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Anteayer Journal of Advanced Nursing

Ageing simulation in health and social care education: A mixed methods systematic review

Abstract

Aim

To identify, evaluate and summarize evidence from qualitative, quantitative and mixed method studies conducted using age suits or other age simulation equipment, with health and social care students.

Design

Convergent segregated mixed method review design as outlined by the Johanna Briggs Institute.

Data Sources

CINAHL (+ with Full Text), MEDLINE, PsycINFO, PubMed, SocINDEX, Web of Science, Cochrane Library, Emerald Insight, Proquest nursing, Science Direct, Wiley Online and BioMed Central (January 2000–January 2020).

Review methods

Convergent segregated synthesis was used to synthesize evidence from the studies and the MERSQI checklist used to appraise quality.

Results

A total of 23 studies were reviewed: one randomized control, two post‐test only randomized control, three quasi‐experimental, 15 one‐group pre/post studies and two qualitative studies. Of the seventeen studies carrying out inferential statistics on attitude scores post intervention, 11 reported an improvement, three indicated no significant change and three reported worsening scores. Key themes included use of appropriate scales, type of equipment used, location and length of interactions, debriefing and contextualization of interventions in broader teaching.

Conclusion

The impact of ageing simulation interventions on health and social care student's attitudes to older people was predominantly positive. However, further high‐quality research is warranted to understand the optimal use of such interventions in the context of health care for a growing ageing population.

Impact

It is important health and social care staff have appropriate knowledge and training to enable them to provide high‐quality care to older people and challenge potential ageism in the system. This review adds to the body of work around the use of simulation and experiential learning to educate health and social care students about ageing and ageism. It also offers recommendations for using ageing simulations effectively to inform attitudes of prospective professionals who will influence future health and social care.

Educational needs and disaster response readiness: A cross‐sectional study of clinical nurses

Abstract

Aim

To analyse clinical nurses’ educational needs and disaster response readiness and the factors influencing their disaster response readiness.

Design

This was a cross‐sectional study.

Methods

A convenience sample comprising 260 nurses with more than a year of working experience at a hospital in Korea was selected from 1‐31 August 2019. Data on nurses’ educational needs and disaster response readiness were collected from participants. A multiple regression model was used to examine the factors influencing disaster response readiness among nurses.

Results

Factors influencing personal readiness were number of years of clinical experience, being female, working in a medical ward, and educational needs for disaster response. Factors influencing self‐protection were working in a medical ward and working in the emergency room. Factors influencing the emergency response were working in a medical ward and working in the emergency room. Factors influencing clinical management were a graduate‐level education or higher, working in a medical ward, working in the emergency room, working in the paediatric ward, experience receiving disaster‐related education, and educational needs for disaster response.

Conclusion

It is essential to be aware of the educational needs and disaster readiness of hospital clinical nurses, to develop their capacity to respond such situations. In addition, to improve the disaster competency of nurses, it is necessary to develop an education programme that considers the factors influencing disaster response readiness in this study.

Impact

Nurses must have the knowledge and skills to respond to a disaster. Nurse educators should help nurses strengthen their disaster‐related knowledge, skills, and judgment. Hospital administrators should encourage nurse educators to provide disaster‐related training and simulation‐based education to increase nurses’ disaster competency to act during disasters.

Exploring patient experiences of participating in a telephone‐based self‐management support intervention: Proactive Health Support (PaHS)

Abstract

Aim

Proactive Health Support is a telephone‐based self‐management intervention that is carried out in Denmark by Registered Nurses who provide self‐management support to people at risk of hospital admission. We aimed to explore participants’ experiences of Proactive Health Support and to identify what the participants find important and meaningful during the intervention process.

Design

Qualitative design involving semi‐structured interview.

Methods

Using a phenomenological–hermeneutical framework, we conducted semi‐structured interviews with 62 participants in their own homes (32 women, 30 men; aged 20–81 years) in spring and fall 2018.

Results

The participants felt confident that they could discuss every matter with the nurses. Participants benefitted from accessibility to the nurses’ professional and medical competences and they felt relief that the nurses contacted them via the telephone due to their multiple health conditions. The participants felt that the nurses were available and helped them to navigate the healthcare system.

