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AnteayerWorldviews on Evidence-Based Nursing

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.

Effects of Probiotics, Prebiotics, and Synbiotics on Calcium Homeostasis and Bone Health With Aging: A Systematic Review

Abstract

Background

Calcium homeostasis and bone health are an increasing concern for middle‐aged and older adults. Many studies have explored the positive effects of probiotics, prebiotics, or synbiotics on serum calcium and bone mineral density (BMD) or other parameters related to bone health. However, the participants, the species, doses and duration of interventions, outcomes, and measurements varied among these studies.

Aims

To systematically evaluate the effect of probiotics, prebiotics, or synbiotics on maintaining calcium homeostasis and improving bone health in middle‐aged and older adults.

Methods

We identified studies in Cochrane Library, Embase, PubMed, Web of Science, CINAHL, China National Knowledge Infrastructure, and Wanfang and articles in English and Chinese published from inception up to January 10, 2019. Randomized controlled trials (RCTs) involving probiotics, prebiotics, or synbiotics for middle‐aged or older adults were employed for meta‐analysis by using RevMan 5.3, and heterogeneity and risk of bias assessment were performed.

Results

A total of eight studies, involving 564 participants, were included. Probiotics, prebiotics, or synbiotics supplementation was able to significantly elevate serum calcium levels (0.52 mg/dl, 95% CI [0.38, 0.66]), heterogeneity: p = .13, I 2 = 44%), while the results of meta‐analysis failed to support the effects of this supplementation on the parameters related to bone health in middle‐aged and older adults, including BMD, parathyroid hormone, osteocalcin, and alkaline phosphatase.

Linking Evidence to Action

Probiotics, prebiotics, or synbiotics supplementation exerts a facilitating influence on the level of serum calcium, while the present study has not yet supported the beneficial effects of such interventions on bone health. Therefore, further studies with high‐quality RCTs are required to determine the effects of probiotics, prebiotics, or synbiotics supplementation on middle‐aged and older adults.

EBP Implementation Leadership of Frontline Nurse Managers: Validation of the Implementation Leadership Scale in Acute Care

Abstract

Background

Frontline nurse managers influence the implementation of evidence‐based practices (EBP); however, there is a need for valid and reliable instruments to measure their leadership behaviors for EBP implementation in acute care settings.

Aim

The aim of this study was to evaluate the validity and reliability of the Implementation Leadership Scale (ILS) in acute care settings using two unique nurse samples.

Methods

This study is a secondary analysis of ILS data obtained through two distinct multisite cross‐sectional studies. Sample 1 included 200 registered nurses from one large Californian health system. Sample 2 was 284 registered nurses from seven Midwest and Northeast U.S. hospitals. Two separate studies by different research teams collected responses using written and electronic questionnaires. We analyzed each sample independently. Descriptive statistics described individual item, total, and subscale scores. We analyzed validity using confirmatory factor analysis and within‐unit agreement (awg). We evaluated factorial invariance using multigroup confirmatory factor analyses and evaluating change in chi‐square and comparative fit index values. We evaluated reliability using Cronbach's alpha.

Results

Confirmatory factor analyses in both samples provided strong support for first‐ and second‐order factor structure of the ILS. The factor structure did not differ between the two samples. Across both samples, internal consistency reliability was strong (Cronbach's alpha: 0.91–0.98), as was within‐unit agreement (awg: 0.70–0.80).

Linking Evidence to Action

Frontline manager implementation leadership is a critical contextual factor influencing EBP implementation. This study provides strong evidence supporting the validity and reliability of the ILS to measure implementation leadership behaviors of nursing frontline managers in acute care. The ILS can help clinicians, researchers, and leaders in nursing contexts assess frontline manager implementation leadership, deliver interventions to target areas needing improvement, and improve implementation of EBP.

