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AnteayerJournal of Clinical Nursing

Social media and drug resistance in nursing training: Using a Twitterchat to develop an international community of practice for antimicrobial resistance

Abstract

Aims and objectives

To assess the impact of a Twitterchat focusing on antimicrobial resistance and it is feasibility for integration within a nursing prelicensure research methods class.

Background

Antimicrobial resistance is one of the greatest threats to global health and food security. Consequently, developing a global approach with large outreach is critical. Twitter, as a popular social media platform, is useful for creating communities of practice and communities of interest.

Design

A case study design using a Twitterchat is a hosted, convened and focussed discussion on a particular topic using a discrete hashtag.

Method

Using a standardised protocol, a Twitterchat was undertaken over a 24‐hr period and digital metrics assessed at 72 hr. A summary of impact was undertaken using an online tool provided by Union Metrics (https://unionmetrics.com/).

Conclusions

At 72 hr, 2,632,762 accounts were reached and over 10 million impressions achieved. Twitterchats can be useful in creating awareness and fostering a community of interest and demonstrating the role of nurses in thought leadership. A formalised research study will draw on this case study to evaluate the impact on the Twitter participants and nursing students.

Relevance to clinical practice

Social media are an accessible and useful tool to harness focus and attention on clinical issues with global relevance. Demonstrating the utility and leverage to nursing students is important in increasing their understanding of the importance of communication and diffusion of information.

Intensive critical care nurses' with limited experience: Experiences of caring for an organ donor during the donation process

Abstract

Objective

To describe how intensive critical care nurses, whose experience is limited, experience caring for an organ donor during the donation process.

Background

Intensive critical care nurses are involved in the care of organ donors and their relatives. This may be challenging and evoke a sense of providing an inhumane care. Few studies have explored how intensive critical care nurses whose experience is limited experience caring for an organ donor during the donation process.

Design

An interview study with an inductive qualitative approach was conducted. The study was reported according to COREQ guidelines.

Methods

This study was performed during 2019. Participants were intensive critical care nurses (n = 7) from different hospitals (n = 4) with <3 years of experience and involvement in the donation process at least once but no more than three times. Data were analysed using qualitative content analysis.

Findings

Five categories emerged: the donation process is emotionally challenging; supporting relatives is an essential but demanding task; a complex and multifaceted process involving a high level of responsibility; needing appropriate prerequisites in the form of education and collegial support; and providing a dignified care based on respect for the organ donor.

Conclusions

Having limited experience as an intensive critical care nurse may not automatically mean that caring for an organ donor is experienced as more challenging than it is for a more‐experienced colleague. However, certain intensive critical care nurses whose experience caring for an organ donor is limited found it to be highly demanding due to its complexity, specifically in regard to informing relatives of the loss of their loved one and providing them with support.

Relevance to clinical practice

Our study revealed a need for further education. This need could be met by simulation tasks during the specialist education in intensive critical care nursing, where primarily ethical aspects and strategies for meeting with and supporting relatives should be examined and practiced.

The introduction of a safety checklist in two UK hospital emergency departments: A qualitative study of implementation and staff use

Abstract

Aims and objectives

To explore the extent to which a checklist designed to support patient safety in hospital Emergency Departments was recognised and used by staff.

Background

Patient crowding in UK Emergency Departments makes it difficult for staff to monitor all patients for signs of clinical deterioration. An Emergency Department Safety Checklist was developed at a UK hospital to ensure patients are regularly monitored. It was subsequently implemented in six hospitals and recommended for use across the National Health Service in England.

Methods

This was a qualitative study in two UK hospital Emergency Departments. Data collection consisted of sixty‐six hours of nonparticipant observation and interviews with twenty‐six staff. Observations were sampled across different days and times. Interviews sampled a range of staff. Data were analysed thematically. The study was undertaken in accordance with COREQ guidelines.

Results

Staff described the Emergency Department Safety Checklist as a useful prompt and reminder for monitoring patients' vital signs and other aspects of care. It was also reported as effective in communicating patient care status to other staff. However, completing the checklist was also described as a task which could be overlooked during busy periods. During implementation, the checklist was promoted to staff in ways that obscured its core function of maintaining patient safety.

