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Anteayer Journal of Advanced Nursing

Nurses' intention to stay: The impact of perceived organizational support, job control and job satisfaction

Abstract

Aim

To propose a theoretical model of intention to stay and examine the effects of perceived organizational support, job control and job satisfaction on intention to stay.

Design

Cross‐sectional multicenter survey.

Methods

The survey was conducted from January 2017 ‐ July 2017 and comprised 3,240 clinical nurses from nine tertiary hospitals in eastern, central and western China, with 2,352 effective responses. Structural equation modeling was used to analyze the relationship between intention to stay and its correlative factors.

Results

The hypothesized model was supported. Job control, perceived organizational support and job satisfaction significantly and directly affected nurses' intention to stay. Furthermore, job control and perceived organizational support showed indirect effects on intention to stay, which was mediated by job satisfaction. Perceived organizational support could positively influence job control to have a further impact on job satisfaction and intention to stay.

Conclusion

Based on a large sample of Chinese tertiary hospital nurses, this study proposed and verified a theoretical model of nurses' intention to stay, revealing that organization characteristics, work characteristics and affective response to work can have an impact on intention to stay.

Impact

This study was the first to examine the relationships among perceived organizational support, job control, job satisfaction and intention to stay, enriching the theoretical model of intention to stay. Nurse managers can improve nurses’ intention to stay by enhancing their perceived organizational support, job control and job satisfaction.

Being honest with causal language in writing for publication

Abstract

The misleading use of causal language in publication is problematic for authors, reviewers, and consumers of the information. Published research in quality journals has important knowledge implications and it is, therefore, contingent on authors to use language that is accurate and appropriate to their work. Language implying unsupported causal relationships may overstate the evidence‐base, especially if accepted by uncritical readers or unwitting members of the general public who may not understand how to interpret inferential statistics.

A survey of telephone nurses’ experiences in their encounters with frequent callers

Abstract

Aim

The aim of this study was to describe telephone nurses’ experiences of their encounters with frequent callers to Swedish Healthcare Direct.

Design

A descriptive inductive design with qualitative approach.

Methods

Data collection was performed during the period of September 2017 – June 2018. A total of 199 telephone nurses working at 10 Swedish Healthcare Direct sites with different geographical locations in Sweden answered a survey containing seven open‐ended questions. Data analysis was performed during the period of September 2018 – June 2019. The answers were analysed using content analysis.

Results

The telephone nurses perceived that the encounters with frequent callers were sometimes frustrating as they felt unable to help. According to the telephone nurses, the frequent callers called about the same issues several times and the calls were often about loneliness and psychiatric problems. The telephone nurses were worried about missing something urgent; one of the aspects leading to this was the perception of knowing the caller. They expressed a wish to know more about frequent callers and strategies for helping them. A common care plan for frequent callers’ calls was suggested.

Conclusion

Telephone nurses often found it difficult to handle calls from frequent callers. However, they had a will to care for frequent callers and to learn more about them. Therefore, a common strategy, education and training for telephone nurses in answering calls from frequent callers could be beneficial for both callers and telephone nurses.

Impact statement

This study offers insights to researchers, telephone nurses and managers of telephone nursing, regarding telephone nurses’ experiences in handling frequent caller calls. These findings can offer direction for the content of a possible intervention.

A Life Where Concealment and Exposure Coexist ‐ the Antiretroviral Therapy Adherence of People living with HIV infection: a Phenomenological Study

Abstract

Aim

The aim of this study is to identify the nature and structure of the real world experiences of people living with HIV infection and adhering to antiretroviral therapy.

Design

Giorgi's phenomenological method was applied.

Methods

Data collection was conducted from 1November 2016 – 1 September 2017. A total of six participants participated in the study. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used to report this study.

Results

The findings show that the structure of the experience of people living with HIV and adhering to antiretroviral therapy is composed of six essential common constituents: 1) Antiretroviral therapy adherence has become a prerequisite for a normal life; 2) Endless adjustments responding to a sensitive body; 3) Dosing Time becomes the framework of the day; 4) Dosing time needing to coincide with the availability of confidential dosing space; 5) Classification of Relationships ‐ those who know of my taking antiretroviral drugs and those who do not; and 6) Recognition of the multiple relationships affecting antiretroviral therapy.

