FreshRSS

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

Impact of Chemotherapy on Symptoms and Symptom Clusters in Postmenopausal Women with Breast Cancer Prior to Aromatase Inhibitor Therapy

Abstract

Aims and Objectives

To examine and compare the differences in symptoms and symptom clusters between postmenopausal women with early stage breast cancer who did and did not receive chemotherapy prior to aromatase inhibitor(AI) therapy.

Background

Women with breast cancer often experience multiple concurrent symptoms during AI therapy. The burden of symptoms prior to AI are associated with nonadherence to cancer treatment. To date, few studies have comprehensively explored the symptoms and symptom clusters occurring prior to AI therapy.

Design

Secondary analysis of a prospective repeated measures study.

Methods

The sample comprised postmenopausal women (N=339) with breast cancer who would receive AI therapy with or without chemotherapy. We collected information on 48 symptoms after surgery or chemotherapy but before AI therapy using different symptom assessment tools. Mann‐Whitney U tests were used to compare the differences in the severity of symptoms between groups. Exploratory factor analysis (EFA) was conducted to determine symptom clusters. This study followed STROBE guidelines.

Results

The most severe symptoms among women with breast cancer prior to AI therapy were: breast sensitivity, unhappy with the appearance of my body, general aches and pain, joint pain and muscle stiffness. Women who received chemotherapy prior to AI therapy experienced significantly higher severity of 22 symptoms than women who did not receive chemotherapy. Through EFA seven distinct symptom clusters were revealed in both groups: cognitive, musculoskeletal, psychological, vasomotor, weight, sexual and urinary, with additional gastrointestinal symptom cluster been identified in women who received chemotherapy.

Conclusions

This study indicates the presence of symptoms among women with breast cancer prior to AI therapy, with higher severity of symptoms and greater number of symptom clusters for women who received chemotherapy.

Relevance to clinical practice

Nurses should assess and be aware of symptoms and symptom clusters existed prior to AI therapy and manage them in advance.

This article is protected by copyright. All rights reserved.

Variations in indwelling urinary catheter use in four Australian acute care hospitals

Abstract

Aims and objectives

To identify the point prevalence of indwelling urinary catheters (IDCs) in adult inpatients in acute care hospitals, and to describe the indications for IDC insertion based on patient age, gender, specialty and hospital.

Background

Catheter‐associated urinary tract infections (CAUTIs) are preventable healthcare‐associated infections. IDC duration is the strongest predictor of CAUTI, and little is known about characteristics of patients who receive an IDC.

Design

Two single‐day point prevalence surveys collected baseline patient data as part of a larger pre‐post control‐intervention study.

Methods

Surveys were conducted at four acute care hospitals in NSW, Australia for all adult patients. Data collection included IDC presence, insertion details and urine culture collection. Point prevalence data were linked with electronically extracted patient demographic data.

This study is presented in line with STROBE checklist (See Supplementary File 1).

Results

Data from 1,630 patients were analysed; with 196 patients (12%) identified as having an IDC on the survey dates. IDC prevalence rates were higher in males (13%) than females (11%). Critical care had the highest rate of patients with IDCs (42%). Urine cultures were collected in 70 patients with an IDC (43%).

Conclusions

Findings indicated similar rates of IDC use in males and females, and there was no significant difference in age between patients with or without an IDC. However, indication for IDC varied by patient age and gender. High rates of urine culture collection may represent routine collection.

Relevance to clinical practice

IDC use is found across genders, all age groups, and specialties. Nurses should be aware that any of their patients may have an IDC, and be particularly aware of certain indications based on patient age and gender. Routine urine culture collection is not advised, and instead nurses should be guided by clinical decision‐making tools.

This article is protected by copyright. All rights reserved.

Nurse staffing and hospital‐acquired conditions: A systematic review

Abstract

Aims and Objectives

This study aimed to systematically review and synthesize primary studies on the relationship between nurse staffing and hospital‐acquired conditions.

Background

Research examining the association between nurse staffing and hospital‐acquired conditions is varied owing to the use of different definitions and methods.

Design

This study was conducted based on a systematic review of related nursing literature.

Methods

The CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO, and RISS databases were searched for either English or Korean language studies published between January 2000 and August 2018 that examined the association between nurse staffing and hospital‐acquired conditions. We used Preferred Reporting Items for Systematic Reviews and Meta‐Analyses check list.

