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Use of personal protective equipment reduces the risk of contamination by highly infectious diseases such as COVID-19

Por: Dos Santos · W. M.

Commentary on: Verbeek JS, Rajamaki B, Ijaz S, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2020; Apr 15;4(4):CD011621. doi:10.1002/14651858.

Implications for practice and research

  • The use of a powered, air-purifying respirator with coverall may protect against the risk of contamination better than an N95 mask and gown but was more difficult to don.

  • The creation of future studies is necessary to compare the risk of contamination during removal of personal protective equipment, PPE).

  • Context

    Currently more than 59 million people are employed in the health sector worldwide, who are at risk of developing life-threatening infectious diseases due to contact with patients’ blood or body fluids.1 Due to the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic, as well as other infectious diseases, healthcare workers (HCW) must...

    Complex interactions between provider, organisation and patient level characteristics influence the effect of pressure ulcer preventive care interventions

    Por: Urrutia-Bastardo · R. · Turin · T. C.

    Commentary on: Baernholdt M, Yan G, Hinton ID, et al. Effect of preventive care interventions on pressure ulcer rates in a national sample of rural and urban nursing units: longitudinal associations over 4 years. Int J Nurs Stud 2019:103455. doi:

    Implications for practice and research

  • Organisational structures that support an improved work environment and workflow for nurses are important contributors towards the prevention of pressure ulcers.

  • Future research on pressure ulcer prevention needs to consider the complex interactions between the characteristics patients, care providers and care organisations.

  • Context

    Pressure ulcers develop due to persisting pressure on a bony site leading to obstruction of the blood flow in healthy capillaries resulting in tissue injury.1 These commonly occur in patients with limited mobility such as those in hospitals or long-term care settings.1 2 The key components in...

    Patients need more than just verbal instructions upon discharge from the emergency department

    Por: Chen · Y. · Shen · Y. · Zhu · Y. · Gao · Y. · Zhao · D. · XI · L. · Li · S. · Liu · J. · Yang · Y. · Qu · J. · Qin · J. · Lee · A. J.

    Commentary on: Hoek AE, Anker SCP, van Beeck EF, et al. Patient discharge instructions in the emergency department and their effects on comprehension and recall of discharge instructions: a systematic review and meta-analysis. Ann Emerg Med 2019;1–10.

    Implications for practice and research

  • Clinicians need to offer written and video formatted information as adjunct to verbal instructions on discharge from emergency departments.

  • Further research is required to identify best practices in discharge management and information sharing with patients.

  • Context

    Patient discharge instructions are important tasks for healthcare professionals in emergency departments (EDs).1 Yet patients’ understanding and recall of their ED discharge instructions is limited.2This systematic review with meta-analysis evaluated the use and efficacy of discharge instructions in the ED.3


    The study provided a systematic review and meta-analysis of 51 articles.4 Data were retrieved to...

    A workplace sales ban and motivational intervention can reduce sugar-sweetened beverage intake and improve cardiometabolic health

    Por: Duong · T. V.

    Commentary on: Epel ES, Hartman A, Jacobs LM, et al. Association of a workplace sales ban on sugar-sweetened beverages with employee consumption of sugar-sweetened beverages and health. JAMA Intern Med 2019;180:9–16.

    Implications for practice and research

  • The impact of a workplace sales ban and motivational interventions on reducing sugar-sweetened beverages (SSBs) consumption and health should be investigated in other settings.

  • SSB sales bans and brief motivation may be a useful combination within public health strategy.

  • Context

    The interventions targeting SSB intake reduction have been implemented in different settings, for example, schools, retailing and food service establishments.1 The environmental interventions include labelling, nutrition standards in public institutions and economic tools (eg, taxes). The association between taxes on SSB consumption has been investigated previously.2 Epel et al sought to explore the potential benefits of an environmental intervention (sales ban, a brief motivation)...