Conclusions

The Emergency Department Safety Checklist can support staff in maintaining patient safety. However, it was not fully recognised by staff as a core component of everyday clinical practice.

Relevance to clinical practice

The Emergency Department Safety Checklist is a response to an overcrowded environment. To realise the potential of the checklist, emergency departments should take the following steps during implementation: (a) focus on the core function of clinical safety, (b) fully integrate the checklist into the existing workflow and (c) employ a departmental team‐based approach to implementation and training.

Oral care practices of long‐term care home residents and caregivers: Secondary analysis of observational video recordings

Abstract

Aims and Objectives

To describe the proportion of toothbrushing task steps, long‐term care residents had an opportunity to complete; the duration and quality of toothbrushing by both residents and caregivers; and the feedback caregivers provided.

Background

Poor oral health is widespread among older adults in long‐term care homes; however, little is known about their actual oral health practices.

Design

Secondary analysis of video recordings.

Methods

A total of 58 video‐recorded sessions were analysed from two long‐term care homes in Canada. Eligible residents had at least one natural tooth, required oral care assistance, had Alzheimer's disease and understood English. Eligible caregivers spoke English and had worked for at least 1 year with people with dementia. Toothbrushing success was identified by the resident's participation in, and completion of, nine toothbrushing steps. Total time spent brushing teeth was calculated by summing the duration of time spent brushing teeth. Quality was described by time spent brushing the facial versus the lingual or occlusal surfaces. Caregiver verbal feedback was pulled from transcripts and analysed using content analysis. STROBE guidelines were used in reporting this study.

Results

The two step residents most frequently completed or attempted were brushing their teeth (77% complete, 7% attempt) and rinsing their mouth (86% complete, 2% attempt). The average time spent brushing teeth was 60.33 s (SD = 35.15). In 66% of observed videos, toothbrushing occurred only on the facial tooth surfaces, with no time spent brushing the lingual or occlusal surfaces.

Conclusion

Caregivers are supporting residents to independently complete toothbrushing; however, the duration and quality of toothbrushing are not sufficient to ensure optimal oral health.

Relevance to Clinical Practice

Clear, detailed guidelines are required to ensure adequate oral care for long‐term care residents. Staff need to be aware that all surfaces should be brushed to ensure proper oral health.

Effects of hospital‐family holistic care model on the health outcome of Patients with permanent enterostomy based on the theory of “Timing It Right”

Abstract

Aims and objectives

To explore the effects of hospital‐family holistic care model based on “Timing It Right” on the health outcome of Patients with permanent colostomy.

Background

Colorectal cancer is a common malignant tumor of digestive system, which seriously threatens human life and health. Colostomy is one of the main treatments for colorectal cancer, which effectively improves the 5‐year survival rate of patients. However, the postoperative psychological and physiological rehabilitation nursing is still faced with great challenges due to the change of body image and defecation pathway caused by colostomy.

Methods

A randomized controlled trial was conducted and 119 patients with permanent enterostomy were randomly divided into two groups, with 60 cases in the intervention group and 59 cases in the control group. The intervention group received routine care、follow‐up and hospital‐family holistic care intervention based on “Timing It Right”, while the control group received routine care and follow‐up. The resilience, self‐care ability, complications and life quality of Patients with permanent enterostomy were compared between two groups before intervention,at discharge , 3 months and 6 months after discharge. CONSORT checklist was applied as the reporting guideline for this study (See supplementary File 1).

Results

108 patients with permanent enterostomy completed the study (90.76%). At 3 months and 6 months after discharge, the resilience and quality of life in the intervention group were significantly better than those in the control group (t = 4.158 vs 7.406, t = 4.933 vs 8.611, P < 0.05); while the complications in the intervention group were significantly lower than that in the control group (25.5% vs 41.51%, 14.45% vs 30.19% ; P < 0.05). The self‐care ability of the intervention group was significantly better than that in the control group (t = 1.543 vs 3.656 vs 6.273, P < 0.05) at discharge, 3 months and 6 months after discharge. The interaction between time and grouping showed that the effect of time factor varied with the grouping. After intervention, there were significant differences in psychological resilience、 self‐care ability、complications and quality of life between the two groups at different observation points (P < 0.01). The three evaluation indices of intervention group increased with the migration of observation time points and were significantly better than those of control group, especially the quality of life (84.35±4.25 vs 60.45±8.42, P < 0.01).