Conclusion

The participants valued the intervention because they benefitted from the nurses’ holistic approach. They described the nurses’ knowledge and professionalism in relation to their symptoms, treatments, and medicine as important and meaningful. Accordingly, the intervention seemed to promote feelings of independence and self‐management among the participants.

Impact

From a nursing perspective, the study highlights that it is possible to establish a close relationship and behavioural change among participants through regular telephone contact.

Effectiveness of blood glucose control protocol for open heart surgery patients

Abstract

Aims

To evaluate the effectiveness of a tailored blood glucose control protocol for postoperative cardiac surgery patients treated in intensive care.

Design

Retrospective study.

Methods

Data for the control group (non‐tailored protocol) were collected from medical records at a tertiary hospital in Seoul, Korea between April–July 2015. Data for the experimental group (tailored protocol) were obtained from medical records between April–July 2016. After adjusting the target blood glucose range, eliminating single‐dose insulin administration and extending the blood glucose measurement time interval, data for blood glucose measurements, time for reaching and maintaining target blood glucose, mean number of daily blood glucose measurements and insulin dose adjustments for the experimental group were collected.

Results

In the experimental group (where the target blood glucose rate was increased) the hypoglycaemia rate and the variation in blood glucose decreased significantly compared with the control group. In particular, the experimental group maintained relatively stable blood glucose levels by retaining a small variation range in glucose, regardless of the presence of diabetes. Time required for maintaining target blood glucose, mean number of daily blood glucose measurements and insulin dose adjustments per patient decreased.

Conclusion

The tailored protocol contributes to the safe and effective control of blood glucose in critical care patients after cardiac surgery and to the efficiency of nurses administering it.

Impact

This study has two significant impacts. The application of the tailored protocol has a positive impact on patients’ blood glucose management, a critical component of treatment for postoperative cardiac patients in intensive care units. It also has a positive impact on the efficiency of nurses applying it. The results of this study are thus expected to facilitate successful implementation of clinical protocols for critical care after heart surgery.

Systematic review: What is the impact of self‐scheduling on the patient, nurse and organization?

Abstract

Aim

To systematically review and evaluate the literature on the impact of self‐scheduling on patient, nurse and organization‐related outcomes.

Design

A systematic review.

Data sources

PubMed, Embase, Web of Science, Cinahl, Scopus, Google Scholar, ERIC and Cochrane Library were screened until October 2019 (week 40) for peer‐reviewed, empirical articles, written in English, Dutch or French.

Review methods

Two reviewers screened title and abstract using predetermined eligibility criteria and one reviewer screened the full texts of relevant hits. Quality was assessed with the Mixed Methods Appraisal Tool.

Results

Studies (N = 23) were retained and classified into explanatory and descriptive studies. The articles reported on a range of outcomes: patient‐ and nurse‐reported quality of care, job satisfaction, satisfaction with scheduling, work/life balance, planning involvement, interaction with colleagues, health and well‐being, psychosocial factors, professional development, nurse manager's scheduling time, general working conditions, turnover, temporary employment agency use and absenteeism, recruitment and retention.

Conclusion

The evidence base is limited. Several studies confirmed the positive impact of self‐scheduling on the nurse and the organization. However, other studies found negative outcomes or no change. These outcomes should be interpreted in the light of contextual factors and the implementation process, which was often not without difficulties. Future research should use a multimethod longitudinal design, bear in mind the possibilities of quantitative research (e.g. for studying psychosocial factors) and employ a theoretical framework.

Impact

This review informs about the inconsistent evidence on the association between self‐scheduling and patient, nurse and organization‐related outcomes and includes enablers and barriers to a successful implementation. These outcomes are influenced by the implementation process and the sustainability of the self‐scheduling system, which are still major challenges for healthcare management. This demonstrates the urgent need for further research.

Peripheral intravenous catheter non‐infectious complications in adults: A systematic review and meta‐analysis

Abstract

Aims

The aim of this systematic review and meta‐analysis was to summarize and quantify peripheral intravenous catheter‐related complications.

Design

This systematic review is reported by means of the Cochrane process for randomized controlled trials and the Meta‐analysis of Observation Studies in Epidemiology for cohort studies.

Data sources

The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases, clinical trial registries such as ClinicalTrials.gov and the reference list of included studies were searched from 2000 ‐April 2019.

