FreshRSS

🔒
❌ Acerca de FreshRSS
Hay nuevos artículos disponibles. Pincha para refrescar la página.
AnteayerJournal of Clinical Nursing

The Risk Factors for the Exacerbation of COVID‐19 Disease: A Case–control Study

Abstract

Aims and Objectives

To investigate the factors associated with the exacerbations of COVID‐19.

Background

At present, COVID‐19 is prevalent in the world, seriously endangering the property and life safety of people around the world. Currently, there are many reports on the clinical features, complications and risk factors of death of COVID‐19, but there are few reports on the factors associated with the exacerbation of COVID‐19.

Design

Case–control Study.

Methods

Patients with COVID‐19 were recruited from four designated hospitals for novel coronavirus pneumonia in Xiangyang City, Hubei Province from January to April 2020. The patients were divided into disease exacerbation group (n = 53) and disease stabilisation group (n = 265) according to the disease progression during hospitalisation. Univariate analysis and multivariate logistic regression were used to identify the factors associated with the exacerbation of COVID‐19. The research was reported according to STROBE statement.

Results

Univariate analysis showed there were significant differences in gender, age, hypertension, heart disease, kidney disease, white blood cell count, percentage of neutrophil, percentage of lymphocyte, C‐reactive protein, lactate dehydrogenase, total protein, albumin, creatinine, calcium ion, rate of erythrocyte sedimentation, cough, expectoration, chest tightness, gastrointestinal discomfort and dyspnoea between the two groups. The variables with p < 0.05 in the aforementioned difference analysis were included in binary logistic regression analysis, which showed that age, hypertension history, chest tightness, percentage of neutrophil, percentage of lymphocyte, lactate dehydrogenase and creatinine were independent factors associated with COVID‐19 disease exacerbation.

Conclusion

Clinicians may warn the exacerbation of COVID‐19 facing above risk factors and associated characteristics, and adjust the diagnosis and treatment plan to delay the disease progression, reduce complications and mortality and improve the prognosis of patients.

Relevance to Clinical Practice

Patients with certain risk factors associated with COVID‐19 diseases exacerbation should be observed and targeted by using effective early interventions.

‘It was difficult, but our struggle to touch lives gave us strength’: The experience of nurses working on COVID‐19 wards

Abstract

Background

Nurses are considered important healthcare professionals during the management of the pandemic process due to the considerable amount of time they spend in the face‐to‐face nursing of infected patients. To optimise the service of healthcare workers, it is recommended that the mental health needs of the health workforce are addressed.

Aims and Objectives

This study aimed to explore the experiences and coping strategies of Turkish nurses working in pandemic units.

Methods

A grounded theory design was applied. In‐depth interviews were conducted with 15 nurses. The data were analysed according to the constant comparative method.

Results

The study generated a core category (‘It was difficult working in the unknown, but our struggle to touch lives gave us strength’), showing that all nurses felt heroic via the satisfaction of touching patients’ lives and uncertain. Four main categories emerged: being caught in the pandemic, empowerment for coping with the struggle, challenges during the coping process and effects of the pandemic on life.

Conclusions

Nurses felt that their profession was sacred and valued by society, and comprehensive support had facilitated the process. Nurses had difficulty in managing their fear of infecting others and adapting to many new elements, the learning process and a lack of understanding of their role as team members. The nurses attending to the pandemic have experienced the effects of COVID‐19 on their lives, such as psychological growth, psychological symptoms and being labelled as high risk.

Relevance to clinical practice

Nurses would be further empowered by government and society's support and acceptance of professionalism in nursing. The findings suggest that the resources for the psychological support of nurses in the pandemic should be increased. Regular and intensive training for nursing is necessary to promote adaptation and efficacy in crisis management.

A cross‐sectional study of United States Academic‐clinical research collaborations: Characteristics, resources, benefits and outcomes

Abstract

Aims

The aims of the study were to compare characteristics, resources, benefits and outcomes of academic‐clinical collaborations of nursing researcher leaders from academic, clinical and joint‐employer sites.

Background

Few research‐based publications addressed academic‐clinical research collaborations. New knowledge could increase nursing and multidisciplinary research productivity, including implementation science.

Design

An anonymous survey using a 40‐item questionnaire.