Conclusion

Adhering to antiretroviral therapy is experienced by people infected with HIV not only as a process they want to hide, but also a critical lifeline that stabilizes their lives. That is, their day‐to‐day living is split into a double life reflecting their coexisting need for concealment and exposure.

Impact

Although much existing literature focuses on the adherence to medication, this study reveals the meaning of antiretroviral therapy in the context of viewing the patient as an independent subject. Contrary to what people living with HIV want, they are at risk of external exposure during the process of treatment. This study highlights the need for nurses to communicate with patients about the strategies they need to meet the challenges they face.

Modeling Individual, Parental and Peer Factors to Glycemic Control in Adolescents with Type 1 Diabetes: A Prospective Study

Abstract

Aim

To construct a model addressing the pathways from baseline diabetes distress, attribution of peer reactions, parenting style and three‐month self‐management to six‐month glycated hemoglobin levels in adolescents with type 1 diabetes.

Design

A prospective design was adopted.

Methods

A total of 177 adolescents aged 10–19 with type 1 diabetes were enrolled from four hospitals in Taiwan. Diabetes distress, attribution of peer reactions and parenting style were collected at baseline, self‐management was collected at the third month and glycated hemoglobin levels were collected at the sixth month. Data were collected from May 2015 to June 2016.

Results

Baseline diabetes distress and three‐month self‐management directly affected six‐month glycated hemoglobin levels. Baseline attribution of peer reactions directly affected baseline diabetes distress and three‐month self‐management; also, it indirectly affected six‐month glycated hemoglobin levels through three‐month self‐management. Baseline parenting style directly affected baseline diabetes distress, baseline attribution of peer reactions, three‐month self‐management and six‐month glycated hemoglobin levels; it also indirectly affected six‐month glycated hemoglobin levels through baseline diabetes distress and three‐month self‐management.

Conclusion

A model simultaneously incorporating individual, parental and peer factors to glycemic control in adolescents with type 1 diabetes has been constructed. Improving diabetes distress and self‐management should be essential strategies to improve glycemic control in adolescents with type 1 diabetes. Encouraging adolescents with type 1 diabetes to communicate openly with peers regarding diabetes care and educating their parents to provide more responsive and autonomy‐encouraging parenting style might be vital strategies to improve diabetes distress, three‐month self‐management and glycemic control.

Impact

Individual, parental and peer factors should be simultaneously considered to improve glycemic control in adolescents with type 1 diabetes. Nurses should evaluate these factors to tailor interventions improving glycemic control in adolescents with type 1 diabetes.

A systematic review on randomized controlled trials: Coaching elements of digital services to support chronically ill adolescents during transition of care

Abstract

Aims

To define digital health services that have been studied among chronically ill adolescents and to describe e‐health coaching elements that may have an impact on transition outcomes.

Design

Systematic review without meta‐analysis.

Data sources

MEDLINE (Ovid), Pub Med, Scopus and CINAHL on 28 May 2018.

Review Methods

Peer‐reviewed articles published between January 2008 ‐ May 2018 were reviewed following the Cochrane Handbook for Systematic Reviews of Interventions and reported according to the Preferred Reporting Items for Systematic Reviews and Meta‐analyses statement.

Results

Twelve randomised controlled trials were included. The interventions varied significantly in duration and content. E‐coaching that included human and social support showed positive impact on transition outcomes. Digital health services incorporated into usual care provide efficient and accessible care.

Conclusion

E‐coaching elements enable tailoring and personalization and present a tool for supporting and motivating chronically ill adolescents during transition of care. Future research should evaluate the effectiveness of e‐coaching elements.

Impact

Digital services are considered a means for increasing adolescents´ motivation for selfcare and for increasing their accessibility to healthcare. The coaching elements in digital services consist of a theoretical basis, human support, interactive means and social support. Included interventions varied in terms of duration, dose, content and design. Our results may serve the development of digital health services for adolescents in transition. E‐coaching can be used to engage and motivate chronically ill adolescents to improve health behaviour and self‐management during transition of care.