Conclusions

The hospital‐family holistic care model based on “Timing It Right” can effectively improve the psychological resilience, self‐care ability, quality of life, reduce complications and improve the health outcomes of patients with permanent enterostomy.

Relevance to clinical practice

Patients with permanent enterostomy have different needs for nursing care at different stages of the disease, and they are dynamically changing. The hospital‐family holistic care model based on “Timing It Right” can effectively improve the health outcomes of patients with permanent enterostomy, which is worthy of clinical application.

Impact of self‐care programmes in type 2 diabetes mellitus population in primary health care: Systematic review and meta‐analysis

Abstract

Aims and Objectives

To evaluate the effectiveness of self‐care programmes in type 2 diabetes mellitus (T2DM) population in primary health care.

Background

The impact of educational interventions on T2DM has been evaluated in various contexts, but there is uncertainty about their impact in that of primary care.

Design

Systematic review and meta‐analysis.

Methods

A search was conducted in PubMed, CINAHL, WOS and Cochrane databases for randomised controlled trials carried out in the period January 2005‐December 2017, including studies with at least one face‐to‐face educational interventions. The quality of the evidence for the primary outcome was evaluated using the GRADE System. A meta‐analysis was used to determine the effect achieved although only the results classified as critical or important were taken into consideration. Checklist of Preferred Reporting Items for Systematic Reviews and Meta‐analyses has been followed. PROSPERO registration Number: CRD42016038833.

Results

In total, 21 papers (20 studies) were analysed, representing a population of 12,018 persons with T2DM. For the primary outcome, HbA1c, the overall reduction obtained was −0.29%, decreasing the effect in long‐term follow‐up. The quality of the evidence was low/very low due to very serious risk of bias, inconsistency and indirectness of results. Better results were obtained for individual randomised trials versus cluster designs and in those programmes in which nurses leaded the interventions. The findings for other cardiovascular risk factors were inconsistent.

Conclusions

Educational interventions in primary care addressing T2DM could be effective for metabolic control, but the low quality of the evidence and the lack of measurement of critical results generates uncertainty and highlights the need for high‐quality trials.

Relevance to clinical practice

Most of self‐care programmes for T2DM in primary care are focused on metabolic control, while other cardiovascular profile variables with greater impact on mortality or patient‐reported outcomes are less intensely addressed.

Front‐line nurses’ perceptions of intra‐hospital handover

Abstract

Aims

To explore nurses’ perceptions of factors that help or hinder intra‐hospital handover.

Background

Miscommunication during clinical handover is a leading cause of clinical incidents in hospitals. Intra‐hospital nursing handover between the Emergency Department and Inpatient Unit is particularly complex.

Design

A descriptive, qualitative study. This research adheres to the consolidated criteria for reporting qualitative research.

Methods

Forty‐nine nurses participated in group interviews, which were analysed using inductive content analysis.

Results

Three categories emerged; 1) ‘Lacking clear responsibilities for who provides handover’; 2) ‘Strategies to ensure continuity of information’; and 3) ‘Strained relationships during handover’.

Conclusions

Intra‐hospital handover requires clear processes, to promote high‐quality information sharing. Ensuring these processes are broad and acceptable across units may ensure nurses’ needs are met. Relational continuity between nurses is an important consideration when improving intra‐hospital handover.

Relevance to clinical practice

Nursing managers are optimally positioned to enhance intra‐hospital handover, by liaising and enforcing standardisation of processes across units. Nurse managers could promote intra‐unit activities that foster front‐line nurses’ communication with each other, to encourage problem‐solving and partnerships.

Relationship between critical thinking disposition and research competence among clinical nurses: A cross‐sectional study

Abstract

Aims and Objectives

To explore the relationship between critical thinking disposition and research competence among clinical nurses.

