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AnteayerJournal of Clinical Nursing

Cold application for pain and anxiety reduction following chest tube removal: A systematic review and meta‐analysis

Abstract

Aim and Objectives

To conduct a systematic review and meta-analysis to evaluate the effects of cold application on pain and anxiety reduction after chest tube removal (CTR).

Background

The act of removing the chest tube often causes pain among cardiothoracic surgery patients.

Most guidelines regarding CTR do not mention pain management. The effects of cold application on reducing pain and anxiety after CTR are inconsistent.

Design

Systematic review and meta-analysis.

Methods

We searched six databases, including Embase, Ovid Medline, Cochrane Library, Scopus, the Index to Taiwan Periodical Literature System and Airiti Library, to identify relevant articles up to the end of February 2021. We limited the language to English and Chinese and the design to randomised controlled trials (RCTs). All studies were reviewed by two independent investigators. The Cochrane Collaboration's tool was used to assess the risk of bias, Review Manager 5.4 was used to conduct the meta-analysis. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was used for assessing certainty of evidence (CoE).

Results

Ten RCTs with 683 participants were included in the meta-analysis. The use of cold application could effectively reduce pain and anxiety after CTR. The subgroup showed that a skin temperature drops to 13°C of cold application was significantly more effective for the immediate reduction in pain intensity after CTR compared with control group. The GRADE methodology demonstrated that CoE was very low level.

Conclusion

Cold application is a safe and easy-to-administer nonpharmacological method with immediate and persistent effects on pain and anxiety relief after CTR. Skin temperature drops to 13°C or lasts 20 min of cold application were more effective for immediate reduction of pain intensity following CTR.

Relevance to clinical practice

In addition to pharmacological strategy, cold application could be used as evidence for reducing pain intensity and anxiety level after CTR.

Interactions between children, parents and nurses during postoperative pain management: A grounded theory study

Abstract

Aim

To explore the interactions between children, parents and nurses during postoperative pain management.

Background

Despite the growing evidence relating to postoperative pain management in children and relevant practice guidelines, children still experience moderate to severe pain after surgery. One factor could be related to the relatively unexplored child–parent–nurse interaction.

Design

A qualitative constructivist grounded theory methodology.

Methods

Data were collected from a paediatric hospital in the United Kingdom. Ten children aged between 6 and 11 years old who had undergone surgery, 11 parents and 10 nurses participated. Methods included face-to-face semi-structured interviews. Data were analysed using constant comparison technique, memos and constructivist grounded theory coding levels. The COREQ guidelines were followed for reporting.

Findings

Three concepts emerged from data, “Parents as a communicator for child-nurse interaction”, “Parents’ emotional turmoil in child-nurse interaction”, andParents’ actions in child-nurse interaction” which constructed the substantive theory of child–parent–nurse interaction during postoperative pain management: “Facilitating or Inhibiting Interactions: Parental Influence on Postoperative Pain Management”. The findings highlight an absence of a three-way interaction between children, parents and nurses and a dyadic interaction process between children and nurses was not apparent. Instead, child–parent–nurse interactions were constructed around two dyads of child–parent and parent–nurse interactions with child–nurse interaction constructed via parents. Parents, as a communicator, influenced the entire postoperative pain management processes between children, parents and nurses by facilitating or inhibiting the interaction processes.

Conclusions

This study identifies potentially important evidence about the unique position parents hold between their child and nurses as a central pivotal communicator during children’s postoperative pain management.

Relevance to clinical practices

This study may help to explain how and why postoperative pain management remains suboptimal. The substantive theory could support improvements in the management of postoperative pain through a much wider recognition of parents’ central pivotal communicator role and the complexity of these child–nurse interactions.

National registry‐based data of adverse events in Finnish long‐term professional homecare in 2009–2019

Abstract

Aims and objectives

The aim of this study was to discover the nature of the adverse events in Finnish long-term professional homecare reported by professionals, and to identify the circumstances in which adverse events occur and their consequences.

Background

Adverse events are incidents causing unintended and unnecessary harm to older people at home. Safety is a basic human right and a fundamental prerequisite for independent living among older people at home. Few studies have focused on both long-term professional homecare environment and the safety of older people.

Design

The research was a descriptive registry-based study.