Review Methods

Using a purpose designed data extraction tool, two authors independently identified studies for full review, data extraction and quality assessment. Dichotomous outcomes were pooled after Freeman–Tukey double arcsine transformation using random‐effects meta‐analysis; estimates of heterogeneity were taken from inverse‐variance fixed‐effect models.

Results

Seventy observational studies and 33 randomized controlled trials were included (76,977 catheters). Peripheral intravenous catheter‐related complications were as follows: phlebitis (with definition) 19.3%, phlebitis (without definition) 4.5%, infiltration/extravasation 13.7%, occlusion 8%, leakage 7.3%, pain 6.4% and dislodgement 6.0%. Subgroup analysis found infiltration/extravasation for emergency department‐inserted catheters was significantly higher (25.2%; p = .022) than for those inserted in other departments and pain was significantly higher (p < .001) in countries with developing economies compared with developed economies.

Conclusion

Peripheral intravenous catheter complications are unacceptably common worldwide. This review suggests substantial and multi‐specialty efforts are needed to address the sequalae associated with complications. The potential benefits for patients and health services are considerable if complications are reduced.

Impact

Peripheral intravenous complications interrupt important treatment which can be distressing for patients and result in longer hospital stays with increased healthcare costs. This review found phlebitis and infiltration are the most prevalent reason for catheter failure. These results provide nurses with a strong evidence base for the development of effective interventions for practice which are vital for preventing poor outcomes for patients with peripheral intravenous catheters.

Formal caregivers’ perceptions and experiences of using pet robots for persons living with dementia in long‐term care: A meta‐ethnography

Abstract

Aim

To explore the formal caregivers’ perceptions and experiences of using pet robots for persons living with dementia residing in long‐term care settings and the factors influencing their perceptions by evaluating, integrating, and synthesizing findings from relevant international research articles using a meta‐ethnography.

Design

Noblit and Hare's interpretative meta‐ethnography.

Data sources

Eight articles, published between 2013–2018, were identified following a systematic search of four databases (Scopus, ProQuest Central, EBSCO, and Google Scholar) between June 2019–February 2020.

Review methods

Two researchers independently appraised the selected articles. Noblit and Hare's seven steps and a meta‐ethnography reporting guidance were used. Reciprocal translation was used to obtain a line of argument synthesis.

Results

Three overarching themes were identified: a beneficial tool but not for everybody, a tool that has limitations but could be overcome, and a positive experience if appropriately introduced and sustained.

Conclusion

This meta‐ethnography contributes to the understanding of current potential benefits and limitations of pet robots for persons living with dementia residing in long‐term settings. It also identifies several factors, as perceived by caregivers, that may influence their acceptability, adoption, and routine use in practice.

Impact

Although for the past two decades pet robots have been used as a psychosocial intervention for persons living with dementia in long‐term care settings, there is a dearth of literature on the perception of formal caregivers and their experience of such interventions. While pet robots can have emotional, social, behavioural, and practical benefits, there are several technological, organizational, and contextual challenges and limitations that constrain their routine use. The solutions synthesized in this review can be of benefit to robot designers, facility managers, policy makers, and other health care professionals interested in introducing pet robots in long‐term care settings.

Nursing discharge teaching for hospitalized older people: A rapid realist review

Abstract

Aim

To develop, refine and put forward a programme theory that describes configurations between context, hidden mechanisms and outcomes of nursing discharge teaching.

Design

Rapid realist review guided by Pawson's recommendations and using the Realist and Meta‐narrative Evidence Syntheses: Evolving Standards.

Data Sources

We performed searches in MEDLINE, Embase, CINAHL Full text, Google Scholarand supplementary searches in Google. We included all study designs and grey literature published between 1998‐2019.

Review Methods

We followed Pawson's recommended steps: initial programme theory development; literature search; document selection and appraisal; data extraction; analysis and synthesis process; presentation and dissemination of the revised programme theory.

Results

We included nine studies and a book to contribute to the synthesis. We developed 10 context–mechanisms–outcome configurations which cumulatively refined the initial programme theory. These configurations between context, mechanisms and outcome are classified in four categories as follows: relevancy of teaching content; patients’ readiness to engage in the teaching–learning process; nurses’ teaching skills and healthcare team approach to discharge teaching delivery. We also found that some of the same contexts generated similar outcomes, but through different mechanisms, highlighting interdependencies between context–mechanisms–outcome configurations.

