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AnteayerEvidence-Based Nursing

Lowering the thresholds of blood pressures in pregnancy, in line with the American College of Cardiology guidelines, has the potential to improve detection and outcomes for mother and baby

Por: Austin · L.

Commentary on: Reddy M, Rolnik DL, Harris K, et al. Challenging the definition of hypertension in pregnancy: a retrospective cohort study. Am J Obstet Gynecol 2020, Jan 16. doi:10.1016/j.ajog.2019.12.272. [Epub ahead of print].

Implications for practice and research

  • Evidence-based hypertensive thresholds need to be clear and consistent to ensure effective management of hypertension in pregnancy.

  • Further research is paramount in determining whether lowering the thresholds of blood pressures in pregnancy, in line with the American College of Cardiology guidelines, would improve detection and outcomes for mother and baby.

  • Context

    Throughout routine antenatal care, blood pressure is used as a screening tool for preeclampsia and its associated adverse outcomes.1 In the non-pregnant setting, the American College of Cardiology now endorses lower hypertensive thresholds and it remains unclear whether these lower thresholds should also be considered in pregnancy. This study2 aims to...

    Multifaceted falls prevention can help to reduce fall rates in high-risk and healthy community-dwelling older adults

    Por: Palmer · K. · Hill · J. · Clegg · A.

    Commentary on: Seon HL, Soyoung Yu. Effectiveness of multifactorial interventions in preventing falls among older adults in the community: a systematic review and meta-analysis. Int J Nurs Stud 2020;106:103564. doi: 10.1016/j.ijnurstu.2020.103564.

    Implications for practice and research

  • Multifaceted falls prevention is effective in reducing fall rates for high-risk and healthy community-dwelling older adults.

  • Exercise or an environmental modification component are important moderating factors in the effectiveness of multifaceted falls prevention in community-dwelling older adults.

  • Further high-quality research is required in the exploration of important mediating factors in the effectiveness of multifactorial interventions for falls prevention in community-dwelling older adults.

  • Context

    A fall is defined as an event that causes a person to, unintentionally, rest on the ground and is not a result of a major intrinsic event or hazard.1 Falls have both a significant clinical and psychological impact on the person and...

    Probiotics may be considered for children and adults with cystic fibrosis

    Por: Hill · J. · Smith · C. · Clegg · A.

    Commentary on: Coffey MJ, Garg M, Homaira N, et al. Probiotics for people with cystic fibrosis. Cochrane Database Syst Rev 2020;1:CD012949. doi:10.1002/14651858.CD012949.pub2.

    Implications for practice and research

  • Probiotics may be considered for children and adults with cystic fibrosis (CF) and might have some limited health benefits.

  • Further research is required on the effects of varying duration, dose and type of probiotics on children and adults with CF.

  • Context

    Cystic fibrosis (CF) is an autosomal recessive genetic disease caused by mutations in the CF transmembrane conductance regulator (CFTR) gene1 and affects an estimated 70 000 adults and children around the world.2 The CFTR impairment causes gut ecosystem imbalance.3 It has been suggested that probiotics can help with restoring gut microbiota in patients with CF.4 This review aimed to summarise the current evidence on the efficacy and safety of...

    Recovery processes can alleviate the effects of presenteeism and emotional exhaustion

    Commentary on: Gillet N, Huyghebaert-Zouaghi T, Reveillere C, et al. The effects of job demands on nurses’ burnout and presenteeism through sleep quality and relaxation. J Clin Nurs 2020;29(3–4):583–592. doi: 10.1111/jocn.15116. Epub 2019 Dec 9.

    Implications for practice and research

  • Work shifts have to consider the role of sleep quality in recovering from workload and emotional dissonance as a way to prevent emotional exhaustion and presenteeism.

  • Further research into interventions that can enhance nurses’ recovery processes is required.

  • Context

    The role of work stress (high demand coupled with low control) in burn-out and health impairment is well known from the scientific evidence, including in nursing.1 As part of this, excessive workload is known to contribute to absenteeism, presenteeism (going to work while ill), increased risk of work accidents and reduced attention to patient needs. Detachment and recovery processes have been shown as...