Results

Totally, 19 published studies were included in the systematic review. Various measures were used to examine association between nurse staffing and hospital‐acquired conditions. The majority of the reviewed studies revealed negative relationships between nurse staffing levels and hospital‐acquired conditions. However, a substantial number of relationships were not significant.

Conclusions

There is a need for future studies to examine the differences in the relationship between nurse staffing and hospital‐acquired conditions and to use precise data collection on registered nurses' hours per patient day and total hours per patient day, as it is difficult to collect data on these measures. The findings of this study suggest that sufficient nurse staffing is a strong indicator of the provision of quality patient care. However, continuous efforts are recommended to find more conclusive relationships between nurse staffing and hospital‐acquired conditions and to formulate guidelines regarding nurse staffing strategies.

Relevance to clinical practice

Nurse staffing is an important managerial strategy. Especially, given health policy changes, hospitals need to develop staffing strategies to prevent hospital‐acquired conditions.

This article is protected by copyright. All rights reserved.

Factors influencing well‐being in clinical nurses: a path analysis using a multi‐mediation model

Abstract

Aims and objectives

To test a hypothetical path model estimating the influence of resilience and gratitude disposition on well‐being in Korean clinical nurses and to verify the mediating effects of burnout, compassion satisfaction, and job satisfaction using a multi‐mediation model.

Background

To improve the well‐being of nurses, it is necessary to consider their personal and work‐related characteristics comprehensively.

Design

A descriptive cross‐sectional design was used.

Methods

A total of 310 clinical nurses participated in this study. A structured questionnaire was used to collect data. A path analysis using a multi‐mediation model was performed using AMOS 23.0 to test the hypothetical path model. This study adhered to the STROBE guideline.

Results

The model's fit indices were adequate. Resilience and gratitude disposition both had significant direct effects on well‐being. Resilience and gratitude disposition had significant indirect effects on well‐being through the effect of burnout, compassion satisfaction, and job satisfaction. Resilience, gratitude disposition, burnout, compassion satisfaction, and job satisfaction explained 68.3% of the total variance of well‐being.

Conclusions

Intervention programs considering these factors may be useful to improve nurses' well‐being.

Relevance to clinical practice

Nurses' well‐being should be assessed along with resilience, gratitude disposition, burnout, compassion satisfaction, and job satisfaction. Interventions for resilience, gratitude disposition, burnout, compassion satisfaction, and job satisfaction could be useful strategies to improve well‐being in nurses.

This article is protected by copyright. All rights reserved.

The types of caregiving reactions experienced by the older spouse caregivers

Abstract

Aims

To examine factors associated with the four types of caregiver reactions according to the modified Caregiver Reaction Assessment (mCRA) and assess the differences in the narrative assessment from spouse caregivers between the high‐positive and high‐negative caregiver reactions.

Background

There is a limited understanding of the factors contributing to positive and negative reactions among older spouse caregivers with chronic illnesses. Narrative assessment from spouse caregivers has not been studied before.

Design

The study design was a paired sample, mixed method survey design. Data were collected from spouse caregivers (≥55 years old) and care‐recipients in one medical institute from February 2017 to December 2017. This manuscript used STROBE checklist to ensure complete reporting.

Methods

Demographic, socioeconomic, Frailty index, Perceived Stress, and Quality of life data were gathered from caregiver‐dyads. mCRA, Relationship, and Life Satisfaction data were collected from caregivers. mCRA identified the four types of caregiver reactions: 1) high‐positive, low‐negative; 2) high‐positive, high‐negative; 3) low‐positive, high‐negative; and 4) low‐positive, low‐negative. A qualitative interview was conducted to understand the differences in the narrative and choice of words used to describe caregiving experience.

Results

Seventy‐five caregiver‐dyads were recruited. Total perceived stress was found to be negatively associated with high‐positive, low‐negative caregiver reaction (baseline category: low‐positive, high‐negative) by multinomial logistic regression. Content analyses showed that low‐positive and high‐negative caregivers used words that implied a lack of volition. Caregivers with positive experience viewed caregiving as a responsibility; the opposite viewed it as having ‘no choice.'

Conclusions

Perceived stress is an important indicator of caregiver reactions. Words used when describing caregiving experiences can potentially depict the spouse caregivers' current state of being as a caregiver.

