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AnteayerJournal of Clinical Nursing

Factors affecting the quality of dementia care at acute care hospitals: A cross‐sectional study

Abstract

Aim and Objectives

The purpose of this study was to investigate which factors are associated with the quality of dementia care in acute care hospitals.

Background

The number of people with dementia who are admitted to acute care hospitals is increasing. Improving the quality of dementia care in acute care hospitals is an important issue. Prior studies have demonstrated that not only knowledge and nursing experience, but also psychological factors and the nursing practice environment are related to high-quality care on general wards.

Design

Cross-sectional hypothesis-testing design.

Methods

Participants were nurses providing care to people with dementia at acute care hospitals. Questionnaires were distributed to 300 acute care hospitals in Japan, 10 copies each and 773 valid responses were received. Based on the hypothesis model, variables were tested using multiple regression analysis. The model described the relationship between quality of care, personal attributes and the nursing practice environment. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used.

Results

Almost 90% of the study sample was female, the mean age was 37.4 ± 9.3 years, and the mean nursing experience was 14.0 ± 8.7 years. The results showed that nursing foundations for quality of care, staffing and resource adequacy, specialist consultation, promoting systematic recreation and exchange, knowledge, and feelings towards people with dementia were associated with the quality of dementia care in acute care hospitals. The adjusted coefficient of determination was 0.367.

Conclusion

This study identified factors associated with the quality of dementia care in acute care hospitals. Knowledge and feelings towards people with dementia are important, and the nursing practice environment plays an important role in improving the quality of dementia care.

Relevance to Clinical Practice

Not only improving nurse's practical ability but also a supportive nursing practice environment enhances the quality of dementia care in acute care hospitals.

Enablers and barriers in hospital‐to‐home transitional care for stroke survivors and caregivers: A systematic review

Abstract

Aims and objectives

To synthesise qualitative research evidence on the experience of stroke survivors and informal caregivers in hospital-to-home transitional care.

Background

Due to a shortened hospital stay, stroke survivors/caregivers must take over complex care on discharge from hospital to home. Gaps in the literature warrant a meta-synthesis of qualitative studies on perceived enablers and barriers during this crucial period.

Design

A systematic review and meta-synthesis.

Methods

A review was guided by Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist where six databases were searched from April to June 2020 including CINAHL Plus, MEDLINE, PsycINFO, Scopus, Web of Science and ProQuest and ProQuest Dissertations and Theses. There was no date limit to the search. Selected studies were critically appraised. A thematic synthesis approach was applied.

Results

The synthesis of 29 studies identified three major findings. First, partnerships with stroke survivors/caregivers empower discharge preparation, foster competence to navigate health and social care systems and activate self-management capabilities. Second, gaps in discharge planning and the lack of timely postdischarge support contribute to unmet care needs for stroke survivors/caregivers and affect their ability to cope with poststroke changes. Third, stroke survivors/caregivers expect integrated transitional care that promotes shared decision-making and enables long-term self-management at home.

Conclusions

Hospital-to-home transition is a challenging period in the trajectory of poststroke rehabilitation and recovery. Further research is required to deepen understandings of all stakeholders’ views and address unmet needs during transitional care.

Relevance to clinical practice

Protocols and clinical guidelines relating to discharge planning and transitional care need to be reviewed to ensure partnership approach with survivors/caregivers in the design and delivery of individualised transitional care. Stroke nurses are in a unique position to lead timely support for survivors/caregivers and to bridge service gaps in hospital-to-home transitional care.

Does participation in extended immersive ward‐based simulation improve the preparedness of undergraduate bachelor’s degree nursing students to be ready for clinical practice as a registered nurse? An integrative literature review

Abstract

Aims and objectives

To determine if extended immersive ward-based simulation programmes improve the preparedness of undergraduate bachelor's degree nursing students to be ward ready for professional practice as a registered nurse.

