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Commentary on: Brewer A. "We were on our own": Mothers’ experiences navigating the fragmented system of professional care for autism. Soc Sci Med 2018; 215:61-8.
Managing conditions like autism disorder requires a multidisciplinary approach that effectively integrates subsections of medical and other professionals and facilitating patients’ and caregivers’ access to required services. The consequences of the rising trend of super-specialisation and sub-specialisation of medical professions on patients and their caregivers need to be studied in future studies.
Studies have shown that increasing fragmentation of the healthcare system leads to systemic deficiencies, lack of coordination between professionals from collaborating disciplines, increased expenditure, inequalities and deprofessionalisation.
In common with many other countries, population ageing, advancements in medical technology, changing disease profiles, the influence of lifestyle choices on health and increased patient expectations are driving health and social care provision in the UK. As the number of people living with one or more long-term conditions rises, interventions to support their health and well-being become increasingly complex. Nurses will not only be expected to deliver complex interventions but are in an ideal position to contribute to priority setting and the development and evaluation of interventions that meet patient needs. It is essential that complex interventions are based on the best available evidence and evaluated if they are to improve health outcomes. In this article we will provide an overview of complex interventions, using dignity therapy as an example, and outline the principles of developing a complex intervention.
The UK Medical Research...
Commentary on: Dewitte L, Vandenbulcke M, Dezutter J. Cognitive functioning and quality of life: diverging views of older adults with Alzheimer and professional care staff. Int J Geriatr Psychiatry 2018;33:1074–1081. doi: 10.1002/gps.4895.
Older adults living with Alzheimer’s disease (AD) respond best to patient-centred care that values and affirms personhood and maintains the ‘self’. Research to examine perceptions and attitudes of professional care staff towards AD in older adults may provide insight into pre-existing quality of life (QOL) biases.
As the prevalence of AD grows across the globe, individuals, caregivers and health organisations struggle to cope with the overwhelming personal, economic, and healthcare system challenges that often accompany the condition. With a growing need for residential care facilities to assume care, QOL has become an important measure to families and staff. The study by Dewitte et al
Commentary on: Arantzamendi M, Garcia-Rueda N, Carvajal A, et al. People with advanced cancer: the process of living well with awareness of dying. Qual Health Res 2018. doi: 10.1177/1049732318816298. [Epub ahead of print 12 Dec 2018].
The process of living well with advanced cancer revolves around an ‘awareness of dying’. This leads to a focus on living a life rather than living an illness. To support development of the theory, future research should explore its applicability in both a family perspective and different cultural contexts.
Little is known about the process of living well with advanced cancer or how to support it.
There is increasing recognition that students in higher education are a population group at high risk of facing mental health challenges. Indeed, the Institute for Public Policy Research recently acknowledged that the level of mental illness and mental distress among UK university students is increasing, and is greater than other sections of the population.
Seventy-eight per cent reported facing mental health problems in the previous year. Two-thirds of respondents reported having felt depressed in the last year. The prevalence of suicidal thoughts in the previous 12 months (33%) was double that reported in the general population
Commentary on: Frögéli E, Rudman A, Gustavsson P. The relationship between task mastery, role clarity, social acceptance, and stress: an intensive longitudinal study with a sample of newly registered nurses. Int J Nurs Stud 2019;91:60–9. doi: 10.1016/j.ijnurstu.2018.10.007
Socialisation processes are needed to enhance role transition and improve the integration of newly qualified nurses (NQNs). A particular emphasis should be placed on fostering social acceptance. This study provides a theoretical basis on which an intervention could be generated to minimise NQN stress. Future studies investigating stress in NQN should also consider the influence of organisational work factors including staffing levels, skill-mix and workload allocations.
The transition from student to newly qualified nurse (NQN) is a vulnerable time period.
Commentary on: Jackson D, Sarki AM, Betteridge R, Brooke J. Medical device-related pressure ulcers: A systematic review and meta-analysis. Int J Nurs Stud 2019;92:109–120.
Medical devices used for diagnostic, preventive or therapeutic purposes may have unintended consequences on patients such as medical device-related pressure injuries, which affect patients’ well-being and increase the cost of care. Further research is warranted to inform strategies for risk assessment and prevention of medical device-related pressure ulcers.
Medical device-related pressure ulcers are areas of localised injury to the skin or underlying tissue as a result of sustained pressure from a device.