    Survivorship care plans have minimal impact on health actions

    Por: Howell · D.

    Commentary on: Hawkins-Taylor C, Anderson DG, Carlson A, et al. Survivorship care plans: health actions taken and satisfaction after use. Oncol Nurs Forum 2019;46:585–94.

    Implications for practice and research

  • Survivorship Care Plans should be a standard of nursing practice and as essential preparatory patient education alongside health promotion counselling at treatment end.

  • Nursing research should shift towards robust research to test the effects of behavioural interventions as an adjunct to Survivorship Care Plans on survivors’ health actions.

  • Context

    Survivorship Care Plans (SCPs) are an element of quality survivorship care.1 Several reports2 and guidelines3 recommend SCPs at end of cancer treatment as a standard of care. SCPs are personalised records of the care that outline follow-up (FU) surveillance, long-term symptoms, signs of recurrence, community resources and lifestyle modifications to reduce late effect risks.4 SCPs help survivors as...

    Shorter intervals and sequential administration of adjuvant chemotherapy are effective in reducing the 10-year risk of recurrence and death in early breast cancer women without detrimental effects

    Por: Catania · G.

    Commentary on: Early Breast Cancer Trialists’ Collaborative Group. Increasing the dose intensity of chemotherapy by more frequent administration or sequential scheduling: a patient-level meta-analysis of 37 298 women with early breast cancer in 26 randomised trials. Lancet 2019;393:1440–52. doi:10.1016/S0140-6736(18)33137-4. Epub 8 February 2019.

    Implications for practice and research

  • Oncology nurses are in the key role to put in practice a proactive approach to determine successful completion of dose-intense regimens.

  • This meta-analysis provides support for nursing research on the effect of nursing interventions delivered to women receiving a dose-intense regimen (eg, symptoms and quality of life).

  • Context

    Researchers have demonstrated that anthracycline and taxane regimen reduce mortality by a third compared with no chemotherapy in early breast cancer, independently of tumour characteristics.1 A previous report suggested that dose-intensification strategies including chemotherapy administration every 2 weeks or giving higher dose of drugs sequentially rather than...

    Social media is a source of health-related misinformation

    Por: Rolls · K. · Massey · D.

    Commentary on: Wang Y, McKee M, Torbica A, et al. Systematic review on the spread of health-related misinformation on social media. Soc Sci Med.2019;240:112552.doi: 10.1016/j.socscimed.2019.112552. [Epub ahead of print 18 Sep 2019].

    Implications for practice and research

  • When nurses and midwives encounter misinformation on social media, they should provide or direct individuals to sources of accurate information.

  • Cross-disciplinary research to understand factors that influence the uptake of health-related (mis)information is required.

  • Context

    Over the past 25 years, the Internet and social media have rapidly become ubiquitous in daily life, and despite improved access to information there are increasing concerns that these social channels are also spreading health-related false information or misinformation.1 2


    The aim of this systematic review1 was to investigate health-related misinformation content on social media and how this was disseminated online including (1)...

    Bariatric surgery could reduce the risk of specific types of breast cancer

    Por: Kerin · U.

    Commentary on: Feigelson HS, Caan B, Weinmann S, et al. Bariatric surgery is associated with reduced risk of breast cancer in both premenopausal and postmenopausal women. Ann Surg 2019 [Epub ahead of print 13 Apr 2019].

    Implications for practice and research

  • Preliminary evidence suggests that bariatric surgery reduces the risk of postmenopausal oestrogen-positive and premenopausal oestrogen-negative breast cancer.

  • International, prospective, longitudinal studies using power calculations are required.

  • Context

    Obesity influences the development, prognosis and mortality rates of many types of cancer including that of the breast.1 Research correlates weight gain in adulthood with an increased risk of breast cancer.2 The International Agency for Research on Cancer contends that the relationship between intentional weight loss and cancer risk is yet to be determined.1 Winder and colleagues3 suggest that bariatric surgery (an intentional weight loss...