Background

The practice readiness of new graduate nurses to enter the workforce continues to raise concern among educators and industry. Often the transition period is a vulnerable time when the reality of clinical practice bears little resemblance of their experiences as a student. Simulation of a busy ward offers the opportunity for pre-registered nurses to practise a variety of situations they are likely to encounter once qualified in a safe and supportive learning environment.

Methods

The review considered studies that investigated the experiences and learning outcomes of nursing students following participation in extended immersive ward-based simulation. Databases searched included CINAHL, EMBASE, Medline and Scopus. Two reviewers independently assessed retrieved studies that matched inclusion criteria using standardised critical appraisal instruments. Reporting of review followed PRISMA checklist.

Results

Fourteen studies met the inclusion criteria. The majority of studies used a quasi-experimental mixed methods approach (10). Programme evaluations focused on self-reporting in learning satisfaction and student perceptions of performance. Six studies used a pre- and post-test design to compare the after effect on preparedness for professional practice. Two studies investigated student learning between simulated experiences and experiences gained during clinical placements.

Conclusion

Learning satisfaction was high among students who participated in programmes that incorporated extended immersive ward-based simulation experiences. Students are able to practise what they need to know and on what will be expected of them in professional practice. Evidence on whether these programmes make a difference in workplace performance, and retention of graduate nurses is yet to be established.

Relevance to clinical practice

Extended immersive ward-based simulation allows educators the opportunity to meet the perceived needs of students in preparation for professional practice.

Exploring newly qualified nurses’ experiences of support and perceptions of peer support online: A qualitative study

Abstract

Aims and Objectives

To explore newly qualified nurses’ support needs and their perceptions of online peer support.

Background

The experience of being a newly qualified nurse is stressful and isolating. Support from colleagues and peers can enhance perceptions of competence and confidence in newly qualified nurses, improve well-being and aid retention. However, despite initiatives such as preceptorship, support needs may remain unmet in busy clinical environments. Online support has potential to offer a partial solution to professional isolation, but there is a lack of research into how technology can support nurses’ emotional and social well-being.

Design

A qualitative exploratory study was designed, employing semi-structured focus groups, analysed using thematic analysis. The study is reported in accordance with the COnsolidated criteria for REporting Qualitative research checklist.

Methods

Eight focus groups, supplemented by one individual interview, were conducted with newly qualified nurses between June 2018–January 2019.

Findings

Two main themes arose. The first was Drowning, a lot of the time with two sub-themes: (i) Feelings and emotions about being a Newly Qualified Nurse: ‘Absolutely terrified’ and (ii) Support within the role: ‘Somebody you can count on’. The second was Potential advantages and disadvantages of online modality: ‘Somebody is going to get in that phone!’ which included three sub-themes (i) Potential advantages, (ii) Potential disadvantages and (iii) Preferences and recommendations.

Conclusions

This study demonstrates that if barriers can be overcome, then online support has potential to contribute to newly qualified nurses’ well-being. Further research is needed to explore technical and ethical issues around online support and evaluate its effectiveness for newly qualified nurses.

Relevance to clinical practice

Online support has the potential to add to existing strategies to support nurses during stressful times. This may be particularly relevant when many staff are working under increased pressure due to the COVID-19 pandemic.

Collaboration among nurses when transitioning older adults between hospital and community settings: a scoping review

Abstract

Background

The transitioning of older patients between healthcare sectors requires the provision of high-quality nursing care. Collaboration among nurses is identified as an essential element of transitional care, yet nurse–nurse collaboration has received little attention.

Aim

The aim of this study was to examine the extent, range and nature of nurse–nurse collaboration when transitioning older patients between hospital and community settings, and to identify gaps in the literature.

Methods

Arksey and O’Malleyʼs (International Journal of Social Research Methodology, 8, 2005 and 19) framework was used to undertake a scoping review to answer the research questions: how do nurses collaborate together when transitioning older patients from hospital to community settings and what are the facilitators, barriers and outcomes of nurse–nurse collaboration when transitioning older patients between sectors? The Nurse–Nurse Collaboration Scale (NNCS) subdomains informed the identification of selected studies.