Relevance to clinical practice

Spouse caregiver's narrative of their caregiving experience may provide easy and quick insights if interventions are needed. Early identification of negative reactions will allow for prompt interventions in mitigating caregivers' stress.

This article is protected by copyright. All rights reserved.

Modeling Factors of Urinary Incontinence in Institutional Older Adults with Dementia

Abstract

Aims and Objectives

This study applied structural equation modeling to explore the relationships among agitated behaviors, depression, cognitive function, and activities of daily living (ADL), as well as associations between these factors and urinary incontinence (UI).

Background

A high prevalence of UI is found among institutional older adults with dementia. People with UI suffer from increased financial burden and social isolation and experience reduced quality of life.

Design

Cross‐sectional, correlational research. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement.

Methods

In total, 226 older adults with dementia were recruited through convenience sampling at 15 long‐term care facilities in southern Taiwan. The UI frequency, agitated behaviors, depression, cognitive function, and ADL were evaluated using bladder records, the Cohen‐Mansfield Agitation Inventory (CMAI), the Cornell Scale for Depression in Dementia (CSDD), the Mini‐Mental State Examination (MMSE), and the Barthel Index (BI), respectively.

Results

ADL performance was found to be significantly associated with UI; however, age, cognitive function, depression, and agitated behaviors were not significantly related to UI. Age did not have effects on any of the variables tested in this model, whereas ADL performance was significantly associated with cognitive function and depression. Results further showed that cognitive function and depression were mediators between ADL and agitated behaviors.

Conclusion

Enhanced ADL independency directly reduced UI, improved cognitive function, decreased degrees of depression, and indirectly reduced agitated behaviors.

Relevance to clinical practice

The findings could serve as a valuable reference for long‐term care facilities in providing effective urinary incontinence care and prevention to older adults with dementia.

This article is protected by copyright. All rights reserved.

Effects of a home‐based nursing intervention program among adolescents with type 1 diabetes

Abstract

Aims and objective

To investigate the effects of a home‐based nursing intervention program established based on the Health Promotion Model on the health outcomes of adolescents with type 1 diabetes mellitus (T1DM).

Background

After diagnosed with diabetes, it is necessary to ensure that nursing care is not limited to the hospital setting but continues at home.

Design

A quasi‐experimental design with a pre‐ and posttest control group was used. The researchers have complied with the guidelines of TREND Checklist in presenting this study.

Method

This study was conducted in İzmir, Turkey, with 71 adolescents (35 in an intervention group and 36 in a control group) diagnosed with T1DM who were registered at the pediatric endocrinology outpatient clinics of two hospitals and were selected using the convenience sampling method between June and December 2017. A home‐based nursing intervention program (5 week) was provided to the intervention group while standard care was provided to the control group. Data were collected at the baseline, and three and six months after a five‐week home‐based nursing intervention. Multi‐way and one‐way analysis of variance, the Bonferroni correction, regression analysis, t‐test, chi‐squared analysis, and a structural equation model were used for data analysis of the iterative measurements.

Results

At the end of the home‐based nursing intervention program, the HbA1c mean scores significantly decreased, while self‐efficacy perception, frequency of managing diabetes and taking responsibility in managing diabetes increased in the intervention group compared to those in the control group. Frequency of hos admission to the hospital and average costs were lower in the intervention group than in control group. The home‐based nursing intervention program using structural equation modeling increased the frequency of managing diabetes and taking responsibility in managing diabetes and decreased HbA1c levels.

Conclusion

The home‐based nursing intervention program was effective in decreasing HbA1c levels, increasing the frequency of diabetes management and taking responsibility in managing diabetes, and improving the self‐efficacy of the adolescents.

Relevance to clinical practice

The home‐based nursing intervention program can be applied by nurses to ease the transition of adolescents with type 1 diabetes mellitus and their parents to healthy daily life practices and ensure their glycemic controls after being discharged.

This article is protected by copyright. All rights reserved.

Children's active participation in decision‐making processes during hospitalisation: an observational study

Abstract

Aims and objectives

The aim was to explore and describe the child's active participation in daily healthcare practice at children's hospital units in Sweden. Objectives: a) Identify everyday situations in medical and nursing care that illustrate children's active participation in decision‐making, b) Identify various ways of active participation, actual and optimal in situations involving decision‐making, c) Explore factors in nursing and medical care that influence children's active participation in decision‐making.