    AFramework for identifying stigmatisation patterns in patients with mental health conditions in the acute healthcare setting

    Por: Al-Sulami · G.

    Commentary on: Perry A, Lawrence V, Henderson C. Stigmatisation of those with mental health conditions in the acute general hospital setting. A qualitative framework synthesis. Soc Sci Med 2020; 255:112974. doi: 10.1016/j.socscimed.2020.112974.

    Implications for practice and research

  • The framework for categorising stigmatisation patterns in patients with mental health conditions may be useful in practice to facilitate stigma reduction in acutecare settings.

  • There is a need for highquality review, including quantitative and qualitative observational and interventional studies, to further explore stigmatisation patterns and reduction interventions.

  • Context

    Stigmatisation is the action of devaluing individuals due to some factor identified as a mark of shame or ‘stigma’. Stigma has been associated with ethnic features and certain health conditions such as HIV and mental illness1; in particular, many patients with mental illness are stigmatised and treated unfairly, which can lead them to refrain from seeking help...

    Virtual reality reduces pain and fear during intravenous cannulation in the emergency department

    Por: Coulter · P.

    Commentary on: Chen YJ, Cheng SF, Lee PC, Lai CH, Hou IC, Chen CW. Distraction using virtual reality for children during intravenous injections in an emergency department: A randomised trial. J Clin Nurs. 2020 Feb;29(3-4):503-510. doi: 10.1111/jocn.15088. Epub 2019 Dec 4.

    Implications for practice and research

  • Virtual reality (VR) head-mounted sets are a valuable tool to help reduce pain and anxiety for intravenous cannulation in children and caregivers.

  • Further studies should focus on comparison of the range of VR devices, their use in different age groups, and their use in the preparation prior to procedures.

  • Context

    Virtual Reality (VR) head-mounted displays (HMDs) are now affordable, and the latest ‘techno’ gadget for home entertainment. Research studies are increasingly focused on this new technology and the use of VR in the hospital setting. The use of VR headsets has great potential as a tool for use...

    Alpha2 agonist dexmedetomidine may reduce duration of delirium in critically ill adults

    Por: Hill · J. · Sange · C. · Clegg · A.

    Commentary on: Burry L, Hutton B, Williamson DR et al. Pharmacological interventions for the treatment of delirium in critically ill adults. Cochrane Database Syst Rev 2019:CD011749. DOI: 10.1002/14651858.

    Implications for practice and research

  • Alpha2 agonist dexmedetomidine may reduce duration of delirium while Cholinesterase inhibitor rivastigmine may prolong the duration of delirium and length of intensive care.

  • Future research should ensure that important clinical outcomes are reported such as symptom management.

  • Context

    Delirium is a multifaceted neurocognitive indication of an underlying medical condition.1

    It frequently occurs in critically ill patients and can have substantial negative consequences with increased mortality and intensive care unit (ICU) length of stay.2 Uncertainty remains around the effectiveness of pharmacological interventions for the treatment of delirium within ICU.3 This Cochrane systematic review aims to examine the effectiveness of pharmacological interventions for treating delirium in critically...

    Consider opportunities to build resilience with individuals who experience suicidal ideas and behaviours following stressful life events

    Por: Fishburn · K. E. · Alfred · L.

    Commentary on: Howarth EJ, O’Connor DB, Panagioti M, et al. Are stressful life events prospectively associated with increased suicidal ideation and behaviour? A systematic review and meta-analysis. J Affect Disord. 2020;266:731–42. doi: 10.1016/j.jad.2020.01.171.

    Implications for practice and research

  • Practitioners need to explore non-traumatic stressful life events in order to identify ways to enhance individual resilience and coping strategies.

  • Future narrative research is required to explore the different types of stressful life events and how these impact on individuals and wider society.

  • Context

    Suicide is a leading cause of death worldwide, and it has devastating effects on families, friends and the professionals who work with suicide victims.1 As such, it is a highly researched area. The review highlights that for every suicide, there are many more who attempt or think about suicide.2 Therefore, it is important to understand the risk factors...

