To describe the patient's experience of family function and its importance in diabetes‐related self‐management.
Many patients fail to reach the targeted glycemic level due to low self‐management adherence. Knowledge is needed regarding the impact of family function on diabetes self‐management.
A qualitative descriptive design.
A purposive sample of 20 patients with type 2 diabetes. Data were collected in March‐June 2017 via audio recorded semi‐structured interviews, field notes and Eco‐maps. Analyzed using thematic framework matrix and thematic analysis.
Four themes were identified: (1) Downplaying disease. The disease was trivialized creating a barrier to family involvement; (2) Second guessing. When diabetes was not discussed, patient and family made their own assumptions; (3) Going it alone. The participants preferred sole disease responsibility to maintain usual family life; (4) No regrets. The participants managed their disease with medications only to maintain family cohesion and “the good life”.
The participants in our study downplayed the consequences of type 2 diabetes and chose to control their disease medically rather than by lifestyle changes. They renounced family involvement to maintain their lifestyle and promote family cohesion.
To systematically review the effectiveness of vinegar consumption in improving glycemic control in adults with type 2 diabetes mellitus.
A systematic review and meta‐analysis.
The CINAHL, Excerpta Medica database (EMBASE), Medline, PubMed, Scopus and Cochrane databases were searched in April 2019. Interventional studies published in the English language, from inception to 15 April 2019, were included.
Two investigators independently assessed the quality of the studies, discussed their findings to reach consensus, and complied with the standards of the Cochrane.
Handbook for Systematic Reviews of Interventions. Random‐effects meta‐analysis was conducted in Review Manager 5.3.5 to assess the effect size. A series of subgroup and sensitivity analyses were conducted to explore the causes of heterogeneity. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
A total of 6 relevant studies, including 317 patients with type 2 diabetes mellitus, were selected from 356 studies identified through electronic searches and reference lists. The meta‐analysis showed significantly better fasting blood glucose and hemoglobin A1c (HbA1c) level. In secondary analyses, there was a remarkable reduction in total cholesterol and low‐density lipoprotein postintervention.
Vinegar content varied across the studies, and the sample sizes in the included studies were relatively small. Therefore, caution should be exercised when trying to extrapolate the results to a larger population.
Existing reviews are limited to narrative synthesis, lacking critical appraisal, heterogenous outcomes, nor any report of fasting blood glucose and HbA1c. This meta‐analysis review extends the evidence on the beneficial effects of vinegar on glycemic control as measured by HbA1c and fasting blood glucose. Clinicians could incorporate vinegar consumption as part of their dietary advice for patients with diabetes.
To assess the incidence of voluntary stopping of eating and drinking in long‐term care and to gain insights into the attitudes of long‐term care nurses about the voluntary stopping of eating and drinking.
A cross‐sectional study.
Heads of Swiss nursing homes (535; 34%) answered the Online‐Survey between June and October 2017, which was evaluated using descriptive data analysis.
The incidence of patients who died in Swiss nursing homes by voluntarily stopping eating and drinking is 1.7% and 67.5% of participants consider this phenomenon highly relevant in their daily work. Most participants (64.2%) rate voluntary stopping of eating and drinking as a natural death accompanied by health professionals and patients are also granted the right to care (91.9%). This phenomenon is expected by the participants less at a young age and more in old age.
Participants' overall views on the voluntary stopping of eating and drinking are very positive, whereas it is assumed that voluntary stopping of eating and drinking is a phenomenon of old age. Professionals still lack sufficient knowledge about this phenomenon, which could be clarified through training.
International Registered Report Identifier (IRRID): DERR1‐10.2196/10358.
Voluntary stopping of eating and drinking is much discussed interprofessional, but there is a lack of knowledge on how this is perceived in the context of long‐term care and about the incidence of the phenomenon.
Voluntary stopping of eating and drinking is rare but noticeable end‐of‐life practises that is considered by professionals to be mainly dignified and peaceful, although moral concerns make it difficult to accompany.
These findings call on long‐term care institutions to discuss voluntary stopping of eating and drinking as an end‐of‐life practice. Positioning on the issue provides clarity for staff and patients and promotes to develop standardized care.
To investigate the long‐term psychological reactions and resilient process of the young survivors after a large‐scale burn disaster of the Formosa Color Dust Explosion in Taiwan.
