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To systematically review advanced nursing roles in caring for people with cognitive impairment and their relatives in acute care hospitals, focusing on describing roles and intervention components.
Systematic review.
We included qualitative and quantitative studies on nurses in advanced roles caring for people with diagnosed or suspected cognitive impairment and their relatives, assessing outcomes at patient, staff and organisational levels. Nurses' advanced role profiles ranged from nurse-led interventions up to Advanced Practice Nurses. We employed the Mixed Methods Appraisal Tool for critical appraisal and conducted a synthesis without meta-analysis using a content analysis approach.
MEDLINE, CINAHL, Cochrane Library, ALOIS, Web of Science and LIVIVO up to May 2024, along with forward and backward citation tracking.
We included 48 studies that described 39 distinct interventions. The majority of these studies employed a quasi-experimental design. Most interventions involved Advanced Practice Nurses (n = 23) and focused on people at risk of or experiencing delirium (n = 22). Nurses in advanced roles predominantly engaged in tasks related to direct clinical practice, as well as coaching and guidance for patients, relatives and colleagues. Their responsibilities also included leadership, collaboration and consultation on a regular basis. Activities related to research and ethical decision-making were infrequently reported.
Many areas of responsibility of nurses in advanced roles align with the needs of hospitalised people with cognitive impairment. Nurses in advanced roles increasingly take on diverse activities across all competence domains of Advanced Practice Nursing, with a focus on coaching and guidance, as well as clinical practice, while leadership, collaboration, research and ethical decision-making become more prominent as their formal training advances.
Our comprehensive description of advanced nursing roles in the care of people with cognitive impairment provides a foundation for developing and refining such roles in hospitals.
We followed the PRISMA guideline and SWiM guideline for reporting.
This study did not include patient or public involvement in its design, conduct or reporting.
Prospero number: CRD42021265157
Introducción. Se conoce como “síndrome post cuidados intensivos” a un conjunto de problemas de salud que persisten tras una enfermedad crítica, pudiendo durar incluso años tras el alta, y que incluyen síntomas cognitivos, físicos y mentales. El paquete de medidas ABCDEF ha demostrado mejorar los efectos indeseados del síndrome, como el delirium, los datos de mortalidad, los días de estancia en la unidad, y sobre todo, siendo útil en el destete de la ventilación mecánica. Objetivo. Describir si los pacientes que ingresan en unidades de cuidados intensivos con una enfermedad crítica, obtienen mejoras en las diferentes áreas del síndrome post cuidados intensivos tras el empleo del paquete de medidas ABCDEF. Método: Se llevó a cabo una revisión sistemática de la literatura disponible entre 2018 y 2023, en las bases de datos PubMed, Scopus y Web of Science (WOS). Resultados. Finalmente se incluyeron 11 artículos para formar parte de este trabajo. Gran parte de los estudios analizados coinciden en que el paquete ABCDEF es útil para minimizar determinados componentes del síndrome post cuidados intensivos, y otros aspectos del proceso de enfermedad del paciente ingresado en UCI. Discusión. El paquete de medidas ABCDEF representa una ayuda a la hora de promover una recuperación más rápida y completa de los pacientes críticos. Los resultados mejoran de manera exponencial al uso del paquete, según varios autores. También ha sido asociado a mejoras en otros aspectos secundarios como la reducción del tiempo de ventilación mecánica, tiempo de estancia en el hospital o mortalidad.
ABSTRACT
Introduction: “Post-intensive care syndrome” is a set of health problems that persist after a critical illness, and can last even months or years after discharge, and that include cognitive, physical, and mental symptoms. The ABCDEF bundle has been shown to improve the unwanted effects of the syndrome, improving delirium, mortality data, length of stay in ICU, and above all, being useful in weaning from mechanical ventilation. Objective: Describing whether critically ill patients admitted to intensive care units show signs of improvements in the different components of post-intensive care syndrome after implementing the ABCDEF bundle. Methods: A systematic review of the available literature between 2018 and 2023 was conducted, in the PubMed, Scopus and Web of Science (WOS) databases. Results: Finally, 11 articles were included to be part of this work. Most of the studies analyzed agree that the ABCDEF bundle is useful for minimizing certain components of the post-intensive care syndrome, and other aspects of the disease process of the patient admitted to the ICU. Discussion. The ABCDEF bundle represents an aid in promoting a faster and more complete recovery of critically ill patients. The results improve exponentially with the use of the bundle, according to several authors. It has also been associated with improvements in other secondary aspects such as reducing mechanical ventilation time, length of hospital stay or mortality
Clinical trials have produced inconclusive results regarding the optimal glucose range for a patient with sepsis in the intensive care unit (ICU) receiving insulin treatment.
