While debate over the appropriate scope and goals of COVID‐19 lockdowns has raged, all public health agencies have been clear on one matter: older adults have the highest rates of mortality (Comas‐Herrera et al., 2020) and should be isolated (Public Health Agency of Canada, 2020). Older adults and individuals with complex health conditions are most vulnerable to the virus. Yet, social isolation contributes to the onset and intensifies depression, feelings of despair and, in older adults with dementia, further cognitive decline.
The COVID‐19 pandemic has presented us with many well documented challenges as well as causing death, disability and economic devastation. All around the globe people were caught unprepared for the pandemic despite the warnings of public health experts. Many of these warnings were not considered serious and moves towards nationalism and populism have challenged global collaboration.
To examine the association between symptoms severity and treatment burden in people living with HIV.
Correlational, secondary analysis of data from participants diagnosed with HIV enrolled in a descriptive, cross‐sectional study examining physical activity patterns.
We analysed data from 103 men and women using self‐report data collected between March 2016 ‐ February 2017. Our primary statistical analyses consisted of explanatory multivariate modelling with individual PROMIS‐29 scores representing symptom severity and treatment burden measured using the Treatment Burden Questionnaire‐13.
Greater symptom severity was associated with higher levels of cumulative treatment burden as well as higher levels of task‐specific medication and physical activity burden. Multivariate regression analyses revealed that fatigue was a risk factor of cumulative treatment burden as well as task‐specific medication and physical activity treatment burden. Effect sizes of multivariate models ranged from small (0.11) to medium (0.16). Additionally, post hoc analyses showed strong correlations between fatigue and other measured symptoms.
Findings support extant treatment burden literature, including the importance of addressing symptom severity in conjunction with treatment burden screening in the clinical setting. Results also suggest clinical interventions focused on the reduction of fatigue could reduce treatment burden in people living with HIV. Strong correlations between fatigue and other symptoms indicate the potential for reducing fatigue by addressing other highly clustered symptoms, such as depression.
People living with HIV exhibiting higher levels of fatigue are at high risk for treatment burden and poorer self‐management adherence. Clinicians should consider incorporating symptom and treatment burden assessments when developing, tailoring and modifying interventions to improve self‐management of HIV and other co‐morbid conditions.
To identify and describe patterns of the shared viewpoints of nurse mentors about the support obtained from link lecturer in assessing underperforming students.
Non‐experimental, exploratory research design.
Q‐methodology was applied to explore the viewpoints of 26 mentors about support. The data were collected from May–September 2018. During the development of the Q‐set, we combined a naturalistic and theoretical approach, resulting in 27 statements. The participants ranked statements into a Q‐sort grid. PQ‐Method 2.35 software was used to perform a principal component analysis to identify different patterns of the mentors' viewpoints.
Five factors of shared viewpoints, which accounted for 62% of the total variance, were derived from the factor analysis: (a) Confident in professional assessment and expects respect from link lecturer; (b) confident about the limit but need guidance in documentation. (c) Confident in the assessment but need support to manage concerns; (d) require knowledge and skills but not emotional support; and (e) dialogue and collaboration rather than information.
Based on our findings, all mentors need different types of support from the link lecturer, depending on their experience as a mentor and nurse and educational credits in mentorship. The central principle identified in this study was that mentors need to feel secure in their role. The accessibility, approachability, and willingness of the link lecturer to participate in dialogue and collaboration are important, but emotional support is not.
Our findings provide insights into the type of support mentors need when assessing underperforming students. The findings highlight the necessity of a link lecturer who is accessible and is meeting the mentors' need for knowledge and skills about assessment and mentoring. The nurse education programme must prioritize resources to ensure that the link lecturer can follow‐up with the student and the mentor.
to provide a conceptual update on change fatigue in nursing as it relates to rapid and continuous change implementation. This doctoral dissertation examined nurses’ experiences of rapid and continuous organizational change, with a core component of the study examining the concept of change fatigue.