Methods

This study consisted of adverse events (N = 61248) in Finnish public long-term professional homecare (2009–2019). Data were described using frequencies and percentages. STROBE statement checklist was chosen for reporting the study process.

Results

By profession, practical nurses and registered nurses reported the most of adverse events (89.8%). These were either critical incidents (78.3%) or near misses (20.0%) and concerned medicine, injuries and accidents, information flow or management. Consequences for older people were usually rated from no-harm to moderate harm. For long-term professional homecare, image harm, extra financial costs, no-harm and prolonged care for older people were among the consequences. Personnel frequently observed the older people afterwards and informed older people of adverse events, yet some of actions were unknown.

Conclusions

Many harmful adverse events are considered harmless for older people. Sometimes this can lead to unmet care needs or missed care. The degree of harm needs to be assessed in terms of physical, mental and social health with the HaiPro reporting system for homecare.

Relevance to clinical practice

An understanding and a comprehensive view of the situation and holistic assessment of care needs includes safety and safety risks to increase safety and feeling of safety for older people at home.

Evaluation of the effect of endotracheal aspiration at different head heights on oxygenation of the brain by non‐invasive method in intensive care patients

Abstract

Objectives

To determine the effect of endotracheal aspiration at different head heights on oxygenation brain by non-invasive method in neurosurgery intensive care patients.

Background

Head elevation of mechanical ventilator-dependent neurosurgery patients and the possible risks of endotracheal aspiration are closely related to the clinical conditions of the patients.

Design

A prospective quasi-experimental study with repetitive measurements in a single group.

Methods

In the study, neurosurgery intensive care patients were adjusted to a head height of 15, 30 and 45° (n = 46, power analysis %90). Cerebral oxygenation levels were determined with a non-invasive device at each head height before and in the 1st, 5th and 30th min of endotracheal aspiration. Data were collected with Patient Information Form and cerebral oxygenation device based on NIRS technology. This study performed according to the TREND reporting guidelines for non-randomized/quasi experimental study.

Results

The highest cerebral oxygenation value was obtained at 30 min. The decrease in the cerebral oxygenation levels of the patients was highest in the 1st min after endotracheal aspiration, at a head height of 15 degrees for the right cerebral region and at a head height of 30 degrees for the left cerebral region. The increase in oxygenation of the right and left cerebral regions occurred highest at a head height of 45 degrees.

Conclusions

The ideal head height should be 45 degrees during and after endotracheal aspiration in regard to maintaining cerebral oxygenation in neurosurgery intensive care patients. It is extremely important to monitor the cerebral oxygenation status of patients, with non-invasive measurement tools during and after endotracheal aspiration, to prevent secondary complications.

Relevance to clinical practice

This study reveals the importance of raising the head 45 degrees in the best preservation of cerebral oxygenation values in neurosurgery intensive care patients. Intensive care nurses should pay attention to maintaining this head height.

Transdermal buprenorphine improves overall quality of life and symptom severity in cancer patients with pain

Abstract

Aim and Objectives

This study explored the effect of transdermal buprenorphine on quality of life and six symptoms in cancer patients with pain.

Background

Transdermal opioids offer advantages over traditional routes of administration. The impact of transdermal buprenorphine on quality of life for patients with cancer in Asian populations is unknown.

Design

This study employed a single-arm observational repeated measures design. Cancer patients with pain were evaluated prior to treatment (baseline). Over a 4-week treatment period, quality of life and symptoms were assessed at 2 and 4 weeks. This study adhered to the recommendations of STROBE guidelines.

Methods

This multi-site study was conducted in six hospitals located across northern, middle and southern Taiwan. Adult cancer patients whose pain was previously stable with opioid analgesics and, based on clinical judgement, were able to convert to transdermal buprenorphine treatment were invited to participate. Quality of life was measured with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30).

Results

Generalised estimating equations showed participants who completed at least one follow-up measurement (N = 80) over 4-weeks had a significant improvement in overall quality of life. Functional status only improved for social functioning. However, symptom severity decreased significantly for nausea/vomiting, pain, insomnia and constipation.

Conclusions

The study provides initial evidence supporting transdermal buprenorphine for providing beneficial effects of improving quality of life and reducing severity of symptoms in Asian patients with cancer.

