The aim of this integrative review was to explore psychosocial vulnerabilities in women after a breast cancer diagnosis that are related to their paid work.
The review methodology was guided by Whittemore and Knafl. The Mehnert Cancer Survivorship and Work Model provided a lens through which to view vulnerability in working women with a focus on facilitating interventions to improve both recovery and work outcomes.
PUBMED, CINAHL, Web of Science, and PsycNET databases were searched for English language papers published between January 2014–June 2020.
Titles and abstracts were screened. Inclusion/exclusion criteria were then applied to full text screen of the remaining articles following PRISMA guidelines. Thirteen studies meeting the inclusion criteria were critically appraised using the Critical Appraisal Skills Programme (CASP) checklist. A constant comparison approach was used to systematically distil findings into categories and assess their fit within the Mehnert Model subdomains.
Vulnerabilities coalesced predominantly within the following subdomains: (a) changes in identity and role functioning; (b) social reintegration; (c) coping strategies; and () social supports. Patterns and themes within these subdomains were related both positively and negatively to form the contours of a survivor's satisfaction/dissatisfaction with quality of life related to work and breast cancer recovery.
Overall, findings highlight the importance of employment and work environments in bolstering women's psychosocial health after a breast cancer diagnosis.
Findings from this review support adapting psychosocial distress screening to include vulnerabilities relating to work life. Nurses are ideally positioned to facilitate this screening and engage clinicians in a dialogue surrounding patient's support needs due to nursing's central role on the interdisciplinary team. Nurses may also foster collective accountability for implementing ongoing multidisciplinary survivorship care plans that include a return to work component.
To compare factors associated with the sedentary lifestyle described in the literature with the factors listed in NANDA International.
Systematic review with meta‐analysis of factors associated with a sedentary lifestyle in adolescents, adults and older people.
An electronic search of PubMed, Scopus, CINAHL and Latin America and the Caribbean Literature on Health and Science databases conducted in May 2016.
Descriptive data were extracted according to a standardized form. The odds ratios for each etiological factor associated with a sedentary lifestyle were extracted directly from the articles or calculated from the data described therein. The meta‐analysis was conducted for factors that were investigated in more than one study.
Thirty‐five articles were included. The statistically significant factors were: lack of social support, of physical space, of time, of motivation, of sports skills and of interest in physical activity, intolerance to activity, being retired, living in a low‐income country, laziness, not having a job/studying, low socioeconomic status and level of knowledge about physical activity, female gender, living in an urban area, negative self‐perception of health, using public transportation, being in the oldest age group in the study and perceived physical disability.
The new factors associated with a sedentary lifestyle and those already included in the NANDA International classification will lead to better clinical guidance for nurses.
Knowledge about these factors can contribute directly to public health policies.
To analyse the interactions of associated factors with post stroke fatigue (PSF) after discharge home and determine the predictors of PSF and their impact on stroke survivors.
A prospective observational study.
A total of 94 patients with acute stroke were recruited between May 2019 ‐July 2020. The main outcomes were fatigue, depression, insomnia, sarcopenia, and health‐related quality of life (HRQOL) and were assessed at admission and 1 month after discharge. Fatigue was measured using the Fatigue Assessment Scale. Depression and Insomnia were assessed using the Hospital Anxiety and Depression Scale‐Depression and Insomnia Severity Index, respectively. Sarcopenia was measured using the SARC‐F questionnaire, and HRQOL was assessed using the Short Form‐8.
Acute phase PSF was an independent predictor of PSF after discharge home. Moreover the path analysis revealed that this effect is mediated through both the direct effect of acute‐phase PSF on PSF after discharge home and through the indirect effect of interaction with pre‐stroke SARC‐F, acute phase depression, and acute phase insomnia, which remains a separate predictor of acute‐phase PSF. In total, 17% of the survivors had persistent PSF. Persistent PSF was significantly associated with depression, insomnia, sarcopenia, and a lower quality of life scores.
