Search time frame; January 1990–March 2018.

Review Methods

Randomized controlled trials involving caregivers in self‐management interventions (≥2 components) compared with usual care for patients with heart failure or chronic obstructive pulmonary disease. A matched sample based on publication year, geographic location and inclusion of an exercise intervention of studies not involving caregivers were identified. Primary outcome of analysis was patient health‐related quality of life.

Results

Thirteen randomized controlled trials (1,701 participants: 1,439 heart failure; 262 chronic obstructive pulmonary disease) involving caregivers (mean age 59; 58% female) were identified. Reported patient health‐related quality of life measures included; Minnesota Living with Heart Failure questionnaire, St. George's respiratory questionnaire and Short‐Form‐36. Compared with usual care, there was similar magnitude in mean improvement in patient health‐related quality of life with self‐management interventions in trials involving caregivers (SMD: 0.23, 95% confidence interval: −0.15–0.61) compared with trials without caregivers (SMD: 0.27, 0.08–0.46).

Conclusion

Within the methodological constraints of this study, our results indicate that involving caregivers in self‐management interventions does not result in additional improvement in patient health‐related quality of life in heart failure or chronic obstructive pulmonary disease. However, involvement of caregivers in intervention delivery remains an important consideration and key area of research.

Impact

Greater understanding and awareness is needed of the methodology of caregiver engagement in intervention development and delivery and its impact on patient outcomes.

The prescribing needs of community practitioner nurse prescribers: A qualitative investigation using the theoretical domains framework and COM‐B

Abstract

Aim

With several qualified community practitioner nurse prescribers (CPNPs) not prescribing, this research aimed to understand what influences this behaviour.

Design

A qualitative research design.

Methods

Semi‐structured interviews, based on the theoretical domains framework (TDF) were conducted with 20 CPNPs. Data collection took place between March‐July 2018 and continued until data saturation was reached.

Results

Nine themes inductively explained prescribing behaviour: 1) ‘Knowledge and experience’; 2) ‘Consultation and communication skills’; 3) ‘Professional confidence and identity’; 4) ‘Wanting the best outcome’; 5) ‘NHS versus patient cost’; 6) ‘Emotion‐led decisions’; 7) ‘Time allocation’; 8) ‘Formulary access’ and 9) ‘Supporting environment for patient‐centred care’. Themes were then deductively mapped to the TDF and COM‐B.

Conclusion

There is an ongoing need to support community practitioner nurse prescribers’ ‘Capability’ to prescribe in terms of knowledge and aquired skills; ‘Opportunity’ to make prescribing easier, such as access to a wider and up to date nurse formulary alongside effective clinical support; and ‘Motivation’ to feel confident in prescribing behaviour, highlighting positive patient outcomes while reducing perceived issues such as cost and non‐adherence.

Impact

Findings show that Capability, Opportunity and Motivation all influence the decision to prescribe. Those responsible for professional regulation and training should ensure community practitioner nurse prescribers have access to the relevant knowledge, skills and formulary to facilitate their prescribing behaviour. Professional confidence and identity as a prescriber should be encouraged, with acknowledgment of influences such as cost and emotion. An environment that allows for patient‐centred care and the best outcome should be supported, this may mean increasing time allocated to consultations.

Understanding the concept of missed nursing care from a cross‐cultural perspective

Abstract

Aims

Aim was to investigate how nursing experts and experts from other health professions understand the concept of rationing/missed/unfinished nursing care and how this is compared at cross‐cultural level.

Design

the mixed‐methods descriptive study.

Methods

The semi‐structured questionnaires were sent to the sample of 45 scholars and practitioners from 26 countries. Data were collected from November 2017 ‐ February 2018.

Results

Assigning average cultural values to participants from each country revealed three cultural groups: High individualism‐high masculine, High individualism‐low masculine and High Low individualistic, medium masculinity. Content analysis of the findings revealed three main themes, which emerged across cultural clusters: (1) Projecting blame for the phenomenon: Blaming the nurse versus blaming the system; (2) intentionality versus unintentionality; and (3) focus on nurses in comparison to focus on patients.

Conclusion

Consistent differences in the understanding of missed nursing care can be understood in line with the nation's standing on two main cultural values: individualism and masculinity.

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A systematic review of adherence to diabetes self‐care behaviours: evidence from low‐and middle‐income countries

Abstract

Aims

To determine diabetes patient's adherence to five self‐care behaviours (diet, exercise; medication, self‐monitoring of blood glucose [SMBG] and foot care) in low‐ and middle‐income countries

Design

Systematic review.