What Do Nurses Need to Practice Effectively in the Hospital Environment? An Integrative Review With Implications for Nurse Leaders

Abstract

Background

When staffing legislation was introduced, New Jersey nurse leaders recognized from the research and their years of clinical leadership experience that the work environment is a multidimensional concept and that staffing is not the only variable related to nurse and patient outcomes. Thus, an understanding of what nurses need in their hospital environment to practice nursing effectively was sought.

Aims

The aim of this study was to examine the evidence regarding clinical nurses’ perception of what they need to practice nursing effectively in the acute care hospital environment.

Methods

The following population, intervention, comparison, outcome question was used to search the literature databases PubMed, CINAHL, Johanna Briggs, and the Sigma Theta Tau Henderson Library: In the hospital environment what do nurses perceive as needed to practice nursing effectively? Specific search criteria and the Johns Hopkins nursing guidelines and tools were used to identify relative studies.

Results

The final review, which addressed what nurses in the hospital environment need to practice nursing effectively, included 25 articles: 20 were an evidence level III, and five were evidence level II. From this review, five key concepts were identified: Leadership, autonomy/decision making, respect/teamwork, resources/staffing, and organizational commitment to nursing.

Linking Evidence to Action

This integrative review, which explored nurses’ perceptions of what is needed to provide effective quality care, identified that providing quality care is multifactorial in nature. Resources, including but not limited to staffing, and leadership were identified as important by nurses as a key factor in supporting quality care. Nurses must be provided with resources and infrastructure to do their jobs, in an environment supported by authentic transformational leadership.

Effects of a Symptom Management Program for Patients With Type 2 Diabetes: Implications for Evidence‐Based Practice

Abstract

Background

Findings from previous studies examining the effectiveness of symptom management on patients with diabetes that were implemented in home settings were inconclusive. Exploring the effects of a diabetes symptom management program on patients with type 2 diabetes mellitus (T2DM) in clinical settings is useful for healthcare providers to improve their diabetes care.

Aims

To examine the effects of a diabetes symptom management program (DSMP) on HbA1c levels, self‐care behaviors, quality of life (QoL), and symptom severity in clinics in patients with T2DM.

Methods

This study was a single‐blind randomized controlled trial. The control group (= 30) received usual care. The experimental group (= 30) received DSMP and usual care. The primary outcome variable was HbA1c levels; the secondary outcome variables were self‐care behaviors, QoL, and diabetes symptom severity. Outcome variables were measured at baseline (T0), 3 months (T1) and 6 months after the intervention (T2), and HbA1c levels were further collected at 9 months after the intervention (T3).

Results

The decreasing levels of HbA1c from T0 to T2 and from T0 to T3 and for severity of diabetes symptoms from T0 to T2 in the experimental group were significantly better than those in the control group. The increasing levels of self‐care behavior and QoL from T0 to T1 and from T0 to T2 in the experimental group were significantly higher than those in the control group.

Linking Evidence to Action

DSMP implemented in the clinic setting has effects on improving HbA1c, self‐care behaviors, QoL, and preventing worsening severity of diabetes symptoms for outpatients with T2DM. Healthcare providers could assess diabetes symptoms of patients with high HbA1c levels and provide symptom management care rather than merely providing education on improvement of self‐care behaviors.

Issue Information

Worldviews on Evidence-Based Nursing, Volume 16, Issue 5, Page 331-331, October 2019.

Does Simulation Training for Acute Care Nurses Improve Patient Safety Outcomes: A Systematic Review to Inform Evidence‐Based Practice

Abstract

Background

Simulation is increasingly used as a training tool for acute care medical‐surgical nurses to improve patient safety outcomes. A synthesis of the evidence is needed to describe the characteristics of research studies about acute care nurse simulation trainings and patient safety. An additional purpose is to examine the effects of acute care registered nurse (RN) simulation trainings on patient safety outcomes.

Methods

Five Internet databases were searched for articles published on any date through October 2018 examining the effect of RN simulation trainings on patient safety outcomes in the adult acute care setting.

Sample

N = 12 articles represented 844 RNs of varying experience levels and 271 interprofessional participants.