Relevance to clinical practice

The findings of this study can inform the clinical practice that the use of transdermal buprenorphine in cancer patients with pain may also reduce the severity of other symptoms and improve overall quality of life.

Trial registration details

This study was registered in ClinicalTrials.gov. Identifier: NCT04315831.

De‐problematising Aboriginal young peoples’ health and well‐being through their voice: An Indigenous scoping review

Abstract

Background

The continued use of a deficit discourse when researching Aboriginal and Torres Strait Islander Peoples of Australia is problematic. Understanding and challenging the researchers position and the power of the words they use is important. It will ensure we do not persist in framing Aboriginal and Torres Strait Islander People as a problem to be solved.

Design

Indigenist review of the evidence of Aboriginal young people's health and well-being.

Methods

This review was conducted using an Indigenist approach to identify texts which amplified the voices of Aboriginal young people of Australia and presents a narrative summary of their accounts. This review is reported in line with the PRISMA-ScR reporting guidelines.

Results

Culture and connection are critical components of Aboriginal young people's health and well-being. Aboriginal young people describe feeling of powerlessness to influence health and well-being of their community, and they understood the risks they and their communities faced. Young people identified the importance of connection to culture, community and Elders as crucial to their social and emotional well-being.

Conclusion

By harnessing an Indigenous analysis, we were able to reveal a strong counter narrative of strength and resilience within their historical, social, and political contexts through the storied accounts of Aboriginal young people.

Relevance to clinical practice

Most of the currently available evidence about Aboriginal health and well-being is immersed in deficit discourse. Literature reviews being the foundation of research and informing nursing practice, we call for a purposeful shift towards the adoption of an Indigenist strength-based approach which emphasises the strength and resilience of Aboriginal young people.

Integrative review of non‐pharmacological intervention and multidimensional evaluation for intraoperative anxiety under spinal anaesthesia

Abstract

Introduction

Patients under spinal anaesthesia experience high levels of anxiety during surgery. Clinical nurses tried to manage patient's anxiety under spinal anaesthesia using non-pharmacological interventions for its benefit. Thus, it is required to identify comprehensive evidences of various non-pharmacological interventions and of how to measure anxiety under spinal anaesthesia.

Aims

This study aims to review current research on the non-pharmacological interventions to relieve intraoperative anxiety under spinal anaesthesia and to identify subjective and objective measures of intraoperative anxiety under spinal anaesthesia.

Methods

Wittemore and Knafl's integrative review methodology was used. Researchers conducted five scientific rigor steps; problem identification, searching literature, evaluation of literature, analysis of literature and presentation of results. The PRISMA checklist was used. To evaluate the level of evidence, critical appraisal tools of Joanna Briggs Institute were used.

Results

Eleven studies were included in this integrative review. Delivering music is the most frequently used as non-pharmacological intervention by researchers. They tried to manage intraoperative anxiety under spinal anaesthesia with using diverse genre and application of music. In addition, dry cupping method, progressive muscle relaxation (PMR) exercise and virtual reality (VR) goggles were used in included studies. Researchers measured intraoperative anxiety under spinal anaesthesia with objective or subjective way. The State-Trait Anxiety Inventory and visual analogue scale were used as subjective method to approach intraoperative anxiety. In contrary, researchers tried to obtain objective evidence of intraoperative anxiety with vital signs, cortisol, blood glucose, alpha-amylase and adrenocorticotropic hormone.

Conclusion

Various types of non-pharmacological interventions are effective to manage patient's intraoperative anxiety under spinal anaesthesia. It is recommended to measure intraoperative anxiety under spinal anaesthesia with using both objective and subjective methods.

Relevance to Clinical Practice

Clinical nurses can use non-pharmacological interventions to manage intraoperative anxiety under spinal anaesthesia by comprehensive monitoring with diverse measures.

‘Paper care not patient care’: Nurse and patient experiences of comprehensive risk assessment and care plan documentation in hospital

Abstract

Aims and Objectives

To explore organisation-wide experiences of person-centred care and risk assessment practices using existing healthcare organisation documentation.

Background

There is increasing emphasis on multidimensional risk assessments during hospital admission. However, little is known about how nurses use multidimensional assessment documentation in clinical practice to address preventable harms and optimise person-centred care.