    Current state of knowledge around nurse-led cardioversion: a launchpad for future projects

    Por: Fournier · J.

    Commentary on: Manoj S, Moore Z, Patton D, et al. The impact of a nurse-led elective direct current cardioversion in atrial fibrillation on patient outcomes: a systematic review. J Clin Nurs 2019;28:3374–85. doi: 10.1111/jocn.14852.

    Implications for research and practice

  • Nurse-led cardioversion clinics demonstrate promising potential in terms of patient safety, reducing wait times, decreasing costs and increasing patient satisfaction.

  • The review suggests the need for further quantitative, outcomes focused studies on nurse and nurse practitioner led cardioversion clinics.

  • Context

    Direct current cardioversion is an electrical cardiac treatment used to reset heart rhythms in some patients with atrial fibrillation.1 While direct current cardioversion had historically been medically led, increased demand for the treatment has led to the development of nurse-led services.2 Nurse and nurse practitioner led cardioversion clinics will be seen more often as our populations age. It is important to...

    Better patient activation is a precursor to engagement in shared decision making

    Por: Kidd · L.

    Commentary on: Poon BY, Shortell SM and Rodriguez HP. Patient activation as a pathway to shared decision-making in adults with diabetes or cardiovascular disease. J Gen Intern Med 2019. doi:10.1007/s11606-019-05351-6. [Epub ahead of print 23 Oct 2019].

    Implications for practice and research

  • Practitioners and healthcare providers should encourage engagement in shared decision making (SDM) in patients with relatively high levels of activation.

  • Further research would be useful to determine how people low in activation can be supported to engage in SDM and ‘what works, for whom and in what circumstances’.

  • Context

    Patient activation, or a patients’ assessment of their understanding, confidence and readiness to manage their own health,1 has been linked with positive health outcomes such as reduced blood pressure, reduced blood glucose levels2 and may be an important precursor to SDM. The relationship between patient activation and SDM, however,...

    Nurses intuitive worrying predicts physiological changes in patients vital signs

    Por: Frazer · K.

    Commentary on: Romero-Brufau S, Gaines K, Nicolas CT, et al. The fifth vital sign? Nurse worry predicts inpatient deterioration within 24 hours. JAMIA Open 2019.

    Implications for practice and research

  • Worry factor scores may assist nurses with assessment and prediction of patient deterioration in hospitals.

  • Further research is needed to determine the weight of the worry factor variable in conjunction with other elements of early warning score systems.

  • Context

    The introduction of early warning scores and rapid responses is associated with improvements in patient outcomes such as cardiopulmonary arrests in general wards, unplanned intensive care unit (ICU) admissions and mortality.1 Internationally, systems enhancing patient safety and reducing risk of adverse events are part of quality measures embedded in organisations.1–3 Douw et al’s systematic review finds nurses’ judgement and intuition in assessing patient signs and symptoms are...

    Resources page

    Por: Heale · R.
    NICE: National Institute for Health and Care ExcellenceNICE Guideline on Long COVID BMJ 2020;371:m4938

    "The magnitude of the population still struggling with symptoms four weeks after their acute illness—commonly called "long COVID-19"—is becoming obvious and demands urgent prioritisation to prevent a further blow to health systems and the healthcare workforce."

    This document explores what is known about Long COVID-19, as well as assessment and interventions related to the condition.

    Centre for Effective Practice: a comprehensive database of clinical tools and resources—created by providers, for providers

    COVID-19 Resource Centre

    Updates to guidelines and clinical resources related to COVID-19 care.

    Pain: part of the COVID Resource Centre

    Guidelines for caring for patients with chronic non-cancer pain and other pain-related conditions while considering the obstacles related to iCOVID-19.

    Mental health and...

    Without adequate nursing support for families, dying at home threatens the values of a good death

    Por: Wright · D. K. · McPherson · C. J.