Background

Despite active participation being a fundamental right for children, they are not always involved in decision‐making processes during their healthcare. There still remains uncertainty on how to support children to actively participate in decisions concerning their healthcare.

Design

A qualitative study with overt, non‐participant observations fulfilling the COREQ checklist criteria (see supplementary File 1).

Methods

Observations of interactions between children aged 2‐17 years with both acute and chronic conditions, their parents, and healthcare professionals were conducted at three paediatric hospitals in Sweden. The Scale of Degrees of Self Determination was used to grade identified situations. The scale describes five levels of active participation, with level one being the least and level five being the most active level of participation. Normative judgements were also made.

Results

Children's active participation was assessed as being generally at levels four and five. Children demonstrated both verbal and non‐verbal ways of communication during decision‐making. Findings indicated that children's, parents', and healthcare professional's actions influenced children's active participation in decision‐making processes involving healthcare.

Conclusions

Healthcare professionals specialised in paediatrics need to embrace both a child perspective and a child's perspective, plan care incorporating key elements of a child‐centered care approach, to ensure children's active participation at a level of their choosing.

Relevance to clinical practice

There is a need for awareness creation to help healthcare professionals facilitate children's active participation in their care and decision‐making.

This article is protected by copyright. All rights reserved.

The effect of volunteers' care and support on the health outcomes of older adults in acute care: A systematic scoping review

Abstract

Aim

To examine the available evidence on the effects of care and support provided by volunteers on the health outcomes of older adults in acute care services.

Background

Acute hospital inpatient populations are becoming older and this presents the potential for poorer health outcomes. Factors such as chronic health conditions, polypharmacy, and cognitive and functional decline are associated with increased risk of healthcare‐related harm, such as falls, delirium, and poor nutrition. To minimise the risk of healthcare‐related harm, volunteer programs to support patient care have been established in many hospitals worldwide.

Design

A systematic scoping review.

Methods

The review followed the PRISMA Checklist for Scoping Reviews (PRISMA‐ScR) (see Supplementary File 1). Nine databases were searched (CINAHL, MEDLINE, EMBASE, COCHRANE, SCOPUS, WEB of SCIENCE, PUBMED, SCIENCE DIRECT and JBI) using the following key terms: ‘hospital', ‘volunteer', ‘sitter', ‘acute care', ‘older adults', ‘confusion', ‘dementia' and ‘frail'. The search was limited to papers written in English and published from 2002‐2017. Inclusion criteria were studies involving the use of hospital volunteers in the care or support of older adult patients aged ≥65 years, or ≥50 years for Indigenous peoples, with chronic health conditions, cognitive impairment and/or physical decline or frailty, within the acute inpatient settings.

Results

Of the 199 articles identified, 17 articles that met the inclusion criteria were critically appraised for quality, and 12 articles were included in the final review.

Conclusions

There is evidence that the provision of volunteer care and support with eating and drinking, mobilising, and therapeutic activities, can impact positively upon patient health outcomes related to nutrition, falls, and delirium. Further robust research is needed to determine the impact of volunteers in acute care and the specific care activities that can contribute to the best outcomes for older adults.

Relevance to Clinical Practice

Volunteers can play a valuable role in supporting care delivery by nurses and other health professionals in acute care services, and their contribution can improve health outcomes for older adults in this setting.

This article is protected by copyright. All rights reserved.

Critical Care Nurses' Experiences of Providing Care for Adults in a Highly Technological Environment. A Qualitative Evidence Synthesis

Abstract

Aims

To synthesise the available body of qualitative evidence relating to nurses' perceptions and experiences of care provision in adult critical care environments.

Methods

The study adhered to ENTREQ (Confidence in Evidence of Reviews of Qualitative Research) guidelines. See Supplemental File 1. A systematic search of the literature in nine databases was undertaken: CINAHL, Web of Science, Medline, Embase, PsycINFO, Campbell Collaboration, Proquest A & I, DART, Lenus. Blind screening to select relevant studies was undertaken and each selected study was assessed for quality using the Critical Appraisal Skills Programme framework (CASP). Guided by Thomas and Harden's three‐stage approach to thematic analysis, line‐by‐line coding of participants' verbatim accounts and the researchers' interpretations in the selected studies' findings was undertaken and then organised into higher order analytical themes. Confidence in the findings were reviewed using GRADE‐CERQual.