Conclusion

This rapid realist review resulted in an explanatory synthesis of how discharge teaching works to improve patient‐centred outcomes. The proposed programme theory has direct implications for clinical practice by giving meaning to the ‘hidden’ mechanisms used by nurses when they prepare patients to be discharged home and can inform curricula for nursing education.

Impact

The essential components, process mechanisms, contexts and impacts of the nursing discharge teaching are not consistently or clearly described, explained or evaluated for effectiveness. This review uncovers underlying contexts and mechanisms in the teaching/learning process between patients and nurses. The resulting programme theory can guide nurse clinicians and managers towards improvements in conducting discharge teaching.

Nursing students’ resilience, depression, well‐being, and academic distress: Testing a moderated mediation model

Abstract

Aim

Academic distress is a leading cause of attrition among nursing students. The present study tested a positive psychology‐oriented model detailing the potential links between nursing students’: (a) psychological resilience; (b) depressive symptoms; (c) intrapersonal well‐being; (d) interpersonal well‐being; and (e) academic distress. Additionally, we tested whether the academic benefits of resilience were conditional upon nursing students’ perceptions of their campus climate as supportive of mental health and well‐being.

Design

A correlational, cross‐sectional design was employed.

Method

Nursing students (N = 933) were selected from the national 2017–2018 Healthy Minds Study (HMS). Students completed measures of resilience, depressive symptoms, intrapersonal well‐being (flourishing), interpersonal well‐being (belonging), and academic distress.

Results

Conditional process modelling tested depression, belonging, and flourishing as mediators of the associations between resilience and academic distress variables. Furthermore, perceptions of campus climate were included as potential moderators of these mediation effects. Results indicated that the protective academic benefits of resilience were primarily explained by decreases in depression but that this effect was strongest for nursing students with negative perceptions of their campus climate.

Conclusion

Findings highlight the psychological and academic benefits of greater resilience and the moderated mediation results suggest that such benefits were conditional on the broader campus climate.

Impact

Nurse educators and policymakers should consider addressing contextual factors, such as campus climate, in addition to resilience training in their efforts to reduce the negative academic impacts of mental health problems and stress in nursing school.

The relative risk of developing type 2 diabetes among individuals with prediabetes compared with individuals with normoglycaemia: Meta‐analysis and meta‐regression

Abstract

Aims

To assess the overall relative risk of diabetes in individuals with prediabetes based on updated diagnostic criteria, as compared with individuals with normoglycaemia; and to identify the study characteristics associated with the heterogeneity between studies.

Design

Meta‐analysis, meta‐regression.

Data sources

PubMed, CINAHL, British Nursing Index. Search time frame: December 1998–December 2018.

Review Methods

The pooled relative risk of developing diabetes among individuals with prediabetes compared with those with normoglycaemia was calculated under a random effects model. Studies reported the natural progression from prediabetes to diabetes were included in this review. Sources of study heterogeneity were examined by a meta‐regression.

Results

Fifty‐nine eligible studies were systematically identified. The pooled relative risk for diabetes among individuals with prediabetes as compared with normoglycaemia was 5.88 (95% CI: 5.02‐6.89). The annualized incidence rate (per 1,000 person‐year) for diabetes among individuals with prediabetes defined by different criteria varied from 2.20–212.15, with high heterogeneity between studies (I 2 = 96.64%, Q test: p < .001). In the multivariable meta‐regression analysis, Asian population significantly increased RR compare to Caucasians. Besides, people with ‘elevated glycated haemoglobin A1c or impaired fasting glucose’ had highest relative risk compare to people with other types of prediabetes.

Conclusion

Individuals with prediabetes had higher risk of developing diabetes than those with normoglycaemia. Races and diagnostic criteria of prediabetes were associated with the magnitude of the estimated risk.

Impact

Prediabetes is a precursor of diabetes. To screen people with prediabetes as early as possible, practitioners could consider haemoglobin A1c test as an alternative to fasting plasma glucose test. Nurses should educate people especially Asians with prediabetes for the prevention of progression to diabetes.

The relevance, feasibility and benchmarking of nursing quality indicators: A Delphi study

Abstract

Aims

To identify indicators of nursing care performance by identifying structures, processes, and outcomes that are relevant, feasible and have the potential for benchmarking in Swiss acute hospitals.

Design

A modified Delphi‐Consensus Technique.