    Commentary on: Hoare S, Kelly MP, Barclay S. Home care and end-of-life hospital admissions: a retrospective interview study in English primary and secondary care. Br J Gen Pract 2019;69(685):E561–9.

    Implications for practice and research

  • Families providing end-of-life care in the home urgently require well-resourced community nursing services.

  • Future research should explore the perspectives of people who choose, for whatever reason, not to take on formal and intimate caregiving roles for their dying family members.

  • Context

    The idea of home as a preferred location to achieve a ‘good death’ has become popular within end-of-life care discourse. So popular that hospital death is a measure of failed palliative care.1 Less attention is paid—with notable exceptions2—to critically examining the challenges of home care at end of life.


    The focus of this study3 was on understanding why some patients...

    Mediating effect of coping style on the relationship between clinical leadership and quality of work life among nurses in tertiary-level hospitals in China: a cross-sectional study

    Por: Li · H. · Chang · H. · Tao · Z. · Zhang · D. · Shi · Y. · Li · X.

    To explore the association between clinical leadership and quality of work life, as well as the mediating role of coping style in this relationship.


    Three tertiary-level hospitals in Liaoning Province, China.


    A total of 1209 nurses were recruited for this study. Registered nurses who work full time with at least 1 year of work experience were eligible as subjects. Exclusion criteria were nurses who work indirectly with patients, such as in education, administration or research.

    Primary and secondary outcome measures

    Questionnaires consisting of the work-related Quality of Life Scale, the Nurse Leadership Scale and the Simplified Coping Style Questionnaire, as well as a demographic data sheet, were used to collect participant information. Pearson’s correlation analysis, hierarchical multiple regression analysis, and asymptotic and resampling strategies were used to analyse the data.


    The mean overall quality of work life score among Chinese nurses was 3.50±0.60. After adjusting for demographic characteristics, clinical leadership was positively associated with the score of quality of work life (β=0.55, p


    Clinical leadership was positively associated with quality of work life and coping style partially mediated the relationship between clinical leadership and quality of work life among nurses in China. Implementing measures focusing on both clinical leadership and coping style may provide success in improving the quality of work life of nurses.

    Feasibility of continuous monitoring of vital signs in surgical patients on a general ward: an observational cohort study

    Por: Leenen · J. P. L. · Dijkman · E. M. · van Dijk · J. D. · van Westreenen · H. L. · Kalkman · C. · Schoonhoven · L. · Patijn · G. A.

    To determine feasibility, in terms of acceptability and system fidelity, of continuous vital signs monitoring in abdominal surgery patients on a general ward.


    Observational cohort study.


    Tertiary teaching hospital.


    Postoperative abdominal surgical patients (n=30) and nurses (n=23).


    Patients were continuously monitored with the SensiumVitals wearable device until discharge in addition to usual care, which is intermittent Modified Early Warning Score measurements. Heart rate, respiratory rate and axillary temperature were monitored every 2 min. Values and trends were visualised and alerts sent to the nurses.


    System fidelity was measured by analysis of the monitoring data. Acceptability by patients and nurses was assessed using questionnaires.


    Thirty patients were monitored for a median duration of 81 hours (IQR 47–143) per patient, resulting in 115 217 measurements per parameter. In total, 19% (n=21 311) of heart rate, 51% (n=59 184) of respiratory rate and 9% of temperature measurements showed artefacts (n=10 269). The system algorithm sent 972 alerts (median alert rate of 4.5 per patient per day), of which 90.3% (n=878) were system alerts and 9.7% (n=94) were vital sign alerts. 35% (n=33) of vital sign alerts were true positives. 93% (n=25) of patients rated the patch as comfortable, 67% (n=18) felt safer and 89% (n=24) would like to wear it next time in the hospital. Nurses were neutral about usefulness, with a median score of 3.5 (IQR 3.1–4) on a 7-point Likert scale, ease of use 3.7 (IQR 3.2–4.8) and satisfaction 3.7 (IQR 3.2–4.8), but agreed on ease of learning at 5.0 (IQR 4.0–5.8). Neutral scores were mostly related to the perceived limited fidelity of the system.