Commentary on: Varagona LM, Hold JL. Nursing students' perceptions of faculty trustworthiness: thematic analysis of a longitudinal study. Nurse Educ Today 2019;72:27–31. doi: 10.1016/j.nedt.2018.10.008.
Student nurses’ trust of nurse educators is dependent on faculty demonstration of care, commitment, competence and professionalism. Larger-scale studies of factors influencing student nurses’ trust in faculty members—and the impact of trust on outcomes—are required, with utilisation of both qualitative and quantitative approaches.
The professional relationship between nurse educators and nursing students is an important factor in enhancing the academic and clinical development of learners. As a result, researchers have sought to understand the relationship more fully, including factors such as power dynamics
Commentary on: Lange P, Lamanna M, Watson R, et al. Undiagnosed delirium is frequent and difficult to predict: results from a prevalence survey of a tertiary hospital. JClin Nurs 2019; 28; 2537–42.
Delirium is common but it is frequently undiagnosed within hospital settings internationally. Older age and dementia are the strongest predictive factors associated with undiagnosed delirium. Validated assessment of all hospitalised patients for delirium is recommended to improve delirium diagnosis among hospitalised patients.
Previous research on delirium prevalence in hospital settings suggests it is a common condition which can affect around 20% of older people.
Commentary on: O’Connell O, Meaney S, O Donoghue KO. Anencephaly; the maternal experience of continuing with the pregnancy. Incompatible with life but not with love. Midwifery 2019;71;12–18.
Identification of anxiety and mental health implications needs to be implicit in caring for women finding out the diagnosis of a baby having anencephaly. Health professionals need associated training. Improved psychological support is needed, and this should be considered when mental health provision services are being scoped. Further research into women’s experiences of having a baby with anencephaly would help inform practice transformation.
Anencephaly is a rare condition, but where termination of pregnancy is culturally and legally restrictive more cases will be experienced. With the current news of areas in the USA restricting abortion, these experiences are likely to increase.
Commentary on: D. Campbell, N. L. Perkins, A.J. Khan, et al. Deprescribing in the Pharmacologic Management of Delirium: A Randomized Trial in the Intensive Care Unit. J Am Geriatr Soc 2019;67(4):695–702.
Electronic alerts were used with pharmacist support to suggest alternative medications to benzodiazepines and anticholinergics. This had no effect on the use of these medications or the short-term patient outcomes. Deprescribing interventions can have little influence where prescribing levels are already very low.
Delirium is a syndrome characterised by an acute onset of disturbed consciousness, cognitive function or perception. It is associated with higher mortality, increased rates of dementia and longer hospital stays.
https://dtb.bmj.com/content/57/7/104
Low back pain (LBP) is the leading cause of disability worldwide and is associated with a significant personal, social and economic burden. The use of often harmful and ineffective treatments (eg, opioids and surgery) represents a major challenge to the safe and appropriate management of non-specific LBP. Greater emphasis is now placed on non-pharmacological treatments. Self-care advice and reassurance should form the mainstay of non-pharmacological treatment for non-specific LBP, but there is a lack of guidance on how best to deliver reassurance in a way that is acceptable to people with LBP. LBP is an unsolved problem and we currently lack truly effective treatments. Effects are often small and short lived and many treatments do not work at all. Honesty about the...
Commentary on: Balk EM, Rofeberg VN, Adam, GP, et al. Pharmacologic and nonpharmacologic treatments for urinary incontinence in women: a systematic review and network meta-analysis of clinical outcomes. Ann Intern Med 2019 Mar 19. doi: 10.7326/M18-3227.
Pharmacological and non-pharmacological interventions to treat urinary incontinence (UI) can effectively be implemented for non-pregnant women with UI in order to improve UI outcomes. Future research can examine barriers to implementation of evidence-based interventions for UI as well as educational programmes for nurses to improve knowledge and UI outcomes.
UI is a prevalent condition across the globe. UI is pervasive in all care settings and communities.
This perspectives article expands on the one published in EBN July 2019, Vol 22-3 about Care of the Older Person by focusing on commentaries specifically related to research with dementia. Dementia rates are growing internationally and along with this are the complexities of caring for this growing cohort of people.
The 13 commentaries are grouped into three themes (see
Pain management and dementia. Carers of those with dementia. Treatment issues for those with dementia.
