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AnteayerWorldviews on Evidence-Based Nursing

Authentic Connections Groups: A Pilot Test of an Intervention Aimed at Enhancing Resilience Among Nurse Leader Mothers

Abstract

Background

Nurse leaders who are mothers are at significant risk for experiencing stress, burnout, and occupational fatigue. Authentic Connections (AC) Groups is an intervention shown to be effective for fostering resilience among at‐risk moms, including physicians; however, it has not previously been tested with nurse leaders.

Aims

Our aims were to test the feasibility and acceptability of the AC Groups intervention with nurse leader mothers and examine its effects on participant resilience, as measured by increased self‐compassion and decreased distress, depression, perceived stress, and burnout.

Methods

A randomized controlled trial design was employed for this pilot study, with 36 nurse leaders at Mayo Clinic. AC participants attended group sessions for an hour per week for 12 weeks. Control group members were provided 1 hr per week of free time over 12 weeks. Multiple self‐report psychological measures were completed at baseline, post‐intervention, and 3‐month follow‐up.

Results

The AC Groups intervention was feasible and well‐received by nurse leaders. Session attendance rates averaged 92%. Despite the small n’s, repeated measures of Analysis of Variance showed significantly greater improvements (p < .05) for participants in the AC Groups than control condition for depression, self‐compassion, and perceived stress, with large effect sizes ( 0.18–0.22). In addition, effect sizes for anxiety and feeling loved approximated the moderate range ( 0.05 and .07).

Linking Evidence to Action

The AC intervention shows promise as a feasible intervention for mitigating nurse leader mothers’ stress by positively impacting indices of well‐being, including depression, self‐compassion, and perceived stress. Given, the prevalence of stress and burnout among nurse leaders, the effectiveness of the AC intervention in fostering resilience in this population has significant implications for research and practice. Further research is warranted with larger numbers from multiple sites, longer follow‐up periods, and biomarker measures of stress.

A Longitudinal Analysis of Nurse Suicide in the United States (2005–2016) With Recommendations for Action

Abstract

Background

Previous studies have demonstrated nurses are at risk of suicide. This is the first national longitudinal study of U.S. nurse suicide.

Aims

To identify the longitudinal incidence, method, and risks of nurse suicide in the United States.

Methods

2005 to 2016 Centers for Disease Control and Prevention National Violent Death Reporting System retrospective analysis of suicide incident rate ratios (IRR).

Results

A total of 1,824 nurse and 152,495 non‐nurse suicides were evaluated. Nurses were at greater risk of suicide than the general population (female IRR 1.395, 95% confidence intervals [CI] 1.323, 1.470, p < .001; male IRR 1.205, 95% CI 1.083, 1.338, p < .001). Female nurses who completed suicide did so most frequently by pharmacologic poisoning (n = 399, 27.2% vs. n = 8,843, 26.9%), whereby male nurses and the general public used firearms (n = 148, 41.7% vs. n = 57,887, 48.4%). Job problems were more likely in nurses (female odds ratio [OR] 1.989, 95% CI 1.695, 2.325, p < .001; male OR 1.814, 95% CI 1.380, 2.359, p < .001), as well as mental health history (female OR 1.126, 95% CI 1.013, 1.253, p < .027; male OR 1.302, 95% CI 1.048, 1.614, p = .016) and leaving a suicide note (female OR 1.221, 95% CI 1.096, 1.360, p < .001; male OR 1.756 [1.412, 2.181], p < .001).

Linking Evidence to Action

The increased risk of suicide in nurses is congruent with previous reports. The consistency in results increases confidence that findings are generalizable and warrant action. The use of pharmacologic poisoning as a method of suicide, most often by opioids and benzodiazepines, indicates a need for improved identification and treatment of nurses with substance use. Workplace wellness programs need to focus on reducing workplace stressors. Further research is indicated to determine best prevention methods. Policy indications include the need to accurately track gender in nursing, enhance substance use disorder programs, and mandate suicide prevention activities.

Sustainability and Outcomes of a Suicide Prevention Program for Nurses

Abstract

Background

We now know that nurses are at greater risk for suicide than others in the general population. It is known that job stressors are prevalent in nurses who die by suicide. Yet, little is known about targeted suicide prevention for nurses. The first nurse‐centric Healer Education Assessment and Referral (HEAR) suicide prevention program was piloted for 6 months in 2016. The HEAR program was effective in identifying at‐risk nurses.