    Using advance care planning for end-of-life care in heart failure improves outcomes

    Por: Harshaw-Ellis · K.

    Commentary on: Schichtel M, Wee B, Perera R, Onakpoya I. The effect of advance care planning on heart failure: a systematic review and meta-analysis. J Gen Internal Med 2019. Epub ahead of print 12 November. https://doi.org/10.1007/s11606-019-05482-w.

    Implications for practice and research

  • Nurses are well equipped to have key roles in facilitating advanced care planning (ACP) for patients and families.

  • Future research of ACP in heart failure (HF) should encompass multiple key components and multidisciplinary teams emphasising ethnic preferences to shift the paradigm of HF end-of-life care.

  • Context

    Heart failure (HF) is a chronic, progressive condition with tremendous burden on healthcare, patients and families. Six million Americans live with HF, projected to be eight million by 2030.¹ Despite medical developments, HF mortality remains 50% 5 years after diagnosis.² As HF progresses, patients, providers and families experience more suffering and symptom burden, impairing quality of...

    Baseline heart failure symptoms have a direct and predictive mediator effect on health-related quality of life in patients with heart failure

    Por: Kennedy · R.

    Commentary on: Heo S, Moser DK, Lennie TA, et al. Prediction of Heart Failure Symptoms and Health-Related Quality of Life at 12 Months From Baseline Modifiable Factors in Patients With Heart Failure. J Cardiovasc Nurs 2020;35(2),116–125.doi: 10.1097/JCN.0000000000000642.

    Implications for practice and research

  • Heart failure (HF) management, which targets multidimensional, modifiable predictors such as New York Heart Association class, depressive symptoms and self-care, may improve HF symptoms and health-related quality of life in the long term.

  • Further longitudinal studies are required in order to establish the nature of the relationship between the modifiable predictors of HF symptoms and how they change over time.

  • Context

    Heart failure (HF) is a chronic condition which is associated with high morbidity and mortality rates, with patients experiencing a major symptom burden and negative effect on their quality of life (QOL).1 Health-related quality of life (HRQOL) is a...

    One in 10 hospitalised patients have a pressure injury worldwide

    Por: Palmer · K. · Hill · J. · Clegg · A.

    Commentary on: Li Z, Lin F, Thalib L, et al. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. Int J Nurs Stud 2020;105:103546. doi: 10.1016/j.ijnurstu.2020.103546. [Epub ahead of print 31 Jan 2020].

    Implications for practice and research

  • The estimated worldwide pressure injury (PI) prevalence is 12.8% in hospitalised adults.

  • Hospitals should continue to see PIs as a priority.

  • Future PI prevalence studies should ensure appropriate sampling methods and training for data collectors.

  • Context

    A pressure injury (PI) or pressure ulcer is localised skin and/or tissue damage which results from sustained pressure and/or shear.1 PIs have significant clinical and economic impact on the patient and healthcare systems with the potential to prolong hospitalisation and increase both morbidity and mortality.2 Despite extensive prevention programmes, evidence suggests that the prevalence of PIs and the...

    Nurses adopt a range of coping strategies when caring for people at the end of life

    Por: Nicol · J.

    Commentary on: Puente-Fernández D, Lozano-Romero MM, Montoya-Juárez R, et al. Nursing professionals’ attitudes, strategies and care practices towards death: a systematic review of qualitative studies. J Nurs Scholarsh 2020;52:301–10.

    Implications for practice and research

  • Nurses can use the explanatory model to help them understand their emotions and the importance of self-care when providing end of life care (EoLC) to patients, and families.

  • Future research should focus on qualitative methods, allowing for better understanding of the relationship between nurses’ attitudes and their EoLC.

  • Context

    Nurses have a pivotal role in providing EoLC to patients and their families. The care individual nurses provide can be influenced by their own attitudes to death and dying, and their perceptions of the quality of care provided at end of life. A review1 concluded that nurses use intrinsic and extrinsic resources to help them cope with the death...