Results

Nine studies (75%) used high‐fidelity scenarios developed locally about high risk but infrequent events. Five studies (42%) incorporated interdisciplinary team members in the scenarios and/or outcome evaluations. Outcome measures were self‐reported, direct observation, or clinical indicators. All studies in this review achieved improved patient safety outcomes. It is unknown how outcomes vary for different groups of RNs because of insufficient gender, ethnicity/race, and age reporting.

Linking Evidence to Action

Findings support the design of simulation training research studies for patient safety outcomes and use of simulation training and research in acute care RNs. Additional high‐quality research is needed to support this field. Future studies should include descriptors that characterize the sample (i.e., age, gender, education level, type of nursing degree, ethnicity or race, or years of experience); incorporate interdisciplinary teams; evaluate a combination of outcome measure types (i.e., self‐report, direct observation, and clinical outcomes) both proximal and distal to the simulation; and that utilize standardized scenarios, validated outcome measure instruments, and standardized debriefing tools.

An Evidence‐Based Approach to Outcome Measurement in Oral and Dental Health Services: Oral Health‐Related Quality of Life and Oral Health Impact

Abstract

Purpose

The purpose of this study was to examine the Oral Health‐Related Quality of Life (OHRQOL) and Oral Health Impact Profile (OHIP) of oral and dental health patients in terms of gender, educational status, and the reason for coming to the oral health center. Also, we investigated the relationships between OHRQOL and OHIP.

Methods

This cross‐sectional study was conducted and planned for dental patients in Turkey. OHRQOL‐United Kingdom (OHRQOL‐UK) and OHIP‐14 were used for data collection. Descriptive statistics, correlation analysis, student t‐tests, and ANOVA were used for data analyses.

Results

Of 527 respondents, 62.8% were female, and 37.2% were male. One‐hundred‐forty‐one (26.8%) participants were illiterate. Three‐hundred‐fifty‐four (67.20%) dental patients had an elementary school degree. Only 32 (6.10%) participants graduated from college and bachelor programs. For dimensions of the OHIP‐14 and OHRQOL‐UK, we detected statistically significant differences in personal characteristics. We found that gender, marital status, age, education status, and reasons for coming to the hospital have a significant impact on OHRQOL and OHIP.

Linking Evidence to Action

These results are expected to provide important evidence‐based information to health managers and decision‐makers in health planning and reimbursement policies. Clinicians and health managers should use OHIP, quality of life (QOL), and evidence‐based practice to determine individual treatments and approaches to improve oral health. QOL is an outcome indicator in healthcare services and evidence‐based practice. Measurements of evidence‐based health outcomes in national health systems can be made, and global comparisons and policies in oral and dental health can be developed.

Development and Validation of the Dutch EBPAS‐ve and EBPQ‐ve for Nursing Assistants and Nurses with a Vocational Education

Abstract

Background

In recent years, there has been an increasing focus on the role of evidence‐based practice (EBP) to increase the quality and safety of care. However, EBP implementation research has predominantly taken place in hospitals and hardly in nursing homes or home care. In these care settings, patients are attended by nursing assistants and registered vocationally trained nurses. A good EBP starting point is to assess their current attitude toward and use of EBP. However, current questionnaires are not valid for assistants and nurses with vocational education.

Aims

To adapt the Evidence‐Based Practice Attitude Scale (EBPAS) and the Evidence‐Based Practice Questionnaire (EBPQ) to a Dutch questionnaire for nursing assistants and registered vocationally trained nurses European Qualification Framework level 3–4 employed in home care or nursing homes.

Methods

Translation, adaptation through cross‐cultural validation, pretesting, exploratory factor analysis, and evaluation of psychometric properties among a group of nursing assistants and registered vocationally trained nurses.