Results

Twelve papers were included with most coming from Scandinavian countries and the majority using qualitative methodologies. Communication, coordination and professionalism were found to be both facilitators and barriers of nurse–nurse collaboration. Gaps in the literature included conflict management, and the outcomes of collaboration which was only reported in one study.

Conclusions

The findings indicate there is limited study of collaboration among nurses when transitioning older patients between hospital and community settings. Future research should address the impact of conflict on nurses working in collaborative practice as well as conducting intervention studies to examine the outcomes of nurse–nurse collaboration.

Workaholism, presenteeism, work–family conflicts and personal and work outcomes: Testing a moderated mediation model

Abstract

Aims and objectives

While research suggests that nurses who experience work–family conflicts (WFC) are less satisfied and perform less well, these negative outcomes may be more important for some nurses. This study proposes a mediated moderation model wherein the interaction between two individual characteristics, workaholism and presenteeism, relates to family life satisfaction and work performance with WFC mediating these relationships.

Background

Because a limited number of nursing studies have examined the potential outcomes of workaholism and presenteeism, we extend past research to address the question of how workaholism and presenteeism affect nurses’ functioning.

Design

We used a cross-sectional questionnaire survey design to test our hypotheses. STROBE guidelines for cross-sectional research were followed in designing and reporting this study.

Methods

A total of 419 nurses completed measures of workaholism, presenteeism, WFC, family life satisfaction and work performance.

Results

Results revealed that the relationships between workaholism and outcomes (family life satisfaction and work performance) through WFC were stronger among nurses characterised by high levels of presenteeism.

Conclusions

These results revealed that high presenteeism may exacerbate the negative relationships of workaholism to family life satisfaction and work performance through WFC.

Relevance to clinical practice

Healthcare organisations and managers should consider addressing work environment factors in their efforts to reduce the negative outcomes (e.g., low family satisfaction and work performance) of nurses’ workaholism, presenteeism and WFC.

Issue Information

Journal of Clinical Nursing, Volume 30, Issue 19-20, Page 2743-2744, October 2021.

‘I want to get back!’ A qualitative study of long‐term critically ill patients’ inner strength and willpower: Back home after long‐term intensive care

Abstract

Aims and objectives

To provide insights into what promotes and challenges inner strength and willpower in formerly critically ill patients back home after a long-term ICU stay.

Background

Critically ill patients demand great resources during an ICU stay, some experience great challenges after discharge from hospital. Knowledge about how health professionals can promote former long-term critically ill patients’ inner strength and willpower after discharge is essential, but still missing.

Design

A qualitative, hermeneutic-phenomenological approach using in-depth interviews with former long-term ICU patients.

Methods

Seventeen long-term ICU patients were interviewed 6–20 months after ICU discharge. The consolidated criteria for reporting qualitative research was used (COREQ,2007).

Results

Back home after hospital discharge, some former patients coped well while others suffered heavy burdens mentally and physically, along with economic problems. They handled their challenges differently: some found comfort and insight by reading their diary written by their ICU nurses, while several were struggling alone experiencing a lonesome silent suffering; these called for a follow-up support by the healthcare system.

Conclusion

Long-term ICU patients’ inner strength and willpower are vital salutogenic resources supporting the fight back to one’s former independent life. However, physical, mental and economic challenges drain their inner strength to go on and succeed. Several long-term ICU patients need health-promoting follow-up support after hospital discharge.

Relevance to clinical practice

This study disclosed a lonely and silent suffering indicating a need for development of systematical health-promoting follow-up programmes including salutogenic components such as health-promoting conversations, diaries and web-based recovery programme along with a cell phone app.

Prognostic value of a brief loneliness questionnaire for patients with coronary heart disease: Proposal for a prediction model

Abstract

Background

In patients with coronary heart disease (CHD), loneliness is associated with increased risk of morbidity and mortality. No predictive tool is available to detect patients who are influenced by loneliness to a degree that impacts mortality.

