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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...

    The integration of personal narratives into hospital-based palliative care can relieve patient psychosocial and existential suffering

    Por: Acorn · M.

    Commentary on: Gundtof Rokiaer S, Missel M, Bergenholtz HM, et al. The use of personal narratives in hospital-based palliative care interventions: An integrative literature review. Palliat Med 2019; 1–17.

    Implications for practice and research

  • Personal narrative interventions can be successfully implemented in hospital-based palliative care to ease psychosocial and existential suffering of patients.

  • An opportunity for research exists into the role and impact of personal narrative interventions more broadly in palliative care and beyond the hospital setting.

  • Context

    Patients with life-threatening illnesses continue to primarily receive care in the hospital setting. Although palliative care is evolving, there remains an emphasis on curative care in the hospital setting1. The focus on curative care often leads patients to experience a lack of psychosocial support and unmet emotional needs.2 This review by Roikjaer and colleagues examined the role that narrative interventions can play...

    Nursing interventions improve preparedness, competence, reward and burden of family caregivers in end-of-life care at home

    Por: Anagnostou · D.

    Commentary on: Becqué YN, Rietjens JAC, van Driel A, et al. Nursing interventions to support family caregivers in end-of-life care at home: a systematic narrative review. Int J Nurs Stud 2019;7:28–39. https://doi.org/10.1016/j.ijnurstu.2019.04.011

    Implications for practice and research

  • Nurses should provide individualised interventions to support family caregivers in end-of-life-care at home.

  • Multicomponent interventions have the potential to address the complex needs of family caregivers.

  • Future research needs to establish effective interventions and their related components.

  • Context

    Informal family caregivers play a crucial role in end-of-life care, especially in the community. However, family caregivers are known to have high needs and psychological morbidity,1 including fatigue, sleep problems, depression, anxiety and burnout. Palliative care aims to provide psychosocial support to patients and families facing terminal illness. Interventions that aim to support family caregivers are increasing and have been reported in the literature.

    Nurses night shift performance improves through taking scheduled naps

    Por: Izadi · N.

    Commentary on: Zion N, Schohat T. Let them sleep: the effects of a scheduled nap during the night shift on sleepiness and cognition in hospital nurses. J Adv Nurs 2019. doi: 10.1111/jan.14031. [Epub ahead of print 22 April 2019].

    Implications for practice and research

  • The implementation of new strategies to allow nurses to nap could have positive impact on nurse performance.

  • Further research is needed to generalise these findings to male shift workers and other shift schedules.

  • Context

    Healthcare workers who work in rotating shifts may experience sleepiness and reduction of job performance.1 2 Further, several studies observed that night shifts can negatively affect physical, psychological well-being and patient safety.3 There are some recommended interventions, including naps, caffeine consumption and brightness exposure, to reduce these adverse effects.4–6 The aim of this study...

    Family perspectives need considering as part of the assisted dying process

    Por: Bravo · P. H.

    Commentary on: Gamondi C, Fusi-Schmidhauser T, Oriani A, et al. Family members’ experiences of assisted dying: a systematic literature review with thematic synthesis. Palliat Med 2019;33:1091–105. doi: 10.1177/0269216319857630.

    Implications for practice and research

  • Family support positively influences patient engagement in assisted dying.

  • Future research is needed to identify and incorporate family needs into evidenced-based assisted dying guidelines.

  • Context

    Though assisted dying is a growing practice, it is not legally permissible throughout the world. Currently, only 176 million people worldwide have legal access to this practice.1 It encompasses two practices: assisted suicide and active euthanasia.2 While rates of assisted dying have increased in countries legally allowing the practice, family requirements differ geographically based on the model of assisted dying used.1 This variability in family responsibility can result in differing family experiences. This study focussed on identifying and understanding these experiences...

    Patients prefer bedside handover and wish to be active partners in it

    Por: Hu · J.

    Commentary on: Oxelmark, L, Whitty, JA, Ulin, K, et al. Patients prefer clinical handover at the bedside; nurses do not: evidence from a discrete choice experiment. International Journal of Nursing Studies. Epub ahead of print: 27 Sep 2019. https://doi.org/10.1016/j.ijnurstu.2019.103444

    Implications for practice and research

  • It is important to have patients as active partners in the team during bedside handovers and have their voices heard.

  • Future qualitative studies are warranted to explore the reasons for individual preferences and identify the barriers and facilitators of implementing bedside handover.