Design

A qualitative descriptive study reported according to COREQ.

Methods

Metropolitan tertiary hospital and rehabilitation hospital servicing a population of 550,000. A sample of 111 participants (12 patients, 4 family members/carers, 94 nurses and 1 allied health professional) from a range of wards/clinical locations. Semi-structured interviews and focus groups were conducted at two time points. The audio recording was transcribed, and an inductive thematic analysis was used to provide insight from multiple perspectives.

Results

Three main themes emerged: (1) ‘What works well in practice’ included: efficiency in the structure of the documentation; the Introduction, Situation, Background Assessment, Recommendation (ISBAR) framework and prompting for clinical decision-making were valued by nurses; and direct patient care is always prioritised. (2) ‘What does not work well in practice’: obtaining the patient's signature on daily care plans; multidisciplinary (MDT) involvement; duplication of paperwork and person-centred goals are not well-captured in care plan documentation. (3) ‘Experience of care’; satisfaction of person-centred care; communication in the MDT was important, but sometimes insufficient; patients had variable involvement in their daily care plan; and inadequate integration of care between MDT team which negatively impacted patients.

Conclusions

Efficient and streamlined documentation systems should herald feedback from nurses to address their clinical workflow needs and can support, and capture, their decision-making that enables partnership with patients to improve the individualisation of care provision.

Relevance to clinical practice

The integration of effective MDT involvement in clinical documentation was problematic and resulted in unmet supportive care from the patient's perspective.

Adverse effects of non‐intubated airway suctioning: a clinical data‐based study

Abstract

Aims and objectives

The purpose of this study was to investigate the adverse effects of non-intubated suctioning.

Background

Airway hygiene aims to maintain a patent airway to ensure adequate ventilation. Nasopharyngeal, oropharyngeal or nasotracheal suctioning may be used in patients who require airway suctioning but do not have an artificial airway. However, no studies till date provide insight into the adverse effects of non-intubated airway suctioning.

Design

A clinical data-based retrospective design.

Method

Using institutional and clinical databases of three university hospitals in 2008–2016, we conducted a study with a propensity score matching method of 3,326 hospitalised patients who had undergone suction therapy with or without a tracheotomy. Conditional logistic regression analyses were performed to investigate the link between suctioning and the probabilities of adverse effects. STROBE checklist was used to report the current study.

Results

Patients who required nasopharyngeal, oropharyngeal or nasotracheal suctioning had a higher risk of gastrointestinal ulcers than tracheotomised patients (adjusted OR 1.99; 95% CI, 1.24–3.20). Patients who received non-intubated suction had a higher risk of developing pneumonia (adjusted OR 1.59; 95% CI, 1.26–2.00), and the risk of aspiration pneumonia was three times higher than tracheotomised patients (adjusted OR 3.04; 95% CI, 1.40–6.60).

Conclusions

Non-intubated patients who require suctioning for airway clearing are more susceptible to gastrointestinal ulcers, pneumonia and aspiration pneumonia. The findings would facilitate in alerting healthcare professionals to this group of patients. However, more clinical research is needed to elucidate the mechanisms of adverse effects in non-intubated patients who require suctioning.

Relevance to Clinical Practice

The adverse effects of suctioning can easily be overlooked in debilitated patients with no intubation. Professionals must be aware of the discomfort and risks that patients may experience.

Food frequency questionnaire for dietary assessment among adults at a risk of coronary heart disease: A mixed‐methods study

Abstract

Aims and objectives

To develop and psychometrically test a food frequency questionnaire for adults at risk of coronary heart disease (Cardio-FFQ).

Background

Comprehensive dietary assessment is critical for the prevention of cardiovascular disease, but appropriate instruments to perform this work are lacking.

Design

A sequential mixed-methods study followed the COREQ and STROBE guidelines.

Methods

This study was conducted between April 2016 and November 2017. It started with dietary history interviews (Phase 1) to identify candidate food items of the Cardio-FFQ, which validity and reliability were assessed (Phase 2) through expert consultation and four seasonal measurements, including test and retest with a 2-week gap every season. Physical activity and blood glucose and lipids were assessed seasonally, while another FFQ was administered during the fourth measurement. Content analysis was used to analyse verbatim interview transcripts, while descriptive and inferential analyses were used to simplify the Cardio-FFQ and examine its psychometric properties.