Change fatigue is understood as the overwhelming feelings of stress, exhaustion and burnout fuelled by feelings of ambivalence and powerlessness associated with rapid and continuous change in the workplace. Change fatigue may cause workers to become withdrawn and greatly influences their decision to leave the workplace and even their profession Little research to date has explored change fatigue in nurses.
Were qualitative in nature.
A critical hermeneutic approach was used. Face to face interviews were conducted with fourteen Registered Nurses. Open‐ended questions were used. Theoretical thematic analysis and inductive analysis of data was completed using Brown and Gilligan’s voice centred relational method. The study spanned from 2015‐2018.
Nurses did experience many of the core elements of change fatigue noted in the non‐nursing literature, including exhaustion, apathy, powerlessness and burnout. Two additional themes emerged pertaining to nurses’ understandings of why they were experiencing change fatigue. These themes included the intensification of nursing work and repeated and ongoing self‐sacrifice.
Participants offered important insight into an emergent concept in the discipline of nursing.
The negative experiences associated with change fatigue are important for administrators and other stakeholders to recognize and acknowledge, as they must work to alleviate change fatigue in their institutions to preserve the well‐being of the nursing workforce. This knowledge is also important to nursing scholars, who may further research the topic and embed it into nursing curricula.
To a) identify the differences and similarities in the extrinsic and intrinsic factors that influence job satisfaction among nurses in urban and rural Ontario; and b) determine the impact of job satisfaction on nurses’ turnover intention among nurses working in rural and urban settings in Ontario.
Cross‐sectional correlational design was used for this study.
Data were collected between May 2019 ‐ July 2019 in southern Ontario. A total of 349 participants completed the Acute Care Nurses Job Satisfaction Scale and The Anticipated Turnover Scale. A stratified sampling technique was used for recruiting the sample population and participants were given the option to respond either online or by mailed survey.
There was no significant difference between rural and urban nurses in either overall job satisfaction level or turnover intention. Peer support/work conditions, quality of supervision and achievement/job interest/responsibility were significant predictors of job satisfaction. There was a significant difference between rural and urban nurses in terms of satisfaction from benefits and job security and the nurses’ job satisfaction levels correlated negatively with their turnover intention.
Several extrinsic and intrinsic factors are associated with nurses’ job satisfaction in rural and urban settings. Developing strategies that improve satisfaction by modulating these specific factors may improve nurses’ job satisfaction and reduce turnover.
Impact: This study discussed how working in a rural or urban hospital may affect nurses’ job satisfaction and turnover intention. The findings can help in improving nurses’ job satisfaction and inform workforce planning to increase nurses’ retention.
The purpose of the this study was to test the factorial structure, internal consistency reliability and concurrent validity of the Caregiver Contribution to Self‐Care Chronic Illness Inventory.
Existing measures of caregiver contribution to self‐care are disease‐specific or behavior‐specific; no generic measures exist.
A cross‐sectional study.
Between April 2017 ‐ December 2018, we enrolled a convenience sample of 358 patients with chronic illnesses and their caregivers. Patients completed the Self‐Care of Chronic Illness Inventory while caregivers completed the Caregiver Contribution to Self‐Care of Chronic Illness Inventory, a modification of the Self‐Care of Chronic Illness Inventory, which includes three scales: the Caregiver Contribution to Self‐Care Maintenance, the Caregiver Contribution to Self‐Care Monitoring and the Caregiver Contribution to Self‐Care Management. Of each scale, we tested the factorial structure with confirmatory factor analysis and reliability with the factor score determinacy coefficient, the global reliability index for multidimensional scale and Cronbach’s alpha. Also, we used Pearson’s correlations for concurrent validity purposes.
Confirmatory factor analysis supported the two‐factor structure of the Caregiver Contribution to Self‐Care Maintenance and Management scales and the one‐factor structure of the Caregiver Contribution to Self‐Care Monitoring scale. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model (Comparative Fit Index=0.933). Reliability estimates ranged between 0.701‐0.961 across the three scales. Concurrent validity of Caregiver Contribution to Self‐Care of Chronic Illness Inventory with the Self‐Care of Chronic Illness Inventory was not sufficiently supported since weak correlations were found.