Results

Twelve studies reported in thirteen papers, including 122 nurses were selected in the final sample for synthesis. Three analytical themes were identified: 1) sometimes machines get all the attention 2) with experience the patient becomes the focus, and 3) technology can't save everybody.

Conclusions

Providing care for adult patients in a highly technological environment is challenging particularly for novice nurses, who face the potential of technology drawing all their attention. Experienced critical care nurses learn to keep technology in abeyance and deliver person‐centred care within the bounds of a technological environment.

Relevance to clinical practice

The review supports Locsin's theory of technological competence and highlights that providing care in critical care requires nurses to actively balance attention for the person while managing machines. Experienced nurses achieve this balance and can offer support to novice nurses. Critical care nurse orientation programmes should be underpinned by a holistic approach which addresses the dualism of technology and care.

This article is protected by copyright. All rights reserved.

Decreasing length of limb immobilisation following nonelective transfemoral percutaneous coronary intervention: A randomised clinical trial

Abstract

Aims and objectives

To assess the intensity and frequency of pain, use of analgesic drugs, and the incidence of paraesthesia, urinary retention and vascular complications upon decreasing affected limb immobilisation from 4–2 hrs after sheath removal in patients submitted to transfemoral percutaneous coronary intervention (PCI).

Background

After sheath removal from the femoral artery following urgent or emergency PCI, patients are maintained with limb immobilisation for a mean period of 4 hr.

Design

Randomised clinical trial (RCT) based on the CONSORT guidelines.

Method

Randomised clinical trial was performed in patients with Acute Coronary Syndrome submitted to transfemoral PCI. The intervention group was submitted to a supine position with the head of the bed elevated (30‐degree angle) with affected limb immobilisation for 2 hr after sheath removal and the control group for 4 hrs. The outcomes were pain complaints, need for analgesic drugs, incidence of paraesthesia, urinary retention and vascular complications. The outcomes were assessed immediately, 6, 12 and 24 hr after release from limb immobilisation before the patients were released from bed rest.

Results

A total of 150 patients (75 in each group) participated in the study. No significant differences in outcomes were observed between the groups, except in relation to the haematoma formation that was higher in the intervention group.

Conclusion

A reduced length of limb immobilisation after sheath removal following PCI does not change the frequency and intensity of pain, need of analgesic drugs, urinary retention and paraesthesia. The incidence of haematoma was higher in the intervention group, without significant clinical manifestations.

Relevance to clinical practice

The results of this study can be considered for patients submitted to elective, urgent or emergency PCI, who have a lower risk of complications, thereby allowing for decreased periods of limb immobilisation.

Editor's note

Journal of Clinical Nursing, Volume 28, Issue 17-18, Page O3-O3, September 2019.

Issue Information

Journal of Clinical Nursing, Volume 28, Issue 17-18, Page 3043-3044, September 2019.

Development and validation of the pressure ulcer management self‐efficacy scale for nurses

Abstract

Background

Pressure ulcers (PUs) represent a current issue for healthcare delivery. Nurse self‐efficacy in managing PUs could predict patients’ outcome, being a proxy assessment of their overall competency to managing PUs. However, a valid and reliable scale of this task‐specific self‐efficacy has not yet been developed.

Objectives

To develop a valid and reliable scale to assess nurses’ self‐efficacy in managing PUs, that is, the pressure ulcer management self‐efficacy scale for nurses (PUM‐SES).

Methods

This study had a multi‐method and multi‐phase design, where study reporting was supported by the STROBE checklist (File S1). Phase 1 referred to the scale development, consisting in the items’ generation, mainly based on themes emerged from the literature and discussed within a panel of experts. Phase 2 focused on a three‐step validation process: the first step aimed to assess face and content validity of the pool of items previously generated (initial version of the PUM‐SES); the second aimed to assess psychometrics properties through exploratory factorial analysis; the third step assessed construct validity through confirmative factorial analysis, while concurrent validity was evaluated describing the relationships between PUM‐SES and an established general self‐efficacy measurement. Reliability was assessed through the evaluation of stability and internal consistency.

Results

PUM‐SES showed evidence of face and content validity, adequate construct and concurrent validity, internal consistency and stability. Specifically, PUM‐SES had four domains, labelled as follows: assessment, planning, supervision and decision‐making. These domains were predicted by the same second‐order factor, labelled as PU management self‐efficacy.