Post‐stroke fatigue may occur in the acute phase and persists after discharge, it will not only affect later depression, insomnia, and quality of life, but also sarcopenia.
Acute phase PSF was found to be an independent predictor of PSF after discharge home. In addition, the interaction with pre‐stroke SARC‐F, acute phase depression and insomnia had an indirect connection with PSF after discharge home, which remains a separate predictor of acute‐phase PSF. Thus, early assessment and management of mental status, sleep problems, and sarcopenia during hospitalization might be an important step in post‐stroke rehabilitation and home transition.
To understand barriers and facilitators of recovery for critical illness survivors’, who are discharged home from the hospital and do not have access to dedicated outpatient care.
Multi‐site descriptive study guided by interpretive phenomenology using semi‐structured interviews.
Interviews were conducted between December 2017 ‐July 2018. Eighteen participants were included. Data were collected from interview recordings, transcripts, field notes, and a retrospective chart review for sample demographics. Analysis was completed using Interpretive Phenomenological Analysis which provided a unique view of recovery through the survivors’ personal experiences and perception of those experiences.
Participants encountered several barriers to their recovery; however, they were resilient and initiated ways to overcome these barriers and assist with their recovery. Facilitators of recovery experienced by survivors included seeking support from family and friends, lifestyle adaptations, and creative management of their multiple medical needs. Barriers included unmet needs experienced by survivors such as mental health issues, coordination of care, and spiritual needs. These unmet needs left participants feeling unsupported from healthcare providers during their recovery.
This study highlights important barriers and facilitators experienced by critical illness survivors during recovery that need be addressed by healthcare providers. New ways to support critical illness survivors, that can reach a broader population, must be developed and evaluated to support survivors during their recovery in the community.
This study addressed ICU survivors’ barriers and facilitators to recovery. Participants encountered several barriers to recovery at home, such as physical, cognitive, psychosocial, financial, and transportation barriers, however, these survivors were also resilient and resourceful in the development of strategies to try to manage their recovery at home. These results will help healthcare providers develop interventions to better support ICU survivors in the community.
To examine the relationship between the dimensions of evidence‐based practice and the therapeutic relationship and to predict the quality of the therapeutic relationship from these dimensions among nurses working in mental health units.
A cross‐sectional design.
Data were collected between February–April 2018 via an online form completed by nurses working at 18 mental health units. Multiple linear regressions were used to examine the relationship between the dimensions of evidence‐based practice and therapeutic relationship. Questionnaires were completed by 198 nurses.
Higher levels of evidence‐based practice were a significant predictor of a higher‐quality therapeutic relationship (β: 2.276; 95% CI: 1.30–3.25). The evidence‐based practice factor which most influenced an improved therapeutic relationship was the nurses’ attitude (β: 2.047; 95% CI: 0.88–3.21). The therapeutic relationship dimension which was most conditioned by evidence‐based practice dimensions was agreement on tasks, which was most favourable with a better attitude (β: 0.625; 95% CI: 0.09–1.16) and greater knowledge and skills for evidence‐based practice (β: 0.500; 95% CI: 0.08–0.93).
In mental health settings, the therapeutic nurse–patient relationship is positively enhanced by evidenced‐based practice and the nurse's level of experience, with a great influence on shared decision‐making.
This research sought to examine the relationship between the evidence‐based practice and the therapeutic relationship in mental health nursing. This study demonstrates that an improved attitude and knowledge of evidence‐based practices of mental health nurses increases shared decision‐making with patients, which is a basic requirement for person‐centred care. Because the therapeutic relationship is considered the backbone of nursing practice in mental health units, this research will have an impact on both mental health nurses and mental health unit managers.
To explore how patients remained involved in their treatment and care of their own health following a shared decision‐making intervention for dialysis choice.
A follow‐up study using semi‐structured interviews.