Methods

Information letters with a link to the questionnaire were emailed to United States nursing research leaders. Data were grouped by institution type: academic, clinical or joint‐employer. Analyses included Kruskal–Wallis tests for ordered responses, Pearson's chi‐square test or Fisher's exact test for categorical responses and Cohen's Kappa agreement statistic for expected and actual time devoted to research. STROBE guidelines were followed.

Results

Of 120 respondents from academic (n = 60; 50.0%), clinical (n = 53; 41.2%) and joint‐employer (n = 7; 5.8%) sites, 78.3%, 92.3% and 100%, respectively, were from metropolitan areas. Mean (SD) priority for active collaborations was higher at joint‐employer sites; p = .002. Clinical sites were more likely to have directors of evidence‐based practice (p = .031) and informatics (p = .008) and librarians (p = .029). Sites with collaborations were more likely to have access to research subjects (p = .008) and post‐award research account management (p = .045). By collaboration status, there were no differences in the number of ethics board‐approved studies. Collaborating site benefits were perceived to be executive leadership support (p = .003), greater research engagement by clinical nurses (p = .048), more co‐authored publications (p = .048) and more abstracts accepted at national meetings (p = .044). Despite more resources and perceived benefits, outcomes did not differ by collaboration status.

Conclusions

Sites with and without academic‐clinical research collaborations differed; however, outcomes were similar. Future efforts should focus on nurse scientist collaboration to address important clinical questions aimed at improving clinical outcomes.

Relevance to Clinical Practice

Despite some successful outcomes, potential benefits of academic‐clinical research collaborations have not been fully actualised.

A challenging balancing act to engage children and their families in a healthy lifestyle – nurses’ experiences of child‐centred health dialogue in child health care services in sweden

Abstract

Aims and objectives

To describe nurses’ experiences of a child‐centred family‐guided intervention for the prevention of obesity, the Child‐Centred Health Dialogue (CCHD) with children and their caregivers when the child is identified with overweight in the child healthcare service.

Background

Interventions aiming to support families towards a healthier lifestyle can lead to decreased risk of overweight evolving into obesity in a child. At the same time nurses have found dialogues on weight challenging and may therefore avoid them.

Design

Qualitative descriptive inductive design following content analysis approach applying the COREQ guidelines.

Methods

Content analysis was used to analyse 13 individual semi‐structured interviews with nurses in the child health service in Sweden after completed training in CCHD, including how to facilitate the dialogue with the use of illustrations.

Results

The theme Health dialogue about weight is a challenging balancing act facilitated by a supportive intervention emerged through eight subcategories in three main categories. Nurses experienced that CCHD with children identified with overweight and their caregivers provoked an emotional response both for themselves and for the caregivers of the child. The training in child‐centred health dialogues promoted the nurses’ work with structure and professionalism, as the nurses carefully took tentative steps to engage the family for a healthy lifestyle.

Conclusions

Emotional and practical challenges in performing CCHD still remained amongst nurses after customized training, which might comprise the child’s rights to be involved in his or her own care when the child was identified as overweight. However, training for nurses, including lectures and tutorials, was found to increase the quality and professionalism of performing CCHD by providing structure, tools and tutorial support.

Relevance to clinical practice

Customized training and illustrations can support nurses when performing a structured intervention such as child‐centred health dialogues.

Communicating prognostic Information and Hope to Families of dying Patients in intensive Care units: A descriptive qualitative study

Abstract

Aims and objectives

To understand how prognostic information is communicated by Jordanian doctors and nurses to the families of dying patients in intensive care units, with an emphasis on exploring how hope and truth telling about patients’ poor prognosis are managed.

Background

Improving end‐of‐life care requires a focus on adequate family–professionals prognostic communication, while maintaining a realistic level of hope and family support.

Design

A descriptive qualitative approach was applied.

Methods

Semi‐structured interviews were conducted with 20 nurses and 15 resident doctors caring for dying patients. Bardin’s procedure of categorical content analysis was applied. The COREQ checklist for reporting qualitative studies was followed.

Results

Two main categories emerged from the data of this study, ‘perspectives on optimistic hope’ and ‘approaches to prognostic communication’. Health professionals experience extreme difficulty, and therefore frequently avoid, openly disclosing information about patients’ poor prognosis to the families. Consequently, the health professionals adopted various methods to balance truth telling against sustaining hope among the patients’ families. Providing false assurance was perceived as permissible and understandable, in order to nurture the families’ hope.