Methods

We examined 19 indicators based on the current evidence and that were pre‐selected by nursing scientists. Between August–October 2019, a consortium of experts (representatives of different cantons, hospitals, and healthcare roles in Switzerland) determined the relevance, feasibility, and suitability for benchmarking these indicators in two‐round modus of digital survey. Consensus was defined a priori by at least 75% agreement on the highest level of a 3‐point Likert‐type scale.

Results

The response rate was 70.4% in the first and 68.4% in the second round. In round one consensus was reached for three indicators on relevance but for none of the indicators regarding feasibility or potential for benchmarking. For round two, the experts suggested two additional indicators (new total of 21 indicators). Of 21 indicators, consensus was reached on twelve regarding relevance, seven regarding feasibility, and two regarding the potential for benchmarking.

Conclusion

A national expert consortium defined 12 of 21 nursing care indicators as relevant. Feasibility, however, was estimated only among seven indicators and a consensus on suitability for benchmarking was reached for two nursing‐sensitive indicators.

Impact

The results show how the indicators to evaluate nursing care performance, which have been identified as priority by Canadian nursing scientists, are assessed in a different setting. There are many overlaps, but also some differences in the assessment of the indicators between the different settings. Different health systems prioritize the indicators to evaluate nursing care performance differently, which is why national surveys are important for the compilation of their own (priority) indicator sets.

The relationships among self‐efficacy, social support, resilience, and subjective well‐being in persons with spinal cord injuries

Abstract

Aims

To examine the contribution of self‐efficacy, social support, and resilience to subjective well‐being (SWB), to examine the mediating effect of resilience in the relationship between social support and SWB, and to investigate if marital status moderates the relationship between social support and SWB among people with spinal cord injuries (SCI).

Design

A descriptive cross‐sectional study, conducted from November 2017–January 2018.

Methods

One hundred and two individuals with SCI were recruited from a rehabilitation center and a community setting in Nepal. SWB, self‐efficacy, social support, resilience, demographics and injury‐related information was collected using self‐reported questionnaires. Hierarchical regression analysis, mediation analysis, and moderation analysis were performed in SPSS and R to test the hypotheses.

Results

Self‐efficacy, social support, and resilience uniquely explained 19% of the variance on SWB after controlling for demographic covariates. In the mediation analysis, resilience partially mediated the relationship between social support and SWB. In the moderation analysis, marital status moderated the relationship between resilience and SWB.

Conclusion

Subjective well‐being of persons with SCI is associated with many factors. Interventions to strengthen self‐efficacy, resilience, and social networks can be effective to enhance SWB. A stronger association between resilience and SWB among single participants reflects the need to provide specific considerations for persons with SCI who are single. Longitudinal and/or experimental studies are needed to further validate these findings.

Impact

This study identified external and internal factors contributing to SWB in persons with SCI. Self‐efficacy, social support, and resilience were found to be significantly associated with SWB. Resilience acted as a mediator between social support and SWB. The relationship between resilience and SWB was stronger in single participants than married participants. The findings have potential implications in the field of nursing since nurses are one of the integral members of the SCI rehabilitation team.

Effectiveness of a Diabetes Education Program based on Tailored interventions and Theory of Planned Behaviour: Cluster randomized controlled trial protocol

Abstract

Aim

To measure the Effectiveness of a Diabetes Education Program for people with T2DM, based on Tailored interventions and the Theory of Planned Behaviour.

Design

Cluster randomized controlled clinical trial.

Methods

This multicentre study will be carried out at 30 primary healthcare centres, where 436 persons with Type 2 Diabetes Mellitus (T2DM), aged between 18–75 years, will be recruited. The experimental educational program to be applied is modelled using components obtained from a systematic review and prior qualitative analysis. In addition, a taxonomy of nursing practice is used to standardize the program, based on the Theory of Planned Behaviour as a conceptual model. The intervention will be carried out by community nurses, using ADAPP‐Ti®, an application developed with FileMaker Pro v.18. The control group will receive usual care and data will be collected at 6, 12, and 18 months, for both groups. The primary outcome considered will be glycosylated haemoglobin and cardiovascular factors, while the secondary ones will be tobacco consumption, body mass index, barriers to self‐care, health‐related quality of life, and lifestyle modification. The protocol was approved by the Ethics Committee of the Province of Malaga (Spain) in November 2014.