Aim

To: (i) propose a prediction model that detects patients influenced by loneliness to a degree that increases one-year all-cause mortality, (ii) evaluate model classification performance of the prediction model, and (iii) investigate potential questionnaire response errors.

Method

A cohort of patients with CHD (n = 7169) responded to a national cross-sectional survey, including two questions on loneliness. Information on cohabitation and follow-up information on one-year all-cause mortality were obtained from national registers. Prediction model development was based on the prognostic values of item responses in the questionnaire on loneliness and of cohabitation, evaluated with Cox-proportional Hazards Ratio (HR). Item responses which significantly predicted one-year mortality were included in the high-risk loneliness (HiRL) prediction model. Sensitivity, specificity and likelihood ratio were calculated to evaluate model classification performance. Sources of response errors were evaluated using verbal probing technique in an additional cohort (n = 7). The TRIPOD checklist has been used to ensure transparent reporting.

Results

Two item responses significantly predicted one-year mortality HR = 2.24 (95%CI = 1.24–4.03) and HR = 2.65 (95%CI = 1.32–5.32) and were thus included in the model. Model classification performance showed a likelihood ratio of 1.89. Response error was evaluated as low.

Conclusion

Based on the prognostic value in a loneliness questionnaire, a prediction model suitable to screen patients with CHD for high-risk loneliness was suggested.

Relevance to clinical practice

The HiRL prediction model is a short and easy-to-use screening tool that offers clinical staff to identify patients with CHD who are influenced by loneliness to a degree that impacts mortality. However, further evaluation of model performance and questionnaire validation is recommended before integrating the model into clinical practice.

Ethical conduct of nursing research

Journal of Clinical Nursing, EarlyView.

‘From Expert to Novice’, Perceptions of General Ward Nurses on Deployment to Outbreak Intensive Care Units during the COVID‐19 Pandemic: A Qualitative Descriptive Study

Abstract

Aims and objectives

This study aimed to explore the perceived preparedness and psychosocial well-being of general ward nurses prior to their deployment into the outbreak intensive care units (ICUs) during the COVID-19 pandemic.

Background

With the surge in COVID-19 cases requiring ICU care, non-ICU nurses maybe deployed into the ICUs. Having experienced through SARS, hospitals in Singapore instituted upskilling programs to secure general ward nurses’ competency in providing critical care nursing. However, no studies have explored the perceptions of general ward nurses on deployment into the ICUs during the COVID-19 pandemic.

Design

Qualitative descriptive study.

Methods

The study was conducted at Singapore’s epicentre of COVID-19 management. Five focus groups were conducted following purposive sampling of 30 general ward nurses identified for outbreak ICU deployment. Focus groups were audio-recorded, transcribed verbatim and data thematically analysed. This study was conducted and reported in accordance with the COREQ checklist.

Results

Three salient themes arose, exemplifying the transition from clinical experts in the general wards to practising novices in the outbreak ICUs. Firstly, ‘Into the deep end of the pool’ described general ward nurses’ feelings of anxiety and stress associated with higher exposure risk and expanded responsibilities to nurse critically ill patients. Secondly, ‘Preparing for “war”’ illustrated deployed nurses’ need for clear communication and essential critical care nursing training. Lastly, ‘Call of duty’ affirmed the nurses’ personal and professional commitment to embrace this transition into the ICUs, and their desire for greater psychosocial support.

Conclusion

The study findings highlight that though general ward nurses perceived their impending ICU deployment positively, they require ongoing support to facilitate a smoother transition.

Relevance to clinical practice

Findings provided an evidence base to improve the preparedness of general ward nurses deployed into the ICUs during the COVID-19 pandemic within key areas of training, information dissemination and psychosocial resilience.