Conclusions

Improving end‐of‐life care in intensive care units in Jordan requires a focus on family–professional communication. Jordanian intensive care doctors and nurses perceived honest family–professional communication regarding dying patients to be extremely challenging. Healthcare professionals should develop their competency of meeting the informational and emotional needs of patients in ICUs and their families, while also honoring their cultural values, during prognostic communication.

Relevance to clinical practice

Effective training of healthcare professionals is vital, on ways to enhance communication of prognostic information and to foster realistic hope among families of dying patients in intensive care units. There is a need to also explore the families’ perspectives on prognostic communication in order to understand the similarities and differences between the professionals’ and families’ perspectives.

Faecal microbiota transplantation (FMT) and the patient experience: A systematic review

Abstract

Aim

To review and synthesise the literature examining the patients’ experience of faecal microbiota transplantation.

Background

Faecal microbiota transplantation is a common treatment for many conditions, including Clostridium Difficile infections. Patients’ experience of treatments is an important influence on clinical decision‐making and treatment adherence.

Design

The PRISMA guidelines guided this systematic review. The review was registered with PROSPERO [CRD42020140446].

Method

A search of Cumulative Index of Nursing and Allied Health Literature, Medline and Embase was conducted for studies published in English and French up to June 2020. Risk of bias was examined using Critical Appraisal Skills Program tools and quality appraisal was performed independently by three reviewers. Primary outcome of interest was the patient experience of faecal microbiota transplantation. Data were synthesized using a narrative approach.

Results

The search identified 3316 citations and 12 studies were included. Methodological quality of studies was moderate to low quality. Few studies have accurately explored the patients’ experience of faecal microbiota transplantation: most focus on clinical outcomes or hypothetical scenarios regarding the patients’ perspectives of faecal microbiota transplantation. Only one study was identified where the sole focus was the patients’ experience of faecal microbiota transplantation. Patient’s experience of faecal microbiota transplantation was diverse and complex with physiological and psychological components dependent on; the patient’s medical condition, the administration method and the efficacy.

Conclusion

Patients did not find faecal microbiota transplantation unappealing, however patients equally reported the procedural experience was unpleasant. Limited results and low quality evidence suggest that further evaluation of the patient experience of faecal microbiota transplantation would be beneficial.

Promoting safer sex in the context of heterosexual anal intercourse: A scoping review

Abstract

Aims and objectives

To locate and summarize existing literature regarding safer sex practices specific to heterosexual anal intercourse and identify promising health promotion strategies.

Background

Much of the literature regarding anal intercourse and safer sex is related to men who have sex with men. However, some studies suggest there are more women than men engaging in unprotected receptive anal intercourse. The risks associated with this sexual practice have been well documented, although many health care providers fail to ask about anal intercourse while addressing safer sex in the heterosexual population.

Design

The study was based on Arksey and O’Malley’s 2005 five‐step methodology.

Methods

A search was conducted of MEDLINE; CINAHL; PsycInfo; Cochrane; and PubMed. Databases were searched from 1990‐2020. The 72 studies selected were classified according to their main area of focus. A grey literature search was also included. This scientific submission has been assessed for accuracy and completeness using the PRISMA‐ScR guideline criteria (Supplementary File 1).

Results

The literature in this area is heterogeneous in terms of method and topic. Prevalence and incidence (n=26) in addition to sexually transmitted infection risks (n=26) related to heterosexual anal intercourse are well understood. However, there is limited information on condom use (n=6), factors that influence heterosexual anal intercourse (n=10), and health promotion strategies for this population and practice (n=4). Two websites that mentioned heterosexual anal intercourse risk reduction activities were included.

Conclusions

Although heterosexual anal intercourse appears to be an increasingly common sexual practice, very little is known about health promotion strategies nurses might utilize for encouraging safer sex in this population.

Relevance to clinical practice

Increased awareness of the prevalence and risks of heterosexual anal intercourse could enhance nurses’ harm reduction strategies. Screening for sexually transmitted infections may be based on incorrect assumptions about sexual practices or due to stigma linked with anal intercourse. Reducing unprotected heterosexual anal intercourse will reduce sexually transmitted infections and their long term sequelae.

Randomised controlled trial of a smartphone application‐based dietary self‐management program on hemodialysis patients

Abstract

Aims and objectives

To develop a smartphone application‐based dietary self‐management program for hemodialysis patients and to examine its effects on biochemical indicators, self‐efficacy, and quality of life.

