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Teenage pregnancy strategy in England: new perspective on effectiveness: a commentary

Por: Lawther · L. · Gillespie · M.

Commentary on: Baxter AJ, Dundas R, Popham F, et al. How effective was England's teenage pregnancy strategy? A comparative analysis of high-income countries. Soc Sci Med 2021;270:113685

Implications for practice and research

  • Individual experiences of the autonomous reproductive choices and pregnancy outcomes of teenagers should be heard

  • It is morally and economically justified to analyse the effectiveness of public health interventions.

  • Whole country public health interventions should be scrutinised to minimise repetition of costly mistakes.

  • A range of measures and a whole systems perspective is required in the analysis and evaluation of effect.

  • Context

    Teenage pregnancy is a global issue in low-income, middle-income and high-income countries, and is associated with suboptimal health outcomes for both the mother, baby and family. Social deprivation, health inequality and educational disadvantage are considered among causative factors and outcomes; therefore, targeting the teenage pregnancy rate is a...

    Medication reconciliation at hospital discharge: A qualitative exploration of acute care nurses’ perceptions of their roles and responsibilities

    Abstract

    Background

    Safe medication management is a cornerstone of nursing practice. Nurses prepare patients for discharge which includes the ongoing safe administration of medications. Medication reconciliation at hospital discharge is an interprofessional activity that helps to identify and rectify medication discrepancies or errors to ensure the accuracy and completeness of discharge medications and information. Nurses have a role in medication safety; however, their involvement in medication reconciliation at hospital discharge is poorly described. The study's aim was to describe acute care nurses’ perceptions of their roles and responsibilities in medication reconciliation at hospital discharge, including barriers and enablers.

    Design

    Using focus groups, this exploratory descriptive study gathered qualitative data from nurses working in five acute care clinical units (medical, surgical and transit/discharge lounge) at a tertiary Australian hospital. The data were analysed using inductive content analysis and reported following the COREQ checklist.

    Results

    Thirty-two nurses were recruited. Three themes emerged from the data: nurses’ medication reconciliation role involves chasing, checking and educating; burden of undertaking medication reconciliation at hospital discharge; team collaboration and communication in medication reconciliation.

    Conclusions

    Nurses had a minor role in medication reconciliation at hospital discharge due to a lack of organisation clinical practice guidance and specialised training. Standardising interprofessional medication reconciliation processes and increasing nurses’ involvement will help to streamline this task, reduce discharge delays, workload pressure and improve patient safety.

    Relevance to clinical practice

    Medication reconciliation at hospital discharge is an interprofessional patient safety activity, however little is known about nurse's role and responsibilities. This study reports nurses’ important contribution to patient safety in terms of healthcare team coordination, medication checking and patient education. Supportive organisations and collaborative teams increased nurses’ willingness to complete this activity.

    Evaluating the feasibility of a web-based discharge education programme to improve general surgical patients postdischarge recovery: a pilot randomised controlled trial

    Por: Kang · E. · Chaboyer · W. · Tobiano · G. · Gillespie · B.
    Objective

    To assess the feasibility of implementing a web-based discharge education programme for general surgery patients both prior to and after hospital discharge.

    Design, setting and participants

    This is a prospective, two-arm, pilot randomised controlled trial. Patients who had a general surgery procedure were recruited from a tertiary hospital between October 2020 and January 2021. Patients were randomly assigned to either the standard education or the web-based education intervention.

    Intervention

    The web-based education comprised of three components designed to enhance patients’ knowledge, skills and confidence to improve their engagement with self-care, and the ability to detect any postoperative issues that can arise during the postdischarge period.

    Main outcomes and measures

    The primary outcome was feasibility in terms of recruitment, randomisation, retention and treatment fidelity related to intervention delivery, adherence and satisfaction. Secondary outcomes were patient activation, self-care ability and unplanned healthcare utilisation.

    Results

    Eighty-five patients were recruited and randomised (42 control; 43 intervention). Twenty-three (27%) were lost to follow-up. All patients received their group allocation as randomised and all patients in the intervention group received the web-based education prior to discharge. Postdischarge, patients accessed the education an average of 3 times (SD 3.14), with 4 minutes (SD 16) spent on the website. 28 (97%) of the intervention patients found the content easy to understand, 25 (86%) found it useful and 24 (83%) were satisfied with its content. There was a significant association between the intervention and patient activation (F(1,60)=9.347, p=0.003), but not for self-care ability and unplanned healthcare utilisations.

    Conclusion

    This pilot study demonstrated the feasibility of implementing a web-based education programme. There was a high number of participants lost to follow-up, requiring additional attention in the design and implementation of a larger trial.