Individual interviews with 13 patients were conducted immediately following their participation in a shared decision‐making intervention for dialysis choice and again 3 months after initiating dialysis. This study reports findings from the follow‐up interviews 3 month after dialysis initiation. Data were collected from August 2017–February 2019 and analysed using systematic text condensation.
The analysis revealed five main findings, which indicated differing levels of: (a) involvement in the decision‐making process; (b) involvement in treatment; (c) involvement in care of own health; (d) involvement of a relative; and (e) support from healthcare professionals.
Following the shared decision‐making intervention, patients who chose home‐based treatment had become more involved in their treatment and care of their own health. The involvement of relatives and support from healthcare professionals contributed positively to this. In contrast, patients who had chosen hospital‐based treatment were less involved in their treatment.
Shared decision‐making in dialysis choice has potential to improve self‐management in people with kidney disease. However, support from healthcare professionals for patients and their relatives should be prioritized in an effort to increase all patients' involvement in their treatment and care of their own health.
To analyse the different types of Aloe vera (AV) effects on various mucocutaneous problems among adults.
A systematic review and meta‐analysis.
An exhaustive scanning of PubMed, Medline, ScienceDirect, and Google Scholar databases was conducted from January 2000–December 2019.
Randomized controlled trials (RCTs) publishing reports on the effects of AV in various mucocutaneous problems, psoriasis, burn, wound‐healing were included. The standardized mean differences (SMD) with 95% confidence Intervals (CIs) were determined for the main outcomes, heterogeneity was analysed using the I 2 test and the risk of bias in the studies was reviewed by the Cochrane risk of bias assessment tool.
The study included 23 trials with a total of 4,023 participants. Six trials were included in the meta‐analysis. The results indicated no significant differences in pain scores as assessed by the Visual Analog Scale (VAS) (SMD = 0.11, 95% CI: −0.37 to 0.59). The Psoriasis Area Severity Index (PASI) scores were significantly lower following AV gel application in two of the studies (SMD = −1.32 95% CI: −1.86 to −0.78). Considering results in a systematic manner, AV accelerated tissue epithelialization and wound‐healing process (N = 3), reduced oral mucositis (N = 3), and improved quality of life (N = 1).
AV might have beneficial effects in reducing pain scores and the severity of mucocutaneous problems compared with placebo, especially with limited mild to moderate adverse effects.
AV may be used as an alternative and integrative approach to reducing symptom severity in mucocutaneous problems and the wound‐healing process. High quality and well‐designed RCTs are still needed to elucidate the effects of AV in a variety of dosages and forms among adults with mucocutaneous problems.
To investigate the energy and protein adequacy of meals and dietary intake of older psychiatric inpatients and describe patient and mealtime factors potentially influencing intake.
Multiple case studies.
Psychiatric inpatients aged 65 years and older, admitted to a single mental health ward during the 6‐week study period (April–May 2019) were eligible for inclusion. Dietary intake was observed for two consecutive days each week (minimum four observation days). Visual plate waste methods were used to estimate patients’ dietary intake at mealtimes, with energy and protein intake calculated using known food composition data and compared with estimated requirements. Medical records were reviewed weekly to collect information on potential factors related to intake and mealtime care. Data from all sources were first summarized in a case record for within‐case analysis using descriptive statistics, followed by cross‐case analysis.
Eight participants (five men, age 67–90 years, two underweight and one overweight, and four requiring some mealtime assistance) had 5–12 days of observation data recorded. Three met their estimated daily energy and protein requirements throughout the study period, while the remaining five participants did not. The main barriers identified as contributing to insufficient energy and protein intake were as follows: missing meals (asleep and treatment); inadequate food provided (insufficiency of the standard hospital menu); and need for increased mealtime assistance.
Poor dietary intake may be common among older psychiatric patients, suggesting that they may also need nursing and multidisciplinary nutrition care interventions shown to effectively prevent and treat malnutrition in other older inpatient groups.