Background

Lack of dietary management in hemodialysis patients can lead to serious complications such as edema, hyponatremia, hyperkalemia, hypertension, uremia, and eventually death; however, studies using smartphone applications for dietary self‐management in hemodialysis patients are rare.

Design

A prospective, single‐blind, randomised, controlled design with repeated measures was followed with 75 hemodialysis patients at a hemodialysis center. Data were collected from January 10, 2017, to May 6, 2018. The study applied the Consolidated Standards of Reporting Trials statement.

Methods

The eight‐week smartphone application‐based dietary self‐management program was developed through collaboration with a hemodialysis equipment company. The experimental group took this program while the control group took an eight‐week general program. Study variables were serum phosphorus, potassium and albumin, self‐efficacy, and quality of life. They were measured at pretest, and eight weeks and 12 weeks after the programs, and analyzed using two‐way repeated measures analysis of variance.

Findings

The smartphone application‐based program significantly improved serum phosphorus, potassium, self‐efficacy, and quality of life over time compared to the general program. There was no significant difference in albumin level changes between the groups.

Conclusions

The smartphone application‐based dietary self‐management program is an opportune and effective nursing intervention to lower serum phosphorus and potassium levels in hemodialysis patients over time. Trial registration was performed on www.cris.nih.go.kr (KCT0005366).

Relevance to clinical practice

Hemodialysis patients can easily use the smartphone application to manage their diet anytime and anywhere. They can get real‐time feedback and solutions to prevent hemodialysis complications. Nurses can provide tailored high‐quality care based on an individual’s lifelog data from the smartphone application.

Newly graduated registered nurses’ evaluation of their preparedness, confidence, and attitudes towards clinical assessments

Abstract

Background

Historically, it has been reported that new graduates make limited use of their clinical assessment skills.

Aims and objectives

To explore new graduates’ preparedness for, and confidence with, clinical assessment and their reliance on electronic monitoring. To identify barriers that hinder, and strategies that enable, clinical assessment.

Design

A mixed method study comprising a cross‐sectional, quantitative survey and qualitative data, gathered using the World Café method.

Methods

Data were collected from volunteers (n=137) of all new graduates (n=160) working in adult settings for a New Zealand district health board over a one‐year period. A paper‐based survey explored use of clinical assessment, using a five‐point Likert scale. Qualitative data comprised written records of group discussions and individual responses to four questions with thematic analysis of results. A STROBE checklist was used.

Results

Most (n=128) new graduates agreed/strongly agreed that clinical assessment was part of their role. Most (n=119) agreed/strongly agreed that assessing patients by technology alone was inadequate. Thirty‐six did not agree/strongly agree that they were well‐prepared to perform clinical assessment. Forty‐one did not agree/strongly agree that they were confident to perform clinical assessment, particularly those aged ≥30 years. Factors limiting use of clinical assessment were lack of time, knowledge, skill, confidence, reliance on doctors and an unsupportive work environment. Factors that would enhance clinical assessment involved increased supervision by experienced staff, provision of short courses and more in‐service education on clinical assessment.

Conclusions

New graduates acknowledged that clinical assessment was part of their role and involved more than electronic monitoring. However, many lacked confidence and preparedness for clinical assessment in their work area, particularly those aged ≥30 years, potentially limiting clinical assessment use. Supportive changes, including short courses to revise clinical assessment skills and supervision of workplace‐specific clinical assessments, could help new graduates more confidently and efficiently assimilate clinical assessment into their practice.

Beyond 2020: addressing racism through transformative indigenous health and cultural safety education

Abstract

The 2020 International Year of the Nurse and Midwife has harshly revealed the need to increase the nursing and midwifery workforce and for the disciplines to invest in anti‐racism initiatives. The World Health Organization (WHO) (2020) has called for a marked increase in the numbers of nurses and midwives, academics and students. However, to ensure the cultural safety of patients and staff, WHO (2020) stated this increase in workforce must include clinicians and educators from underrepresented populations, in particular Indigenous populations. Stemming from our experiences as First Nations nurses, midwives, practitioners, researchers, educators, and allies, this editorial outlines our agenda to reform Indigenous health and cultural safety curricula in Australian higher education institutions.