To investigate the optimal glucose range in patients with sepsis in the ICU independent of confounding covariates.
Targeted trial emulation of glucose ranges using causal inference targeted maximum likelihood estimation and longitudinal mixed-effects models combined with survival models.
Single-centre, academic referral hospital in Boston, Massachusetts, USA.
Adults fulfilling sepsis 3 criteria with at least three glucose readings and insulin treatment from the Medical Information Mart for Intensive Care (MIMIC)-IV database (2008–2019).
Five predefined glucose distributions with means at 100, 130, 160 (baseline), 190 and 220 mg/dL mimicking current guidelines’ recommendations (140–180 mg/dL).
The primary outcome was in-hospital mortality. Modified counterfactual treatment-policy risks across distinct time-weighted glucose ranges were estimated.
Of 73 181 eligible patients, 8002 patients with a median age of 66 years (41% women, 67% white ethnicity, 57% diabetes) were included. There was a U-shaped curve between glucose range and mortality in patients without diabetes, but overall, this association was not significant (mean glucose at 100 mg/dL with 21% mortality and mean glucose at 220 mg/dL with 26% mortality, p-for-trend 0.26). Mortality was lowest at 17%, with mean glucose between 130 and 160 mg/dL. Hypoglycaemic events (
Our data suggest a U-shaped association of glucose and mortality with an optimal average glucose between 160 and 190 mg/dL. These results confirm current guideline recommendations. Together with recent results from randomised controlled trials, intensivists should aim for a liberal glucose range in most patients.
by Plotine Jardat, Alexandra Destrez, Fabrice Damon, Noa Tanguy-Guillo, Anne-Lyse Lainé, Céline Parias, Fabrice Reigner, Vitor H. B. Ferreira, Ludovic Calandreau, Léa Lansade
Olfaction is the most widespread sensory modality animals use to communicate, yet much remains to be discovered about its role. While most studies focused on intraspecific interactions and reproduction, new evidence suggests chemosignals may influence interspecific interactions and emotional communication. This study explores this possibility, investigating the potential role of olfactory signals in human-horse interactions. Cotton pads carrying human odours from fear and joy contexts, or unused pads (control odour) were applied to 43 horses’ nostrils during fear tests (suddenness and novelty tests) and human interaction tests (grooming and approach tests). Principal component analysis showed that overall, when exposed to fear-related human odours, horses exhibited significantly heightened fear responses and reduced interaction with humans compared to joy-related and control odours. More precisely, when exposed to fear-related odours, horses touched the human less in the human approach test (effect size: Rate Ratio(RR)=0.60 ± 0.24), gazed more at the novel object (RR = 1.32 ± 0.14), and were more startled (startle intensity – Cohen’s d = −0.88 ± 0.39; and maximum heart rate – Cohen’s d = 1.16 ± 0.47) by a sudden event. These results highlight the significance of chemosignals in interspecific interactions and provide insights into questions about the impact of domestication on emotional communication. Moreover, these findings have practical implications regarding the significance of handlers’ emotional states and its transmission through odours during human-horse interactions.by Ugur Yilmaz, Huseyin Celik, Pinar Arpinar-Avsar
This study examined how time pressure influences lower-limb biomechanics during single-leg maximal countermovement jumps (CMJs), with a focus on kinetic and kinematic responses during both jumping and landing phases. Participants performed single-leg CMJs under two conditions: self-paced (SP) and reaction-time (RT), the latter simulating time-constrained environments. Joint angles, ground reaction forces (vGRF), and joint moments were analyzed. Significant differences emerged between SP and RT tasks in jumping-phase kinetics and kinematics, with only kinematic differences present during landing. The RT condition led to reduced hip and knee flexion, increased peak vGRF, and shorter flight times, yet no improvement in jump height. This suggests inefficient energy transfer possibly due to reduced range of motion and increased muscle co-contraction or pretension strategies. Joint moment analysis revealed a shift from a hip-dominant strategy in SP to a knee-dominant strategy in RT. Landing in RT was characterized by reduced joint flexion and increased frontal plane loading, potentially elevating the risk of lower-limb injury. Time pressure modifies motor strategies in single-leg CMJs, promoting faster execution at the cost of performance efficiency. These findings underscore the importance of training for both explosive performance and neuromuscular control under time-constrained, sport-specific conditions.To identify and synthesise nursing interventions directed at family caregivers of patients with end-stage renal disease undergoing haemodialysis.