Older psychiatric patients experience similar nutrition and mealtime issues to other older inpatients. This study highlights the need for nurses and the multidisciplinary team to ensure patients order and receive adequate food, especially when they miss meals and that they receive proactive mealtime assistance.
This study aimed to explore the role and impact of advanced practice nurses (APNs) in care of patients following fragility hip fracture by systematically reviewing the available evidence.
A search of the databases Ovid Medline, CINAHL, Embase, Emcare, Cochrane Library, and Google Scholar was conducted from January–February 2019.
This systematic review adhered to The PRISMA Statement. Study selection was managed using the Covidence software platform and quality was assessed using JBI Critical appraisal tools. Studies included adults >18 years and described the role and impact of APNs in care of patients following fragility hip fracture on clinical and non‐clinical outcomes.
There were 19 papers identified that met the inclusion/exclusion criteria. Quality was graded as moderate to low risk of bias. Six characteristics of APNs were identified: (1) coordination; (2) collaboration; (3) education; (4) assessment, investigation and treatment recommendations; (5) discharge planning, support and follow up; and (6) documentation. Overall mortality and LOS improved when characteristics of the APN role were present.
Key findings from this systematic review showed: (1) The APN title and role are not clearly defined, but characteristics of the APN role are evident; (2) characteristics of APNs promote the delivery of best practice hip fracture care and have a positive impact on mortality and LOS; and (3) innovative service delivery models involving APNs should be considered to address future projections of hip fracture rates and improve outcomes.
This systematic review provides evidence of the role characteristics of APNs in fragility hip fracture and the impact of the role on outcomes. Findings from this research could be used to develop service delivery models using APNs to care for patients following fragility hip fracture and to inform practice where APN roles may improve outcomes for other patient cohorts.
To describe and synthesize diverse empirical evidence regarding physical activity (PA) in the context of advanced breast cancer (ABC).
Integrative review guided by the work of Whittemore and Knafl (2005).
Six electronic databases were systematically searched to identify relevant literature published between January 2007–June 2019.
Abstracts of papers that met the inclusion criteria were reviewed by two researchers and full texts of eligible papers were assessed. Data were extracted by two independent researchers and inter‐rater reliability of data extraction established. Quality of papers was evaluated using the Mixed Methods Appraisal Tool. Data were organized according to comprehensive thematic analysis and the biobehavioural model for the study of exercise interventions.
Of the 532 abstracts, 18 studies met the inclusion criteria which included six randomized controlled trials, one quantitative non‐randomized study, seven quantitative descriptive studies, three mixed method studies and one qualitative study. Results from studies enrolled fell into four domains: PA performance and its influence on survival; barriers and preferences for PA; interventions to enhance PA; perceived benefits of PA from qualitative feedback.
Evidence suggests that ABC patients are physically inactive. Main barriers of PA are less aerobic fitness and heavy symptom burden. Simple, tailored and specialist‐supervised PA is preferred by ABC patients. Form of joint self‐instructed and group accompanying is advocated as well. PA intervention programmes identified in this review vary on type, intensity, duration and frequency, while generally, are found to be feasible, safe and beneficial to patients’ physical and psychosocial well‐being.
The results propose tailored, supervised, group‐based PA programmes are in urgent need for ABC patients. Clinical professionals should manage more feasible and safer PA interventions to help improve patients’ overall health. More research with rigorous methodology design is warranted to explore PA’s effect on long‐term health outcomes.
To evaluate the effectiveness of non‐pharmacological non‐invasive supportive interventions for impacts on women's comfort and well‐being during induction of labour.
A quantitative systematic review without meta‐analysis.
Databases were searched for primary research published in English between 2000–2019: AMED, CINAHL, Medline, Maternity and Infant Care database, PsycINFO, and ProQuest. The quality of studies was evaluated using JBI levels of evidence and established critical appraisal tools. Studies describing measures of comfort, coping, and well‐being for women during induction of labour were included.