Conclusion

PUM‐SES is a 10‐item scale to measure nurses’ self‐efficacy in PU management. A standardised 0–100 scoring is suggested for computing each domain and the overall scale. PUM‐SES might be used in clinical and educational research.

Relevance to clinical practice

Optimising nurses’ self‐efficacy in PU management might enhance clinical assessment, determining better outcomes in patients with PUs.

The impact of congenital heart disease on the psychological well‐being and quality of life of Hong Kong Chinese adolescents: A cross‐sectional study

Abstract

Aims and objectives

To examine the psychological well‐being and quality of life of Hong Kong Chinese adolescents with congenital heart disease.

Background

Congenital heart disease (CHD) in adolescents is associated with having negative psychological impact and impairment to quality of life. A literature review revealed that most studies on the impact of CHD on the psychological well‐being and quality of life of adolescents to date have been conducted in Western populations.

Method

A cross‐sectional design was employed. Adolescents aged 12–18 with CHD attending an outpatient clinic in an acute public hospital were invited to participate. Another similar age group of healthy Chinese adolescents was also invited to participate for comparison purposes. Subjects were asked to respond to the Chinese version of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales, Center for Epidemiologic Studies Depression Scale for Children, Rosenberg Self‐Esteem Scale and a demographic sheet. A STROBE checklist was completed.

Results

Adolescents with CHD exhibited more depressive symptoms, lower self‐esteem and poorer quality of life than their healthy counterparts. Disease severity might affect the self‐esteem, depressive symptoms and quality of life of adolescents with CHD. Disease severity, depressive symptoms, self‐esteem level and types of treatment received were associated with the quality of life of adolescents with CHD.

Conclusions

Hong Kong Chinese adolescents suffering from CHD experience negative impacts on their psychological well‐being and quality of life. In this group, disease severity may affect psychological well‐being and quality of life. Specifically, quality of life of adolescents with CHD was associated with disease severity, depressive symptoms, self‐esteem level and the type of treatment received.

Relevance to clinical practice

The findings contribute to clinical care guidelines and serve as a reference in developing nursing intervention to adolescents with CHD so as to uphold quality of care. Clinical trial registration: NCT03255850 (Clinical trial.gov).

Catheter Dwell Time and Risk of Catheter Failure in Adult Patients with Peripheral Venous Catheters

Abstract

Aims and objectives

To explore whether the risk of peripheral venous catheters failure remained constant throughout catheter use in adult patients.

Background

Peripheral venous catheters, widely used in adult patients, may have a critical threshold dwell time associated with increased risk of catheter failure.

Design

Prospective, observational study. We have complied with the STROBE Checklist of items.

Methods

This study was conducted from July to October 2018 in Hunan, China. Data on patient factors, catheter factors, and catheter failure events were collected. Poisson regression was used to assess the effect of catheter dwell time on catheter failure while adjusting for other variables.

Results

A total of 1477 patients were included in the analysis. There were 854 cases (57.8%) of catheter failure. The median dwell time to catheter failure was 52 h (interquartile range: 36–73 h). The incidence rate of catheter failure significantly increased by 1.1%/h in the first 38 h after catheter insertion. From 39–149 h, the incidence rate significantly decreased, and at >149 h, there was no significant change in the incidence rate. Meanwhile, factors like vascular quality and infused drugs showed having an impact on catheter failure events.

Conclusions

The risk of catheter failure may not remain constant throughout the dwell time. The results suggest that nurses should assess the insertion site frequently in the first 38 h.

Relevance to clinical practice

The significant increase in the risk of catheter failure per hour may warrant close and frequent inspection of insertion site during the first 38 hours.

The effects of family functioning and resilience on self‐management and glycaemic control among youth with type 1 diabetes

Abstract

Aims and objectives

To examine the effects of family functioning and resilience on self‐management and glycaemic control among youth with type 1 diabetes (T1D) and to determine whether resilience mediates the effects of family functioning on self‐management and glycaemic control.

Background

Poor self‐management and glycaemic control are common in youth with T1D. Family functioning and resilience are known to be important psychosocial factors that contribute to individual health and development. However, no studies have explored the effects of family functioning and resilience on self‐management and glycaemic control among youths with T1D in mainland China.

Design

This study was conducted using a survey with a convenience sample following the STROBE guidelines.