Enabling patient safety awareness using the Green Cross method. A qualitative description of users’ experience

ABSTRACT

Aim

The Green Cross method was developed to support health care staff in daily patient safety work. The aim of this study was to describe users’ experiences of the method when working with patient safety and their views on the core elements.

Background

Patient safety systems needs to be user friendly to facilitate learning from adverse events. The Green Cross method is described as a simple visual method to recognize risks and preventable adverse events (PAEs) in real time. There are no previous studies describing users’ experiences of the Green Cross method.

Design

A qualitative descriptive design.

Methods

32 healthcare workers and managers from different specialties in a Swedish hospital were interviewed, from May – September 2018 about their experiences of the Green Cross method; either individually or as part of a group. The interviews were analyzed using thematic analysis. The study follows the COREQ guidelines for qualitative data.

Results

Participants associated the Green Cross method with patient safety, but no core elements of the method were identified. Instead, the opportunity to be engaged in patient safety work in a systematic way was underlined by all study participants. Highlighted key areas were the simplicity and the systematic framework of the method along with a need of distinct leadership. The daily meetings promoted trust and dialogue and developed the patient safety mindset. Daily meetings, together with the visualization of the cross, were emphasized as important by users who otherwise had limited knowledge of the entire method.

Conclusion

This study offers valuable information that can help deepen the understanding of how the method specifically supports patient safety work.

Relevance to clinical practice

Health care workers are expected to report patient safety issues. This study presents user‐friendly aspects of the method as well as limitations, relevant for present and future users.

Persons with dementia as internet users: what are their needs? A qualitative study

Abstract

Aims and objectives

The aim of this study was to identify the needs and expectations of persons with dementia regarding dementia‐related information on the internet concerning content, presentation, navigation, language and design.

Background

Research on internet‐related needs of persons with dementia is lacking. However, the importance of the internet as a source of health information is increasing. To improve health literacy and to ensure participation in therapy decisions, target group‐specific health information is necessary, especially for persons with chronic conditions like dementia.

Design

We conducted a qualitative interview study between April 2019 and April 2020 in the German speaking part of Switzerland. To report the study, we used the COREQ checklist.

Methods

We analysed the interview data using content analysis according to Mayring.

Results

Four interviews with five persons with dementia took place We identified two main themes: (1) “use of media and changing needs” and (2) “information about dementia on the internet”. The first theme is related to changing user habits due to progressing dementia. The second theme is focussed on requirements concerning design and content. Critical reception and assessment of internet‐based information are also addressed.

Conclusions

Information should be adapted to the course of disease. Opportunities and positive aspects should also be mentioned. The presentation should be well‐structured. Health professionals might support persons with dementia in searching and interpreting internet‐based information.

Relevance to clinical practice

Website operators should consider specific needs of persons with dementia regarding design and content. Involving persons with dementia in the development of website content and design could be an opportunity for better meeting their needs.

Stage‐related implications of community‐acquired pressure injuries for the acute medical inpatients

Abstract

Aims

To analyse the prevalence of any‐stage pressure injuries at hospital admission and their impact on short‐, mid‐ and late‐term mortality. Patient characteristics associated with pressure injuries and the impact on hospital costs were also investigated.

Background

In medical patients acutely admitted to hospital, no study analysed the presence of pre‐existing pressure injuries and the related short‐ and long‐term mortality according to the overall stages of severity thereof.

Design

Retrospective cohort study following the STROBE guideline.

Methods

In a population of 7217 acute medical inpatients, the presence and staging of pressure injuries were assessed at hospital admission. The impact of pressure injury on 30‐, 180‐ and 365‐day mortality was analysed by multivariate Cox regression models.

Results

The prevalence of community‐acquired pressure injuries was 14.9% (stage‐1: 8.1%; stage‐2: 3.5%; stage‐3: 1.6%; stage‐4: 1.1%; unstageable: 0.5%). Hemiplegia/paraplegia, anaemia, poor functional status, high nutritional risk, clinical instability and systemic inflammatory response, but not hydration status, were found to be associated with the occurrence of stage‐2‐and‐above pressure injuries. An increasing difference was found in Diagnosis‐Related Groups (DRG) weight according to pressure injury stages. A distinct and progressively increasing risk‐of‐death for any‐stage pressure injury was shown after 365‐days. A significantly increased mortality risk for all considered time intervals was found for unstageable and stage‐4 pressure injuries.