Background

The development of the nursing discipline and evidence‐based practice calls for research competence and critical thinking disposition among clinical nurses. The verification of the relationship between critical thinking disposition and research competence could make contributions to promoting related knowledge building and providing practical implications for nurses, nurse educators and nurse managers. However, there is a lack of evidence exploring the relationship between critical thinking disposition and research competence in clinical nurses.

Design

A cross‐sectional study.

Methods

A total of 156 clinical nurses from two tertiary hospitals participated in this study. The Chinese Version of Critical Thinking Disposition Inventory and Research Competence Scale for Clinical Nurses were used to measure critical thinking disposition and nursing research competence, respectively. Data were collected in September 2017. Descriptive statistics, bivariate correlation and linear regression were used to analyse data. The STROBE checklist was used in reporting this study.

Results

The clinical nurses surveyed showed a positive inclination to general critical thinking but reported an overall low level of nursing research competence. A moderate degree of positive correlation was found between critical thinking disposition and research competence among clinical nurses. Educational degree was also found as an influencing factor of nursing research competence of clinical nurses.

Conclusion

The critical thinking disposition of clinical nurses is positively related to their research competence.

Relevance to clinical practice

Nurses with a passion for nursing research should pay attention to improving their critical thinking dispositions. Nurse educators and managers should provide better learning, working and research environments and more supports to cultivate critical thinking disposition and improve nursing research competence in nursing research education and practice.

The effectiveness of nurse‐led interventions for preventing urinary tract infections in older adults in residential aged care facilities: A systematic review

Abstract

Aims and Objectives

To explore the effectiveness of nurse‐led interventions to prevent urinary tract infections in older adults living in residential aged care facilities.

Background

While most empirical studies focus on the treatment of urinary tract infections, few studies have examined the effectiveness of nurse‐led interventions in preventing urinary tract infections.

Design

Systematic review.

Methods

Eight electronic databases were searched for relevant studies published between 2008–2018. The inclusion criteria were as follows: (a) a focus on older adults, (b) evaluation of nurse‐led interventions, focusing on prevention of urinary tract infection, (c) implemented in residential aged care facilities, and (d) outcomes reported as incidence or prevalence of urinary tract infection. The selected papers were critically appraised using the Mixed Methods Appraisal Tool. The data were analysed with narrative synthesis, and findings were reported following the PRISMA guidelines.

Results

A review of 1,614 titles and abstracts identified four studies that met the inclusion criteria. Three types of nurse‐led interventions were identified: (a) the appointment of advanced practice nurses, (b) those focused on a single specific nursing intervention, and (c) implementation of a multicomponent nursing intervention. All included studies reported at least some positive outcomes. However, the included studies were highly heterogeneous and it was impossible to determine the most effective intervention approach.

Conclusions

Nurses are leaders in health care and are well placed to lead prevention of urinary tract infections in residential aged care; however, evidence of the effectiveness of a nurse‐led approach is limited. High‐quality randomised controlled trials are warranted to address the knowledge gap and advance practice in this area.

Relevance to clinical practice

When developing an effective nurse‐led intervention programme, the programme should be grounded in nurse‐led principles and consider the complex staffing factors to ensure that nurse‐led programmes are tailored to an effective level.

Factors influencing the implementation of Epilepsy Specialist Nurse role: Using the Consolidation Framework for Implementation Research

Abstract

Background

Research to support the added value of including Epilepsy Specialist Nurses as members of the multidisciplinary team is developing, yet little information exists on factors influencing the translation of these roles into practice.

Aim

To describe the enabling and inhibiting factors to the implementation of the Epilepsy Specialist Nurse role in the Republic of Ireland.

Methods

A qualitative design involving semi‐structure interviews, observation and analysis of documents, such as portfolios was used. The sample included 12 Epilepsy Specialist Nurses, 24 multidisciplinary team members, and 35 individuals with epilepsy and family members. Data were analysed using the Consolidation Framework for Implementation Research. Reporting rigour is demonstrated using the COREQ checklist (See Appendix S1).