Data sources

We searched MEDLINE, CINAHL, PUBMED, SCOPUS, PsycINFO, EMBASE, Cochrane library and EMCARE for the period January 1990 to June 2017.

Review methods

Title, abstract and full text screening were done according to an eligibility criteria. A narrative synthesis of the literature was conducted.

Results

A total of 7,109 studies were identified of which 27 met the review eligibility criteria and were included. All the studies used self‐report of adherence to diabetes self‐care. Studies reported adherence rates in two major forms: 1) mean number of days participants performed a recommended dietary behaviour/activity during the past week

; and 2) proportions of participants adhering to a recommended self‐care behaviour. Mean number of days per week participants adhered to a self‐care behaviour ranged from 2.34.6 days per week for diet, 5.5‐6.8 days per week for medication, 1.8‐5.7 days per week for exercise, 0.2‐2.2 days per week for SMBG and 2.2‐4.3 days per week for foot care. Adherence rates ranged from 29.9‐91.7% for diet, 26.0‐97.0% for medication taking, 26.7‐69.0% for exercise, 13.0‐79.9% for self‐monitoring of blood glucose and 17.0‐77.4% for foot care.

Conclusion

Although most diabetes patients do not adhere to recommended self‐care behaviours, adherence rates vary widely and were found to be high in some instances.

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Developing a rare disease chronic care model: Management of systemic sclerosis (MANOSS) study protocol

Abstract

Aim

The aim of the Management of Systemic Sclerosis (MANOSS) study described in this protocol is to develop a chronic care model, based on a contextual analysis and stakeholder involvement, for patients living with the rare disease systemic sclerosis in Switzerland.

Design

Applying an implementation science approach, this study starts with an explanatory sequential mixed method study for contextual analysis, followed by broad stakeholder involvement for model development and a Delphi study to reach consensus.

Methods

First, a quantitative cross‐sectional survey with patients and healthcare professionals will be conducted to identify current practice patterns of chronic illness management and technology readiness. Second, qualitative interviews with patients, family members and healthcare professionals will be performed to gain a deeper understanding of care needs identified in the quantitative survey. Third, a model of care will be co‐created with input from patients, healthcare professionals and other experts. The eHealth enhanced Chronic Care Model will serve as a guiding framework. The new model and corresponding outcome parameters will be refined using a Delphi‐study approach to reach consensus on a testable model of care for persons living with systemic sclerosis. The protocol has received ethical approval in September 2018 by the Swiss Ethics Committee.

Discussion

The MANOSS study's participatory approach is essential for contextual fit of the model for patients with systemic sclerosis in this setting. Subsequent feasibility testing and implementation are planned to evaluate the model's value in relation to health disparities faced by this patient population.

Impact

Patients living with this rare disease lack access to coordinated, specialized care and self‐management support from qualified healthcare professionals. Reengineering of current care, with consideration for technological opportunities, is warranted to meet patients' and families' needs.

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Dysphagia and factors associated with malnutrition risk: A five‐year multicentre study

Abstract

Aims

To describe the associations between dysphagia and malnutrition risk and to identify predictors for dysphagia in a group of persons at risk of malnutrition in hospitals and nursing homes.

Design

A secondary analysis of cross‐sectional data from the years 2012‐2016.

Methods

The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool for Adults (MUST). The data were compared regarding malnutrition risk and dysphagia. Regression analyses was conducted to identify variables that were associated with the risk of malnutrition and dysphagia.

Results

Patients (N=17,580) were included in the study sample. The prevalence of dysphagia was 6.6% and the prevalence of malnutrition risk was 18.9%. A multivariable logistic regression analysis resulted in the identification of dysphagia and cancer as variables with the highest odds ratios with regard to malnutrition risk. Patients with cancer, stroke, or respiratory diseases represent a high‐risk group for the co‐occurrence of dysphagia and risk of malnutrition.

Conclusions

Screening for dysphagia should be carried out on patients at risk of malnutrition as an integral part of their admission to a healthcare institution and especially on the higher risk group of patients with cancer, a stroke, or a respiratory disease.

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Qualitative evidence syntheses: assessing the relative contributions of multi‐context and single‐context reviews

Abstract

Aims

To examine the strengths and weaknesses of multi‐context (international) qualitative evidence syntheses in comparison with single‐context (typically single‐country) reviews. We compare a multi‐country synthesis with single‐context syntheses on facility‐based delivery in Nigeria and Kenya.