Longitudinal study with follow‐up interviews using standardized questionnaire during November 2015 ‐ June 2018.
The burn survivors received structured assessment in the four‐wave interviews including the five‐item Brief Symptom Rating Scale, nine‐item Concise Mental Health Checklist and two‐item Patient Health Questionnaire for depressive symptoms and suicide risk assessment. Post‐traumatic psychological symptoms were assessed through the four‐item Startle, Physiological Arousal, Anger and Numbness Scale and six‐item Impact of Event Scale.
The response rates were 65.1%, 74.2%, 76.9% and 78.5% across the four‐wave interviews among 484 burn survivors. The participants were mean‐aged 23.1 years with just over half having 40% or more burn wounds in total body surface area. The respondents at each wave were similar in gender, age and percent of total body surface area burned. In the first two years of recovery, the respondents showed resilience in coping with stress of trauma under family and social support. While there was a decreasing trend of psychological symptoms over the first two years, hypnotic use and alcohol consumption remained at about 10% in the final interview, which were accompanied by psychological symptom recurrence.
Young burn survivors recovered both psychologically and physically under supportive care and personal resilience in two years after the burn event, yet post‐traumatic mental distress and coping efforts after two years during community reintegration should be detected and managed. Early prevention and detection of mental health deterioration is needed even after two years of burn disasters.
The study demonstrated post‐burn longitudinal changes on psychological reactions. Nursing staffs may help young burn survivors identify mental distress and stress management needs in the long‐term psychological adaptation process.
To discuss nurses’ contributions to global health through their participation in GAPFON®.
Discussion paper that reviews literature related to global health, global nursing and midwifery based on the contributions of the GAPFON® report.
A literature search of electronic databases was conducted for published articles during 2014–2018 in English focusing on the main themes of the GAPFON® report. Manual searches of relevant journals and internet sites were also undertaken.
Recommendations and strategies were discussed that could have an impact on the advancement of the nursing profession's contribution to global health based on the GAPFON® report outcomes.
GAPFON® provides a framework to synergize and converge our activities to address professional issues around the globe, through implementation of the suggested strategies identified in the GAPFON® report. GAPFON® has engaged with nursing and midwifery leaders around the globe to determine both the most pressing health issues and professional issues within regions and the report is a synthesis of all the data, reflecting regional and global challenges. This article explores ways of how the report can be used as a basis for engagement with decision makers in global health.
Advances in the professional areas embedded in the GAPFON® Model are expected to lead to capacity building, evidence‐based practice and ultimately improved quality of global health care. The strategies for implementation identified by regional stakeholders can have an impact on the global health agenda by focusing on nurses and midwives as the drivers of this change.
To explore the experience and feelings associated with the endocrine therapy treatment trajectory in women with breast cancer and what affects medication taking behaviour.
Qualitative systematic review
Qualitative studies were extracted from PubMed, EMBASE, CINAHL, PsycINFO from inception of each database until February 2019.
The systematic search method SPIDER (sample, phenomenon of interest, design, evaluation, research type) was used. Thematic synthesis of the qualitative data was used.
A total of 478 were identified in the initial search. Only 17 articles met inclusion criteria and were included in this review. Five analytical themes and 17 descriptive subthemes were identified.
The systematic review highlights knowledge, balancing the scales, self‐efficacy and support influence medication taking behavior to women with breast cancer.
To examine the content, focus and effectiveness of person‐centred care (PCC) interventions aimed at increasing staff PCC behaviour in health and social care settings for people with dementia.
Systematic search and narrative synthesis of quantitative data.
PsychINFO, Medline, EMBASE, Web of knowledge, CINAHL, ASSIA and BNI were searched from inception to 5 November 2016.
All records retrieved were screened using predetermined eligibility criteria. Quality assessment was performed with the Effective Public Health Practice Project tool (EPHPP).
A total of 4,367 records were screened and 33 studies examining the impact of PCC interventions were included. Eight different categories of PCC intervention were identified, with seven of these having at least some evidence to support their effectiveness in increasing staff PCC behaviour.
The range of interventions and outcome measures identified in this review highlight different ways PCC behaviour can be demonstrated by staff and the range of interventions that can be used to enhance PCC staff behaviour. Future, more rigorously controlled research comparing the relative effectiveness of these interventions, will support nursing facilities and staff to choose appropriate interventions to support them in enhancing PCC.