Could standing orders have a place? A phenomenological exploration of experienced ward‐based registered nurses' views on the escalation protocol for patient deterioration

Abstract

Aims and objectives

To explore experienced ward-based Registered Nurses’ views on the potential use of standing orders, prior to the escalation protocol, for patient deterioration.

Background

Ward based nurses are required to follow set steps of the escalation protocol. The introduction of standing order policies would allow nurses to intervene earlier when deterioration was first detected.

Design

Hermeneutic Phenomenology.

Methods

Ten experienced ward-based RNs were recruited. Semi-structured interviews were conducted, with the data subjected to thematic analysis. Diekelmann's framework was used to analyse the texts, seeking the highest level of hermeneutic analysis namely, a constitutive pattern. COREQ guidelines were utilised.

Results

Four main themes emerged: (1) Ambiguity in perception: the escalation protocol; (2) Observations within acceptable parameters, but the patient is deteriorating; (3) Paradoxes of escalation: well laid out protocol, but hard to escalate; (4) We could intervene with standing orders, but are we permitted? The constitutive pattern namely, Dualism in Perception related to the dissonance conveyed by participants regarding the escalation protocol.

Conclusions

Notwithstanding the benefits of the escalation protocol for junior staff, the RNs offered critique of the established escalation practices and the restrictive role of the protocol. Another aspect of the protocol, that is ‘worried criterion’ was viewed positively. The participants expressed a desire to apply nurse-driven standing orders, to enable them to intervene earlier for patient deterioration.

Relevance to clinical practice

Organisations should consider new policies introducing standing orders for implementation by experienced RNs. The engagement of experienced ward-based nurses in forming ‘patient at-risk teams’ could assist organisations to deal with cases of clinical deterioration prior to activation of the escalation of care protocol.

How emergency nurses cope and motivate themselves to sustain their caring work: An integrative literature review

Abstract

Aims and objectives

The aim of this integrative review was to assess how emergency nurses cope and motivate themselves to sustain their caring work.

Background

The need to enhance sustainability of the workforce creates a demand to consolidate contemporary evidence related to emergency nurses’ motivations, how they cope and sustain themselves for caring work.

Design and methods

The integrative literature review informed by Whittemore and Knafl involved searching four databases, which yielded 977 published research papers (2008–2021). A total of 33 studies met the inclusion and quality assessment criteria. The PRISMA checklist for review was followed.

Results

No studies addressing all three areas (motivations, coping and caring sustainability) together were identified. Integration of evidence from quantitative and qualitative research was achieved in three categories: (1) emergency nurses’ motivations to sustain their work, (2) emergency nurses’ coping strategies and (3) sustaining care as emergency nurses.

Conclusion

To sustain themselves in caring work, emergency nurses need to be intrinsically and extrinsically motivated and know how to cope effectively with stressors and work demands. There is need for research examining the relationships between these aspects of emergency nursing work.

Relevance to clinical practice

To ensure the sustainability of emergency nurses’ work and careers understanding of the factors that influence and sustain their motivations and coping strategies is important for nurses and their clinical leaders and managers.

Dual‐lumen power injectable peripherally inserted central catheters in allogeneic hematopoietic stem cell transplantation: A prospective observational study

Abstract

Aims and Objectives

To explore whether dual-lumen power injectable peripherally inserted central catheters (PICCs) could be effectively and safely applied in allogeneic hematopoietic stem cell transplantation (allo-HSCT) and for serum cyclosporine level monitoring.

Background

Compared to conventional central venous access devices, PICC provides a feasible route not only for fluid infusion, but also for blood sample collection in patients undergoing oncological treatments.

Design

A prospective observational study was conducted according to the STROBE guidelines.

Methods

We prospectively evaluated the applications and complications of power injectable PICCs in 52 consecutive allo-HSCT recipients. We also compared the cyclosporine levels in 188 paired blood samples, simultaneously obtained via power injectable PICCs and percutaneous venous puncture, to investigate whether power injectable PICC is a feasible route for cyclosporine concentration monitoring in allo-HSCT.