    Trial registration number

    ACTRN12620000389909p.

    Defining CD4 T helper and T regulatory cell endotypes of progressive and remitting pulmonary sarcoidosis (BRITE): protocol for a US-based, multicentre, longitudinal observational bronchoscopy study

    Por: Koth · L. L. · Harmacek · L. D. · White · E. K. · Arger · N. K. · Powers · L. · Werner · B. R. · Magallon · R. E. · Grewal · P. · Barkes · B. Q. · Li · L. · Gillespie · M. · Collins · S. E. · Cardenas · J. · Chen · E. S. · Maier · L. A. · Leach · S. M. · OConnor · B. P. · Hamzeh · N. Y.
    Introduction

    Sarcoidosis is a multiorgan granulomatous disorder thought to be triggered and influenced by gene–environment interactions. Sarcoidosis affects 45–300/100 000 individuals in the USA and has an increasing mortality rate. The greatest gap in knowledge about sarcoidosis pathobiology is a lack of understanding about the underlying immunological mechanisms driving progressive pulmonary disease. The objective of this study is to define the lung-specific and blood-specific longitudinal changes in the adaptive immune response and their relationship to progressive and non-progressive pulmonary outcomes in patients with recently diagnosed sarcoidosis.

    Methods and analysis

    The BRonchoscopy at Initial sarcoidosis diagnosis Targeting longitudinal Endpoints study is a US-based, NIH-sponsored longitudinal blood and bronchoscopy study. Enrolment will occur over four centres with a target sample size of 80 eligible participants within 18 months of tissue diagnosis. Participants will undergo six study visits over 18 months. In addition to serial measurement of lung function, symptom surveys and chest X-rays, participants will undergo collection of blood and two bronchoscopies with bronchoalveolar lavage separated by 6 months. Freshly processed samples will be stained and flow-sorted for isolation of CD4 +T helper (Th1, Th17.0 and Th17.1) and T regulatory cell immune populations, followed by next-generation RNA sequencing. We will construct bioinformatic tools using this gene expression to define sarcoidosis endotypes that associate with progressive and non-progressive pulmonary disease outcomes and validate the tools using an independent cohort.

    Ethics and dissemination

    The study protocol has been approved by the Institutional Review Boards at National Jewish Hospital (IRB# HS-3118), University of Iowa (IRB# 201801750), Johns Hopkins University (IRB# 00149513) and University of California, San Francisco (IRB# 17-23432). All participants will be required to provide written informed consent. Findings will be disseminated via journal publications, scientific conferences, patient advocacy group online content and social media platforms.

    Development of a web‐based discharge education intervention to improve the postdischarge recovery of general surgical patients

    Abstract

    Background

    Postoperative complications contribute to unplanned hospital readmissions, reoperations, and increased mortality for surgical patients. Discharge education for general surgical patients is often inadequate, and challenged by organizational, clinician and patient factors.

    Purpose

    This research describes the development of the web-based discharge education intervention to improve patients’ knowledge, skills, and confidence in self-managing their recovery after general surgery.

    Methods

    The intervention was informed by the UK Medical Research Council guidance for developing and evaluating complex interventions and Knowledge-to-Action framework, consisting of four iterative stages. Stakeholder engagement was undertaken throughout the development process and a logic model was utilized to map the working mechanism of the intervention. The concept of patient activation and Knowles adult learning theory underpinned the development process.

    Results

    The literature review and stakeholders’ engagement in qualitative interviews and a series of meetings resulted in a web-based discharge education program with three different components: (1) post general surgery warning signs; (2) post general surgery everyday care instructions; and (3) animation video on wound potential wound complications.

    Conclusion

    The web-based discharge education was developed according to the needs and preferences of healthcare providers and general surgical patients. Despite the rigorous and systematic approach used to develop the intervention, its effectiveness requires testing.

    Clinical relevance

    This comprehensive iterative approach serves as a guide for others planning web-based interventions designed for surgical patients and the research approach used may inform those developing web-based interventions for other patient groups.

    How does workplace bullying influence nurses’ abilities to provide patient care? A nurse perspective

    Abstract

    Aims and objectives

    To explore how workplace bullying influences nurses’ abilities to provide patient care.

    Background

    Nurses’ experiences of workplace bullying undermine nursing work environments and potentially threaten patient care. Although there is a link between nurses’ experiences of workplace bullying and poor patient care, additional exploration is necessary as current evidence remains underdeveloped and inconclusive.

    Design

    Qualitative descriptive study.