Conclusions

In acute medical inpatients, the presence of community‐acquired pressure injuries is part of a multidimensional clinical complexity. The presence and staging of pressure injuries have an independent dramatic impact on of early‐to‐late mortality and hospital costs.

Relevance to clinical practice

This study documented as community‐acquired pressure injuries are highly prevalent and represents an independent predictor of outcomes in strict dependence of the progression of thereof stage. The presence of community‐acquired pressure injuries should be interpreted as a critical marker of frailty and increased vulnerability.

What is a clinical academic? Qualitative interviews with healthcare managers, research‐active nurses and other research‐active healthcare professionals outside medicine

Abstract

Aim and objectives

To explore the concept of ‘clinical academic’ from the perspectives of healthcare managers and research‐active healthcare professionals outside medicine.

Background

Clinical academics are understood to be healthcare professionals who combine clinical and research responsibilities within their role. However, there is no agreed definition for this term either within or across nursing, midwifery and the other healthcare professions outside medicine.

Design

Qualitative service evaluation, reported using the COREQ checklist.

Methods

Semi‐structured qualitative interviews were conducted with a purposive sample of eight healthcare managers and 12 research‐active clinicians within a UK hospital group. Interviews were audio recorded, transcribed verbatim, and analysed using the Framework method.

Results

Clinical academics were described in four themes. Two themes explored the components of the role and the contribution of these individuals to their profession: combining clinical practice, research and education; and pushing boundaries. The third theme identified the clinical academic label as: a title that doesn’t fit. The final theme examined a characteristic mindset of research‐active clinicians. There were no clear differences in the perceptions of managers and research‐active clinicians.

Conclusions

Clinical academics were perceived as valuable members of their team and were able to push the boundaries to move their profession forward. Some research‐active clinicians did not identify with the term ‘clinical academic’ and for some managers and research‐active clinicians, the term was viewed as jargonistic. A clear and accepted definition would aid development of clinical academic career pathways and identities. It would also assist in evaluating the impact of these roles.

Relevance to practice

As clinical academics roles and opportunities are being developed across the professions outside medicine, it is important to have a shared common understanding of ‘clinical academic’ to support the creation of career pathways and curricula, and to enable the evaluation of these roles.

Clinical Academic Research Internships: what works for nurses and the wider nursing, midwifery and allied health professional workforce

Abstract

Nurse‐led research and innovation is key to improving health experiences and outcomes and reducing health inequalities. Clinical academic training programmes for nurses to develop research and innovation skills alongside continued development of their clinical practice are becoming increasingly established at national, regional and local levels. Though widely supported, geographical variation in the range and scope of opportunities available remains. It is imperative that clinical academic opportunities for nurses continue to grow to ensure equity of access and opportunity so that the potential of nurse‐led clinical academic research to improve quality of care, health experience and health outcomes can be realised. In this paper we describe and report on clinical academic internship opportunities available to nurses to share internationally, a range of innovative programmes currently in operation across the UK. Examples of some of the tangible benefits for patients, professional development, clinical teams and NHS organisations resulting from these clinical academic internships are illustrated. Information from local evaluations of internship programmes were collated to report what has worked well alongside ‘real‐world’ set‐up and sustainability challenges faced in practice. Clinical academic internship schemes are often opportunistically developed, making use of hybrid models of delivery and funding responsive to local needs and available resources. Key enablers of successful clinical academic internship programmes for nurses were support from senior clinical leaders and established relationships with local universities and wider organisations committed to research capacity building.

Newly graduated nurses’ socialisation resulting in limiting inquiry and one‐sided use of knowledge sources—An ethnographic study

Abstract

Aim

To explore how the socialisation into the clinical setting and interaction between newly graduated nurses and experienced nurses influences the new graduates’ use of knowledge sources.

Background

Newly graduated nurses’ use of knowledge sources in decision‐making has been subject to an increased interest in relation to evidence‐based practice. Despite interventions to strengthen nurses’ competencies required for making reflective clinical decisions within an evidence‐based practice, studies highlight that new graduates only draw on knowledge from research, patients and other components within evidence‐based practice to a limited extent. Research exploring new graduates’ use of knowledge sources calls attention to the experienced nurses’ decisive role as a valued knowledge source. The new graduates’ process of socialisation and their interaction with the experienced nurse raises further questions.