Results

While there was overwhelming support for the role, barriers and enablers were identified across all domains of the Consolidation Framework for Implementation Research. Enablers included national policies and guidelines, leadership from senior nursing and medical colleagues, climate of learning and mentorship, networking opportunities, infrastructural supports and competence of Epilepsy Specialist Nurses. Barriers included the limited consideration of service expansion and the increasingly complex nature of clinical cases on workload capacity. Deficits in infrastructural supports, challenges in relation to role preparation, role implementation and role responsibility, including concerns around lone practitioner models and concerns that the role was a cost‐saving measure, also emerged as potential barriers to future sustainability.

Conclusion

The Consolidation Framework for Implementation Research offers researchers a pragmatic typology for analysing interrelationships between enabling and inhibiting factors that impact implementation of advanced practice roles, across different evidence sources, disciplines and boundaries.

Relevance to clinical practice

In order to secure role sustainability, managers need to address the rate of service expansion, models of role development, deficits in supports and perceived motivations for role development on the quality, acceptability and sustainability of services provided.

The role of nurses and midwives in the provision of abortion care: a scoping review

Abstract

Aims and Objectives

We undertook a systematic scoping review of literature on nursing or midwifery abortion care to define the role and scope of the nurse and midwife within the global context of abortion.

Background

An estimated 56 million women seek abortions each year; nurses and midwives are commonly involved in their care (Singh, Remez, Sedgh, Kwok, & Onda, 2018). As new models of abortion care emerge, there is a pressing need to develop a baseline understanding of the role and scope of nurses and midwives who care for women seeking abortions.

Design

The review design was Arksey and O’Malley’s five‐stage methodological framework. The review follows the PRISMA‐ScR checklist.

Methods

MEDLINE, CINAHL, Scopus and Science Direct were used to identify original research, commentaries and reports, published between 2008‐2019, from which we selected 74 publications reporting on the nursing or midwifery role in abortion care.

Results

Nurses and midwives provide abortion care in a variety of practice. Three themes emerged from the literature: the regulated role; providing psychosocial care and; the expanding scope of practice.

Conclusions

The literature on nursing and midwifery practice in abortion care is broad. Abortion‐related practices are potentially over‐regulated. Appropriately trained nurses and midwives can provide abortions as safely as physicians. The preparation of nurses and midwives to provide abortion care requires further research. Also, healthcare organisations should explore person‐centred models of abortion care.

Relevance to clinical practice

Abortion care is a common procedure performed across many healthcare settings. Nurses and midwives provide technical and psychosocial care to women who seek abortions. Governments and regulatory bodies could safely extend their scope of practice to increase women’s access to safe abortions. Introduction of education programs, as well as embedding practice in person‐centred models of care, may improve outcomes for women seeking abortions.

The impact of street clothes among caregivers on residents with dementia in special care units: the STRECLO study

Abstract

Aims and objectives

This study aimed to examine the impact of caregivers' street clothes on people living in special care units (SCUs). We hypothesized that caregivers wearing street clothes would improve residents’ relationships with other residents and caregivers, and as a consequence would improve their quality of life.

Background

Environmental factors have been recognized as important elements in the care of people with dementia. Among these factors, the importance of the caregivers’ appearance and more particularly their street clothes has been raised.

Design

The Street Clothes study (STRECLO) was designed as a multicenter crossover observational study.

Method

This study was conducted in two volunteer nursing homes. It involved videotaping residents (N=24) over a 6‐month period: caregivers wore uniform and then street clothes for two consecutive three‐month periods. Three outcome measures were observed: 1) behaviors of residents, 2) contents of conversations and 3) proximal interactions between residents and caregivers. The STROBE checklist was used to ensure quality reporting during this observational study.

Results

When caregivers wore street clothes, we observed: 1) greater solicitation and less anxiety in residents, 2) content of conversations between residents and caregivers included more personal and less health information, and 3) more proximal interaction between caregivers and residents.

Conclusion

To our knowledge, this is the first study which investigated the long‐term effects on residents of SCU caregivers wearing street clothes. Our study demonstrated the potential benefit of not wearing uniform on the quality of life of institutionalized people with dementia.