The Caregiver Contribution to Self‐Care of Chronic Illness Inventory is valid and reliable and can be used in clinical practice and research.
The Caregiver Contribution to Self‐Care of Chronic Illness Inventory is an useful instrument to evaluate the extent to which caregivers contribute to patient self‐care in chronic illnesses.
To examine the effectiveness of extracorporeal magnetic stimulation for treatment of stress urinary incontinence
Systematic review and meta‐analysis.
Four electronic databases from inception to 18 May 2019.
Two authors independently performed the search, assessed the methodological quality and extracted data. The final studies included in the analysis were selected after reaching consensus with the third author.
A total of 20 studies were included in the systematic review and 12 of these in the meta‐analysis. Quality assessment indicated that only eight of 17 randomized controlled trials had low risk in overall risk of bias, whereas all controlled trials had serious risk of bias. The weighted mean effect size of magnetic stimulation on quality of life, number of leakages, pad test outcomes and number of incontinence events was 1.045 (95% CI: 0.409‐1.681), ‐0.411 (95% CI: 0.178–0.643), ‐0.290 (95% CI: 0.025‐0.556) and ‐0.747 (95% CI: ‐1.122 to ‐0.372), respectively. Subgroup analysis revealed a significant difference in the type of quality of life measurement used. Sensitivity analyses revealed that a high degree of heterogeneity persisted even after omitting studies individually.
Extracorporeal magnetic stimulation may be effective in treating urinary incontinence and improving quality of life without major safety concerns. However, because of a high degree of heterogeneity among studies, inferences from the results must be made with caution.
We recommend that clinical nurses apply extracorporeal magnetic stimulation to treat stress urinary incontinence among female patients and encourage researchers to conduct further qualitative and quantitative studies to develop consistent content and dosage for the intervention.
The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews (www.crd.york.ac.uk/Prospero with the registration number #CRD42019138835).
To provide: (1) an overview of interventions aimed at improving mental health of student or novice nurses; and (2) an evaluation of their effectiveness on dropout‐related outcomes.
Research papers published between January 1971 ‐ February 2019 were identified from the following databases: Embase, Medline, PsycInfo, CINAHL, ERIC, the Cochrane Library, Web of Science and Google Scholar.
We followed the procedures recommended by the Editorial Board of the Cochrane Collaboration Back Review Group. We included peer‐reviewed articles with a quantitative research design, examining interventions aimed at improving mental health of student and novice nurses and their effect on dropout‐related outcomes. The large variation in studies prohibited statistical pooling and a synthesis without meta‐analysis of studies was performed.
We identified 21 studies with three areas of focus: managing stress or stressors (N=4); facilitating the transition to nursing practice (N=14); and a combined approach (N=3). Five studies showed a statistically significant effect on dropout‐related outcomes. The overall risk of bias was high.
A wide range of interventions are available, but the evidence for their effectiveness is limited. There is a need for high‐quality studies in this field, preferably with a randomised controlled design.
This study aimed to explore nursing and midwifery students' evaluation of the clinical learning environment and mentoring and to identify distinct student profiles relating to their perceptions.
This study employed a cross‐sectional design.
The study population included nursing and midwifery students in a university hospital in Finland.
All nursing and midwifery students who completed their clinical placement were invited to take part in the study in the academic year 2017–2018.
The data (N=2609) were gathered through an online survey using the Clinical Learning Environment, Supervision and Nurse Teacher scale. The data were analyzed using a K‐mean cluster algorithm to identify nursing and midwifery students' profiles.
The findings from this study indicate four distinct profiles (A, B, C and D) of nursing and midwifery students in relation to the clinical learning environment and mentoring. Profile A (N=1352) students evaluated their clinical learning environment and mentoring to the highest level (mean varied from 9.44 to 8.38); and Profile D (N=151)‐ to the lowest (mean varied from 5.93 to 4.00).