    Tick box cultures and systematised practices may prevent nurses fulfilling their roles as compassionate caregivers

    Por: Lee · A. J.

    Commentary on: Sims S, Leamy M, Levenson R, et al. The delivery of compassionate nursing care in a tick-box culture: Qualitative perspectives from a realist evaluation of intentional rounding. Int J Nurs Stud 2020;107:103580.

    Implications for practice and research

  • Prescriptive ‘intentional rounding’ to systematically assert clinical nursing interactions does not facilitate ‘compassionate care’.

  • Nursing research must interrogate implementation of strategies which assert ‘tick box cultures’, and ensure that such initiatives are evidence based.

  • Context

    Compassion sits at the heart of nursing as one of the fundamental characteristics of the profession.1 It captures empathy, dignity, kindness, respect, morals and virtues, and is contextually dependent on personal, social and cultural viewpoints. In response to calls of neglect and failure to meet basic physiological needs in one UK Hospital Trust, the Francis report,2 concluded ‘regular interactions’ between nurses and patients should be systematic...

    Using smart phone technology can aid in better bowel preparation and improve healthcare delivery

    Por: Yarra · P. · Talari · M. P.

    Commentary on: Guo B, Zuo X, Li Z, et al. Improving the quality of bowel preparation through an app for inpatients undergoing colonoscopy: a randomized controlled trial. J Adv Nurs 2019. doi: 10.1111/jan.14295

    Implications for practice and research

  • Healthcare professionals should recognise and utilise newer technology to improve the quality of bowel preparation for patients undergoing colonoscopy.

  • App-based instructions which are user friendly, personalised and interactive can result in better quality of healthcare delivery.

  • Context

    Colonoscopy is the standard method for screening, diagnostic evaluation and treatment of colorectal lesions.1 Quality of bowel preparation greatly impacts the success of colonoscopy in diagnostic yield, adenoma detection and patient safety.1 2 Multiple studies have shown that inpatients are more likely to have poor bowel preparation.2 Improving bowel preparation by combining conventional tools with newer technology can result in greater...

    Research made simple: using multiperspective interpretative phenomenological analysis to explore healthcare phenomena

    Por: McInally · W. · Gray-Brunton · C.
    Using interpretative phenomenological analysis to explore multiperspectives

    Interpretative phenomenological analysis (IPA) was originally developed in 1995 by Johnathan Smith as a method to undertake experiential research in psychology and has gained prominence across health and social sciences as a way to understand and interpret topics that are complex and emotionally laden, such as chronic illness experiences.1 2 IPA aims to uncover what a lived experience means to the individual through a process of in-depth reflective inquiry.3 The IPA draws on phenomenological thinking, with the purpose to return ‘to the things themselves’3 (p168). However, IPA also acknowledges that we are each influenced by the worlds in which we live and the experiences we encounter. Therefore, IPA is an interpretative process between the researcher and researched, influenced predominantly by Heidegger’s interpretive phenomenology, hermeneutics and idiography. Within IPA, it is typical for researchers...

    Inclusion of people with dementia in research can help nurses understand how to deliver successful reminiscence interventions

    Por: Lee · K.

    Commentary on: Abu Khait, A Shellman, J, Sabo K. Metasynthesis of Patients’ Perspectives about Reminiscence in Dementia Care. West J Nurs Res 2020;1–15. https://doi.org/10.1177/0193945919897927

    Implications for practice and research

  • Understanding reminiscence therapy from the perspectives of people with dementia can assist nurses to deliver reminiscence sessions which reduce negative emotions and improve self-esteem.

  • The inclusion of patient perspectives can enhance further theoretical development of a middle-range theory relating to reminiscence therapy in dementia care.

  • Research methods should be inclusive in their design so as not to exclude people in the later stages of dementia.

  • Context

    Reminiscence is a therapeutic intervention used to support people with dementia. It involves sharing life experiences, memories and stories from the past. While it is suggested that people with dementia can benefit from the principles of reminiscence, there is a lack of supporting evidence from the...