Discussion

The degree of metabolic control in T2DM is not always associated with healthy lifestyles and significant levels of medication are often prescribed to achieve clinical objectives. An intervention focused on needs, based on the best available evidence and a solid conceptual framework, might successfully consolidate appropriate self‐care behaviour in this population.

Impact

The study will result in the publication of an educational program featuring well‐defined interventions and activities that will enable clinicians to tailor health care to the individual's needs and to combat treatment inertia in attending this population.

Relationship‐based care model in paediatrics: A randomized controlled trial to implement the parents’ perception of the quality of nursing care

Abstract

Aim

To evaluate whether the application of the Relationship‐based care model as a new treatment, called "Take 5 min", affects the level of anxiety, depression, and perceived quality of nursing care of parents of paediatric patients and the work satisfaction of the nursing staff.

Design

Single‐blind randomized controlled trial.

Methods

The trial was performed from February–July 2016. The trial was conducted with one intervention (N = 101) and one control group (N = 90). Nurses applied the treatment named “Take 5 Minutes”, which consisted of dedicating some short time (from 5 to 10 min) to the relationship with the parents using specifically designed communication strategies. The primary outcome was the evaluation of anxiety and depression of parents; the secondary was the parent perceived quality of nursing care.

Results

In the experimental group, participants had a lower level of anxiety and depression and highlighted that the effect of the “Take 5 Minutes” was proportional to the initial seriousness of parents’ anxiety and depression. Higher scores for the perception of the quality of care were given from the parents of the experimental group.

Conclusion

The “Take 5 Minutes” treatment offered to parents of paediatric patients demonstrated significant improvements in terms of their anxiety, depression, and perceived quality of nursing care.

Impact

Caregivers of paediatric patients are subject to psychological disorders such as depression and anxiety. The communication by the nursing community is of fundamental importance in the management of anxiety and depression in the caregivers of hospitalized patients. Caregivers who received the “Take 5 Minutes” treatment demonstrated a significant decrease in anxiety and depression compared with the control group caregivers. The perceived level of quality of nursing care showed a significant increase in the group of caregivers who received the T5M treatment. The RBC model does not require extra costs for health organizations and can be applied during the usual practice of care. Practices such as T5M could become part of paediatric patient care guidelines and nurses should be trained to apply them.

Trial Registration Number

Padua Research: ID No. 10,034; ClinicalTrials.gov: ID No. NCT04199429.

Effect of a compassion fatigue resiliency program on nurses’ professional quality of life, perceived stress, resilience: A randomized controlled trial

Abstract

Aims

This study aimed to conduct a short‐ and long‐term Compassion Fatigue Resiliency Program and compare its impact on nurses’ professional quality of life, perceived stress, and resilience.

Design

The research was conducted between January 2017 January 2019 as a randomized controlled trial.

Methods

The sample comprised 125 oncology–haematology nurses randomly assigned to a Experimental I, Experimental II, or control group. The Compassion Fatigue Resiliency Program was conducted with the nurses as an intervention. Experimental I received a short‐term program (5 hr per day for 2 days, 10 hr in total) while Experimental II received a long‐term one (5 weeks, 2 hr per week, 10 hr in total). Measurements were obtained during pre‐ and post‐test and at 3‐, 6‐, and 12‐month follow‐ups. Research hypotheses were analysed using multilevel models.

Results

The results of multilevel model analyses showed there was no statistically significant difference between mean scores for compassion fatigue, burnout, perceived stress, and resilience of nurses in the short‐ or long‐term groups or of those in the control group. Mean compassion satisfaction scores of nurses in the short‐ or long‐term groups were significantly higher than those in the control group. Mean compassion satisfaction scores of nurses in the short‐ or long‐term groups were significantly higher than the control group's pre‐test mean after 6 and 12 months.

Conclusion

This study concluded that short‐ or long‐term programs had no influence on compassion fatigue, burnout, perceived stress, and resilience; however, both programs positively affected compassion satisfaction. We recommend that further studies be conducted, which will help determine the effectiveness of new programs.

Impact

Caring for patients with cancer can generate work‐related stress that can negatively affect oncology nurses’ physical and emotional health, which could lead to compassion fatigue. The program provided nurses with an opportunity to improve their compassion satisfaction. Because there was no difference between both programs regarding mean compassion satisfaction scores, a short‐term program may be preferred to encourage more participation among nurses. We also recommend further studies should be conducted that include environmental improvements along with the training programs.