Results

Cross‐cultural validation led to modified items of EBPQ and EBPAS. The sample comprised 273 nurses. Analysis of both instruments showed a robust factor structure. EBPAS‐ve: internal consistency: α = 0.76; intra‐rater reliability: ICC = 0.52. EBPQ‐ve: α = 0.75; ICC = 0.60. Convergent validity (correlation EBPAS‐ve and EBPQ‐ve's subscale Attitude): r = .300 (p < .01). Construct validity: significantly higher scores (p < .01) in the group with higher education.

Linking Evidence to Action

Psychometric qualities of both instruments were satisfactory, although we recommend refinement of EBPAS‐ve's subscale Divergence and extra instructions for the EBPQ's subscale Attitude. To our knowledge, this is the first adaptation of an EBP measurement instrument for nursing assistants and registered vocationally trained nurses. The questionnaires appeared to be feasible and showed multiple valid and reliable properties, including a satisfactory intra‐rater reliability. Both questionnaires may facilitate the implementation of EBP as they contribute to a richer understanding of the attitude toward and use of EBP in nursing homes and home care.

Implementation of Nurse‐Driven HIV Screening Targeting Key Populations in Emergency Departments: A Multilevel Analysis From the DICI‐VIH Trial

Abstract

Background

In countries with concentrated HIV epidemics, optimizing screening to reach individuals with undiagnosed infection is essential. The DICI‐VIH study, a cluster‐randomized crossover trial conducted in eight French emergency departments (EDs), found that a strategy combining nurse‐driven targeted HIV screening with routine diagnostic testing was effective.

Aim

The aim was to investigate factors associated with the implementation of HIV screening targeting key populations in EDs.

Methods

A self‐administered questionnaire was distributed at registration to patients aged 18–64 years and able to give consent during the DICI‐VIH intervention. Based on their responses, those belonging to key populations were offered a rapid test by triage nurses. Two key stages of the process were evaluated: questionnaire distribution by providers and test acceptance by patients. Patient information, daily workload, and ED characteristics were collected. The associations between these variables and (a) the proportion of questionnaires distributed and (b) the proportion of tests accepted were evaluated using multilevel modeling in order to examine differences in screening implementation between EDs.

Results

Questionnaire distribution proportions varied from 23% to 48% across EDs. They were higher on weekdays than weekends (odds ratio, OR: 3.77; 95% CI: 3.57–3.99) and when research staff participated (OR: 1.31; 95% CI: 1.26–1.37). They decreased over time (OR: 0.76; 95% CI: 0.71–0.82; 4th [Q3] vs. 1st quartile [Q0] of intervention days) and with increased patient flow (OR: 0.61; 95% CI: 0.56–0.67; Q3 vs. Q0 of eligible patients). Test acceptance varied from 64% to 77% across EDs, increased with research staff participation (OR 1.20; 95% CI: 1.03–1.40), and decreased over time (OR: 0.75; 95% CI: 0.60–0.92; Q3 vs. Q0). Patients who accepted were more likely to be younger (OR: 0.76; 95% CI: 0.61–0.96; 50–64‐year‐old vs. 30–39‐year‐old patients).

Linking Evidence to Action

Patient flow, intervention duration, weekdays, and research staff participation were important determinants of targeted screening implementation. These findings could help guide future implementation in similar settings.

Emotional Expression of Persons with Dementia: An Integrative Review with Implications for Evidence‐Based Practice

Abstract

Background

The ability to express emotion typically is preserved longer than language and cognitive function in persons living with dementia. Emotional expression may be an important indicator of underlying individual needs and feelings and may therefore facilitate person‐centered care.

Aims

This review aimed to examine how emotional expression has been described, measured, and utilized in empirical studies.

Methods

The design of this study was an integrative literature review. A systematic search was conducted through electronic databases using defined search terms. Articles published up to March 2018 were included. The method proposed by Whittemore and Knafl was used for data synthesis and review integration. Quality appraisal of the selected articles was evaluated by the Mixed Methods Assessment Tool.