Methods

A total of 204 Chinese youth who had been diagnosed with T1D for at least six months were recruited. Family functioning, resilience, self‐management and diabetes distress were measured using self‐reports and standard measurement tools. Glycaemic control was assessed by glycated haemoglobin (HbA1C) levels. A structural equation model was used to test the hypothesized model.

Results

The final model accounted for 52.1% and 19.5% of the total variance of self‐management and HbA1C level, respectively. Resilience had a direct effect on self‐management and an indirect effect on control of HbA1C. Family functioning had an indirect effect on both self‐management and control of HbA1C through resilience. The model remained invariant across the mild‐distress and severe‐distress groups.

Conclusion

In Chinese youth with T1D, resilience positively affected self‐management and ultimately optimized glycaemic control, even in the presence of diabetes distress. Family functioning positively affected self‐management and glycaemic control by promoting resilience.

Relevance to clinical practice

This study found that family functioning and resilience had positive effects on self‐management and glycaemic control in youth. This study confirms the importance of incorporating resilience assessments and family‐based resilience interventions into clinical nursing practice with youth with T1D.

Indigenous mothers' experiences of using acute care health services for their infants

Abstract

Aims and Objectives

To develop an understanding of how Indigenous mothers experience selecting and using health services for their infants can assist nurses in improving their access to care. This understanding may ultimately lead to improved health outcomes for Indigenous infants and their families.

Background

Access to acute care services is important to minimise morbidity and mortality from urgent health issues; however, Indigenous people describe difficulties accessing care. Indigenous infants are known to use the emergency department frequently, yet little is known about the facilitators and barriers their mothers experience when accessing these services.

Design

This study undertook a qualitative, interpretive description design.

Methods

This article adheres to the reporting guidelines of COREQ. Data collection methods included interviews and a discussion group with Indigenous mothers (n = 19). Data analysis was collaborative and incorporated both Indigenous and Western ways of knowing, through the application of Two‐Eyed Seeing.

Results

A thematic summary resulted in six themes: (a) problematic wait times; (b) the hidden costs of acute care; (c) paediatric care; (d) trusting relationships; (e) racism and discrimination; and (f) holistic care.

Conclusions

The experiences of Indigenous mothers using acute care services for their infants suggest a role for culturally safe and trauma and violence‐informed care by health providers in the acute care context.

Relevance to Clinical Practice

Nurses can improve access to acute care services for Indigenous mothers and infants through the provision of culturally safe and trauma and violence‐informed approaches care, by building rapport with families, providing care that is respectful and nonjudgemental, eliminating fees associated with using acute care services and linking families with cultural resources both in hospital and within the community.

Availability and perceived usefulness of guidelines and protocols for subcutaneous hydration in palliative care settings

Abstract

Aims and objectives

To evaluate the availability of, adherence to, and perceived usefulness of guidelines and protocols for managing hydration and subcutaneous hydration in palliative care settings.

Background

Hydration at the end of life and the use of a subcutaneous route to hydrate generate some controversy among health professionals for different reasons. Having guidelines and protocols to assist in decision‐making and to follow a standard procedure may be relevant in clinical practice.

Design

Cross‐sectional telephone survey, with closed‐ended and open‐ended questions designed specifically for this study.

Methods

Data were obtained from 327 professionals, each from a different palliative care service. Mean, standard deviation, minimum and maximum were calculated for continuous variables; frequency distributions were obtained for categorical variables. A qualitative content analysis was performed on the open‐ended questions. The article adheres to the STROBE guidelines for reporting observational studies.

Results

Only 24.8% of the participants had guidelines available to assist in making decisions regarding hydration, and 55.6% claimed to follow them ‘always or almost always’. Of the participants, 38.8% had subcutaneous hydration protocols available, while 78.7% stated that they ‘always or almost always’ followed these protocols. The remaining participants considered the protocols as useful tools despite not having them available.

Conclusions

Only 25% of the participants' services had guidelines for hydration, and less than 40% had protocols for subcutaneous hydration. However, adherence was high, especially in cases where protocols existed. Among the participants who did not have guidelines and protocols, attitudes were mostly favourable, but mainly as a reference and support for an individualised clinical practice.

Relevance to clinical practice

Guidelines and protocols on hydration in palliative care may be more useful as a solid reference and support for individualised practice than as instruments for standardising care. From this perspective, their development and availability in palliative care services are recommended.

❌