Results

Phase I involved 34 participants during their first onset of acute coronary syndrome and generated 176 candidate food items (consumed by at least three participants) under 12 food categories. These food items were simplified to form the 133-item Cardio-FFQ after discarding items with trivial contributions to food commonalities or between-person variance. Further analysis showed that the simplified questionnaire had satisfactory content validity, concurrent validity, convergent validity, predictive validity, known-group validity and test–retest reliability.

Conclusion

The 133-item Cardio-FFQ is a valid and reliable tool for a comprehensive dietary assessment appropriate for adults at risk of coronary heart disease.

Relevance to clinical practice

Nurses may use the Cardio-FFQ to conduct a dietary assessment to better support people to commit to healthy diets, aiming to reduce the risk of coronary heart disease.

Comparison of perineal outcomes in Chinese women adopting lateral positions and lithotomy positions during the passive and active phases of the second stage of labour: An observational study

Abstract

Aims

To compare the effects of the adoption of lateral positions and lithotomy positions during the passive and active phases of the second stage of labour on perineal outcomes.

Design

An observational study with prospectively collected data, conducted in three hospitals in China.

Method

Attending midwives recorded the perineal outcomes and characteristics of women giving birth between July–November 2020. Binary logistic regression was performed to explore the effects of lateral positions on perineal outcomes during different phases of the second stage of labour. The STROBE guidelines guided the reporting of this study.

Results

Among primiparous women, when compared with those who adopted lateral positions during the passive phase of the second stage of labour and changed to lithotomy positions during the active phase, women who assumed lateral positions during both the passive and active phases had a higher rate of intact perineum/first-degree perineal tears and a reduced risk of episiotomy, and episiotomy/second-degree perineal tears. No significant difference was found in perineal outcomes between those who assumed lithotomy positions during the passive and active phases and those who adopted lateral positions during the passive phase and changed to lithotomy positions during the active phase. No significant difference was found in perineal outcomes among multiparous women, regardless of different positions adopted at the passive and/or the active phase.

Conclusion

Lateral positions during the active phase may have protective effects on the perineum in primiparous women. However, adopting lateral positions only during the passive phase did not promote better perineal outcomes, regardless of parity.

Relevance to clinical practice

This study will provide a further reference for the use of lateral positions during different phases of the second stage of labour among primiparous and multiparous women in clinical practice, contributing to the perineal protection during childbirth.

Communication experiences of tracheostomy patients with nurses in the ICU: A scoping review

Abstract

Introduction

The quality of care for tracheostomy and mechanically ventilated patients in intensive care units (ICUs) has improved considerably. However, the communication barrier attributable to these procedures generates many problems for patients, as they are unable to communicate effectively with family members and ICU healthcare professionals, especially nurses.

Aims

To describe (1) tracheostomy patients’ needs, emotions and difficulties when communicating with ICU nurses and (2) which strategies nurses and patients have adopted to improve their communication.

Methods

A scoping review was completed using the Joanna Briggs Institute method and following the PRISMA-ScR Checklist. The research question was developed using the Population, Concept and Context framework. Five databases were searched. After screening, two researchers independently analysed the 75 papers, and finally, 19 studies were included in this review.

Results

All studies used a qualitative design. Seven adopted a phenomenological and two a hermeneutic approach, involving a total of 265 patients. Two main themes and four subthemes were identified: (1) the tracheostomy patients’ needs, emotions and difficulties communicating with ICU nurses (patients’ emotions, communication needs, and their content and difficulties) and (2) strategies that nurses and patients adopted to improve communication (communication strategies).

Conclusions

It is essential to develop effective communication with tracheostomy patients to ensure they feel relieved, safe and considered. Communication content should focus on information relating to the person's personal condition and active involvement in care.

Relevance to clinical practice

It is important to prioritise the communication process in tracheostomised patients and create the organisational conditions that foster effective communication processes. Developing training programmes for new or practising nurses is essential to instil greater awareness about this crucial fundamental need.

A qualitative study on the perspectives and needs of oncology nurses about recognition and management of suicide risk in cancer patients

Abstract

Aims

To determine the perspectives and needs of the oncology nurses in recognising and managing the risk of suicide in cancer patients.