  • Context

    Clinical handover is a valuable source of patient health information for nurses and patients. Numerous studies have found that bedside handover could significantly enhance the delivery of relevant information and decrease miscommunication between patients and nurses.1 Besides, bedside handover could increase patient participation and safety.2 However, the implementation of bedside handover...

    Walking may ameliorate fatigue in women receiving chemotherapy for breast cancer

    Por: Yee · J. · Dhillon · H.

    Commentary on: Huang HP, Wen FH, Yang TY, et al. The effect of a 12-week home-based walking program on reducing fatigue in women with breast cancer undergoing chemotherapy: a randomized controlled study. Int J Nurs Stud 2019;99:103376.

    Implications for practice and research

  • Walking during chemotherapy for breast cancer may minimise cancer-related fatigue.

  • Further research is needed to explore strategies to enhance adherence and the effects of walking in low-functioning and inactive women.

  • Context

    Cancer-related fatigue is a common and debilitating symptom experienced by people with cancer. Evidence is increasingly supporting benefits of exercise in ameliorating fatigue during and following treatment for breast cancer.1 Home-based exercise interventions are advantageous due to low cost and high accessibility. Although not examined as extensively as supervised programmes, home-based interventions are not as effective in reducing fatigue.2 This study3 examines the effects of...

    Cigarette smoking increases persistent pain intensity and interference, impairs function and sleep

    Por: Cox · F.

    Commentary on: Khan JS, Hah JM, Mackey SC. Effects of smoking on patients with chronic pain: a propensity-weighted analysis on the Collaborative Health Outcomes Information Registry. Pain 2019;160:2374–9.

    Implications for practice and research

  • Active smokers should be educated about the complex bidirectional relationship between smoking and pain.

  • Studies are required to identify targeted interventions to encourage smoking cessation and improve outcomes for smokers with persistent pain.

  • Context

    The association between cigarette smoking and lung cancer was described in epidemiological studies in 1950. Smoking remains a public health issue with a strong association between demographic and socioeconomic factors. Chronic pain is also related to working, socioeconomic and educational status.1 Nicotine is suspected as providing an antinociceptive (pain-relieving) effect, yet chronic smokers have an increased risk of persistent pain. Smoking cessation in people with no pain at baseline report up to four times as...

    Enhancing the role of nursing in primary care facilitates task sharing and addresses human resource shortages to achieve optimal population health outcomes

    Por: Scott · L. · May · C.

    Commentary on: Karimi-Shahanjarini A, Shakibazadeh E, Rashidian A, et al. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019.

    Implications for practice and research

  • Task shifting is a pragmatic approach that can address human resource shortages in primary care globally

  • The reorganization of the healthcare workforce includes expanding primary care nursing that improves healthcare accessibility, continuity of care, and quality of care provision

  • Further research should evaluate outcome measures following the implementation of this healthcare modelTask shifting is a pragmatic approach that can address human resource shortages in primary care globally

  • Context

    Globally, countries are faced with a chronic shortage of healthcare workers. The demand for healthcare services continues to grow with an ageing population and individuals living with chronic disease.1 Human resource shortages within primary healthcare systems...

    Higher prevalence of pressure ulcers in people receiving palliative care is not necessarily an indicator of poor care

    Por: Ernsth Bravell · M.

    Commentary on: Ferris A, Price A, Harding K. Pressure ulcers in patients receiving palliative care: a systematic review. Palliat Med 2019;33:770-782. doi: 10.1177/0269216319846023.

    Implications for practice and research

  • Pressure ulcers are highly prevalent in patients receiving palliative care, probably due to underlying conditions, which may provide a false-negative picture of healthcare-associated harm in the palliative care.

  • There is a need of more research on how to prevent pressure ulcers and how to increase comfort when pressure ulcers occur among palliative patients.

  • Context

    Pressure ulcers can be seen as an adverse event or care injury1 that causes pain and distress for the patient, but it may also cause feelings of failure of care among nursing staff and increased costs for care.2 The difficulty with pressure ulcers is the complexity, where no single factor predicts pressure ulcers, but the occurence is often...

    More research is needed to understand how to provide optimal palliative dementia care to people living at home

    Por: Kupeli · N.

    Commentary on: Miranda R, Bunn F, Lynch J, et al. Palliative care for people with dementia living at home: a systematic review of interventions. Palliat Med 2019;33:726-742. doi:10.1177/0269216319847092. Epub 2019 May 6.