Design

Discussion Paper.

Background

Qualitative evidence increasingly contributes to decision‐making. International organisations commission multi‐context reviews of qualitative evidence to gain a comprehensive picture of similarities and differences across comparable (e.g. low‐ and middle‐income) countries. Such syntheses privilege breadth over contextual detail, risking inappropriate interpretation and application of review findings. Decision‐makers value single‐context syntheses that account for the contexts of their populations and health services. We explore how findings from multi‐ and single‐context syntheses contribute against a conceptual framework (adequacy, coherence, methodological limitations and relevance) that underpins the GRADE Confidence in Evidence of Reviews of Qualitative Evidence approach.

Data sources

Included studies and findings from a multi‐context qualitative evidence synthesis (2001‐2013) and two single‐context syntheses (Nigeria, 2006‐2017; and Kenya, 2002‐2016; subsequently, updated and revised).

Findings

Single‐context reviews contribute cultural, ethnic and religious nuances as well as specific health system factors (e.g. use of a voucher system). Multi‐context reviews contribute to universal health concerns and to generic health system concerns (e.g. access and availability).

Implications for nursing: Nurse decision‐makers require relevant, timely and context‐sensitive evidence to inform clinical and managerial decision‐making. This discussion paper informs future commissioning and use of multi‐ and single‐context qualitative evidence syntheses.

Conclusion

Multi‐ and single‐context syntheses fulfil complementary functions. Single‐context syntheses add nuances not identifiable within the remit and timescales of a multi‐context review.

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The Effect of Music Intervention on Patients with Cancer‐related Pain: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Abstract

Aim

To synthesize the effect of music intervention on patients with cancer‐related pain in randomized controlled trials.

Design

A systematic review and meta‐analysis of randomized controlled trials following Cochrane methods.

Data resources

Systematic searches were conducted in Science Direct, Web of Science, Springer Link, Networked Digital Library of Theses & Dissertations, Ovid, CINAHL, Pubmed, Cochrane Library, Proquest, Council of Higher Education National Thesis Center, ULAKBIM Turkish National Databases for studies published in English and Turkish without year limitation. The review period covered 1978‐March 2018.

Review methods

The risk of bias of eligible studies was evaluated by two researchers using the Cochrane Collaboration tool.

Results

Six studies with 593 participants met the inclusion criteria. Music intervention was generally applied by the passive listening method, which ranged from 30‐60 minutes and 1‐3 sessions. No significant publication bias was found in the main outcomes. As a result of the meta‐analysis, it was found that music interventions have a moderate effect on cancer‐related pain.

Conclusion

Music intervention can have a positive effect on the management of cancer pain. The studies reported no adverse events. Nurses can use music intervention to manage cancer‐related pain.

Impact

The meta‐analysis addressed the effect of music intervention on cancer‐related pain. The statistical result indicates that music intervention was moderately effective in cancer‐related pain. The findings of this study will contribute to the application of effective music intervention by nurses and will provide guidance for the development of studies related to the effect of music intervention on cancer‐related pain.

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Systematic review and meta‐analysis: Physical‐procedural interventions used to reduce pain during intramuscular injections in adults

Abstract

Aims

To assess the effectiveness of physical‐procedural interventions in reducing pain during intramuscular injections.

Design

Systematic review and meta‐analysis.

Method

English keywords were used to search databases [MEDLINE (OVID, Ebsco), SCOPUS, Science Direct, COCHRANE and the reference lists from retrieved articles] from their inception to November 2017 and randomized and quasi‐experimental trials were selected based on inclusion and exclusion criteria. The standardized mean difference and random effects model were used.

Results

From 2318 articles, 15 articles (1996‐2017) met the criteria for the meta‐analysis. Physical‐procedural interventions described in the articles were included in this systematic review. The overall standardized mean difference was 0.595 (95% confidence interval (CI)=0.417‐0.773), indicating a moderate effect on pain levels. Generally, these interventions (two‐needle technique, acupressure, manual pressure, ShotBlocker, Z‐technique, airlock technique, injection site postinjection massage and speed of injection) have been found to moderately reduce pain.

Conclusion

It seems difficult to conclude that a single intervention reduces pain in adults. However, we can state that the most effective interventions for reducing pain during intramuscular injections in adults involve the ventrogluteal site, the Z‐technique and manual pressure.