A convergent-integrated mixed-methods systematic review.
A comprehensive search was conducted in EBSCOHost databases (Academic Search Complete, CINAHL Complete, MEDLINE with Full Text, MedicLatina, ERIC) and the PubMed database. Studies were appraised using the Mixed-Methods Appraisal Tool (MMAT), and interventions were classified using the Cochrane Effective Practice and Organisation of Care taxonomy.
Quantitative data were narratively synthesised and transformed into textual descriptions to enable integration with qualitative findings. A thematic synthesis was conducted to group similar concepts.
Twenty-three studies met the inclusion criteria. Most were quantitative or mixed methods with moderate-to-high methodological quality. Interventions were primarily classified as disease management (n = 10) or self-management support (n = 9). Common components included education, coping strategies, empowerment, and psychosocial support. Positive effects were observed on caregiver quality of life, anxiety, depression, and self-efficacy. Caregiver burden outcomes were mixed, potentially influenced by time and intervention intensity. Additional benefits were noted from relaxation techniques and intradialytic exercise. Qualitative data revealed culturally embedded coping strategies such as spiritual practices, time management and seeking social support.
Educational and empowerment-based nursing interventions—particularly those supporting dyadic coping and family-centred care—can improve caregiver outcomes. Frameworks such as the Roy Adaptation Model and the ‘Timing it Right’ approach enhance intervention design and relevance.
By addressing caregiver needs through structured education, psychosocial support and contextually sensitive approaches, nurses can mitigate caregiver burden and promote long-term caregiver well-being and patient adherence to treatment.
Although patients and caregivers were not directly involved, this review contributes to improving nursing care for family caregivers of individuals with ESRD, aiming to enhance their quality of life.
Children with special needs frequently experience accidents and injuries due to motor control difficulties. The most common home accidents include falls, burns, poisoning, drowning and choking. Compared to their typically developing peers, children with special needs are at a higher risk of home accidents and emergency department visits. Falls related to balance impairments are especially common in this population. The aim of this study is to assess the effects of a virtual reality-based home accident control simulation combined with first aid training on the awareness and initial responses to home accidents of parents of children with special needs, using a single-group pre-post quasi-experimental design.
This quasi-experimental study, using a pre-test/post-test design, is planned to include 100 volunteer parents of children with special needs who are registered at a Barrier-Free Life Application and Research Centre. The parents will receive training on home accidents via virtual reality simulation, supplemented by first aid and transfer training. Data will be collected using the Descriptive Information Form and the Home Accident Awareness Questionnaire for Parents of Children with Special Needs. Children’s balance status will be assessed to determine their fall risk using the Children’s Balance Assessment Form, the Tinetti Balance and Gait Assessment and the Nintendo Wii Fit Balance Board.
Ethical approval was obtained from the Ethics Committee of Istanbul Topkapi University. The results will be disseminated through peer-reviewed journals and academic conferences.
NCT06839196 (ClinicalTrials.gov). Protocol version: 1.2; Protocol Date: 30 April 2025. All items from the WHO Trial Registration Data Set are available in the registry record.
This study aimed to explore the direct and indirect effects of secondary traumatic stress (STS) on nurses' perceived work ability and the effect of these two variables on job satisfaction, organisational turnover intention and intention to leave the nursing profession.
A cross-sectional study was conducted from June to November 2023.
Data were collected by sending an online survey to a convenience sample of nurses. Instruments for data collection included a 37-item questionnaire divided into three sections: (i) socio-demographics, job satisfaction, organisational turnover intention, and intention to leave the profession; (ii) perceived work ability assessed through the Work Ability Index (WAI); (iii) STS measured with the Secondary Traumatic Stress Scale.
Two hundred seventy-one nurses completed the questionnaire. STS negatively and statistically impacted on WAI, and it was a direct determinant of intention to leave the nursing profession. WAI showed a direct, positive and significant impact on job satisfaction and it was a significant partial mediator in the relationship between STS and job satisfaction. Job satisfaction mediated between WAI, the intention to leave the nursing profession, and the organisational turnover intention.