Predictors of family focused practice among health visitors: A mixed methods study

Abstract

Aims

To determine what predicts health visitors’ family focused practice with mothers who have mental illness. To explore health visitors’ experiences of family focused practice and what factors, if any, enable and or hinder it.

Design

A sequential mixed methods design was employed.

Methods

In Phase 1, 230 health visitors, in five Health and Social Care Trusts in the United Kingdom were recruited using convenience sampling and completed the Family Focused Mental Health Practice Questionnaire. Three multiple regression models were developed to test whether workload (Model I), professional knowledge (Model II) and health visitors’ professional and personal experience (Model III) predicted their family focused practice. In Phase 2, 10 health visitors, who completed the questionnaire, participated in semi‐structured interviews to describe their experiences of family focused practice. The data collection of the two phases was conducted from September 2017 ‐ September 2018.

Results

Model III was significant. While personal experience of parenting was positively associated with family focused practice, length registered as a health visitor and personal experience of mental illness was negatively associated. Qualitative findings suggested that increasing years of professional experience and personal experience of mental illness enabled health visitors to support mothers and their children, but not other adult family members, including partners. Limited skills and knowledge to support mothers with severe mental illness (i.e. schizophrenia) hindered family focused practice.

Conclusion

This study advances understanding of how health visitors’ professional and personal experiences can influence their family focused practice and highlights the importance of organisations promoting their capacity to support mothers with severe mental illness and to include mothers’ partners.

Impact

A clear understanding of factors affecting health visitors’ capacity to engage in family focused practice will help to inform policy, education and practice in health visiting; with potential to improve outcomes for the whole family.

Efficacy of mind‐body therapies and exercise‐based interventions on menopausal‐related outcomes among Asian perimenopause women: A systematic review, meta‐analysis, and synthesis without a meta‐analysis

Abstract

Aims

To evaluate the efficacy of exercise‐based interventions and mind‐body therapies on quality of life, menopausal symptoms and depression among Asian perimenopausal women.

Design

A systematic review, meta‐analysis and synthesis without meta‐analysis (SWiM).

Data sources

Six electronic databases were systematically searched: PubMed, CINAHL, Embase, PsycINFO, Scopus and ProQuest.

Review methods

The point of inception of each database to 15 November 2018 were systematically searched. A meta‐analysis and SWiM were used to present the results. Review Manager 5.3 and The Cochrane Risk of Bias tool were used for meta‐analyses and assessing of risk of bias respectively.

Results

Twenty‐three studies were reviewed. Significant effects in exercise‐based interventions and mind‐body therapies were found for quality of life, menopausal symptoms and depression but not for hot flashes. Limitations of this review include insufficient blinding of participants and/or researchers found in most of the included studies and high levels of heterogeneity in the meta‐analyses. Evidence found in this review is to be interpreted with caution.

Conclusion

Healthcare professionals can consider exercise‐based interventions or mind‐body therapies to manage menopausal symptoms. Future trials of good quality can examine the cost‐effectiveness and optimal intervention duration. Intervention effects on specific menopausal symptoms such as sleeplessness in Asia can be examined in future.

Impact

What problem did the study address? Exercise‐based interventions and mind‐body therapies suggests effectiveness on quality of life, menopausal symptoms and depression among Asian perimenopausal women. What were the main findings? Exercise‐based interventions and mind‐body therapies improve quality of life, menopausal symptoms and depression but not hot flashes. Long‐term exercise‐based interventions is effective in managing depression. Due to varied limitations in the review and included studies, firm conclusions cannot be reached. Where and on whom will the research have impact? Healthcare professionals in Asia can consider implementing exercise‐based interventions and mind‐body therapies for symptomatic perimenopausal Asian women.

The effect of mindfulness training on burnout syndrome in nursing: a systematic review and meta‐analysis

Abstract

Aim

To analyse the effect of mindfulness training on levels of burnout among nurses.

Background

Burnout syndrome is a common occupational hazard for nursing staff. Mindfulness training has been proposed as a valid intervention for burnout.

Design

Systematic review and meta‐analysis.

Data sources

The CINAHL, LILACS, Medline, ProQuest, PsycINFO, Scielo and Scopus databases were consulted, using the search equation “Nurs * AND burnout AND mindfulness”. There was no restriction on the year of publication.