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Mothers' views of health problems in the twelve months after childbirth: A concept mapping study

Abstract

Aims

To identify the health problems that women feel require help and subsequent help‐seeking behaviour during the twelve months period after childbirth.

Background

Many women experience physical and mental health problems after childbirth, but there is a gap in understanding how they perceive their health after childbirth. Studies suggested they are inhibited in expressing their needs and so seek informal rather than professional help for their health problems.

Design

Mixed‐method study.

Method

Australian women were recruited by an online platform and purposive sampling (N=81) in 2017‐2018, based on an established concept mapping methodology. A first group created 83 brainstorm statements and a second group sorted and rated the statements on women's perception of the prevalence of the issues and their help‐seeking advice to others. Bradshaw's Taxonomy of Needs theoretically underpins the explanation of the results of women's felt need after childbirth.

Results

Multidimensional scaling resulted in six clusters which categorised into three domains: ‘health issues and care', ‘support' and ‘fitness'. Despite being directly asked, about two‐thirds of the women did not report experiencing any health problems.

Conclusion

Concept maps uniquely depict women's views on seeking help. This study suggests a need to reconsider the approach to care for women in the twelve months after childbirth.

Impact

Among our participants who declared health problems most of them had professional help to resolve it. Family and friends were a key source of help‐seeking. Post‐childbirth routine care was focused on infant care and limited to the first six weeks after childbirth. The content of current post‐childbirth care must be reviewed.

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Prevention Behaviors of Esophageal Cancer: protocol for a mixed methods study

Abstract

Aim

The aim is to implement an educational program for the family members of patients with esophageal cancer on prevention behaviors in Golestan province, north of Iran.

Design

In this mixed methods research, qualitative and quantitative studies will be conducted.

Methods

This study will be carried out using an exploratory mixed method design in Golestan province, north of Iran in 2018‐2019. The research will include three consecutive phases. At first, a qualitative study will be carried out to determine the preventive behavior and measures of esophageal cancer. In this phase, the participants will be selected using the purposive sampling method. Later, semi‐structured interviews will be conducted with the relatives of patients with esophageal cancer to collect the necessary qualitative data. The second phase will include a literature review based on the information collected from the first phase. Later, a researcher‐made questionnaire will be designed based on the extended parallel process model. Furthermore, a comprehensive program will be proposed about self‐care of the patients with esophageal cancer. In the third phase, a quantitative quasi‐experimental research will be conducted over two groups of participants to measure the effectiveness of this program. This research was approved by the Ethics Committee of Yazd Shahid Sadoughi University of Medical Sciences, Iran in November 2017.

Discussion

Educational interventions should be designed purposefully according to the needs of the target group to improve their self‐care behaviors. We also expect that this research can improve the individuals' access to high‐quality preventive behaviors with regard to esophageal cancer.

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Perceived stress and self‐efficacy are associated with diabetes self‐management among adolescents with type 1 diabetes: A moderated mediation analysis

Abstract

Aims

The aims of this study were to: a) determine if self‐efficacy mediates the relationship between perceived stress and diabetes self‐management in adolescents with type 1 diabetes; and b) explore whether perceived stress moderated the self‐efficacy and diabetes self‐management relationship.

Design

Non‐experimental, descriptive correlational design, conducted from January‐ December 2016.

Methods

Guided by the Adaptation to Diabetes framework, data on demographic and clinical characteristics, perceived stress, self‐efficacy and diabetes self‐management were collected. Descriptive analyses and regression analyses were generated by SPSS Version 22. Structural equation modeling was implemented with the MPlus program.

Results

There was no direct effect of perceived stress on diabetes self‐management; however, self‐efficacy mediated the relationship between perceived stress and diabetes self‐management. Adolescents who had high self‐efficacy and low perceived stress demonstrated better diabetes care activities and diabetes communication than would be predicted from the main effects of self‐efficacy and perceived stress alone.

Conclusions

Decreasing perceived stress and improving self‐efficacy are important strategies to improve diabetes self‐management in adolescents with type 1 diabetes.

Impact

Adolescents with type 1 diabetes experience considerable stress with daily self‐management demands. This study highlights the mediating role of self‐efficacy on perceived stress and diabetes self‐management. Assessment of perceived stress and self‐efficacy in self‐management tasks in adolescents with T1D may help nurses individualize self‐management education and support. Incorporating strategies to promote stress management and self‐efficacy in diabetes education may also improve diabetes self‐management.

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