    Implications for practice and research

  • The European Association of Palliative Care (EAPC) domains provide a useful framework for guiding palliative dementia care for those living and dying at home.

  • Research is required to better understand how to design and implement palliative dementia care interventions for people living at home

  • Context

    Dementia is a leading cause of death,1 and keeping people with dementia at home for longer is a key governmental goal. There is growing recognition that dementia is a terminal illness and a palliative care approach may be appropriate. The EAPC provides a comprehensive definition of palliative dementia care and a framework for outcomes of good end-of-life care.2...

    Nurses should be empowered to be proactively involved in family decision meetings on intensive care unit patient care decisions

    Por: Khan · M.

    Commentary on: Pecanac K, King B. Nurse-Family Communication During and After Family Meetings in the Intensive Care Unit. J Nurs Scholarsh 2019;51:129–37

    Implications for practice and research

  • Nurses should be included in the family meeting in an active role to discuss the patient’s condition.

  • Education sessions can be arranged for nurses before involving them in the family communication process. This will improve their knowledge of, attitude to and involvement in their role in the family discussion session.

  • Context

    Nurses are important members of the intensive care unit (ICU) team and evidence suggests that they should participate in the ICU family discussion by sharing information about the patient’s condition, advocating for the patient’s wishes, and helping patients and patients’ families understand the care plan. ICU family discussion is highly recommended to address the concerns of patients and patients’ families and explain the plan of care.

    Timely psychological interventions can ameliorate symptoms of prolonged grief

    Por: Chan · S.

    Commentary on: Johannsen M, Damholdt MF, Zachariae R, et al. Psychological interventions for grief in adults: a systematic review and meta-analysis of randomised controlled trials. J Affect Disord 2019;253:69–86. doi: 10.1016/j.jad.2019.04.065

    Implications for practice and research

  • Psychological interventions have the potential to reduce grief symptoms. It could be most efficacious to bereaved adults if offered at a minimum 6 months postloss.

  • Future studies could focus on how psychological intervention works on grief and its effects on older bereaved adults with longer follow-up assessment period.

  • Context

    Grief is a normal response to the death of a loved one. Most people could adapt to such loss over time. However, some bereaved individuals have persistent grief symptoms. Prolonged grief disorder (PGD) was a new diagnosis in the International Classification of Diseases, 11th Revision (ICD-11).1 Prolonged grief (PG) is associated with functional impairment, psychological and physical morbidity,...

    Pain assessments in emergency departments lack consistency and validity, and this impacts effective pain management

    Por: Wehner · L.

    Commentary on: Sampson FC, Goodacre SW, O’Cathain A. The reality of pain scoring in the emergency department: findings from a multiple case study design. Ann Emerg Med 2019:1–11.

    Implications for practice and research

  • It is imperative that a systematic pain assessment tool is used consistently for healthcare practitioners to transform patient pain assessment data into clinical action.

  • Further research needs to address the effectiveness of a systematic approach to pain assessment and evaluation of this assessment to achieve effective pain management.

  • Context

    Pain scales or tools are a fast, measurable method to objectify the subjective perception of pain. In the emergency department (ED), pain assessments are used for patient triage and assessment for all patients. While routine use of these tools have been shown to improve pain management,1 there is conflicting data about the validity and barriers that accompany the use of...

    Negative workplace behaviour: nurses power games, blame culture and incivility--why nurses do not care for each other

    Por: Heaslip · V. · Nadaf · C.

    Commentary on: Hawkins N, Jeong S, Smith T. New graduate registered nurses’ exposure to negative workplace behaviour in the acute care setting: an integrative review. Int J Nurs Stud 2019;93:41–54.

    Implications for practice and research

    There is a need for:

  • Uniform terminology of negative workplace behaviours.

  • Strategies to support new registrants’ resilience as part of transition programmes.

  • Training for nurse leaders on developing positive workplace cultures.

  • Healthcare organisations to recognise and take action on negative workplace behaviour.

  • Further research exploring the impact of negative workforce behaviour on patient care.

  • Context

    There is increasing recognition of intraprofessional bullying and harassment within the nursing workforce contributing to poorer mental health, increased sickness and absence1 and poor retention. In particular, there is growing attention on recently registered nurses who have been identified as a group at high risk of experiencing bullying and harassment. This...

    Australian secondary analysis reveals that vascular access device procedures aimed at preventing harm may be causing skin complications

    Por: McNamara · A.