Results

Most of the articles used feeling‐related terms without specific definitions. Less frequently, terms such as affect, emotion, and mood were defined. Although these terms were used interchangeably in the articles, affect, which was defined as expressed emotion in general, was a comprehensive term to encompass other terms. Measurement of emotional expression was performed using observational methods, with direct observation or video recording using a hand‐held camera. In both cases, observed emotion was coded with diverse methods or tools. In studies, the emotional expression was utilized as (a) an outcome to demonstrate the effect of interventions, (b) a factor to show relationship with other variables, or (c) an observed value itself.

Linking Evidence to Action

This review provides insights about measurement options for emotional expressions among persons with dementia in long‐term care. Long‐term care staff should pay attention to emotional expression of persons with dementia to understand underlying unmet needs. Development of adequate measurement of emotional expression could facilitate development of emotion‐oriented intervention program to improve psychological well‐being and the behavioral and functional health of persons living with dementia.

Issue Information

Worldviews on Evidence-Based Nursing, Volume 16, Issue 4, Page 251-251, August 2019.

Implementing Follow‐Along Physical Activity Videos with People Living With Chronic Conditions: A Feasibility Study

Abstract

Background

Compelling evidence supports multiple benefits of physical activity (PA) even in small bursts. Less than 50% of Americans achieve recommended PA levels, lower still for individuals living with chronic illness or disease.

Purpose

The purpose of this study was to develop and evaluate the feasibility and preliminary effects of 3‐min follow‐along video scenarios to promote brief episodes of low–moderate levels of PA among individuals with chronic diseases.

Methods

Guided by our previous studies and self‐efficacy theory, the program (WellMe in 3© for Patients) was modeled after another program developed for healthcare staff. An advisory panel and a health and fitness expert guided the creation of twelve 3‐min video scenarios that included two individuals living with chronic illness and a fitness leader who guided the PA scenarios and how to adapt them based on limitations. The 12 scenarios included 3 min of aerobic activities, stretching, or balance. Preliminary pilot effects were measured among 39 patients living with chronic conditions for one month. Standardized instruments were used to measure PA levels, PA self‐efficacy (SE), and quality of life (QoL); usability and satisfaction were assessed using researcher‐developed tools. Descriptive and inferential statistics were used to evaluate change over time.

Results

Twelve video scenarios were created tailored to persons with chronic illness. Thirty‐nine participants piloted the program, reporting an average of two chronic conditions. Baseline QoL scores were lower than normative data, self‐efficacy scores were low‐to‐moderate, and PA levels were very low. Participants averaged using one video per day. 62% of participants provided complete self‐reported pre‐ and post‐QoL and SE data and 41% provided pre‐ and post‐PA (accelerometer) data. Significant improvements were found for general health and energy scores, and trends were found for self‐efficacy scores. PA levels were highly variable with nonsignificant increases from baseline. Effect sizes were low–moderate for several measures. About 79% of participants rated program “Very good”; all recommended the program.

Linking Evidence to Action

Physical activity has multiple health benefits for all people including those living with chronic conditions. Even short bouts of physical activity have health benefits. A program of 3‐min follow‐along PA videoclips for individuals living with chronic disease holds promise for clinicians and researchers.

Change‐of‐Shift Nursing Handoff Interruptions: Implications for Evidence‐Based Practice

Abstract

Background

The importance of change‐of‐shift handoffs in maintaining patient safety has been well demonstrated. Change‐of‐shift handoff is an important source of data used in surveillance, a nursing intervention aimed at identifying and preventing complications. Surveillance requires the nurse to acquire, process, and synthesize information (cues) encountered during patient care. Interruptions in handoff have been observed but there is a gap in the evidence concerning how interruptions during nurse‐to‐nurse handoff impact the change‐of‐shift handoff process.

Aims

To describe registered nurses’ perceptions of interruptions experienced during change‐of‐shift handoff at the bedside in critical care units and analyze the number, type, and source of interruptions during change‐of‐shift handoff at the bedside.