Relevance to clinical practice

Given the budgetary constraints faced by nursing homes, wearing street clothes for caregivers could be readily applied to clinical practice and represents a promising way to increase the quality of life of dementia residents and their families.

Vulnerability in Birth; A negative capability

Abstract

Aim

This article explores the literature on women’s expectations for birth, the sociocultural context from which these expectations originate and their impact on the interpretation of birth experience.

Background

Childbirth is associated with specific expectations from women with the potential for dissatisfaction if these expectations are not met.

Design

This paper presents a systematic analysis of the concept of vulnerability in childbirth.

Findings

A framework was extracted from the literature that linked the themes of a Discourse of control, Construction of inadequacy, and Shame of exposure to explain the sociocultural origin of dominant childbirth expectations in the literature. The experience of vulnerability unique to the birthing event is suggested as exposing the woman to this underlying contextual framework and impacting the interpretation of her birth.

Conclusion

This synthesis has exposed the transient experience of vulnerability during birth as a significant contributor to the birthing woman’s interpretation of the birth and her place within it.

Relevance to Clinical Practice

An explanatory framework is offered to clinicians that could increase their awareness of sociocultural and historical factors impacting a woman’s expectations for birth. Appreciation of the woman’s vulnerability in birth, exposing her to the influence of this framework, can assist clinicians to facilitate a quality birth experience for women. Furthermore, supporting women and midwives to accept this experience of birth vulnerability as a ‘negative capability’, can facilitate an empowering birth experience.

Pain relief from nonpharmacological interventions in the intensive care unit: A scoping review

Abstract

Aims and Objectives

To describe what is known from the existing literature on nonpharmacological interventions targeting pain in patients admitted to the ICU.

Background

Patients receiving intensive care nursing are exposed to a wide range of pain provoking tissue damage, diseases, surgery and other medical procedures in addition to the pain caused by nursing care procedures. The present shift to light sedation to improve patient outcomes and comfort underscores the need for effective pain management. Opioids are the mainstay for treating pain in the ICUs, whereas nonpharmacological treatments are understudied and possibly under‐used.

Method

A scoping review was undertaken using five of the six steps in the Arksey and O´Malley framework: (a) identification of the research question, (b) identification of relevant studies, (c) study selection, (d) charting the data and (e) collating, summarising and reporting the results. CINAHL, MEDLINE, PubMed, BMJ Best Practice, British Nursing Index and AMED databases were searched using relevant keywords to capture extensive evidence. Data were analysed using the six‐step criteria for scoping reviews suggested by Arksey and O´Malley for data extraction. To ensure quality and transparency, we enclosed the relevant Equator checklist PRISMA.

Results

Our search yielded 10,985 articles of which 12 studies were included. Tools for pain assessments were VAS, NRS, ESAS and BPS. Interventions explored were hypnosis, simple massage, distraction, relaxation, spiritual care, harp music, music therapy, listening to natural sounds, passive exercise, acupuncture, ice packs and emotional support. Reduction in pain intensity was conferred for hypnosis, acupuncture and natural sounds.

Conclusion

The findings support further investigations of acupuncture, hypnosis and listening to natural sounds.

Relevance to Clinical Practice

The main finding suggests the use of comprehensive multimodal interventions to investigate the effects of nonpharmacological treatment protocols on pain intensity, pain proportion and the impact on opioid consumption and sedation requirements.

Consistency of postoperative pain assessments between nurses and patients undergoing enhanced recovery after gynaecological surgery

Abstract

Aims and objectives

To explore the consistency of pain intensity and pain location assessed by nurses and patients in gynaecology undergoing enhanced recovery after surgery pathway.

Background

Several studies have shown that clinical nurses' assessment of patients' pain is not always accurate. Little is known about the accuracy of nurses' pain assessments for gynaecological patients. Postoperative pain assessment and management is an essential part of enhanced recovery after surgery.

Design

Comparative cross‐sectional study.