Methods

Ethnography using participant‐observation and individual semi‐structured interviews of nine newly graduated nurses from a University Hospital in Denmark. Data were collected in 2014. The study adheres to COREQ.

Results

Two main structures were found: “Striving for acknowledgment” and “Unintentionally suppressed inquiry.”

Conclusions

New graduates are socialised into limiting their inquiry on clinical practice and unintentionally being restricted to using the experienced nurse as predominant knowledge source. Depending on how the experienced nurse responds to the role as predominant knowledge source, they could either limit or nurture the new graduates’ inquiry into practice and thus the variety of knowledge sources used in clinical decision‐making. Limited inquiry into the complexity of nursing practice indirectly excludes the use of a variety of knowledge sources, which are fundamental to an evidence‐based practice.

Relevance

If clinical practice wishes to benefit from the newly graduated nurses’ inquiring approach and skills within evidence‐based practice, clinical practice will have to greet the nurses with a supportive culture where questioning practice is seen as a strength rather than a sign of insecurity and incompetence.

Polypharmacy and pattern of medication use in community‐dwelling older adults: A systematic review

Abstract

Aim

To synthesise current study findings on the diseases and the corresponding medications that are potentially associated with polypharmacy in community‐dwelling older adults.

Background

Polypharmacy is receiving increased attention as a potential problem for the older population. Although several scientific investigations have studied polypharmacy, most of them were carried out in long‐term care facilities or mixed settings rather than in community settings solely.

Methods

This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Relevant studies published in the English language in peer‐reviewed journals were identified from searches of seven electronic databases for the period of January 2000 through December 2019. Inclusion criteria were: (1) Participants were older adults aged 65 years and older; (2) Polypharmacy was defined by medication count; (3) Medication classes associated with polypharmacy were revealed; (4) Studies were conducted in outpatient care or community settings. The Joanna Briggs Institute critical appraisal checklists for cross‐sectional studies and for cohort studies were used to assess the methodological quality.

Results

Ten studies were considered having appropriate and acceptable quality to be reviewed, comprising nine cross‐sectional studies and one cohort study. Polypharmacy was most defined as concurrently using five or more medications. Polypharmacy prevalence ranged between 7%–45%. Older age, comorbidity, poor self‐perceived health status, limitations in physical activity, history of falls, depression, and pain were positively associated with polypharmacy. The most prevalent medication taken by older adults with polypharmacy was cardiovascular drugs.

Conclusions

The prevalence of polypharmacy in older adults varying widely may be due to geographical locations, clinical practice guidelines, and polypharmacy definition used.

Relevance to Clinical Practice

Validated measurements to investigate medications associated with polypharmacy are required. How polypharmacy develops over time needs to be investigated in longitudinal studies in order to formulate strategies for reducing polypharmacy.

Embedded researchers in Australia: Survey of profile and experience across medical, nursing and midwifery and allied health disciplines

Abstract

Aims and objectives

This study explores embedded researcher's age, qualifications, research environment and experience in healthcare and academic organisations in Australia and makes comparisons across three core professional disciplines of nursing and midwifery, medicine and allied health.

Background

The embedded researcher model, where a researcher is embedded as a core member of the clinical team, offers promise to support the implementation of research evidence into practice. Currently, there is a lack of clarity about how the model has been adopted across the three largest professional disciplines in Australian health care.

Design

A cross‐sectional survey was designed and reported, using the STROBE Statement.

Methods

A purposive sample of embedded researchers was invited to participate in an exploratory online survey. Embedded researchers worked, or had worked, for a minimum of 30% of their time, in a healthcare organisation doing research or building research capacity. Participant responses were extracted from the survey and imported into SPSS for analysis.

Results

Perspectives of 100 Australian embedded researchers were compared across nursing and midwifery (36%, n = 37), allied health (35%, n = 36) and medicine (26%, n = 27). Professional differences are reported in respondents’ qualifications and experience, employment conditions and their research cultures and environments. Comparatively, most nursing and midwifery embedded researchers were older, more clinically experienced than allied health respondents, who were more research qualified. Medical‐embedded researchers are typically older, more clinically experienced and focussed on producing personally relevant clinical research. Nursing and midwifery embedded researchers reported doing clinical research within their teams, as well as research capacity building, management and clinical practice roles.

Conclusions

Embedded researchers describe different career trajectories across the three largest professional disciplines in Australian health care.