The findings highlight that nursing and midwifery students evaluate their clinical learning environment and mentoring more highly when: they have a named mentor, student and mentor discuss learning goals, there is a final assessment in clinical learning, the mentor's guidance skills support student learning, the clinical learning supports the student's professional development and pre‐clinical teaching in an educational institution supports learning in the clinical placement.
Clinical learning plays an important role in nurse and midwifery education. Mentoring of clinical practice was shown to have a great influence on students' perceptions of their success in clinical learning. We suggest that clinical practice should be strengthened by the building of collaboration between nursing teachers and registered nurses.
To explore decision control preferences and decisional conflicts and to analyze their association among the surrogate decision‐makers in the intensive care unit.
The study carried out a cross‐sectional survey among the surrogates.
Participants were 115 surrogate decision‐makers of critical patients, from August to September 2019. A Chi square test and logistic regression were used to assess decision control preferences and decisional conflicts, and Spearman's rank correlation coefficient was employed to examine their association.
Of 115 surrogate decision‐makers, 51.3% preferred a collaborative role, and 63.48% were somewhat unsure about making decisions. Logistic regression analysis identified decision control preferences was associated with surrogates’ age, education level, and personality traits, while decisional conflicts was associated with surrogates’ age, education level, character, medical expense burden, and Acute Physiology and Chronic Health Evaluation‐II score. Cohen's kappa statistics showed a bad concordance of decision‐making expectations and actuality, with kappa values of 0.158 (p<0.05). Wherein surrogates who experienced discordance between their preferred and actual roles, have relatively higher decisional conflicts.
This study identified individual differences of surrogate decision‐makers in decision control preferences and decisional conflicts. These results imply that incorporation of the individual decision preferences and communication styles into care plans is an important first step to develop high quality decision support.
This research is a contribution to the limited study on decision control preferences and decisional conflicts among surrogate decision‐makers of critically ill patients. Moreover, based on the investigation of understanding the status and related factors of decision preferences and decisional conflicts set the stage for developing effective decision support interventions.
To identify currently available self‐efficacy instruments for type 2 diabetes self‐care and to evaluate the evidence for their measurement properties.
Systematic review of measurement properties.
The PubMed, Embase and CINAHL databases were searched from their inception to 27 May 2019.
The updated COnsensus‐based Standards for the selection of health Measurement INstruments methodology were applied.
Twelve instruments were identified from 3,665 records. Eight instruments were related to self‐efficacy in performing a comprehensive set of the tasks/behaviours for diabetes self‐care and the other four addressed specific behaviours related to diabetes self‐care, such as insulin management. Most of the 12 instruments were developed based on Bandura's self‐efficacy theory as their theoretical background. Overall, sufficient high‐quality evidence for measurement properties was seldom identified. The Diabetes Management Self‐Efficacy Scale is currently the best instrument, with particularly the 4‐factor, 16‐item version being demonstrated to have sufficient high‐quality evidence for structural and internal consistency and sufficient moderate‐quality evidence for reliability and convergent validity.
None of the instruments evaluated all of the relevant measurement properties. The Diabetes Management Self‐Efficacy Scale is currently the most suitable instrument for potential use in practice and research. The measurement invariance across languages, measurement error and responsiveness of this instrument still need be evaluated.
This systematic review provides clinicians and researchers with a comprehensive list of available instruments for measuring self‐efficacy in diabetes self‐care, as well as evidence for helping them to select the most appropriate instrument. Using a psychometrically sound instrument will accurately inform practitioners about the levels of self‐efficacy in self‐care among patients with type 2 diabetes in practice and avoid threatening the credibility of research studies on self‐efficacy in diabetes self‐care.
To synthesize evidence of the psychometric properties of the Five‐item World Health Organization Well‐being Index in mental health settings and critically appraise the methodologies of the included studies.
Protocol for a systematic psychometric review.