Review methods

Papers were selected for analysis in accordance with the PRISMA guidelines. The meta‐analysis was carried out using Review Manager 5.3 software.

Results

The sample was of 17 articles including 632 nurses. Mindfulness training reduces levels of burnout, producing lower scores for emotional exhaustion and depersonalization and higher for personal accomplishment. The differences in the means were 1.32 (95% CI: ‐9.41 – 6.78), 1.91 (95% CI: ‐4.50 – 0.68) and 2.12 (95% CI: ‐9.91 – 14.14) respectively, between the intervention and control groups.

Conclusion

Mindfulness training reduces the emotional burden and hence levels of burnout, among nurses. However, further randomised clinical trials are required.

Impact

Mindfulness intervention reduces the level of burnout among nursing staff. Mindfulness, through body‐mind training, allows workers to address and overcome situations of severe emotional impact. These results may have a positive impact for well‐being and quality of life in nurses and also for the quality care. Hospitals can provide mindfulness training, which has been proposed as a potential strategy to reduce nurses burnout.

A randomized controlled trial of the Effects of a telehealth educational intervention on medication adherence and disease activity in rheumatoid arthritis patients

Abstract

Aims

To examine the effects of a tailored telehealth educational intervention on medication adherence and disease activity in discharged patients with rheumatoid arthritis (RA).

Design

An un‐blinded randomized controlled trial.

Methods

A total of 92 eligible patients were recruited from January 2015 ‐ December 2015. Participants were randomly assigned to either the intervention (N=46) or control group (N=46). The intervention group received four educational sessions delivered through a telephone across a 12‐week intervention. The content of the education mainly included: subject's knowledge about disease; treatment goals; the importance of taking medication correctly; side effect management; remembering to take medication. The control group received only standard care including discharge instructions. Outcome measures included medication adherence and disease activity.

Results

The intervention group had significantly higher medication adherence compared with the control group at 12th and 24th week. There was no significant difference between two groups in disease activity at 12th and 24th week.

Conclusions

The telephone‐delivered tailored educational intervention effectively improved medication adherence among discharged patients with rheumatoid arthritis. However, no significant benefits of the intervention on disease activity were detected.

Impact

Good medication adherence in rheumatoid arthritis patients contributes to controlling symptom and inflammation, preventing the progressive structural damage. This study demonstrated that the telehealth educational intervention could improve patients' medication adherence but didn't have a direct impact on clinical condition in the short term. The intervention for discharged patients with rheumatoid arthritis can be integrated into the clinical setting by the nursing staff as follow up care.

Bibliometric analysis of qualitative research on patients’ experiences of intestinal stoma published between 2002 and 2018

Abstract

Aims

The purpose of this paper was to perform a bibliometric analysis of the production of qualitative research in scientific journals through aggregation by levels and to identify factors of diversity, such as types of designs, in qualitative research on the experience of having an intestinal stoma between 2002 and 2018.

Design

Descriptive bibliometric study focused on the production of qualitative research on the subject of study, on three levels: micro, meso, and macro.

Methods

Databases such as PubMed, CINAHL, Web of Knowledge, Scopus, SciELO, CUIDEN, Lilacs and Google Scholar were used to collect the data, between August‐November 2018.

Results

Nursing was the main area of knowledge. Brazil was the predominant country of origin. The most productive journal was the Journal of Wound, Ostomy & Continence Nursing. English and Portuguese were the main languages of scientific communication. The number of authors was typically between 2 and 6. Authors conducted descriptive and phenomenological studies.

Conclusion

The present bibliometric study helps us map the qualitative research on the experiences of individuals with an intestinal stoma, as well as to understand patterns in the designs, methods, disciplines, and journals involved in this area of research. This will allow nurses to have a leading contribution to stoma care at their disposal.

Impact

What problem did the study address?

This study sought to analyses the production of original qualitative research that explored the perspectives of people with intestinal stoma from 2002 to 2018.

What were the main findings?

Nursing is the most concerned field about qualitative research on experiences of people with intestinal stoma. It also remarked that there were many philosophies, designs, methods, techniques, and types of analysis used.