Relevance to clinical practice

Embedded researchers from different professional disciplines enact their work differently. It appears that when they engage in research capacity building via a range of management and networking roles, embedded researchers contribute to their organisation's research culture and receive greater recognition for their achievements.

Chronic limb‐threatening ischaemia and reframing the meaning of ‘end’

Abstract

Introduction

The possibility of amputation and/or death from chronic limb‐threatening ischaemia (CLTI) is real, and deeper understandings of the person and family's capacity and preparedness for limb loss and clinical interventions (active or palliative) are required.

Background

The lead‐in period to the surgeon's recommendation for amputation for CLTI may be sudden or protracted; the number/invasiveness of previous revascularisation interventions varies, and limb loss and end‐of‐life considerations frame the experience.

Method

This prospective, longitudinal, interpretative phenomenological study in three vascular surgical units involved 19 CLTI journeys. Participants were interviewed when making decisions about amputation (15 patients, 12 family members) and, where applicable, 6‐months postamputation (8 patients, 7 family members). Hermeneutic interpretation using Heidegger's philosophical construct of Being‐towards‐death guided the analysis. The COREQ checklist ensured rigour in research reporting.

Findings

Some participants were unable to face the possibility of death and metaphorically ‘fled’, either through productive optimism or through hoping for more time (Heidegger's inauthentic positioning towards death). For others, authentic positionings of Being‐towards‐death were understood as: the confrontation of the certainty of their death by making choices about how to die; the indefiniteness of death where treatment choices influenced timing, yet the time for death remained unknown; the nonrelational nature of death, as the journey could only be lived by the person; and death as not to be outstripped, where for some, there was a freeing of oneself for amputation and/or death.

Discussion

The term ‘end of limb’ to denote the futility of the limb is a useful marker that emphasises the noncurative nature of CLTI. This may help to instigate and support discussions about end of life to support palliation care planning and the person and family's existential preparation for death.

Conclusion

Death frames the experience of CLTI. Using ‘end‐of‐limb’ and ‘end‐of‐life’ terminology may facilitate a family/patient‐centred approach to possible amputation and other conservative or palliative strategies.

Relevance to Clinical Practice

Understanding of CLTI illness experience. Decisions about revascularisation, amputation or conservative care. End‐of‐life care for CLTI.

Disclosure Experience Among COVID‐19‐Confirmed Patients in China: A Qualitative Study

Abstract

Aim

To understand COVID patients’ experiences of and perspectives on disclosure of their illness and to explore and describe the factors affecting disclosure decisions among COVID patients in China.

Background

Disease disclosure is a critical component of prevention and control of a virus outbreak, and this is especially true during the COVID‐19 pandemic. Understanding COVID patients’ experiences and perspectives on disclosure could play a vital role in COVID management.

Design

A qualitative study.

Methods

A semi‐structured interview guide was used to conduct qualitative in‐depth interviews from April to June 2020. All the interviews were audio‐recorded and transcribed and then a thematic analysis was conducted. The Standards for Reporting Qualitative Research (SRQR) were applied to this study.

Results

A total of 26 COVID‐confirmed patients were recruited for the in‐depth interviews. Four themes emerged from the thematic analysis on disclosure: persons disclosed to, reasons for disclosure, reasons for nondisclosure, and impact of disclosure. The participants disclosed their COVID diagnosis to different groups, including family, close friends, community members, and workplace contacts. The main reasons for disclosure included: government policy, social responsibility, gaining support, and fear of being blamed for nondisclosure. However, some participants decided not to disclose to some groups for fear of facing stigma and discrimination or to protect family members from discrimination. Despite the potential benefits of obtaining support after disclosure, many participants did experience stigma and discrimination, privacy exposure, psychological distress, and social isolation.

Conclusions

An individual’s decision as to whether to disclose their COVID‐positive status is affected by many factors. To prevent the spread of COVID‐19 and reduce the potential risks of disclosure, such as discrimination and privacy exposure, a balanced intervention should be designed to protect COVID patients and to secure any contact tracing. Therefore, the chances of discrimination could be decreased and patients’ confidentiality could be protected.

Relevance to Clinical Practice

As the number of COVID patients increases, disclosure of an individual’s infectious status is encouraged by health departments. Despite the potential benefits of disclosure, discrimination and privacy exposure should not be ignored. A disclosure protocol is necessary to ensure patients’ privacy regarding their COVID status.

❌