Trial registered at ClinicalTrials.gov (The name of the trial register: Effect of a Compassion Fatigue Resiliency Program; the clinical trial registration number: NCT04372303).

Ethical leadership and decision authority effects on nurses’ engagement, exhaustion, and turnover intention

Abstract

Aim

The aim of the present study was to investigate emotional exhaustion, work engagement, and turnover intention in the nursing profession by exploring the antecedent effects of ethical leadership and job components such as decision authority.

Background

Emotional exhaustion, low work engagement, and high turnover intention are prevalent issues in the nursing profession. The experience of feeling overworked has led to feelings of burnout and low morale among nurses in Ireland, which has prompted the authors to identify potential variables that reduce these outcomes—in this case, ethical leadership and decision authority.

Design

A descriptive, cross‐sectional survey design was used across three hospital sites.

Methods

A cross‐sectional sample of 89 nurses was recruited from three Irish hospitals to capture the experience of nurses between December 2017 ‐ February 2018. Hypotheses were tested using path model analysis.

Results

Ethical leadership positively predicted decision authority among nurses. Ethical leadership also had an indirect effect on all three outcome variables (work engagement, exhaustion, and turnover intention). Further effects were noted in relation to the mediators in relation to the three outcome variables. Decision authority had a positive effect on work engagement and related to lower turnover intention.

Conclusions

The present study demonstrated the role of ethical leadership as a mechanism to positively affect job control and work experience outcomes for nurses at work. Ethical leadership style in hospitals and providing nurses with the authority to make decisions can improve their work experience and help to engage, support, and retain nurses.

Impact

The study found support for the positive role of ethical leadership in relation to decision authority and as a positive predictor of work engagement, negative predictor of emotional exhaustion, and turnover intention among nurses.

Effects of upright positions during the second stage of labour for women without epidural analgesia: A meta‐analysis

Abstract

Aims

To assess the effects of upright positions on maternal outcomes for women without epidural analgesia in comparison with recumbent positions during the second stage of labour.

Background

Upright positions have many physiological advantages. The underlying benefits and risks of upright positions during the second stage of labour have been reported in many studies but the results are divergent.

Design

A meta‐analysis of randomized controlled trials.

Data sources

The Cochrane Library, PubMed, Embase, CINAHL and ProQuest databases were systematically searched from inception to 17 June 2019.

Review methods

We conducted the quality appraisal using the Cochrane Collaboration's tool and performed meta‐analyses using the Review Manager 5.3 software. The primary outcomes were instrumental vaginal delivery and the duration of the second stage of labour.

Results

Overall, 12 studies including 4,314 women were included. Upright positions significantly decreased the rate of instrumental vaginal delivery (risk ratio [RR] = 0.74, 95% CI 0.59–0.93), shortened the active pushing phase (mean difference [MD] = −8.16 min, 95% CI −16.29 to −0.02), decreased the rate of severe perineal trauma (RR = 0.35, 95% CI 0.14–0.87) and episiotomy (RR = 0.52, 95% CI 0.29–0.92), but significantly increased the rate of second‐degree perineal trauma (RR = 1.45, 95% CI 1.10–1.90). However, there was no significant difference in the duration of the second stage of labour or postpartum haemorrhage.

Conclusions

Upright positions are beneficial for improving maternal outcomes. Several results should be considered with caution. Researchers need to clarify the definition of upright positions and conduct large, robust studies in the future to provide stronger evidence.

Impact

This meta‐analysis explores a crucial issue in intrapartum care and clarifies the benefits and possible risks of upright positions in the second stage of labour. Midwives and obstetricians are encouraged to apply upright positions depending on women's preferences and labour progress but should take measures to prevent perineal trauma.

The association between mindfulness and health promotion in undergraduate nursing students: A serial multiple mediator analysis

Abstract

Aim

This study was conducted to examine the association between mindfulness and health promotion among undergraduate nursing students and explore the mediation effect of certain factors (perceived stress, depressive symptoms, self‐care agency, and impulsivity) on this relationship.

Design

Cross‐sectional quantitative design.