Where and on whom will the research have an impact?

Nurse researchers need to publish their findings and align their research interests to meet national health priorities.

Paternal mental health during the perinatal period: A qualitative systematic review

Abstract

Aims

To examine fathers’ experiences and needs associated with mental health during the perinatal period.

Design

Qualitative studies were meta‐synthesized using the steps outlined by Sandelowski and Barroso.

Data sources

Six databases (PubMed, Embase, PsycINFO, CINAHL, Scopus and ProQuest) were searched for qualitative studies from each database’s inception to 24 June 2019.

Review Methods

Studies were critically appraised using the Critical Appraisal Skills Program (CASP) tool. Qualitative data were extracted, meta‐summarized, then meta‐synthesized.

Results

Fourteen studies were included and four themes emerged: (1) negative feelings and psychological difficulties; (2) role strain and role conflict with multiple sources; (3) coping strategies that buffered negative feelings and psychological difficulties; and (4) support needs to enhance mental health.

Conclusion

Fathers reported poor mental health and expressed needs to enhance their mental health across the perinatal period. Future studies can focus specifically on paternal mental health. The development of theory‐guided, family‐inclusive, technology‐based healthcare services are needed to manage mental health. Healthcare providers can promote positive mental health to prepare fathers, increasing their awareness to manage their mental health and to seek timely help.

Impact

Problem‐focused coping (i.e. support and problem‐solving with partners and childcare involvement) helped fathers to buffer their negative feelings and psychological difficulties. Future studies should focus on paternal mental health rather than on general fathering experiences. Healthcare providers should focus on promoting positive mental health and well‐being. Policymakers should create awareness on paternal mental health across the perinatal period.

Thriving among older people living at home with home care services – a cross‐sectional study

Abstract

Aim

To explore the level of thriving and associated factors among older adults living at home with support from home care services.

Design

An exploratory, cross‐sectional survey design.

Method

A sample of 136 participants (mean 82 years) responded to a survey about thriving, health, psychosocial and care‐related factors in 2016. Descriptive analysis and multiple logistic regression analysis with a stepwise backwards elimination procedure were performed.

Result

The results showed that the level of thriving was relatively high among adults living at home with support from home care services, with dimensions concerning engaging in activities and peer relations and keeping in touch with people and places being rated the lowest. Regression analysis showed that participating in social relations and experiencing self‐determination in activities in and around the house were associated with thriving.

Conclusion

Facilitating social relations and creating opportunities for self‐determination seem necessary to support thriving among older adults living at home with support from home care services.

Impact

The findings in this study adds important knowledge about place related well‐being when living at home with home care services.

Associations of occupational stress, workplace violence and organizational support on chronic fatigue symptoms among nurses

Abstract

Aims

Chronic fatigue syndrome is an agnogenic disease worldwide. Nurses are at a high risk of chronic fatigue syndrome. However, no research has been done to examine the associations of workplace violence, organizational support and occupational stress with chronic fatigue syndrome among Chinese nurses. This study aimed to examine effects of these factors on chronic fatigue syndrome in this occupational group.

Desine

Cross‐sectional. All participants voluntarily completed a questionnaire survey.

Methods

The study was conducted in Liaoning province from December 2017 to January 2018. Self‐administered questionnaires were distributed to 1200 nurses, including Effort‐Reward‐Imbalance, Workplace Violence Scale, Survey of Perceived Organizational Support, together with age, gender, marital status, education levels, physical activities, job rank, monthly income and weekly working hours. Complete responses were obtained from 1080 (90%) participants. Chronic fatigue syndrome was diagnosed by doctors according to the Centers for Disease Control and Prevention criteria. Multivariable logistic regression was performed to examine these independent risk factors.

Results

The prevalence of chronic fatigue syndrome was 6.76%. The results of logistic regression analysis showed that nurses who experienced serious higher levels of overcommitment, workplace violence and less organizational support were more likely to be classified as chronic fatigue syndrome.

Conclusion

There was a high prevelence of chronic fatigue syndrome. Lower workplace violence, more organizational support and lower overcommitment could be effective resources for reducing chronic fatigue syndrome.