The review protocol has been registered in the International Prospective Register for Systematic Reviews. The bibliographic databases MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science will be searched for relevant studies. The psychometric properties of each study will be evaluated according to the Consensus‐based Standards for the Selection of Health Measurements Instruments.
The results of our psychometric review will synthesize the psychometric properties of the Five‐item World Health Organization Well‐being Index in mental health settings and identify possible gaps in the literature regarding methodological quality and its reliability, validity, and responsiveness to change.
The evaluation of patient well‐being is important, and the Five‐item World Health Organization Well‐being Index is an increasingly used patient‐reported outcome measure. It is simple to collect, free to use, and consists of five questions using positive health statements. Although the number of studies assessing the validity, reliability, and responsiveness of the questionnaire is increasing worldwide, there is a need to summarize the existing evidence of the psychometric properties of this questionnaire. The proposed study's findings will contribute to future research recommendations and help midwives and nurses in different settings pick an effective, appropriate questionnaire to evaluate patient well‐being.
The aim of this study was to explore current Australian Nurse Practitioners (NPs) models of prescribing used and medicines prescribed within their scopes of practice.
Descriptive online electronic national survey
An online survey of Australian NPs was conducted in 2017. A total of 252 NP participants reported on their current prescribing practices.
Participants reported prescribing via three prescribing models with autonomous prescribing the most frequently used, followed by prescribing under supervision and prescribing under a structured arrangement. Participants reported prescribing a total of 298 separate medications, representative of all major drug classifications from the Australian Medicines Handbook.
NPs appear to engage in several modes of prescribing as relevant to their context of practice with most NPs prescribing using all models of prescribing at different times. Findings also highlight the diversity of and breath of the medicines that NP prescribe and highlight the need for NPs to have broad capability in relation to the quality use of medicines, irrespective of specialty or location of practice.
Findings of this research add to the international literature on NP prescribing and through identification of models of prescribing and medicines prescribed inform future NP education and policy.
To identify challenges and opportunities for stroke survivors and caregivers in hospital to home transition care.
Due to shortened hospital stays, stroke survivors and caregivers must take responsibility for complex care on discharge from hospital to home. Gaps exist in the literature that synthesises studies on hospital to home transition care.
A systematic integrated review.
Six databases were searched systematically between 18 June 2018 ‐ 31 October 2018 including Medline, CINAHL, Web of Science, ProQuest, Scopus and Science Direct. The search did not have a date limit.
Studies that met the selection criteria were critically reviewed. Data were extracted from the studies for analyses. A convergent qualitative synthesis approach using inductive thematic synthesis was applied to the review.
The analysis of 23 studies identified three major findings. First, health and social care systems influence transition care by either enabling stroke survivors and caregivers to manage transition care via well‐coordinated services or preventing them from accessing services. Second, health professionals’ partnership with stroke survivors and caregivers largely decides tailored support for them. Successful partnerships and engagements with stroke survivors and caregivers depend on organisational resources. Third, survivors and caregivers are at different levels of readiness to cope with challenges. Individualised support for them to develop resilience is highly regarded.
Stroke survivors and caregivers encounter enormous challenges in self‐management of hospital to home transition care. Further research is required to address their expectations of support during transition care.
There is a lack of synthesis of studies on factors affecting hospital to home transition care for stroke survivors. Health and social care system designs, health professionals’ commitment to individualised care and the self‐management capability of stroke survivors and their caregivers have a profound influence on the transition care experiences.
To determine the effectiveness of a hydrophobic dressing (Cutimed Sorbact®) against a silver dressing (Aquacel® Ag Extra) in the level of colonization of chronic venous leg ulcers. The secondary endpoints are health‐related quality of life, level of pain, and time to complete healing.
Open randomized controlled trial, with blinded endpoint.