Background

Cancer patients are one of the groups with a high risk of suicide. The perspectives and needs of oncology nurses regarding their recognition and management of suicide risk in such patients need to be clarified.

Design and methods

This qualitative descriptive study used a sample of 33 oncology nurses that were sampled by maximum variation sampling from different oncology units and hospitals. Data were collected with in-depth interviews via a semi-structured interview form and analysed with content analysis. The COREQ guideline was followed for the reporting of the study.

Results

Three main themes and eight subthemes were identified, namely ‘An uncertain atmosphere: sensing the risk of suicide but not seeing the picture’ (Subthemes: Inability to identify suicide risk, Unclear responsibilities and Distress as a result of uncertainty), ‘Efforts to give meaning to and compensate losses of patients’ (Subthemes: Attributions to cancer-related losses of patients and Interventions to alleviate distress related to loss) and ‘Hindrances beyond the nurse’ (Subthemes: Stigma towards psychosocial problems and getting help, Disagreement with the Physician and A lack of institutional culture on suicide prevention).

Conclusions

Our study revealed that oncology nurses have insufficient knowledge and skills and unclear roles in recognising and managing suicide risk. In addition, nurses have difficulty in helping patients due to the insufficient support of team members, stigmas of patients and their relatives towards getting help, patient workloads, and inadequate institutional support in risk management. Training programmes aiming to increase nurses’ awareness, knowledge and skills should be developed and embedded into current in-service education programmes and undergraduate education curricula as part of professional improvement.

Relevance to clinical practice

The results of the study can contribute to planning the content and scope of suicide prevention training peculiar to oncology nursing.

Factors that influence hospital nurses’ escalation of patient care in response to their early warning score: A qualitative evidence synthesis

Abstract

Background

The Early Warning Score (EWS) is a validated tool that has improved patient outcomes internationally. This scoring system is used within the hospital setting to identify potentially deteriorating patients, thus expediting referral to appropriate medical personnel. It is increasingly recognised that there are other influencing factors along with EWS, which impact on nurses’ decisions to escalate care.

Aim

The aim of this review was to identify and synthesise data from qualitative studies, which examined factors influencing nurses’ escalation of care in response to patients’ EWS.

Methods

The systematic search strategy and eligibility criteria were guided by the SPIDER (Sample Phenomenon of Interest Design Evaluation Type of Research) framework. Eleven databases and five grey literature databases were searched. Titles and abstracts were independently screened in line with pre-established inclusion and exclusion criteria using the cloud-based platform, Rayyan. The selected studies underwent quality appraisal using CASP (Critical Appraisal Skills Programme, 2017, https://www.casp-uk.net/casp-toolschecklists) and subsequently synthesised using Thomas and Harden's thematic analysis approach. GRADE–CERQual (Grading of Recommendations Assessment Development and Evaluation–Confidence in the Evidence from Reviews of Qualitative research) was used to assess confidence in results. The EQUATOR listed guideline ENTREQ (Tong et al., 2012, BMC Medical Research Methodology, 12) was used to synthesise and report findings.

Results

Eighteen studies from seven countries including 235 nurses were identified. Following synthesis, four analytical themes were generated with eighteen derived consequent findings. The four themes identified were as follows:

1) Marrying nurses’ clinical judgement with EWS 2) SMART communication 3) EWS Protocol: Blessing and a Curse 5) Hospital Domain.

Conclusion

Nurses strive to find balance by simultaneously navigating within the boundaries of both the EWS protocol and the hospital domain. They view the EWS as a valid essential component in the system but one that does not give a definitive answer and absolute direction. They value the protocols’ ability to identify deteriorating patients and convey the seriousness of a situation to their multidisciplinary colleagues but also find it somewhat restrictive and frustrating and wish to have credence given to their own intuition and clinical judgement.

Understanding the nursing practices and perspectives of transfusion reaction reporting

Abstract

Aims and Objectives

The aim of this study was to investigate nurse perspectives on transfusion-related adverse reaction reporting practices.

Background

Transfusion-related adverse reaction reporting is an essential component of hemovigilance in Canada, but reporting rates vary and under-reporting of minor transfusion-related adverse reactions exists. To our knowledge, this is the first report of nursing transfusion-related adverse reaction reporting attitudes.