This study addressed the health priority of increasing PCC for people with dementia. It found preliminary evidence that seven of the eight intervention types identified are effective at increasing staff PCC behaviour in health and social care settings for people with dementia.
To describe the type and the amount of formal and informal care received during the first year after home discharge and to identify the baseline predictors of the formal and informal care needs of stroke survivors.
Longitudinal study. Data were collected between June 2013–May 2016.
Survivors (N = 415) were enrolled during discharge from rehabilitation hospitals and interviewed at 3 (T1), 6 (T2), 9 (T3), and 12 (T4) months. The linear mixed effects model with random intercept and random slopes was used to trend for the amount of formal and informal care received by survivors during the four observation times.
Regarding formal care, only physiotherapy and speech therapy decreased significantly over time. Stroke survivors received a mean of 17 hr of paid informal care per week at T1 and these hours did not significantly decrease after one year from discharge, while unpaid informal care decreased significantly over time. Higher numbers of paid informal caregiving were predicted by older age, higher education levels, lower physical functioning, and living without unpaid informal caregivers while higher numbers of unpaid informal care were predicted by lower physical functioning and living with unpaid informal caregivers.
Stroke has a great effect on survivors’ lives. During the first few months after rehabilitation hospital discharge, survivors need further care because they are often discharged before achieving independent functioning.
The results of this study could be important to guide future interventions aimed at imporving stroke survivors' conditions after post rehabilitation hospital discharge.
To examine the experiences of health transitions for young people with intellectual disabilities and their carers and identify the implications for nursing practice.
A systematic review and critical appraisal of qualitative, quantitative, and mixed methods studies.
A search of the relevant literature published 2007–2017 was carried out in AMED, ASSIA, CINAHL, MEDLINE, PsycINFO, PubMed, and Science Direct Sociological Abstracts databases.
A total of 12 of 637 papers identified in the search met the inclusion criteria for this review. A narrative review of the papers was undertaken by synthesizing the key findings and grouping them into concepts and emergent themes.
Four main themes were identified: (a) becoming an adult; (b) fragmented transition process and care; (c) parents as advocates in emotional turmoil; and (d) making transitions happen.
The range of issues that have an impact on the transition from child to adult health services for young people with intellectual disabilities and their carers raise important implications for policy development, nursing practice, and education.
在AMED、ASSIA、CINAHL、MEDLINE、PsycINFO、PubMed和Science Direct Sociological Abstract数据库中搜索了2007至2017年间发表的相关文献。
To examine seven determinants of Registered Nurses’ aspirations to become a manager in four Norwegian public hospitals.
Research evidence shows that nurses submit few applications to management positions. Understanding the determinants that influence nurses’ aspirations to become managers can provide healthcare organizations with important knowledge on the drivers and barriers in recruitment and on the development of nurse managers.
This study adopted a cross‐sectional web‐based survey design.
Logistic regression analysis based on 2,630 Registered Nurses’ responses to a self‐completion survey in a Norwegian regional health authority collected during October 2014. The overall response rate was 40%.
Findings indicate that men and younger nurses are most likely to report an aspiration in management. The social support of an immediate supervisor and institutional stress are positively associated with an aspiration to become a manager; however, high experienced workloads have the opposite effect.
Healthcare organizations should work strategically to develop a human resource management policy that ensures that the organization develops the nurse managers it needs now and in the future.
This study addresses the challenge of having enough qualified nurse managers. The main findings indicate that job demands can have both a negative and positive impact on nurses’ aspirations to become a manager. Healthcare organizations should, however, reduce demands and consider increasing job resources. The results should have an impact on the human resource department, managers, and other key personnel in healthcare organizations.
To explore the extent to which a more person‐centred climate could explain the variation in quality of care, as rated by relatives to nursing home residents in three countries.
A cross‐sectional, correlational, anonymous questionnaire study.
Questionnaires were administered to 346 relatives to residents in six nursing homes in Australia, Norway and Sweden between April–June 2016. Relatives (N = 178) agreed to participate. Data were analysed using descriptive statistics and hierarchical multiple regression.
The results showed that the relatives’ experiences of a more person‐centred climate were associated with higher ratings of the quality of care. A person‐centred climate of safety had the strongest unique association with the quality of care, explaining 14% of the variance in quality of care. In addition, the results indicated that the relatives in general were satisfied with the quality of care and that children to the residents rated the quality of care higher than partners or other relatives.