Methods

An exploratory descriptive design was used. One hundred nurse‐to‐nurse handoffs were observed, and four focus groups were conducted. Observation data were analyzed with descriptive statistics and quantitative content analysis. Focus group data were analyzed with qualitative content analysis.

Results and Findings

Of the 1,196 interruptions observed, 800 occurred in the communication between the two nurses involved in the handoff. Over 80% (645) of these interruptions were from the nurse receiving handoff and included questions or clarification of information received. About half of the nurses reported that interruptions occurred during handoff. Focus group findings revealed that whether or not something is an interruption is determined by the individual nurse’s appraisal of value added to their knowledge of the patient and/or plan of care at the time of handoff.

Linking Evidence to Action

Interruptions during handoff are evaluated as useful or disruptive based on the value to the nurse at the time. Strict structuring or mandating of handoff elements may limit nurses’ ability to communicate information deemed most relevant to the care of a specific unique patient.

Correlates of Physical Activity During Pregnancy: A Systematic Review with Implications for Evidence‐based Practice

Abstract

Background

Numerous attempts have been made to improve women's physical activity participation during pregnancy, but activity levels remain low.

Aim

To examine systematically the associations of physical activity participation during pregnancy with non‐modifiable correlates (not subject to change) and modifiable theoretical correlates of physical activity.

Methods

This systematic review followed PRISMA (preferred reporting items for systematic review and meta‐analysis) guidelines. It includes cross‐sectional and longitudinal studies that assessed non‐modifiable correlates and modifiable theoretical correlates of physical activity. Five electronic databases were searched for studies published in the English language between 2010 and 2017. An author‐developed data collection tool was used to examine selected variables; effect sizes were determined; and study bias was assessed.

Results

Ten studies were included in the final review. Overall, effect sizes for non‐modifiable correlates of physical activity were small to moderate, except for mental health (d = 1.35) and prior physical activity (d = 0.63). By contrast, modifiable theoretical correlates of physical activity (e.g., self‐efficacy [d = 0.96–1.42] & intention to be physically active [d = 1.62]) had moderate to large effects in the expected direction with physical activity during pregnancy.

Discussion

The findings underscore the importance of developing physical activity interventions for pregnant women that are guided by modifiable theoretical correlates, taking into consideration non‐modifiable correlates of physical activity.

Linking Evidence to Action

Clinicians should help pregnant women to increase self‐confidence in their ability to be physically active and provide anticipatory guidance to overcome barriers to physical activity.

Barriers and Facilitators for the Use of NURSING Bedside Handovers: Implications for Evidence‐Based Practice

Abstract

Background

Previous studies on bedside handovers have identified nurse‐related barriers and facilitators for implementing bedside handovers, but have neglected the existing ward’s nursing care system as an important influencing factor.

Aims

To determine the association between the existing nursing care system (i.e., decentralized, two‐tier, or centralized) on a ward and the barriers and facilitators of the bedside handover.

Methods

Structured individual interviews (N = 106) on 14 nursing wards in eight hospitals were performed before implementation of bedside handovers. The structured interview guide was based on a narrative review. Direct content analysis was used to determine the nursing care system of a ward and the degree to which barriers and facilitators were present. Pearson’s Chi‐square analysis was used to determine whether there were associations between the nursing care systems concerning the presence of barriers and facilitators for implementing bedside handovers.

Results

Twelve barriers and facilitators were identified, of which three are new to literature: the possible loss of opportunities for socializing, collegiality, and overview; head nurse’s role; and role of colleagues. The extent to which barriers and facilitators were present differed across nursing care systems, with the exception of breach of confidentiality (barrier), and an existing structured handover (facilitator). Overall, nurses working in decentralized nursing care systems report fewer barriers against and more facilitators in favor of using bedside handovers than nurses in two‐tier or centralized systems.

Linking Evidence to Action

Before implementing bedside handovers, the context of the nursing care system may be considered to determine the most effective process to implement change. Based on these study findings, implementing bedside handovers could be more challenging on wards with a two‐tier or centralized care system.

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