Aim

The purpose of this paper is to report the 3‐year sustainability and outcomes of this nurse suicide prevention program.

Methods

Descriptive statistics are provided of program outcomes over the course of 3 years.

Results

Over the 3 years, 527 nurses have taken advantage of the screening portion of the program. Of these, 254 (48%) were Tier 1 high risk, and 270 (51.2%) were Tier 2 moderate risk. A startling 48 (9%) had expressed thoughts of taking their own life, 51 (9.7%) had a previous suicide attempt, whereas only 79 (15%) were receiving counseling or therapy. One hundred seventy‐six nurses received support from therapists electronically, over the phone, or in person; 98 nurses accepted referral for treatment. The number of group emotional debriefs rose from eight in 2016 to 15 in 2017 to 38 in fiscal year 2019. Many of the debriefs are now requested (vs. offered), demonstrating the development of a culture open to reaching out for mental health treatment.

Linking Evidence to Action

The initial success of this pilot program has been sustained. A nurse suicide prevention program of education, assessment, and referral is feasible, well‐received, proactively identifies nurses with reported suicidality and facilitates referral for care. The HEAR program has provided service to physicians and residents for 10 years and now supports effectiveness in nurses. The HEAR program is portable and ready for replication at other institutions.

The Effects of an Intensive Evidence‐Based Practice Educational and Skills Building Program on EBP Competency and Attributes

Abstract

Background and Significance

Evidence‐based practice (EBP) is a systematic problem‐solving approach to the delivery of health care that improves quality and population health outcomes as well as reduces costs and empowers clinicians to fully engage in their role, otherwise known as the quadruple aim in health care. The Helene Fuld Health Trust National Institute for Evidence‐based Practice in Nursing and Healthcare at The Ohio State University College of Nursing has been offering 5‐day EBP immersion programs since 2012. The goal of the program is for the participants to acquire EBP competence (e.g., knowledge, skills, and attitude) and sustain it over time.

Purpose and Aims

The purpose of this study was to evaluate the effects of the 5‐day EBP immersion (i.e., an education and skills building program) on EBP attributes and competence over time.

Method and Design

A longitudinal pre‐experimental study was conducted that gathered data with an anonymous online survey from 400 program attendees who attended 16 5‐day immersions between September 2014 and May 2016. Participants completed five valid and reliable instruments at four points over 12 months, including EBP beliefs, implementation, competency, knowledge, and perception of organizational readiness and culture.

Results

Findings indicated statistically significant improvements in EBP attributes and competency over time. The results of this study support the hypotheses that EBP competency and attributes can be significantly improved and sustained by attending an intensive 5‐day EBP educational and skills building program such as the one described in this study. This study can help leaders and organizations to mitigate many of the traditional barriers to EBP.

Linking Evidence to Action

The results of this study indicate that EBP attributes and competencies can be improved and sustained by attending an intensive 5‐day EBP immersion, regardless of clinicians’ prior educational preparation.

Issue Information

Worldviews on Evidence-Based Nursing, Volume 17, Issue 1, Page 1-1, February 2020.

Prevalence and Correlates of Depression, Anxiety, Stress, Healthy Beliefs, and Lifestyle Behaviors in First‐Year Graduate Health Sciences Students

Abstract

Background

Graduate and professional students are reported to have higher than average rates of depression compared to age‐ and gender‐matched populations. Further, more than half of student health visits are due to anxiety, yet little is known about the relationships among depression, anxiety, and healthy lifestyle behaviors in this population as well as what factors predict depression and anxiety.

Aims

The purposes of this study were as follows: (a) to examine the prevalence of depression, anxiety, stress, physical health, healthy beliefs, and lifestyle behaviors in incoming first‐year health sciences professional students; (b) to describe the relationships among these variables; and (c) to determine predictors of depression and anxiety.

Methods

A descriptive correlational study design was used with baseline data collected from first‐year graduate health sciences students from seven health professions colleges who were participating in a wellness onboarding intervention program, including Dentistry, Medicine, Nursing, Optometry, Pharmacy, Social Work, and Veterinary Medicine.

Results

Seventeen percent of incoming students reported moderate‐to‐severe depressive symptoms with 6% reporting suicidal ideation. In addition, 14% of the participating students reported moderate‐to‐severe anxiety. Factors that predicted depression and anxiety included having less than 7 hr of sleep per night, worse general health, lower healthy lifestyle beliefs, lower healthy lifestyle behaviors, higher stress, and a perceived lack of control.