Results

The median PICC placement duration was 29 days. The insertion-site blood oozing and central line-associated bloodstream infection rates were 36.5% (19/52) and 26.9% (14/52), respectively, indicating the feasibility of these PICCs for various applications in allo-HSCT. No power injectable PICC-related thrombotic adverse events were identified; 90.4% (47/52) of cases with power injectable PICC removal occurred because of lack of medical utility, suggesting that power injectable PICC-related complications were manageable. However, cyclosporine levels in samples obtained via these PICCs were significantly higher than those in samples obtained via percutaneous venous puncture (261.5 ± 139.2 vs. 232.4 ± 253.6 ng/ml; p = 0.019 [set 1]; 254.8 ± 89.3 vs. 225.1 ± 233.3 ng/ml; p<0.001 [set 2]; 283.6 ± 103.9 vs. 238.0 ± 254.7 ng/ml; p = 0.006 [set 3]; 291.0 ± 94.9 vs. 266.0 ± 274.7 ng/ml; p = 0.016 [set 4]).

Conclusion

The power injectable PICC is a feasible venous access device for allo-HSCT.

Relevance to clinical practice

The dual-lumen power injectable PICCs provided a reliable access for blood sample collection, decreasing the number of blind percutaneous venous punctures in allo-HSCT. However, its application in cyclosporine level monitoring needs further investigation.

Dimensions of hospital workplace violence: Patient violence towards the healthcare team

Abstract

Aims and Objectives

To investigate the cognitive dimensions nurses use when perceiving patient-to-healthcare provider workplace violence.

Background

The concept of workplace violence, especially with respect to healthcare settings, has been well documented. Healthcare workers are at particular risk for experiencing violence from their patients, though these incidents often go unreported. Experiencing violence in the workplace has been associated with numerous negative outcomes, including absenteeism, burnout and diminished quality of care. However, little emphasis has been placed on understanding the concept of violence itself, or why one type of violence might go unreported whilst another is readily communicated to officials.

Design

A card-sorting, multidimensional scaling design.

Methods

Thirty two nurses completed the card-sorting task. Using multidimensional scaling (MDS), 75 reported incidents of violence were considered. SPIRIT research reporting checklist followed.

Results

Nurses categorise patient violence in three dimensions: physical versus verbal, active versus threatening and more versus less severe. Implications for further research and intervention are discussed.

Conclusions

Violence in the hospital workplace is a complex perception by the healthcare worker that cannot be captured by a single dimension.

Relevance to clinical practice

This study provides a theoretical framework for understanding the complexity of patient-to-provider violence in a hospital setting. It sheds light on why only a minority of such events are reported. This model can serve as a foundation for future research exploring interventions for hospital violence.

Application of the national early warning score (NEWS) in patients with acute aortic dissection: A case–control study

Abstract

Background

The vital-sign monitoring strategy of patients with acute aortic dissection in the emergency department is mainly based on traditional experience. This study attempts to explore the significance of the national early warning score (NEWS) in monitoring the condition of patients with acute aortic dissection during emergency observation and to provide evidence for emergency nurses in optimal and scientific monitoring of patients.

Methods

The case–control method was used to continuously enrol patients with acute aortic dissection who had been in the emergency department; the STROBE checklist was used in this process. Based on patients’ clinical deterioration, they were divided into two groups: clinical deterioration and non-clinical deterioration. The NEWS at each time point was compared by independent-samples t-test, and the predictive power of NEWS was evaluated according to the area under the receiver operating characteristic curve.

Results

A total of 290 patients with acute aortic dissection were included: 46 patients showed clinical deterioration and 244 did not. There were significant differences in the NEW scores of the two groups at admission time and at 12, 8, 4 and 0.5 h before clinical deterioration. The NEW scores of the clinical deterioration group showed an upward trend, while the non-clinical deterioration group showed a relatively stable trend. The NEWS can be used to predict the occurrence of clinical deterioration earlier at 4 h before clinical deterioration. Simultaneously, the patient's respiration rate and SpO2 had better predictive performance than other vital signs.