STS negatively impacted nurses' work ability, influencing their job satisfaction through the mediation of WAI, whereas job satisfaction independently affected nurses' organisational turnover intention. Moreover, STS was a positive and direct determinant of the intention to leave the nursing profession.
Nurses, as helping professionals, are exposed to extreme stressful events resulting from the traumatic experiences of patients. STS in nurses can lead to emotional exhaustion, turnover intention, job dissatisfaction and reduced work ability. The findings from this study offer insights that can help shape organisational health policies aimed at reducing STS, preserving nurses' work ability, enhancing job satisfaction and mitigating turnover intentions within and outside the nursing profession.
This study followed the STROBE checklist guidelines for cross-sectional studies.
No Patient or Public Contribution.
Objetivo principal: Evidenciar la seguridad del inicio de vasopresores mediante un catéter venoso periférico corto en pacientes adultos con diagnóstico de choque séptico, a través de la metodología Enfermería Basada en Evidencia. Metodología: Revisión sistemática. La búsqueda de evidencia se realizó en dos periodos, del 15 al 23 de septiembre del 2022 y del 3 al 20 de octubre del 2022, se utilizaron fuentes de búsqueda e información: base de datos PubMed y el buscador Google académico. Resultados principales: Se evaluaron 19679 pacientes, el tiempo de administración de la infusión fue de 101.05 horas, con una duración media de 22.63 horas, el evento adverso con más incidencia fue la extravasación con duración media de 7.5 horas, el vasopresor más utilizado fue la norepinefrina. Conclusión principal: Administrar vasopresores por vía periférica es seguro, considerando factores que reducirían significativamente el riesgo de complicaciones.
Objetivo principal: Comprender la experiencia en la atención del parto respetado de una mujer atendida en una unidad de partería profesional. Metodología: Estudio cualitativo fenomenológico llevado a cabo en una usuaria con control de embarazo casi exclusivo en la Unidad de Partería seleccionada a conveniencia. Se realizaron entrevistas en profundidad y análisis de contenido. Resultados principales: Surgieron las siguientes categorías que dan sentido a la experiencia de parir: 1) parir con amor, 2) la partera como vía del empoderamiento de la mujer y su familia e 3) Interculturalidad-respeto a las tradiciones. Conclusión principal: El análisis de las categorías muestra que el parto respetado es una vivencia única, personalizada, con resultados positivos tanto para la madre y el recién nacido como para los familiares.
Objetivo principal: Determinar la efectividad de la hipotermia terapéutica (HT) como medida de neuroprotección y de reducción de la mortalidad en recién nacidos con encefalopatía hipóxico-isquémica (EHI). Metodología: Enfermería Basada en Evidencia. Bases de datos consultadas: Cinahl, Cuiden, Epistemonikos, Lilacs, PubMed, Scopus, Scient Direct, Scielo, Librería Cochrane y Google Académico, traducción documental a través del DeCS, lectura crítica realizada mediante FLC 3.0 y síntesis de la evidencia de acuerdo con la escala Oxford. Resultados principales: 18 estudios comparados, encontrándose un 83% de efectividad neuroprotectora de la HT, evidenciando la importancia de su aplicación en tiempos <6 y 6-12 horas. Conclusiones principales: La HT tiene un impacto positivo en el tratamiento de la EHI de moderada a grave, mejora la neuroprotección, aumenta la función neurológica y el pronóstico del sistema nervioso, disminuye la discapacidad grave y la tasa de morbimortalidad neonatal.
Objetivo principal: valorar la efectividad de los diferentes sellos torácicos existentes e identificar el tratamiento inmediato óptimo del neumotórax abierto. Metodología: revisión sistemática en bases de datos bibliográficas de gran repercusión en la comunidad científica, identificando estu- dios que analizaran la eficacia de los diferentes sellos torácicos. Resultados principales: los sellos torácicos comercializados no ventilados propician el desarrollo de un neumotórax a tensión, mientras que los ventilados evitan esta complicación. Esto es posible gracias a su función ventiladora y adhesiva, siendo el sello Russel® el que obtuvo mejores resultados. Conclusión principal: los sellos torácicos comercializados con canales ventilados laminados son los recomendados para el tratamiento del neumotórax abierto por evitar el desarrollo de un neumotórax a tensión, quedando en último lugar el uso de un sello completamente oclusivo.