Linking Evidence to Action

These findings highlight the need to routinely screen incoming health sciences students for depression and anxiety upon entrance into their academic programs so that evidence‐based interventions can be delivered and students who report severe depression or suicidal ideation can be immediately triaged for further evaluation and treatment. Providing cultures of well‐being and emphasizing self‐care throughout academic programs also are essential for students to engage in healthy lifestyles.

Evaluating the Outcomes of a Web‐Based Stress Management Program for Nurses and Nursing Assistants

Abstract

Objective

The purpose of this quality improvement project was to determine the utilization, satisfaction, and effect of a web‐based stress management program for nurses and nursing assistants (NAs).

Methods

This quality improvement project provided BREATHE, a web‐based stress management program that consisted of six modules that describe, identify, and help nurses manage stress for 31 nurses and NAs working on a subacute rehabilitation unit at a mid‐Atlantic community hospital.

Measurements

The number of login attempts and time spent on the program were included, as were the nurse stress scale (NSS), a 34‐item validated instrument that captures seven dimensions of stress, and a seven‐item satisfaction survey given at the end of the modules.

Results

Nurses utilized and were satisfied with the evidence‐based program BREATHE and reported significant improvement in NSS scores.

Linking Evidence to Action

Findings suggest that BREATHE was effective at reducing the NSS score among nurses and NAs. The web‐based nature of the program allowed nurses to engage in it at times most convenient for them, which added to the program’s acceptability and overall satisfaction.

Has the Reporting Quality of Systematic Review Abstracts in Nursing Improved Since the Release of PRISMA for Abstracts? A Survey of High‐Profile Nursing Journals

Abstract

Background

The PRISMA for Abstracts (PRISMA‐A) was developed to guide authors to present a structured abstract. However, the adherence of abstracts to these guidelines in some areas was of concern.

Aims

To determine whether the publication of PRISMA‐A resulted in an improvement in the abstracts reported with nursing systematic reviews (SRs).

Methods

This was a cross‐sectional study. We searched PubMed for randomized controlled trials–based SRs published in top‐tier nursing journals. A PRISMA‐A checklist was used to assess abstracts in the SR included. Total score on checklists, comparison of total scores between two periods, and effect factors were analyzed.

Results

Overall, abstract reporting compliance with PRISMA‐A has not improved significantly with the time span. Of the 81 SRs, 74.1% were structured. About half reported eligibility criteria, information sources, and description of the effect as recommended. Registration status was reported only in 4.9%. The reporting quality was significantly higher for journals with higher impact factors (p < .001).

Linking Evidence to Action

Although not inclusive of all SRs in the nursing field, our sample reflects the general trend that there was no significant improvement in the compliance of SR abstracts reported in nursing with the release of PRISMA‐A. There is room for improvement, as most items have not been fully reported.

Estimation of Body Fluid Status by Fluid Balance and Body Weight in Critically Ill Adult Patients: A Systematic Review

Abstract

Background

The charting of daily fluid balances and measurement of body weight changes are two noninvasive methods commonly used in the intensive care unit for estimating body fluid status. The determination of body fluid status plays an important role in the management of critically ill patients where aggressive fluid resuscitation is often required. This can adversely affect patient outcomes if changes in fluid distribution are not detected early in patients who are susceptible to fluid overload.

Aim

To synthesize the best available evidence on the accuracy of daily fluid balance charting compared with the measurement of body weight for the estimation of body fluid status in critically ill adult patients.

Methods

The review considered studies that investigated the accuracy of charting daily fluid balances or changes in body weight measurements or used both noninvasive methods in the estimation of body fluid status. The search sought to identify published, English language studies from 1980 until February 2018. Databases searched included MEDLINE, CINAHL, EMBASE, TRIP, Scopus, TROVE, ProQuest Dissertations, Australian and New Zealand Trials Registry, and Cochrane Central Register of Clinical Trials. Three reviewers independently assessed retrieved studies that matched inclusion criteria using standardized critical appraisal instruments.

Results

The review included 13 cohort studies. Effectiveness of daily fluid balance charting was affected by inaccuracies observed in seven studies. Inability to obtain consecutive daily body weight measurements reduced the accuracy of monitoring changes in five studies. Seven studies found measurement of daily fluid balance inconsistent with changes in body weight.

Linking Evidence to Action

The accuracy of charting fluid balance is suspect. Measurement of body weight is hard to accomplish. A combination of the two commonly used methods is more likely to be effective in estimating body fluid status than reliance on one single approach.