Conclusion

The NEWS can be used to triage patients with acute aortic dissection admitted to the emergency department. Continuous use of the NEWS for monitoring can play a vital role in early warning of clinical deterioration in patients with acute aortic dissection. In clinical care, attention should also be paid when patients with acute aortic dissection have abnormal respiration rate and SpO2.

Infrared augmented reality device versus standard procedure for peripheral venous catheterisation in children less than 3 years old: A quasi‐experimental cluster randomised controlled trial

Abstract

Aim and objective

The objective of this study was to evaluate the AccuVeinAV400® viewing device for peripheral venous catheter insertion in children on the first try.

Background

Inserting a peripheral venous catheter is the most frequent invasive procedure carried out by healthcare professionals in hospitalised children. Several attempts are sometimes necessary, and veins can be damaged.

Design

A quasi-experimental cluster randomised controlled trial based on the CONSORT 2010 guidelines.

Methods

This randomised study comparing standard practice to the use of AccuVein400® was carried out on children who were less than 3 years old, with difficult intravenous access (DIVA Score), hospitalised in three paediatric units and who needed cannulation.

Result

A total of 304 children were included (156 in the AccuVein arm and 148 in the standard arm). There was no significant difference between AccuVein and standard groups in age (respectively, 2.5 ± 0.9 years vs. 2.5 ± 0.8), or mean DIVA score (respectively 5.9 ± 1.3 vs. 5.5 ± 1.2). The success of cannulation on the first attempt was 40.38% in the AccuVein arm vs. 41.2% in the standard arm (p = .6). The caregiver's assessment of pain on the Face Legs Activity Cry Consolability scale was 4.8 ± 0.2 in the AccuVein arm vs. 5.0 ± 0.2 (p = .4).

Conclusions

The use of AccuVein400® did not lead to greater success in intravenous insertion at the first attempt in children under 3 years of age with difficult intravenous access.

Relevance to clinical practice

This device can therefore be used according to the healthcare professionals' situation and needs. It is widely used in paediatric wards, and our study shows that it offers a support tool that reassures healthcare professionals and helps validate their choice of vein easiest to catheterise.

Association between pregnancy intention and smoking or alcohol consumption in the preconception and pregnancy periods: A systematic review and meta‐analysis

Abstract

Aims

To investigate the association between pregnancy intention and smoking or alcohol consumption in preconception and pregnancy periods.

Background

Suboptimal lifestyle such as smoking and alcohol consumption can lead to devastating outcomes on the maternal and foetus. Pregnancy intention exerts a significant effect on promoting healthy lifestyle behaviours. However, no reliable evidences confirmed pregnancy intention was associated with smoking and alcohol consumption before and during pregnancy.

Design

Systematic review and meta-analysis.

Methods

We performed a comprehensive search from databases including PubMed, Cochrane, Web of Science, IEEE Xplore, MEDLINE, ProQuest and Scopus from the inception of these databases up to November, 2020. All eligible studies exploring the association between pregnancy intention and smoking or alcohol consumption were included. The fixed- or random effect pooled measure was used to estimate the odds ratio (OR) or risk ratio (RR) and 95% CI. In addition, the PRISMA checklist was used in this meta-analysis.

Results

A total of 23 studies were included in this systematic review and meta-analysis. During pregnancy, the findings suggested that women with unplanned pregnancy were 68% more likely to consume cigarettes (OR = 1.68, 95% CI = 1.44–1.95) and 44% more likely to consume alcohol (OR = 1.44, 95% CI = 1.15–1.81) than those women with planned pregnancy. Meanwhile, during preconception, women with unplanned pregnancy were 30% more likely to consume cigarettes (OR = 1.30, 95% CI = 1.10–1.53) and 20% more likely to consume alcohol (OR = 1.20, 95% CI = 1.01–1.42) than those women with planned pregnancy.