    Patients with hospital-onset sepsis are less likely to receive sepsis bundle care than those with community-onset sepsis

    Por: Basheer · A.

    Commentary on: Baghdadi JD, Wong MD, Uslan DZ et al. Adherence to the SEP-1 Sepsis Bundle in Hospital-Onset v. Community-Onset Sepsis: a Multicenter Retrospective Cohort Study. J Gen Intern Med 2020; Feb 10. doi: 10.1007/s11606-020-05653-0. [Epub ahead of print]

    Implications for practice and research

  • Patients with hospital-onset sepsis are less likely to receive sepsis bundle adherent care compared with community-onset sepsis, reasons for which are multifactorial.

  • High-quality prospective cohort studies are needed to explore disparities in adherence, factors affecting non-adherence and its effect on mortality.

  • Context

    Adherence to sepsis bundles is associated with good outcomes in community-onset sepsis.1 Although evidence for similar benefit is lacking in hospital-onset sepsis, a uniform protocol such as SEP-1 (Severe Sepsis and Septic Shock Early Management Bundle-1) is recommended for all types of sepsis. Limited data suggest disparity in adherence to SEP-1 between community-onset sepsis and hospital-onset...

    Patients with advanced heart failure benefit from tailored multidisciplinary palliative care interventions

    Por: Kennedy · R.

    Commentary on: Datla S, Verberkt CA, Hoye A, et al. Multi-disciplinary palliative care is effective in people with symptomatic heart failure: a systematic review and narrative synthesis. Palliat Med 2019;338:1003–16.

    Implications for practice and research

  • Heart failure management which includes tailored multidisciplinary palliative care (PC) interventions improve patient outcomes, reduces acute hospitalisations and decreases costs.

  • Large multicentre trials need to be conducted to ensure generalisability of the findings with consensus needed regarding the key elements of the PC intervention and study population.

  • Context

    Heart failure (HF) is a chronic condition which is associated with high morbidity and mortality rates with patients experiencing a major symptom burden and negative effect on their quality of life (QOL).1 While pharmacological and technological advancements have been made in the management of HF, the prognosis of patients with HF remain poor and many patients die as a...

    Nurses consider family involvement as an important element of patient care

    Por: Alcindor · M. · Cadet · M.

    Commentary on: Østergaard B, Clausen AM, Agerskov H, et al. Nurses’ attitudes regarding the importance of families in nursing care: a cross-sectional study. J Clin Nurs 2020;297-8:1290–1301. DOI 10.1111/jocn.15196.

    Implications for practice and research

  • Nurses developing a positive attitude towards patient’s families can help create a culture of inclusivity that can be beneficial to support quality nursing care, family cohesiveness and patient safety.

  • Correlational studies are required to explore if relationships exist between the quality of nursing care and family engagement in patients’ care.

  • Context

    There is a growing body of evidence concerning the importance of family involvement in patient care. The evidence base suggests that engaging families in the care of patients supports quality nursing care and patient concordance with treatment.1

    Methods

    Employing a cross-sectional study, 1720 (79%) out of 2177 nurses completed a survey questionaire.

    Cultural diversity needs to be integrated throughout undergraduate nursing curricula

    Por: Walter · R.

    Commentary on: Flateland SM, Pryce-Miller M, Skisland AVS, et al. Exploring the experiences of being an ethnic minority student within undergraduate nurse education: a qualitative study. BMC Nursing, 18:63. https://doi.org/10.1186/s12912-019-0389-0

    Implications for practice and research

  • Diversity training is needed for nurse educators; the numbers of nursing faculty from ethnic minority groups should be increased.

  • Research is needed to identify best practices for equitable academic opportunities for ethnic and cultural minority nursing students.

  • Context

    There is a growing body of evidence suggesting that ethnic and cultural minority students face multiple, unique challenges in completing an undergraduate degree in nursing. The challenges include discrimination, language barriers, social and cultural marginalisation and a lack of culturally sensitive academic support.1 Little is known about the experiences of migrant status students in Scandinavian undergraduate nursing programmes. The current study explored the lived experiences of migrant...

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