Methods

A total of 160 patients were recruited and only 85 patients and 17 nurses participated. Patients and nurses recorded pain scores (using an 11‐point Numeric Rating Scale) and pain location (incision pain, surgical area pain in the abdominal cavity, other pain or no pain) on Pain Assessment Forms at 4 hr after surgery and on the first and second postoperative days. We used the STROBE guidelines to report our study.

Results

The patients' pain score was higher than that of nurses from 4 hr to second day after laparoscopic surgery at rest. The pain scores of both nurses and patients decreased over this period of time. All the intraclass correlation coefficients were between 0.214–0.296. At the three time points, surgical area pain in the abdominal cavity and abdominal incision pain were the main pain areas. All the kappa coefficients were between 0.164–0.255.

Conclusions

The consistency of postoperative pain assessment about pain score and pain location between nurses and patients was not high. We should attach importance to systematic pain assessment, and more detailed enhanced recovery after surgery pathways should be developed about pain assessment.

Relevance to clinical practice

Continuing education for nurses regarding pain assessment is necessary. Nurses should accept the patient's self‐reported pain. There should be a step that gives more time for pain assessment in enhanced recovery after surgery pathways.

Critical care nurses' perception of care coordination competency for management of mechanically ventilated patients

Abstract

Aims and Objectives

To evaluate nurses’ care coordination competency for mechanically ventilated patients in intensive care units (ICUs) of Saudi Arabia (SA).

Background

ICUs are increasingly using multidisciplinary approach to provide critical care. Functionality gaps remain within these teams preventing optimum performance, including a lack of adequate care coordination in the management of mechanically ventilated (MV) patients.

Design

A cross‐sectional survey of ICU nurses working across 20 hospitals in SA.

Methods

The Nurses’ Care Coordination Competency Scale (NCCCS) survey for MV patients was administered to all the nurses to assess their care coordination competence. The data were analysed using Student's t test, ANOVA and linear regression. Reporting of this research follows STROBE guidelines.

Results

A total of 254 nurses participated in the survey. The overall NCCCS mean score was 3.94 (±0.69) out of a 5‐point scale. Also, the “promoting team cohesion factor (Factor 1)” had a mean score of 3.90 (±0.77), the “understanding care coordination needs factor (Factor II)” had a mean score of 4.00 (±0.77), the “aggregating and disseminating information factor (Factor III)” had a mean score of 4.05 (±0.76), and the “devising and clearly articulating the care vision factor (Factor IV)” had a mean score of 3.78 (±0.87). The mean overall NCCCS score was 4.10 among Indians, 3.98 among Filipinos and 3.81 among Saudi nationals.

Conclusion

There were a high overall score and subscale scores of nurses’ care coordination competence for mechanically ventilated patients, but few gaps were identified in some of the items.

Relevance to Clinical Practice

The results provide information on the status and gaps in ICU nurses’ care coordination competencies to address the needs of mechanically ventilated critically ill patients. The NCCCS can be utilised as an educational tool for nurses who are new to the ICU work environment.

Factors associated with quality of life in patients with diabetic hypoglycaemia

Abstract

Aims and Objectives

To identify determinants of quality of life among patients who had experienced hypoglycaemia and who were undergoing insulin treatment.

Background

Patients with diabetes receiving insulin treatment are at high risk for hypoglycaemia, which tends to affect their quality of life.

Design

With a cross‐sectional and observational study design (see the STROBE checklist and Appendix S1).

Methods

One hundred and fifty patients with type 2 diabetes who had received insulin treatment and had experienced hypoglycaemia (<70 mg/dl) in the last 6 months were recruited. Data were collected from May 2016–February 2018 using the Knowledge of Hypoglycaemia Scale, Fear of Hypoglycaemia Scale, Social Support Scale and the simplified Taiwanese version of the Quality of Life Scale developed by the World Health Organization.

Results

Factors found to be associated with quality of life in patients with hypoglycaemia included having an educational level of senior high school or above, being on an insulin regimen only, engaging in regular exercise, diabetes complications, fear of hypoglycaemia and greater social support, which accounted for 28.5% of the total variance.