Nurse‐Led Tele‐Coaching on Modifiable Cardiovascular Risk Factors in People with Type 2 Diabetes Mellitus: A Systematic Review and Meta‐Analysis

Abstract

Background

Tele‐coaching has been used by nurses as one of the accessible and sustainable interventions for individuals with type 2 diabetes mellitus. However, evidence has been lacking to demonstrate its effectiveness in mitigating the related cardiovascular risk factors.

Aims

To systematically evaluate the effectiveness of nurse‐led tele‐coaching on the modifiable cardiovascular risk factors (glycated hemoglobin, blood pressure, & lipid levels) among individuals with type 2 diabetes mellitus.

Methods

A systematic search of eight databases (Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, PsycINFO, Web of Science, & ProQuest Dissertations and Theses) was conducted for randomized controlled trials of nurse‐led tele‐coaching for individuals with type 2 diabetes mellitus published in English up to October 30, 2018. A meta‐analysis was conducted for the primary outcomes of the studies.

Results

Twelve randomized controlled trials were selected that included 3,030 participants. Results from the meta‐analysis revealed statistically significant reductions for not only glycated hemoglobin (pooled mean difference = −1.23, 95% CI: −1.63 to −0.8, I 2 = 0%, p < .00) but also systolic blood pressure (SBP; pooled mean difference = −2.22, 95% CI: −3.95 to −0.49, I 2 = 0%, p < .01); such findings are supportive of the use of nurse‐led tele‐coaching on the primary outcome.

Linking Evidence to Action

Results from the meta‐analyses have shown that nurse‐led tele‐coaching is an effective and accessible intervention that could improve the glycemic control and SBP among individuals with type 2 diabetes mellitus.

External Facilitation as an Evidence‐Based Practice Implementation Strategy During an Antibiotic Stewardship Collaborative in Neonatal Intensive Care Units

Abstract

Background

Despite research support, evidence‐based practices (EBPs) are inconsistently implemented throughout the United States. Facilitation is one implementation strategy to speed adoption in clinical settings. Facilitation has not been previously described in the literature as an implementation strategy within neonatal care.

Purpose

The purpose of this study was to categorize and describe essential features of facilitation in the context of implementing an EBP using perspectives elicited from neonatal clinicians and external facilitators (EFs).

Methods

In this qualitative descriptive study, semistructured interviews were conducted with a purposive sample of neonatal clinicians and EFs. Participants shared their experiences related to the strategy of facilitation while implementing an EBP during the California Perinatal Quality Care Antibiotic Stewardship Collaborative. Interviews were transcribed, coded, and analyzed using directed content analysis.

Results

Five categories emerged to address facilitation as an implementation strategy: (a) facilitated change management, (b) unit and organization receptivity, (c) evaluation strategies, (d) supportive culture, and (e) facilitator stewardship.

Linking Evidence to Action

Implementing EBP is complex and multifactorial. Results from this study provide insights into influencing barriers and drivers as experienced by internal and external facilitators, and context factors that impacted the success of implementation.

Is Donated Breast Milk Better Than Formula for Feeding Very Low Birth Weight Infants? A Systematic Review and Meta‐Analysis

Abstract

Background

The role of donated breast milk and formula feeding in very low birth weight infants (VLBWIs) remains unclear.

Objective

The objective for this study was to evaluate the efficacy and safety of breast milk and formula for feeding VLBWIs.

Methods

A comprehensive search of PubMed databases was conducted on November 30, 2018, to identify related randomized controlled trials (RCTs). Pooled odds ratio (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using either a fixed or random‐effects model.

Results

Seven RCTs with a total of 876 infants were included. The formula showed more advantages in increasing infant weight (MD = −6.58, 95% CI: −11.19 to −1.98) and length (MD = −0.30, 95% CI: −0.41 to −0.20) than donated breast milk, but formula could also significantly increase the risks of necrotizing enterocolitis (OR = 0.33, 95% CI: 0.18 to 0.59) and length of hospital stay (MD = −3.78, 95% CI: −6.84 to −0.72) when compared with donated breast milk. No significant differences on the head circumference gain (MD = −0.16, 95% CI: −0.33 to 0.01), sepsis (OR = 1.21, 95% CI: 0.84 to 1.75), retinopathy of prematurity (OR = 1.22, 95% CI: 0.73 to 2.05) and mortality (OR = 0.84, 95% CI: 0.47 to 1.52) were found.