    Continuous monitoring of vital signs with a wearable device was well accepted by patients. Nurses’ ratings were highly variable, resulting in on average neutral attitude towards remote monitoring. Our results suggest it is feasible to monitor vital signs continuously on general wards, although acceptability of the device among nurses needs further improvement.

    Risk of acute deterioration and care complexity individual factors associated with health outcomes in hospitalised patients with COVID-19: a multicentre cohort study


    Evidence about the impact of systematic nursing surveillance on risk of acute deterioration of patients with COVID-19 and the effects of care complexity factors on inpatient outcomes is scarce. The aim of this study was to determine the association between acute deterioration risk, care complexity factors and unfavourable outcomes in hospitalised patients with COVID-19.


    A multicentre cohort study was conducted from 1 to 31 March 2020 at seven hospitals in Catalonia. All adult patients with COVID-19 admitted to hospitals and with a complete minimum data set were recruited retrospectively. Patients were classified based on the presence or absence of a composite unfavourable outcome (in-hospital mortality and adverse events). The main measures included risk of acute deterioration (as measured using the VIDA early warning system) and care complexity factors. All data were obtained blinded from electronic health records. Multivariate logistic analysis was performed to identify the VIDA score and complexity factors associated with unfavourable outcomes.


    Out of a total of 1176 patients with COVID-19, 506 (43%) experienced an unfavourable outcome during hospitalisation. The frequency of unfavourable outcomes rose with increasing risk of acute deterioration as measured by the VIDA score. Risk factors independently associated with unfavourable outcomes were chronic underlying disease (OR: 1.90, 95% CI 1.32 to 2.72; p


    The systematic nursing surveillance of the status and evolution of COVID-19 inpatients, including the careful monitoring of acute deterioration risk and care complexity factors, may help reduce deleterious health outcomes in COVID-19 inpatients.

    Instruments for measuring nursing research competence: a protocol for a scoping review

    Por: Chen · Q. · Huang · C. · Castro · A. R. · Tang · S.

    Nursing research competence of nursing personnel has received much attention in recent years, as nursing has developed as both an independent academic discipline and an evidence-based practiing profession. Instruments for appraising nursing research competence are important, as they can be used to assess nursing research competence of the target population, showing changes of this variable over time and measuring the effectiveness of interventions for improving nursing research competence. There is a need to map the current state of the science of the instruments for nursing research competence, and to identify well validated and reliable instruments. This paper describes a protocol for a scoping review to identify, evaluate, compare and summarise the instruments designed to measure nursing research competence.

    Methods and analysis

    The scoping review will be conducted following Arksey and O’Malley’s methodological framework and Levac et al’s additional recommendations for applying this framework. The scoping review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. The protocol is registered through the Open Science Framework ( Eight English databases and two Chinese databases will be searched between 1 December 2020 and 31 December 2020 to retrieve manuscripts which include instrument(s) of nursing research competence. The literature screening and data extraction will be conducted by two researchers, independently. A third researcher will be involved when consensus is needed. The COnsensus-based Standards for the selection of health Measurement INstruments methodology will be used to evaluate the methodological quality of the included studies on measurement properties of the instruments, as well as the quality of all the instruments identified.

    Ethics and dissemination

    Ethical approval is not needed. We will disseminate the findings through a conference focusing on nursing research competence and publication of the results in a peer-reviewed journal.

    Clinical Nursing Introduction Program for new graduate nurses in Sweden: study protocol for a prospective longitudinal cohort study

    Por: Johansson · A. · Berglund · M. · Kjellsdotter · A.