Evidence-based nursing commentaries on dementia and cognitive decline (2017–2020) Evidence that active pain treatment improves sleep quality...
Commentary on: Duxbury J, Baker J, Downe S, et al. Minimising the use of physical restraint in acute mental health services: the outcome of a restraint reduction programme (‘REsTrain YOURSELF’). Int J Nurs Stud 2019;95:40–8.
To improve the outcome of physical restraints programmes, a broader reduction prediction model must be created to capture contextual factors such as admission rate and level of violence influencing the use of coercive measure in the mental health settings. Interventions such as ‘REsTrain YOURSELF’ empowers mental healthcare professionals and personnel in mental health settings to assume ownership of changes in their wards and engages service-users through informed practice and patient-centered approaches.
Coercive interventions including physical and chemical restraints are universally used to prevent psychiatric patients to harm themselves or others. However, the use of coercive measures is currently a highly debated and controversial...
Commentary on: Liang SY, Jansson DR, Hogan PG, et al. Emergency department environmental contamination with methicillin-resistant Staphylococcus aureus after care of colonized patients. Ann Emerg Med 2019;4:31578–6.
Appropriate environmental surface decontamination practice and use of personal protective equipment are essential to reduce transmission of methicillin-resistant Staphylococcus aureus (MRSA) in emergency department care settings. Further investigations are required to explore improved environmental disinfection techniques and MRSA decolonisation strategies in order to address MRSA surface contamination when treating MRSA-infected patients.
Patients colonised or infected with methicillin-resistant Staphylococcus aureus (MRSA) shed bacteria and contaminate environmental surfaces during their hospital stay, and create risks for transmission of MRSA to healthcare professionals and other patients.
This article summarises a recent EBN Twitter Chat on the challenges involved with determining the right time and approach to support adolescents in taking more responsibility for their disease management. The Twitter-Chat was led by Line Caes (@LineCaes) from the University of Stirling and moderated by Roberta Heale (@robertaheale). The pre-chat Blog can be found at: https://bit.ly/2LKCd7m.
Adolescence is a stage in development characterised by rapid changes in physical, cognitive, emotional and social functioning.
Commentary on: Smet L, Heggermont WA, Goossens E, et al. Adherence, knowledge, and perception about oral anticoagulants in patients with atrial fibrillation at high risk for thromboembolic events after radiofrequency ablation. J Adv Nurs 2018;74:2577–87.
Increased knowledge about oral anticoagulants (OACs) and treatment satisfaction may increase the adherence to OAC in patients with atrial fibrillation (AF). There is a need for long-term effects of educational interventions regarding adherence and the intake of OAC in patients with AF.
AF occurs frequently and leads to a higher incidence of thromboembolic events and stroke. Therefore, OACs are crucial and recommended. This therapy can be carried out with vitamin K antagonists (VKAs) or non-VKA OAC (NOACs). Both have demonstrated a significant reduction in the risk of thromboembolic events. Additionally, an effective rhythm control strategy, the catheter ablation, is useful and reduces the...
Commentary on: Pérez T, Moriarty F, Wallace E, et al. Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study. BMJ 2018;363:k4524. doi: 10.1136/bmj.k4524.
The process of medication reconciliation could be a strategy to reduce the risk of potentially inappropriate prescribing among older primary care patients. There exists a significant association between hospital admission and potentially inappropriate prescribing, but further research regarding medication management across all involved healthcare professions is needed.
A crucial approach of the WHO’s third global patient safety challenge is to identify potentially inappropriate prescribing, associated with adverse drug events, hospital admissions and reduced quality of life.
Commentary on: Elmokhallalati Y, Woodhouse N, Farragher T, et al. Specialist palliative care support is associated with improved pain relief at home during the last 3 months of life in patients with advanced disease: analysis of 5-year data from the national survey of bereaved people (VOICES). BMC Med 2019. https://doi.org/10.1186/s12916-019-1287-8.
People who receive specialist palliative care or have a stated preference to die at home have a significantly higher chance of experiencing good pain relief as they die, irrespective of their disease aetiology. People dying with cancer receive better pain relief than those dying of non-cancer disease. Access to specialist palliative care services and advance care planning should be available to all; irrespective of diagnosis. Researchers and policymakers should consider how to ensure improvements in pain management for patients at home through advice and support from community...
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