Two articles met the criteria for inclusion. There is limited evidence to suggest that women having outpatient cervical priming were more satisfied with their experience than women having inpatient cervical priming and that outpatient cervical priming did not increase women's anxiety. A specifically designed information brochure explaining the induction process improved women's knowledge and understanding.
The quantitative systematic review followed the Centre for Reviews and Dissemination guidelines and Cochrane Effective Practice and Organisation of Care guidance. Quality appraisal was conducted using JBI levels of evidence, Cochrane Risk of Bias, and other established tools. A narrative description of the quantitative data was undertaken. There was insufficient evidence to perform a narrative synthesis or meta‐analysis due to the nature of the study designs and insufficient outcome data.
Globally, the number of women having an induction of labour is increasing and there is a lack of evidence on the effectiveness of supportive interventions. Components of supportive care for women having induction of labour require urgent evaluation. Measurement tools which capture the complexity of supportive care for women having induction of labour need to be developed and validated.
This is the first review to evaluate non‐pharmacological, non‐invasive supportive interventions for women having induction of labour. The findings of this review identify the urgent need to develop an evidence base for effective supportive.
To examine the mediating role of employee well‐being on the relationship between work‐life balance practices, the need for achievement and intention to leave among nurses in Malaysia.
Work‐life balance practices are associated with employee perceptions of the need for achievement and well‐being which subsequently influence their intention to leave the organization. This study contributes new knowledge to nursing studies on work‐life balance in an Asian and Islamic society where the expectations for women are to focus on family rather than career.
A cross‐sectional, explanatory mixed methodology.
This is a two‐phase study conducted between 2015–2017 with 401 nurses in East Malaysia. In Phase 1, researchers surveyed 379 nurses to test eight hypotheses and in Phase 2 researchers interviewed 22 nurses to explore the results of Phase 1.
Phase 1 revealed job satisfaction mediates the relationship between work‐life balance practices (e.g. flexibility and choice in working hours, supportive supervision), financial success, and intention to leave. However, life satisfaction and money as a motivator did not mediate such relationships. Phase 2 identified four important factors that cast light on survey results: working conditions of Malaysian nurses; inadequate compensation in the public healthcare sector; team‐based practices; and pressure on senior nurses in both administrative and clinical roles.
This is one of the first studies to investigate work‐life balance issues among nurses in Malaysia. Outcomes of this study extend the debates on work‐life balance and employee well‐being in an Asian Islamic social context.
The use of flexible working arrangements and collectivist teamwork approaches, improving compensation and employment benefits and eliminating the ‘time‐based job promotion’ policy may help to mitigate work‐life balance issues and intention to leave among nurses in Malaysia.
The Theory of Heat Stress Management addresses the phenomenon of occupational heat stress and applies the theory to surgical staff wearing personal protective equipment while performing surgery. This discussion paper relates development of the prescriptive middle range theory of heat stress management to inform and advance research and provide evidence to support new standards of care in clinical nursing practice.
The prescriptive middle range theory was developed by summarizing essential elements of the theory, describing the linkages among the dimensions of the theory, enumerating nursing interventions and physiological, psychological and cognitive outcomes, stating relevant assumptions, defining and identifying relationships between the concepts of heat stress management in observable and measurable terms.
This discussion paper is based on the first author's experiences with occupational heat stress, observed improvements in surgical personnel's thermal comfort by using a cooling intervention and knowledge gained from an extensive integrated literature review and ongoing clinical research.
The middle range theory was developed to create awareness of the impact heat stress has on the health and well‐being of all healthcare personnel at risk for heat stress due to wearing personal protective equipment. Nurses need to recognize individuals in thermally stressful environments, evaluate and monitor individuals’ physiological and psychological responses and promote comfort by providing interventions to alleviate occupational heat stress.
The Theory of Heat Stress Management combines dimensions specific to heat stress affecting surgical staff and provides a perspective that facilitates knowledge development, can enhance nursing practice and support exploration of the linkages and prescriptions of the theory through research.