Linking Evidence to Action

The donated breast milk shows more advantages in reducing the incidence of NEC and length of hospital stay, but also more disadvantages in increasing the weight and length of VLBWIs and ELBWIs when compared with preterm formula feeding. Currently, there is no solid evidence demonstrating a significant advantage of donated breast milk over formula in the feeding of VLBWIs. Larger‐scale RCTs with rigorous designs are needed to elucidate the feeding plans of VLBWIs.

Issue Information

Worldviews on Evidence-Based Nursing, Volume 16, Issue 6, Page 421-421, December 2019.

The MINDBODYSTRONG Intervention for New Nurse Residents: 6‐Month Effects on Mental Health Outcomes, Healthy Lifestyle Behaviors, and Job Satisfaction

Abstract

Background

In 2017, the National Academy of Medicine convened its Action Collaborative for Clinician Well‐being and Resilience in an effort to stem the epidemic levels of burnout, depression, and suicide among healthcare clinicians. Nurses report higher rates of substance abuse, depression, and suicide than the national average. Newly licensed registered nurses (NLRNs) report high levels of burnout and stress. Suboptimal health in nurses is linked to medical errors. Few studies address the mental health and lifestyle behaviors of NLRNs or provide evidence‐based solutions to improve these outcomes.

Aims

This study evaluated the 6‐month effects of the MINDBODYSTRONG for Healthcare Professionals program on the mental health, healthy lifestyle behaviors, and job satisfaction of NLRNs participating in a nurse residency program.

Methods

A two‐group randomized controlled trial was conducted with 89 NLRNs at a large, Midwestern academic medical center. The intervention group received eight 30– to 35‐min weekly sessions as part of the MINDBODYSTRONG program, a cognitive behavioral skill‐building program incorporating strategies to improve mental and physical health. The control group acted as the attention control group receiving eight weekly 30– to 35‐min debriefing sessions as part of the normal nurse residency program.

Results

Data were collected at baseline, immediately postintervention, 3 months postintervention, and 6 months postintervention. The intervention group scored better on mental health outcomes, healthy lifestyle behaviors, and job satisfaction at 6 months postintervention than the control group. Significant improvements were found for depressive symptoms and job satisfaction; there were moderate to large positive effects for the MINDBODYSTRONG program on all variables.

Linking Evidence to Action

The MINDBODYSTRONG program sustained its positive effects across time and has excellent potential as an evidence‐based intervention for improving the mental health, healthy lifestyle behaviors, and job satisfaction in NLRNs.

The Effectiveness of Parenting Interventions on Psychosocial Adjustment in Parents of Children and Adolescents with Type 1 Diabetes: A Meta‐Analysis

Abstract

Aims

Parenting interventions in this review refer to supportive parenting training provided for parents or primary caregivers of children and adolescents with type 1 diabetes mellitus (T1DM). The review aimed to synthesize evidence about parenting interventions in parents or caregivers of children and adolescents with T1DM, and to evaluate the effect of interventions in reducing parents’ or caregivers’ psychological distress, helping them share diabetes management responsibility, seek social support, and improve their quality of life.

Methods

We searched PubMed, MEDLINE, EMBASE, CINAHL, Cochrane, and Web of Science from January 1978 to October 2018. Randomized controlled trials (RCTs) comparing an intervention group of parenting programs with a control group of usual care were included. The primary outcomes were stress, family responsibility and conflict, and social support. Secondary outcomes included other psychological index and quality of life. Pooled effect sizes of weighted mean difference (WMD) were calculated.

Results

A total of 17 RCTs with 962 participants met the inclusion criteria. Findings of the meta‐analysis showed parenting interventions could significantly reduce parents’ depression (WMD = −5.78, 95% CI: −6.23 to −5.33, I 2 = 0%) and distress (WMD = −5.28, 95% CI: −10.31 to −.25, I 2 = 0%), and help them ask for positive social support (WMD = .83, 95% CI: .03 to 1.64, I 2 = 0%). No beneficial changes of other outcomes were found.

Linking Evidence to Action

Parents of children and adolescents with T1DM need support from the multidisciplinary team in health care, especially in mental health, family management of childhood diabetes, and social support. Parenting interventions may help parents reduce psychological distress and depression and assist them to ask for social support. Future research should include well‐designed RCTs with large samples, appropriate measures with clear definitions, objective assessment, and separation of effects on mothers and fathers.

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