Conclusions

During the process of glycaemic control, patients inevitably experience hypoglycaemic episodes. Therefore, healthcare providers should assist patients with disease management to improve their quality of life. Future studies should also recruit patients who claim to have experienced hypoglycaemic symptoms, rather than considering only those with blood glucose levels below 70 mg/dl, to expand the generalisability of the findings. Future studies may also focus on the management of hypoglycaemia in patients on an insulin regimen, and on examining the effect of health education programmes on prevention of hypoglycaemia.

Relevance to clinical practice

The present findings could provide a reference for healthcare providers to consolidate nursing care guidelines and to improve such patients' quality of life.

Factors Related to Self‐care Behaviors among Patients with Diabetic Foot Ulcers

Abstract

Aims and objectives

The purpose of this study is to examine the level of self‐care behaviors among patients with diabetic foot ulcers (DFU) and identify factors related to their self‐care behaviors.

Background

This study focused on the self‐care behaviors of patients diagnosed with DFU, a complication of diabetes.

Design

A cross‐sectional study design was adopted.

Methods

From July to August 2018, 131 outpatients and inpatients with DFU were given a survey questionnaire regarding self‐care behaviors and expected related factors at two Korean hospitals. In this study, self‐care behaviors were diabetes management and diabetic foot care. Demographic, disease‐related, and laboratory characteristics were collected. The data were analyzed in terms of descriptive statistics, a t‐test, ANOVA, Pearson's correlation coefficient, and stepwise multiple regression. STROBE checklist was used as the guideline for this study.

Results

Moderate levels of self‐care behaviors were found. The stepwise multiple regression analysis revealed that diabetes management was significantly related to perceived family support, experience of diabetic education, perceived stress, a problem‐focused coping style, experience of hospitalization, and comorbidity. Furthermore, diabetic foot care was significantly associated with the experience of diabetic education, perceived family support, and serum level of erythrocyte sedimentation rate (ESR) and hemoglobin A1C (HbA1C).

Conclusions

Perceived family support was the main factor affecting diabetes management, and diabetic foot care was greatly affected by the experience of diabetic education. It is necessary to develop diabetes education programs and nursing interventions to increase family support to improve the self‐care behaviors of patients with DFU.

Relevance to clinical practice

Self‐care behaviors among patients with DFU are important, as they affect healing of the wound and the quality of life. Further development of family‐based diabetes education or programs is recommended to promote the self‐care behaviors of patients with DFU.

Exploring dementia care competence of nurses working in acute care settings

Abstract

Aims and Objectives

To examine the current status of dementia care competence of nurses working in acute care settings as well as the relationship between competence and demographic attributes.

Background

Most people with dementia are older individuals when they are admitted to unfamiliar acute care settings for treatment, and they are prone to displaying BPSD. If nurses working in acute care settings are not sufficiently competent in dementia care, providing proper patient care is difficult.

Design

The study used a one‐sample descriptive‐correlation design.

Methods

This study enrolled nurses at two medical centres in southern Taiwan as the research participants and performed a stratified random sampling according to the units where they served. The Dementia Care Competence Scale was used for data collection. An independent samples t test, ANOVA and Pearson's product–moment correlation were performed for data analysis (See STROBE).

Results

A total of 308 valid questionnaires were collected. The results showed that dementia care competence of nurses working in acute care settings was moderate. In particular, they had insufficient knowledge of the special needs related to dementia and lacked the skills and patience necessary for identifying, preventing and managing BPSD. Additionally, although the nurses tended to have a positive attitude, they seldom communicated with people with dementia. This study also found that dementia care competence was better in nurses who were older, who had more seniority, who had taken care of people with dementia for a longer period of time and who had received training in dementia care.

Conclusions

Dementia care training topics for nurses working in acute care settings should include palliative care for dementia, skills for managing behavioural and psychological symptoms of dementia and communication techniques for improving person‐centred care. Nurses should also be encouraged to maintain a warm, friendly attitude when providing patient care.

Relevance to Clinical Practice

Continuing education in managing behavioural and psychological symptoms of dementia is necessary for currently practicing acute care nursing staff and should be developed according to the staff's educational background and needs.

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