Conclusion

The findings suggested that women with unplanned pregnancy were more likely to follow unhealthy behaviours such as smoking and alcohol consumption before and during pregnancy. Health professionals should consider the women's desire for pregnancy to decrease preconception and pregnancy smoking or alcohol consumption in future studies.

Relevance of clinical practice

Pregnancy intention is the key determinant of smoking and alcohol consumption during preconception and pregnancy periods. Offering effective contraception in primary healthcare setting could prevent unplanned pregnancy. Meanwhile, popularising minimal alcohol consumption and comprehensive smoke-free legislation would be beneficial to improve reproductive outcomes.

Experience of mental health nurses regarding mechanical restraint in patients with psychomotor agitation: A qualitative study

Abstract

Aim

To explore mental health nurses’ experiences whilst managing a patient with psychomotor agitation, and the factors that influence the decision to use mechanical restraints.

Background

Psychomotor agitation is considered a potentially violent psychiatric emergency. The management of disruptive behaviours includes mechanical restraints as the last resort although its use has consequences for patients, professionals and the therapeutic relationship.

Design

A qualitative study design with a hermeneutical approach was developed.

Methods

A total of 31 nurses were purposively sampled from six short- and medium-stay mental health inpatient units. Data were obtained from semi-structured interviews. A thematic content analysis following the seven steps of Colaizzi's method was performed. Three researchers independently conducted an inductive analysis within a perspective of a hermeneutic paradigm. The COREQ checklist was followed in carrying out this research.

Results

Four themes emerged from the analysis: 1) Nurses’ perceptions of restraint methods, 2) Factors influencing decision-making, 3) Consequences for professionals of the use of mechanical restraint and 4) Alternatives to mechanical restraint.

Conclusions

Aspects such as the importance of teamwork, the issue of cognitive dissonance, ethical conflict and barriers to effecting the withdrawal of these measures affect the mental health nurse's decision-making process. The understanding of these aspects is crucial to further reducing its incidence and negative consequences and achieving the elimination of mechanical restraints.

Relevance for Clinical Practice

Knowing how nurses feel during the patient's episode of psychomotor agitation and which factors influence the decision on whether to apply coercive methods can guide us on the quality of care offered.

Increased afternoon step count increases heart rate variability in patients with cardiovascular risk factors

Abstract

Aims and objectives

The present study investigated whether morning or afternoon activity is more effective at increasing the high-frequency (HF) index, a parasympathetic index, in patients with cardiovascular risk factors.

Background

A decreased HF index, a heart rate variability (HRV) parameter, is a well-established marker of poor cardiovascular prognosis. Because blood pressure and sympathetic tone are higher in the morning, physical activity and exercise in the afternoon has been recommended for patients with cardiovascular diseases. However, there have been no reports concerning the superior effects of afternoon exercise on parasympathetic activity and sleep.

Design

This observational study was a post hoc comparison.

Methods

Patients’ physical activity was measured for 1 month to determine their habits. Patients’ HF index was measured by 24-h Holter electrocardiography. The study enrolled 56 patients. Each patient’s morning step count (before lunch) and afternoon step count (between lunch and dinner) were compared. We adhered to the STROBE guidelines in the present study.

Results

Thirty-one patients took more steps in the morning, and 25 patients took more steps in the afternoon. The present study showed that those who took more steps in the afternoon had a significantly higher HF index during the first hour after sleep onset and during sleep than those who took more steps in the morning (p = .003, .047).

Conclusions

The present study showed that those who took more steps in the afternoon had a significantly higher HF index during the first hour after sleep onset and a higher HF index during sleep than those who took more steps in the morning.

Relevance to clinical practice

Exercise in the afternoon may improve the prognosis in patients with cardiovascular disease by not only preventing excessive blood pressure, afterload, and sympathetic tone but also positively influencing the parasympathetic system and sleep.

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