    Commentary on: Ullman AJ, Mihala G, O’Leary K, et al. Skin complications associated with vascular access devices: a secondary analysis of 13 studies involving 10,859 devices. Int J Nurs Stud 2019;91:6–13.

    Implications for practice and research

  • Clinicians should routinely consider age, medical diagnosis, skin integrity and location of vascular access device before inserting vascular access devices.

  • The use of retrospective studies can adversely impact results due to the limitations in data collected, primarily misclassification bias, the data are subject to confounding and temporal relationships which are often difficult to assess.

  • Context

    There is a wealth of evidence focusing on the prevention of harm when using vascular access devices with the focus being on both reducing systemic and local infections1 and the promotion of device performance.

    This study by Ullman and colleagues aims to expand on this knowledge by identifying the patient, device and healthcare-related characteristics...

    Compounded creams no better than placebo creams for localised chronic pain

    Por: Hu · J.

    Commentary on: Brutcher RE, Kurihara C, Bicket MC, et al. Compounded topical pain creams to treat localized chronic pain: a randomized controlled trial. Ann Intern Med 170:309–18. doi: 10.7326/M18-2736.

    Implications for practice and research

  • Considering the increased costs and minor benefit from compounded creams, clinicians need to caution against routine use of compounded creams for chronic pain.

  • Future studies are warranted to determine whether targeting specific types of chronic pain or adding other agents would lead to better results of compounded creams.

  • Context

    The use of compounded topical creams for localised chronic pain has increased dramatically. The participants in this study, military personnel, are one of the populations who might benefit from this treatment as opioid therapy may have a negative effect on their judgement and motor skills. In 2015, the Centers for Medicare and Medicaid Services spent >500 million dollars on compounded topical pain...

    Qualitative research shows that preferences for place of end-of-life care and death are shaped by the uncertainty of living with a life-limiting illness for patients and family caregivers and are neither synonymous nor stable

    Por: Robinson · J. · Gott · M.

    Commentary on: Gerber K, Hayes B, Bryant C, et al. ‘It all depends!’: a qualitative study of preferences for place of care and place of death in terminally ill patients and their family caregivers. Palliat Med 2019; 33:802-811. doi:10.1177/0269216319845794

    Implications for practice and research

  • Healthcare professionals need to be aware of the unstable nature of preferences for place of end-of-life care and death, include caregivers in place of care discussions and pay attention to the context within which decisions are made.

  • Research that captures preferences for place of care and death at one point in time must be treated with caution given the instability of these preferences when living with, or caring for someone with, a life-limiting illness.

  • Context

    Palliative care philosophy positions home as the optimum place of death, and survey research has concluded that most people would prefer to die at home.

    Metasynthesis: dying adults transition process from cure-focused to comfort-focused care

    Por: Lillie · A. K. · Cheesley · A.

    Commentary on: Meeker MA, McGinley JM, Jezewski MA. Metasynthesis: dying adults’ transition process from cure-focused to comfort-focused care. J Adv Nurs 2019 Feb 7. Epub ahead of print. doi:10.1111/jan.13970

    Implications for practice and research

  • It is important to introduce and integrate the concept of palliative and end-of-life care well in advance of anticipated death to allow patients and those important to them to reframe their expectations and understanding of their condition that enables patients and families to find meaning and value in the last phase of life.

  • There is a need for more research into the barriers and enablers of transition to end-of-life care.

  • Context

    This paper addresses an important topic as communication and shared decision making are integral to good end-of-life care.1 It interrogates the transition from cure-focused medical care to care that prioritises comfort and quality of life and quality...

    Incidence and prevalence of medical device-related pressure ulcers in children and adults

    Por: Hu · J.

    Commentary on: Jackson D, Sarki AM, Betteridge R, Brooke J. Medical device-related pressure ulcers: A systematic review and meta-analysis. Int J Nurs Stud 2019;92:109–120.

    Implications for practice and research

  • Medical devices used for diagnostic, preventive or therapeutic purposes may have unintended consequences on patients such as medical device-related pressure injuries, which affect patients’ well-being and increase the cost of care.

  • Further research is warranted to inform strategies for risk assessment and prevention of medical device-related pressure ulcers.

  • Context

    Medical device-related pressure ulcers are areas of localised injury to the skin or underlying tissue as a result of sustained pressure from a device.1 Medical device-related pressure ulcers occur across hospital departments.2 Patients who use medical devices are twice more likely to develop pressure injuries than patients who do not use medical devices.3 Medical device-related pressure ulcers decrease patients’ quality...

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