Design

This qualitative descriptive study explored the nursing practices and perspectives of transfusion-related adverse reaction reporting by conducting one-on-one interviews with nurses (n = 25) working in adult oncology inpatient and outpatient units.

Methods

Data were thematically analysed; data collection ended when saturation was reached. The COREQ checklist was used to guide this study.

Results

The study revealed that the nursing practices of transfusion-related adverse reaction reporting are not standardised to meet the institutional reporting guidelines. Under-reporting of febrile reactions exists at this institution. Major concepts uncovered included the factors impacting nurses' transfusion-related reporting practices, as well as barriers and facilitators to transfusion reporting.

Conclusion

A practice change in transfusion-related adverse reaction reporting is needed to achieve optimal hemovigilance at this institution. Using the barriers and facilitators identified in this study, institutions can better inform future interventions by employing strategies like TR reporting education in order to improve reporting of transfusion-related adverse reactions in this hospital and other similar institutions.

Relevance to clinical practice

This study informs clinical practice and decision-making for nurses and nursing educators who manage blood transfusion administration procedures.

Path model on decision‐making ability of clinical nurses

Abstract

Aims and objectives

To identify and examine the relationship between the factors influencing the decision-making ability of clinical nurses in hospitals, South Korea, and to establish a model, to verify the fit and the effect.

Background

Clinical nurses are exposed to environments and situations where they make continuous decisions according to the need of direct treatment and nursing.

Design

This study used a cross-sectional descriptive design, relation prediction modelling and adheres to the STROBE guidelines.

Methods

The model construction was based on the information processing theory by Hansen and Thomas (Nursing Research, 17, 436, 1968). The model consists of 5 exogenous variables (expertise, critical thinking disposition, knowledge-sharing behaviour, nursing work environment, and decision-making stress) and 3 endogenous variables (analytic-systematic decision-making type, intuitive-interpretive decision-making type and decision-making ability). Participants were 274 clinical nurses, who were working at two hospitals in Seoul, South Korea. The data was analysed using SPSS WIN 18.0 and AMOS 20.0 program. Path analysis to verify the hypothetical model was used, and the fit was evaluated by χ 2/df, GFI, AGFI, NFI, CFI and RMSEA. Data were collected from March to May 2017.

Results

The fit index of the modified path model was χ 2/df = 2.25, GFI = .972, AGFI = .929, NFI = .967, CFI = .981 and RMSEA = .068. The analytic-systematic decision-making type had the greatest direct effect on the clinical nurses’ decision-making ability, which is the final outcome variable, followed by significant direct and indirect effects on critical thinking disposition.

Conclusion

This study suggests that the clinical nurses’ decision-making ability in hospitals were leadingly influenced by analytic-systematic decision-making type and critical thinking disposition.

Relevance to clinical practice

In the nursing practice, nurses need to pay attention the analytic-systematic decision-making type and critical thinking disposition for improving decision-making ability of clinical nurses in hospitals.

Self‐performed Five Times Sit‐To‐Stand test at home as (pre‐)screening tool for frailty in cancer survivors: Reliability and agreement assessment

Abstract

Aims and Objectives

The self-performance of a Five-Times-Sit-To-Stand (FTSTS)-test, without the usual supervision by a medical professional, provides valuable opportunities for clinical practice and research. This study aimed: (1) to determine the validity of the self-performed FTSTS test in comparison to a supervised reference test and (2) to determine the reliability of a self-performed FTSTS test by cancer survivors.

Background

Early detection of frailty in cancer survivors may enable prehabilitation interventions before surgery or intensive treatment, improving cancer outcomes.

Design

A repeated measures reliability and agreement study, with one week in between measures, was performed.

Methods

Cancer survivors (n = 151) performed two FTSTS tests themselves. One additional reference FTSTS test was supervised by a physical therapist. The intraclass correlation coefficient (ICC), structural error of measurement (SEM) and minimally important clinical difference (MID) were calculated comparing a self-performed FTSTS test to the reference test, and comparing two self-performed FTSTS tests. The Guidelines for Reporting Reliability and Agreement Studies (GRASS) have been used.