    High levels of nursing turnover represent a problem for healthcare organisations and patient safety. Experiences during the first years in the nursing profession have a significant impact on nurses’ future decisions concerning their careers. Nurses at the start of their professional career need to practise their hands-on skills as well as their theoretical knowledge. In addition, new graduate nurses need regular support and opportunities to reflect on experiences in their new profession. The aim of the present study is to describe the Clinical Nursing Introduction Program (CNIP) and present a study design in which the programme is used to support new graduate nurses’ transition into the nursing profession.

    Method and analysis

    The present study examines the CNIP at a general hospital in southwest Sweden, which lasts for 14 months. The programme has a unique profile based on a person-centred approach and consists of five components: employment and organisation, a compulsory introduction week, two placements in different clinical settings, education days and process-oriented nursing supervision. The present study presents a protocol for a prospective longitudinal cohort study, using qualitative and quantitative methods in the collection and analysis of data. Measurements will include data collection between 2019 and 2023 when the nurses start the CNIP (baseline) and then after 1 and 2 years.

    Ethics and dissemination

    This study has been approved by the Regional Ethical Review Board in Gothenburg (Dnr 1056-18). Study findings will be presented at national and international conferences and published in peer-reviewed journals.

    Trial registration number

    273573 (

    Psychometric properties and use of the DEMQOL suite of instruments in research: a systematic review protocol

    Por: Hoben · M. · Chamberlain · S. A. · O'Rourke · H. M. · Elliott · B. · Shrestha · S. · Devkota · R. · Thorne · T. · Lam · J. · Banerjee · S. · Hughes · L. · Estabrooks · C. A.

    Dementia is a public health issue and a major risk factor for poor quality of life among older adults. In the absence of a cure, enhancing health-related quality of life (HRQoL) of people with dementia is the primary goal of care. Robust measurement of HRQoL is a prerequisite to effective improvement. The DEMQOL suite of instruments is considered among the best available to measure HRQoL in people with dementia; however, no review has systematically and comprehensively examined the use of the DEMQOL in research and summarised evidence to determine its feasibility, acceptability and appropriateness for use in research and practice.

    Methods and analysis

    We will systematically search 12 electronic databases and reference lists of all included studies. We will include systematically conducted reviews, as well as, quantitative and qualitative research studies that report on the development, validation or use in research studies of any of the DEMQOL instruments. Two reviewers will independently screen all studies for eligibility, and assess the quality of each included study using one of four validated checklists appropriate for different study designs. Discrepancies at all stages of the review will be resolved by consensus. We will use descriptive statistics (frequencies, proportions, ranges), content analysis of narrative data and vote counting (for the measures of association) to summarise the data elements. Using narrative synthesis, we will summarise what is known about the development, validation, feasibility, acceptability, appropriateness and use of the DEMQOL. Our review methods will follow the reporting and conduct guidelines of the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis.

    Ethics and dissemination

    Ethical approval is not required as this project does not involve primary data collection. We will disseminate our findings through peer-reviewed publications and conference presentations.

    PROSPERO registration number


    Frailty is a predictor of mortality in surgical emergency admissions among UK adults

    Por: Nimura · M. · Kojima · G.

    Commentary on: Hewitt J, Carter B, McCarthy K, et al. Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study. Age Ageing 2019;48:388–94. doi: 10.1093/ageing/afy217.

    Implications for practice and research

  • Frailty assessment for emergency surgical patients may be useful in prognostication and outcome improvement.

  • Further research is needed to improve outcomes by identifying frail older people and administering interventions while still in the community.

  • Context

    Frailty is a term that has been well-established and associated with deteriorated capacity to maintain homoeostasis and vulnerability to stressors.1 Various studies have demonstrated the links between frailty and its adverse outcomes.2 3 While many of the previous studies focused on its negative impacts on older populations, evidence on frailty among emergency surgical patients is scarce. Hewitt et al4 examined frailty status among adult patients aged 18...