Methods

A total of 195 undergraduate nursing students from a public university in Jordan participated in this study. A demographic questionnaire was used in addition to using well‐established, validated tools to measure health promotion, mindfulness, perceived stress, depressive symptoms, impulsivity, and self‐care agency. Data were collected between March and November 2018. Data were analysed using PROCESS macros.

Results

The direct association between mindfulness and health promotion was positive but not statistically significant. Simple mediation analysis showed that perceived stress is the only statistically significant mediator (effect = 0.03; 95% CI: LL = 0.008, UL = 0.057). The serial multiple mediator analyses revealed that three combinations of the mediators made the mindfulness effect on health promotion statistically significant; perceived stress and self‐care agency (effect = −0.01, 95% CI: LL = −0.022, UL = −0.01); depressive symptoms and self‐care agency (effect = 0.016, 95% CI: LL = 0.006, UL = 0.03); and perceived stress with depressive symptoms and self‐care agency (effect = 0.006, 95% CI: LL = 0.002, UL = 0.013).

Conclusions

The results of this study add to the literature evidence concerning the mediation role of perceived stress, depressive symptoms, and self‐care agency on the relationship between mindfulness and health promotion among nursing students.

Impact

This study examined the complex relationship between mindfulness and health promotion. There is a mediation effect of nursing students’ perceived stress, depressive symptoms, and self‐care agency on the relationship between mindfulness and health promotion. Researchers interested in designing mindfulness‐based interventions to optimize health promotion of nursing students could benefit from the findings of this study.

Peer support among parents of children with congenital heart defects: A qualitative analysis of written responses submitted via an online survey

Abstract

Aim

To explore experiences of peer support among parents of children with congenital heart defects.

Design

A study analysing written responses to open‐ended questions about peer support, collected via an online survey distributed in Sweden.

Methods

Respondents were recruited during 3 months in 2018 by means of convenience sampling, through ads via the Swedish foundation for families with children who have heart defects and two closed Facebook groups for peer support. An online survey containing open‐ended questions was distributed and responses were analysed with systematic text condensation.

Results

Peer support was grounded in a mutual understanding among parents and involved highly appreciated emotional support. Listening to the stories of peers meant an opportunity to gain useful insights about what life is like for parents of children with heart defects. Receiving and providing peer support was described as rewarding on a personal level. Negative aspects of peer support were also described, which sometimes led to psychological distress and withdrawal from peer support activities.

Conclusion

Peer support is emotionally relieving and appreciated among parents of children with congenital heart defects, who consider providing the support a rewarding responsibility. While peer support activities may have considerable benefits for individuals, it may also lead to psychological distress for some.

Impact

This study addressed peer support among parents of children with congenital heart defects. The main findings illustrate the potential impact peer support can have on individuals and calls attention to the experienced benefits related to peer support activities, while also providing some insights regarding potential negative aspects. The findings have relevance for nurses, midwives, and other health professionals working in settings providing care for these families.

Informal dementia caregivers’ experiences and perceptions about mealtime care: A qualitative evidence synthesis

Abstract

Aims

To systematically identify, evaluate and synthesize the available qualitative evidence on the mealtime care experiences of informal caregivers of people with dementia.

Design

A qualitative evidence synthesis using the Thomas and Harden method.

Data Sources

All qualitative and mixed‐method studies in English and Chinese were retrieved from PubMed, Web of Science, Embase, Cochrane, CINAHL, CNKI, WanFang, and Vip from the inception of each database until November 2019.

Review Methods

Two researchers independently selected the studies using qualitative assessment and review instruments for quality evaluation and thematic synthesis for the data analysis.

Results

Ten studies were chosen for this review. The analytical themes identified included injecting a new element, moving forward in the challenge and external supports facilitating better coping.

Conclusion

Community nurses should effectively use resources to provide food‐related information and services to families with dementia. Future research should combine informal caregiver experiences and clinical skills to develop high‐quality interventions to improve the quality of mealtimes.

Impact

The findings established that informal caregivers experienced not only changes in their roles and concerns but also emotional changes. Informal caregivers develop different coping strategies to adapt to feeding issues without professional support. Although informal caregivers attach great importance to mealtimes and nutrition issues, they experience a lack of information and support services. Community nurses can provide more economical, practical, and accessible information resources based on informal caregivers’ perceptions of mealtime care. Future interventions need to be more aware of the importance of dyad or family‐centred support services.

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