Patients with chronic venous leg ulcers with signs of critical colonization will be randomized in a concealed sequence using computer software to receive one of the alternative dressings. A total of 204 participants recruited in Primary Health Care and nursing homes will be necessary to assure statistical power. Measures will include sociodemographic variables, wound‐related variables (area, exudate, and time to healing), level of pain, adverse effects, and health‐related quality of life. Smear samples will be collected from the ulcers and will be subject to DNA‐typing technique through polymerase chain reaction to obtain the level of colony‐forming units. Measures will be collected at baseline, 4, 8, and 12 weeks.
Elevated levels of microorganisms prevent wound healing and favour its chronification. The main target when colonization is present is to reduce the bacterial load to levels that promote immune system mobilization. Hydrophobic dressings prevent the formation of biofilm in the wound by means of physical effect, so that the possibility of antimicrobial resistance is significantly reduced.
Current evidence about the effectiveness of dressings to minimize venous leg ulcers colonization is very limited. Previous studies have important methodological flaws. This study will permit to obtain the effectiveness of hydrophobic dressings against silver dressings with a robust design based on conditions of routine clinical practice in Primary Health Care and nursing homes.
The aims of the present study were: a) to investigate the current state of postpartum glucose screening in rural China; and b) to explore the factors influencing postpartum blood glucose screening among women with prior GDM based on Andersen's behavioural model of health service use.
A multisite, cross‐sectional study design, conducted from November 2017 to January 2018.
A total of 465 women with prior GDM were included from two county‐level hospitals in rural China. The potential influencing factors for postpartum blood glucose screening based on Andersen's behavioural model, including predisposing, enabling, and need factors, were collected by self‐reported questionnaires. Chi‐square tests and logistic regression were used to explore the influence of these factors on whether screening of blood glucose level after delivery occurred.
The mean age of the women was 31.92 years old (SD 5.16) and the mean time after delivery was 16.73 months (SD 15.07). The postpartum glucose screening proportion was 32.7%. Women who did not have a full‐time job (p = .011) (predisposing factor), had not received any treatment for GDM (p = .002), and were not informed about screening plans for diabetes by health professionals (p < .001) (enabling factor) were less likely to engage in postpartum glucose screening. The need factor, high actual risk of developing type 2 diabetes mellitus (T2DM), was not associated with postpartum blood glucose screening (p > .05).
In rural China, most women with prior GDM were not screened for T2DM after delivery. The women with prior GDM who did not have a full‐time job or had not received any prior treatment for GDM should be the target population for health education on postpartum glucose screening.
There is a need for data on postpartum blood glucose testing rates among rural women. Future interventions aimed at increasing postpartum blood glucose screening are needed.
To summarise the international empirical literature to provide a comprehensive understanding of older nurses’ decision making surrounding the timing of their retirement.
The global nursing shortage is increasing. Amongst some countries it has become an economic imperative to consider raising the state pension age and to extend working lives.
An integrative literature review using an integrated design.
MEDLINE, CINAHL and Business Source Premier databases were searched for studies between January 2007 ‐ October 2019.
Quality appraisal of the studies were conducted. Findings were summarised, grouped into categories and themes extracted. Two models were developed for data representation.
132 studies were identified by the search strategy. Of these, 27 articles were included for appraisal and synthesis. 16 papers were quantitative, seven qualitative and four mixed methods. The research took place in 13 different geographical locations. Most studies were of a questionnaire design, followed by interviews and focus groups. The total participant sample was 35,460. Through a synthesis of the studies, four themes were identified: Health, Well‐being and Family factors; Employer factors; Professional factors; Financial factors.
This review revealed the heterogeneity of studies on this subject and confirmed previous findings but also established a ranking of criteria that influences nurses’ decision making: age, followed by personal and organisational factors. Four extracted themes of push and pull factors map onto these factors. No ‘one‐size‐fits‐all’ strategy exists to ensure the extension of older nurses’ working lives. Organisations need to foster an environment where older nurses feel respected and heard and where personal and professional needs are addressed.
Organisations need to implement HR policies addressing nurses’ personal well‐being and retirement preparation. Older nurses are more likely to extend their working lives if they feel committed to their organisation and when professional standards are maintained.