This study advances the understanding of the relationship between person‐centredness in nursing homes and quality of care, showing that person‐centred climate aspects of safety and hospitality have a significant role in the quality of care as perceived by relatives.
Person‐centredness in nursing homes is often mentioned as a quality of care indicator, but the empirical evidence for this suggestion is limited. This study expanded the evidence‐base for person‐centredness as a significant aspect of relatives’ experiences of the quality of care in nursing homes.
To explore (a) resilience among patients over the first 6 months following a first ischemic stroke; (b) factors associated with resilience at hospitalization, 1, 3 and 6 months post‐discharge; (c) baseline predictors of resilience at 6 months post‐discharge.
a cohort study.
From February 2017 ‐ January 2018, 217 patients presenting at two hospitals with a first ischemic stroke were recruited. Their resilience, medical coping styles, general self‐efficacy, functional independency, socio‐demographic and clinical data were assessed while they were still in hospital (baseline) and at 1, 3 and 6 months after discharge.
Resilience among stroke patients decreased significantly 1 month after hospital discharge and remained stable. Predictors of resilience were: self‐efficacy and resignation at baseline; number of children, functional independency, general self‐efficacy and resignation at 1 month; and religion, resignation, self‐efficacy, confrontation at 3 months and 6 months. The baseline factors that predicted resilience at 6 months were income level, religion, stroke severity at discharge, self‐efficacy and resignation.
Stroke survivors experienced a significant decrease in resilience from hospitalization until 1‐month post‐discharge. Factors contributing to resilience after a stroke varied across time. Self‐efficacy and coping styles were particularly important and contributed to long‐term resilience.
Understanding resilience among stroke survivors is needed to inform the development of interventions to enhance the psychological recovery of survivors. The levels of resilience among stroke survivors were low compared with those in the normal older population. Nurses should provide greater psychological support during hospitalization to stroke survivors and especially to those with lower income, higher stroke severity at discharge, no religion, lower self‐efficacy or who use resignation as a coping strategy as those survivors may have lower resilience 6 months later. Future studies are needed to test interventions designed to change or modify stroke survivors’ coping styles and promote self‐efficacy thereby enhancing higher resilience.
To evaluate the relationship between the pressure exerted on the heel of one foot resting directly on a mattress, versus that exerted on the other heel, protected by a pillow beneath the Achilles tendon area and the changes thus produced in perfusion, oxygenation and temperature in the heels skin of healthy volunteers, lying in a supine position.
Experimental study in a preclinical phase, with healthy volunteer subjects and intrasubject control.
The study was carried out from November 2017 ‐ May 2018. A pressure measurement surface was placed between the subject and the constant low‐pressure support surface. Doppler laser devices were used to measure local temperature and perfusion. The degree of oxygenation was determined using an infrared beam close to the pressure zone in each heel. Both feet rested immobile on the bed, in a natural position, for two hours. To ensure intrasubject control, in every case the left heel was raised slightly, compared with the right.
Eighteen subjects took part in this study. Analysis of the results obtained showed that capillary blood flow was significantly reduced in the heel subjected to pressure, compared with the other heel, while no significant effects on oxygen saturation or temperature were observed. The variables associated with greater oxygen saturation were capillary blood flow, local temperature and pressure exerted. Fat‐free mass, fat mass and duration of exposure to pressure were all significantly associated with reduced oxygen saturation.
In healthy subjects, when the heel is subjected to constant pressure against a constant low‐pressure support surface, there is a significant reduction in blood flow, compared with the heel where pressure is relieved. However, there are no significant differences in temperature or tissue oxygenation.
Significant reductions in vascular flow were observed; however, the oxygenation and temperature of the heel tissues remained unchanged. These findings, corroborated in real patients, would advance our understanding and facilitate decision‐making on measures to prevent pressure ulcers, such as repositioning or tissue protection.
To investigate palliative care nurse attitudes towards medical assistance in dying.
An exploratory cross‐sectional study design.
A mailed letter recruited participants with data collection occurring on a secure online survey platform between November 2017 and February 2018. Data analyses included descriptive and bivariate statistics and stepwise linear regression.
Palliative care nurse attitudes toward medical assistance in dying were explained by perceived expertise in the social domain of palliative care, personal importance of religion/faith, professional importance of religion/faith and nursing designation.