Impact

Workplace violence, organizational support and occupational stress were related to chronic fatigue syndrome, which helped to explain why Chinese nurses suffered higher prevelance of chronic fatigue syndrome. Overcommitment explained chronic fatigue syndrome better than Effort/Reward Ratio, so intrinsic stress played a more critical role than extrinsic stress in chronic fatigue syndrome. Chinese nurses suffered serious sleep disorders and impairment of concentration and memory. These symptoms might also atributed to serious occupational stress, unsafe and unsupportive working environment. Creating a safe and supportive working emvironment, releiving intrinsic occupational stress should be considered as an institutional strategy to early prevent chronic fatigue syndrome.

The effectiveness of music therapy for patients with cancer: a systematic review and meta‐analysis

Abstract

Aims

To assess the effectiveness of music therapy on the quality of life, anxiety, depression, and pain of patients with cancer.

Design

Systematic review.

Data sources

Five electronic databases were searched in September 2018 for randomized controlled trials evaluating music therapy for patients with cancer.

Review methods

The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook Version 5.1.0 and the Revman version 5.3 software was used to perform the meta‐analysis. The outcomes were overall quality of life, anxiety, depression and pain.

Results

A total of 19 trials evaluating 1548 patients were included in this study, of which 765 were in the control group and 783 in the experimental group. Compared with standard care, music therapy can significant increase the score of overall quality of life in patients with cancer. In addition, music therapy was found to be more effective for decreasing the score of anxiety, depression, and pain.

Conclusion

Music therapy can improve the overall quality of life of patients with cancer, with an observed optimal intervention duration of 1‐2 months. Meanwhile, anxiety, depression, and pain are improved as well. Nevertheless, high‐quality trials are still needed to further determine the effects of music intervention in supportive cancer care.

Worldwide prevalence of sexual harassment towards nurses: A comprehensive meta‐analysis of observational studies

Abstract

Aims

Sexual harassment towards nurses is a major concern universally, but no meta‐analysis on the worldwide prevalence of sexual harassment towards nurses has yet been published. This study examined the worldwide prevalence of sexual harassment against nurses and explored its moderating factors.

Design

Meta‐analysis of observational studies.

Data sources

The PubMed, PsycINFO, EMBASE, and Web of Science databases from their commencement date to February 2018 were systematically and independently searched by two investigators.

Review methods

Data on the prevalence of sexual harassment experienced by nurses were extracted and pooled using the random‐effects model.

Results

A total of 43 studies covering 52,345 nurses were included in the analyses. Female nurses accounted for 83.87% of the 32,970 subjects in 25 studies with available data on gender ratio. The prevalence of sexual harassment towards nurses in the past 12 months and during nursing career were 12.6% (95% CI: 10.9–14.4%) and 53.4% (95% CI: 23.1–83.7%), respectively. Gender, use of the WHO questionnaires, lower middle‐income and high‐income countries, sample size, survey year, and mean age of subjects were significantly associated with the prevalence of sexual harassment.

Conclusion

The high prevalence of sexual harassment against nurses found in this meta‐analysis represents the ongoing sexism and deleterious effects (e.g., poor work quality and efficiency, increased stress and job dissatisfaction) in the profession. Appropriate preventive measures, training, and empowerment of nurses are needed to ensure workplace safety and equality in this profession.

Impact

The study addressed the worldwide prevalence of sexual harassment against nurses and its moderating factors. Health authorities and hospital administrators should develop organizational policy and preventive strategies to ensure nurses’ workplace safety and equality.

The effectiveness of a nurse‐led intervention to support family caregivers in end‐of‐life care: Study protocol for a cluster randomised controlled trial

Abstract

Aim

To evaluate the feasibility of a structured nurse‐led supportive intervention and its effects on family caregivers in end‐of‐life care at home.

Background

Family caregivers are crucial in end‐of‐life care. They may experience burden due to the responsibilities associated with caregiving. Some family caregivers feel insufficiently prepared for their caregiver role. Nurses have a unique position to provide supportive interventions at home to reduce caregivers’ burden and improve preparedness. However, few nurse‐led interventions are available to support family caregivers in end‐of‐life care at home.

Design

We will perform a cluster randomised controlled trial. The clusters consist of twelve home care services, randomly assigned to the intervention group or the control group.