Objetivo: Describir variables clínicas, sociodemográficas, Calidad de Vida Relacionada con la Salud (CVRS) en Hemodiálisis (HD) y Peritoneodiálisis (PD), en Hospital Puerto Montt, Chile. Metodología: cuantitativo descriptivo, transversal. n=75 (47 HD, 28 PD). Aprobado por Comité de Ética, revisión fichas clínicas, cuestionario sociodemográfico y KDQOL-36. Resultados: 51% mujeres, 49% hombres, 56% sector urbano, 20% 51-60 años. HD: 49% casados, 36% tratamiento sobre 84 meses. PD; 43% casados, 25% tratamiento 12-48 meses. KDQOL-36: 43% HD y 54% PD perciben “Buena” su salud. Esfera física; 25%, ambas terapias, refiere limitación en actividades de la vida diaria; 38% de PD refiere dolor “moderado”. Esfera psicológica; HD 28% refiere tranquilidad y sosiego “casi siempre”; PD 35% desánimo y tristeza “algunas veces”. Conclusiones: existe impacto negativo en dimensiones de CVRS; pero, globalmente considerada “Buena”; permitiendo formular mejoras para pacientes.
O objetivo foi analisar as contribuições do processo de aprendizagem vivencial para o desenvolvimento do cuidado sensível no estudante de enfermagem. Pesquisa descritiva, qualitativa, desenvolvida a partir dos registros do formulário de avaliação preenchido por estudantes do terceiro, oitavo e novo período. Foram obtidas amostras não intencionais, dos anos de 2013, 2014 e 2015, totalizando 298 participantes. O campo de estudo foi a Sala Azul, situado na Faculdade de Enfermagem da Universidade Estadual do Rio de Janeiro. Buscou-se respeitar os procedimentos ético-legais que envolvem pesquisas com seres humanos. Emergiram três categorias: Espaço de reflexão para o cuidado de si e do outro; Espaço de aprendizagem da empatia multidimensional e Espaço que promove redução do estresse através do relaxamento. Os resultados sugerem que o processo de aprendizagem vivencial possibilita o desenvolvimento do autoconhecimento, o cuidado de si e do outro, as habilidades empáticas e estratégias de gerenciamento do estresse.
Introducción: El manejo del paciente neurocrítico precisa un estrecho control de la presión de perfusión cerebral y de la presión intracraneal. A lo largo de los años, se ha estudiado la relación entre las intervenciones y los cuidados de enfermería, con la alteración de las cifras de presión intracraneal, demostrándose que, algunas de ellas como los cambios posturales y la aspiración de secreciones, producen un importante impacto. Objetivo: Determinar la influencia de los cambios de posición y la aspiración de secreciones en la presión intracraneal y encontrar un consenso de actuación para mejorar la calidad de la práctica diaria. Método: Se realizó una búsqueda en varias bases de datos, entre abril y mayo de 2017, para recuperar el mayor número de evidencias recientes posibles. Se establecieron criterios de inclusión y exclusión. Tras los procesos de cribado de los artículos, diez de ellos se incluyeron en la revisión sistemática. Resultados y conclusiones: El personal de enfermería constituye una pieza clave en el cuidado de estos pacientes. Todos los estudios coincidieron en que tanto los cambios de posición como la aspiración de secreciones tienen influencia sobre la PIC.
Objetivo principal: identificar las producciones científicas sobre manejo de residuos procedentes de los servicios de salud (RSS) por el equipo de salud en unidades hospitalarias, y analizarlas a la luz de las buenas prácticas. Metodología: revisión integrativa con búsqueda en las bases LILACS, WEB OF SCIENCE, BDENF, MEDLINE / PUBMED. Criterios de inclusión: estudios realizados en unidades hospitalarias y que aborden la gestión en ese contexto. Resultados principales: se seleccionaron 24 publicaciones para representar la muestra de la encuesta. Gran parte de los profesionales no realizan la práctica de segregación y manejo correctamente. La falta de conocimiento de los profesionales es un factor agravante. Conclusión principal: es de extrema importancia la capacitación de los profesionales acerca del manejo adecuado y mayor inversión del gobierno para mejoras en la implantación de regulaciones y fiscalización para la gestión de RSS.
FreshRSS 