Results

Mean age of cancer survivors was 65.6 years (SD = 9.3), 54.6% were female, median time since diagnosis was 2 years [IQR = 1], and tumour type varied (e.g., breast cancer (31.8%), prostate cancer (17.2%), gastrointestinal cancer (11.9%) and haematological cancer (11.9%)). Validity of the self-performed FTSTS test at home was acceptable in comparison with the reference test (ICC = .74; SEM = 3.2; MID = 3.6) as was the reliability of the self-performed FTSTS test (ICC = .70; SEM = 2.2; MID = 3.8).

Conclusions

The self-performed FTSTS test is a valid and reliable measure to assess lower body function and has potential to be used as objective (pre-)screening tool for frailty in cancer survivors.

Relevance to clinical practice

The self-performed FTSTS test at home may indicate the cancer survivors in need of prehabilitation in advance of surgery or intensive treatment. The feasibility, short amount of time needed and potential cost-effectiveness of the self-performed FTSTS test can make it a valuable contribution to personalised care and precision medicine.

Caregiver training: Evidence of its effectiveness for cognitive and functional improvement in older adults

Abstract

Aims and objectives

The objectives of this study were to assess the benefits of a caregiver training programme on the cognitive and functional status of older adults, and to compare the effects of this programme according to type of caregiver (professional vs. family caregiver).

Background

Due to demographic changes that have resulted in an aging population, the role of caregiver of an older adult has become very important in recent years.

Design and Methods

The sample was composed of 160 older adults: (a) 100 received care from caregivers who had taken the three-month training programme (treatment group), of which 60 were professional caregivers and 40 were family caregivers, and (b) 60 received care from caregivers who had not taken the programme (control group). In order to evaluate programme effects on cognitive and functional status, we used both direct measures answered by the older adults (MMSE, CAPE and EuroQol) and caregiver reports (Barthel and RMPBC). We used a quasi-experimental, pre-post design. We followed SQUIRE 2.0 guidelines for reporting.

Results

The results showed that older adults who were cared for by caregivers that had participated in the training programme showed gains in quality of life and cognitive ability and maintenance of functional ability. Within the treatment group, although everyone significantly improved their scores, the older adults cared for by family caregivers improved in more of the cognitive sub-items than did their peers in the professional caregiver group.

Conclusions

The data obtained show that a caregiver training programme based on cognitive stimulation produces cognitive, functional and health-related quality-of-life benefits in older adults. Furthermore, the caregivers reported increased satisfaction with their work.

Relevance to clinical practice

The improvements obtained in the older adults and in caregivers show the relevance of this type of intervention when working in the clinical field of caregiving.

Post‐discharge care needs of the older people with hospital‐associated disability: A longitudinal study

Abstract

Aims

To investigate the change and associated factors of care needs within 6 months post-discharge in older people with hospital-associated disability, and the relationship between time-varying care needs and physical function.

Background

Older people with hospital-associated disability will have various care needs post-discharge. Understanding their care needs will help to improve their health. However, studies on this population are still limited.

Design

A longitudinal study.

Methods

The older people who met the inclusion and exclusion criteria were selected in 2 tertiary hospitals in Zhejiang Province, China. The questionnaire survey method was used to collect data about socio-demographic characteristics, physical function and care needs. The data of 375 older people who completed follow-up were analysed using logistic regression analysis, generalised estimating equations and generalised additive mixed model. We followed STROBE checklist for reporting the study.

Results

The care needs of the older people with hospital-associated disability declined unevenly, it decreased rapidly in the first three months, and then flattening out. The percentage of people with care needs in each dimension decreased over time, but daily care and rehabilitation needs were consistently more important. Socio-demographic factors and physical function had different effects on need at different time points, the physical function was the main factor among them. There were non-linear relationships between the physical function and different care needs with different inflection points.

Conclusion

This research revealed change patterns of the care needs of older people with hospital-associated disability post-discharge and the non-linear relationship between physical function and care needs. These findings may help healthcare professionals and caregivers to provide accurate care.

Relevance to clinical practice

The findings can be used to identify effective approaches to address the care needs of older people with hospital-associated disability based on the time of discharge, in conjunction with age, education, and especially physical function, which will promote the justify allocation of nursing resources.

What does this paper contribute to the wider global clinical community?

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