The predictive middle‐range Theory of Heat Stress Management will guide nurses to promote the health and well‐being of healthcare workers and influence and improve clinical nursing practice, education, and research related to heat stress management.
to identify: (1) nursing competencies for FCC in a hospital setting; and (2) to explore perspectives on these competencies among Dutch and Australian professionals including lecturers, researchers, Registered Nurses and policy makers.
A multinational cross‐sectional study using Q‐methodology.
First, an integrative review was carried out to identify known competencies regarding FCC and to develop the Q‐set (search up to July 2018). Second, purposive sampling was used to ensure stakeholder involvement. Third, participants sorted the Q‐set using a web‐based system between May and August 2019. Lastly, the data were analysed using a by‐person factor analysis. The commentaries on the five highest and lowest ranked competencies were thematically analysed.
The integrative review identified 43 articles from which 72 competencies were identified. In total 69 participants completed the Q‐sorting. We extracted two factors with an explained variance of 24%. The low explained variance hampered labelling. Based on a post‐hoc qualitative analysis, four themes emerged from the competencies that were considered most important, namely: (a) believed preconditions for FCC; (b) promote a partnership between nurses, patients and families; (c) be a basic element of nursing; and (d) represent a necessary positive attitude and strong beliefs of the added value of FCC. Three themes appeared from the competencies that were considered least important because they: (a) were not considered a specific nursing competency; (b) demand a multidisciplinary approach; or (c) require that patients and families take own responsibility.
Among healthcare professionals, there is substantial disagreement on which nursing competencies are deemed most important for FCC.
Our set of competencies can be used to guide education and evaluate practicing nurses in hospitals. These findings are valuable to consider different views on FCC before implementation of new FCC interventions into nursing practice.
The purpose of this study was to develop and validate an individualized nomogram to predict venous thromboembolism (VTE) risk in hospitalized postoperative breast cancer patients.
A single‐central retrospective and non‐interventional trial.
For model development, we used data from 4,755 breast cancer patients between 1 November 2016–30 June 2018 (3,310 patients in the development group and 1,445 in the validation group). Overall, 216 patients developed VTE (150 in development group and 66 in validation group). The model was validated by receiver operating characteristic curves and the calibration plot. The clinical utility of the model was determined through decision curve analysis.
The individualized nomogram consisted of six clinical factors: age, body mass index, number of cardiovascular comorbidities, neoadjuvant chemotherapy, surgical treatment, hospital length of stay and two pre‐operative biomarkers of Homocysteine and D‐dimer. The model at the 3.9% optimal cut‐off had the area under the curve of 0.854 (95% CI, 0.824–0.884) and 0.805 (95% CI, 0.740–0.870) in the development and validation groups. A p = 0.570 of the calibration test showed that the model was well‐calibrated. The net benefit of the model was better between threshold probabilities of 5%–30% in decision curve analysis.
The nomogram of VTE risk assessment, is applicable to hospitalized postoperative breast cancer patients. However, multi‐central prospective studies are needed to improve and validate the model. Effectiveness and safety of thromboprophylaxis in high‐risk patients are needed to demonstrate in interventional trials.
This nomogram can be used in clinical to inform practice of physicians and nurses to predict the VTE probability and maybe direct personalized decision making for thromboprophylaxis in hospitalized postoperative breast cancer patients.
个体化列线图由6个临床因素组成:年龄、体重指数、心血管共病数量、新辅助化疗、手术治疗、住院时间以及术前同型半胱氨酸和D‐二聚体两个生物标志物。在开发组和验证组中,3.9%最优截止点的模型下面积为0.854(95%可信区间,0.824‐0.884)和0.805(95%可信区间,0.740‐0.870)。校准试验的p = 0.570 表明模型校准良好。在决策曲线分析中,阈值概率在5%‐30%之间,模型的净效益较好。