Methods

The study population consists of family caregivers of patients in the last phase of life. In the intervention group, nurses will systematically assess the supportive needs of family caregivers, using an assessment tool and the method of clinical reasoning. Family members of the control group receive care as usual. Primary outcome is burden measured by the Self‐Rated Burden Scale. Secondary outcomes are preparedness for caregiving, caregiving reactions and acute (hospital) admissions of the patient. In addition, the feasibility of the intervention will be evaluated. The study was funded in October 2016 and was ethically approved in April 2019.

Impact

Findings from this study will contribute to the scientific and practical knowledge of nursing interventions to support family caregivers in end‐of‐life care.

Measuring next of kin satisfaction with hospital cancer care: using a mixed‐method approach as basis for improving quality and safety

Abstract

Aim/s

To explore next of kin satisfaction with cancer care, map next of kin suggestions for involvement and combine this information to create a basis for improving quality and safety in hospitals.

Design

Convergent parallel mixed‐methods design applying the 20‐item FAMCARE Scale survey instrument for quantitative measurement of satisfaction with care and with an open‐ended question used for qualitative analysis.

Data sources

Responses from 238 next of kin (November 2016 ‐ November 2017).

Methods

Exploratory factor analysis, regression analysis and qualitative content analysis were combined.

Results

Both hospitals scored better in medical treatment (median, interquartile range: 1.5, 1.1‐2.0), than in satisfaction with information and involvement of next of kin (1.9, 1.3‐2.4), p<0.001 (Wilcoxon signed ranks test). After adjusting for differences in demographical and clinical variables, the total FAMCARE scores were 13% higher (95% confidence interval: 1‐27%, Wald p=0.029) at one of the hospitals. Qualitative findings support that the hospitals are not providing an equal offer to next of kin involvement in hospital cancer care that includes a proactive approach.

Conclusion

As a basis for quality and safety improvement, next of kin satisfaction and involvement in cancer care should be addressed in a two‐sided perspective, balancing the next of kin's need for involvement in cancer treatment with the patient's perspective.

Impact

There is limited knowledge of next of kin satisfaction with hospital cancer care and how next of kin would like to be involved in this trajectory. Several aspects of satisfaction with cancer care can prompt change to improve service quality and safety (e.g. information, involvement, practical care), but this is an underused source of information. Next of kin are key in cancer care and our study demonstrates a potential large impact on future practical ways of improving cancer care service provision in an integrative perspective including next of kin.

Gender differences in the impact of health literacy on hospital readmission among older heart failure patients: A prospective cohort study

Abstract

Aims

To investigate the impact of limited health literacy on 1‐year hospital readmission among both older men and women with heart failure.

Design

Prospective cohort study.

Methods

A total of 286 patients with heart failure (men=144, women=142) aged 65 years or older at baseline from two tertiary hospitals were enrolled from June to November 2017. Patients were followed up until November 2018. The Brief Health Literacy Screening Tool was used to assess baseline health literacy. One‐year readmission after discharge was assessed via medical records or telephone interview. A hierarchical logistic regression was performed.

Results

The prevalence rates of limited health literacy and one‐year hospital readmission among older women were 74.7% and 35.9%, respectively compared with 48.6% and 27.1% in older men. Limited health literacy significantly increased the risk of 1‐year hospital readmission in both older men and women with heart failure. More importantly, older women with limited health literacy had a much higher risk of hospital readmission (odds ratio 10.17, 95% confidence interval 2.19‐47.14) than did older men with limited health literacy (odds ratio 5.27, 95% confidence interval 2.04‐13.59).

Conclusions

Our findings highlight that a baseline assessment of health literacy would help prevent unplanned hospital readmissions after discharge in both older men and women with heart failure. Health professionals should recognize that women with limited health literacy are more vulnerable to re‐hospitalization than are men with limited health literacy.

Impact

Few studies have addressed gender differences in the link between health literacy and hospital readmission among patients with heart failure. We found that older women with limited health literacy had a much higher risk of hospital readmission than did their male counterparts. Health professionals should be aware of gender differences in health literacy in discharge planning, including self‐management counselling for older patients with heart failure.

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