This study reveals the perceived importance of religion, versus religious affiliation alone, as significant in influencing provider attitudes toward assisted dying. Further research is needed to understand differences in attitudes between registered nurses and registered practical nurses and how the social domain of palliative care influences nurse attitude.
Organizations must prioritize nursing input, encourage open interprofessional dialogue and provide support for ethical decision‐making, practice decisions and conscientious objection surrounding medical assistance in dying.
Longitudinal nursing studies are needed to understand the impact of legislation on quality and person‐centred end of life care and the emotional well‐being/retention of palliative care nurses.
The current study is aimed at developing a culturally‐informed education program to increase cultural competence in emergencies among health care students and to examine its effectiveness using a randomized controlled trial.
This is a mixed‐methods study, which comprises two phases: (1) Development of educational intervention to increase cultural competence, based on a review of published scientific literature and primary data collection from qualitative semi‐structured interviews with key informants; (2) Implementation and assessment of the intervention effectiveness in increasing cultural competence in health students, using a randomized controlled trial.
The qualitative phase will include semi‐structured interviews with ten key informants. Data will be analyzed using Interpretative Phenomenological Analysis. The assessment of intervention efficacy will be examined by a randomized controlled trial. This phase will include a total of 200 undergraduate health profession students who will be randomized (1:1 ratio) to intervention or non‐intervention group. Both study groups will complete pre and post‐intervention questionnaires assessing three principles of cultural competence: attitudes, knowledge and skills. The study is supported by two‐year funding, beginning in September 2018.
Although the importance of culturally‐sensitive health services has long been recognized, there is a lack of cultural competence training in the medical education system, especially in the context of emergencies. Incorporating cultural competence education into the curricula offers an appealing strategy to enhance systematic understanding of cultural diversity at the early stages of professional training.
The development of cultural competence training and curricula focusing on situations that may arise during emergencies may play a significant role in minimizing cultural dissonance, improve patient‐provider communication and produce better clinical outcomes.
To evaluate the efficacy of the Portuguese version of the metacognitive training (MCT) programme for schizophrenia and its effects on psychotic symptoms, insight into the disorder and functionality.
This is a randomized controlled trial that will be undertaken in six psychiatric institutions in Portugal.
This study was approved in March 2019. The sample will consist of people with schizophrenia. The evaluation instruments will include sociodemographic and clinical questionnaires, the Psychotic Symptom Rating Scales, the Beck Cognitive Insight Scale, the World Health Disability Assessment Schedule, and the Personal and Social Performance Scale, applied to both groups at three different times. In the experimental group, the eight MCT modules will be applied over 4 weeks.
It is expected that at the end of the programme, the experimental group will have reduced severity of psychotic symptoms and improved insight into the disease and functionality.
Schizophrenia is a severe mental disorder that, in most cases, leads to the deterioration of cognitive and social functioning as a result of psychotic symptoms. Metacognitive training for schizophrenia has been used in several countries, but its efficacy remains unclear. It is a type of programme that consists of changing the cognitive infrastructure of delusions.
To develop and psychometrically test a self‐efficacy scale for ostomy care nursing management.
This study adopted a multi‐method and multi‐phase design.
Phase 1 of the study was comprised of the developmental tasks, where items were generated based on the emergent themes from literature. The items were then discussed with a panel of experts. Phase 2 focused on the validation process of the scale, where its content validity, construct and concurrent validity, and its internal consistency were assessed. The validation process was conducted between January 2018 ‐ January 2019.
The final version of the self‐efficacy scale in ostomy care nursing management encompasses 24 items in three domains, namely the clinical assessment domain, the education and relationship domain, and the teamwork domain. The scale showed the evidence of face and content validity, adequate construct and concurrent validity, and adequate internal consistency.
The developed scale can be used in clinical and educational research.
This study presents the development and validation of the first valid and reliable self‐reporting measurement for nurses’ self‐efficacy in ostomy care nursing management. Self‐efficacy ostomy care nursing management encompasses 24 items and three domains, which are clinical assessment, education and relationship, and teamwork. This research will have an impact on nursing education, as it addresses the need for a specific self‐efficacy assessment of ostomy care nursing management. Self‐efficacy ostomy care nursing management will have an impact on nurses and patients, as it can be used to improve nurses’ self‐efficacy and clinical outcomes for patients in ostomy care.