    Methods

    Fifteen inpatient staff nurses who have experienced workplace bullying while working in one hospital located in the southern region of the USA participated in individual, semi‐structured interviews. Inductive thematic analysis was used to analyse interview transcripts in NVivo 12 software. The COREQ checklist for qualitative studies has been used in reporting this study.

    Results

    Three themes, and respective subthemes, were generated from data analysis: (a) workplace bullying as part of the nursing work environment, (b) workplace bullying's influence on nurses and (c) workplace bullying's influence on patient care. Workplace bullying was perceived to be inherent in the nursing work environment; nurses felt that they were targets of workplace bullying because (a) they were new nurses, (b) there was an abuse of power, or (c) the nature of the work occasioned it. Nurses were mentally and emotionally influenced by the bullying. Some nurses perceived that workplace bullying did influence their ability to provide patient care; however, others did not.

    Conclusions

    Organisations must support new nurses and manage relational attributes of the nursing work environment to reduce workplace bullying. Nursing leaders should receive education on fostering and sustaining favourable nursing work environments and be held accountable for behavioural expectations of the organisation.

    Relevance to clinical practice

    Understanding how nurses perceive the work environment to influence their experiences of workplace bullying informs the development of organisational interventions to reduce the behaviour. Furthermore, exploring how nurses’ experiences of workplace bullying influences their abilities to provide patient care increases our understanding of workplace bullying implications.

    Patient involvement in surgical wound care research: A scoping review

    Abstract

    Active involvement of patients in planning, conducting, and disseminating research has been adopted by many organisations internationally, but the extent to which this occurs in surgical wound care is not evident. This scoping review aimed to identify how patients have been involved in surgical wound care research and the quality of its reporting. Full‐text studies focused on preoperative and postoperative surgical wound care in the acute care setting, published in English between 2004 and 2019, were included in the review. Screening, data charting, and quality assessment were conducted by two reviewers independently, adjudicated by a third, and then reviewed by five others. Thematic analysis synthesised the findings. Of the eight included studies, seven explained the methods for patient involvement and five described aims related to patient involvement and commented on patient involvement in the discussion. None met all of the quality assessment criteria. Three themes emerged: involvement in modifying and refining research processes, connecting and balancing expert and patient views, and sharing personal insights. Recommendations to improve patient involvement in surgical wounds research include the following: using framework and tools to inform future research; training researcher and patients in their respective research roles; and ongoing monitoring of patient involvement.

    Evaluating the Implementation of a Multi‐Component Intervention to Prevent Surgical Site Infection and Promote Evidence‐Based Practice

    Abstract

    Background

    Published clinical practice guidelines on surgical site infection prevention are available; however, adherence to these guidelines remains suboptimal.

    Aims

    The aim of this study was to evaluate the effectiveness and perceived benefits of intervention and implementation strategies co‐created by researchers and clinicians to prevent surgical site infections.

    Methods

    This mixed‐method evaluation study involved an audit of nurses’ wound care practices, followed by focus group and individual interviews to understand the perceived benefits of the intervention and implementation strategies. Descriptive statistical analyses were used to compare post‐intervention audit data with baseline results. Deductive and inductive content analyses were undertaken on the qualitative data.

    Results

    The audit showed improvements in using aseptic technique and wound care documentation practices following intervention implementation. Nurses perceived the change champion as effective in role‐modelling good practice. Education strategies including a poster and using a scenario‐based quiz were viewed as easy to understand and helpful for nurses to apply aseptic technique in practice. The instructions and education conducted to improve documentation were considered important in the success of the Wound Care Template implementation.

    Linking Evidence to Action

    The integrated knowledge translation approach used in this study ensured the intervention and the implementation strategies employed were appropriate and meaningful for clinicians. Such strategies may be used in other intervention studies. The change champion played an important role in driving change and acted as a vital partner during the co‐creation and the implementation processes. Ongoing education, audit and feedback became integrated in the ward nurses’ routine practice, which has the potential to continuously improve and sustain evidence‐based practice.

    Wound care practices across two acute care settings: A comparative study

    Abstract

    Aims and objectives

    Describe and compare current surgical wound care practices across two hospitals in two health services districts, Australia.

    Background

    Surgical site infections (SSI) are a complication of surgery and occur in up to 9.5% of surgical procedures, yet they are preventable. Despite the existence of clinical guidelines for SSI prevention, there remains high variation in wound care practice.

    Design

    Prospective comparative design using structured observations and chart audit.

    Methods

    A specifically developed audit tool was used to collect data on observed wound care practices, documentation of wound assessment and practice, and patients’ clinical characteristics from patients’ electronic medical records. Structured observations of a consecutive sample of surgical patients receiving wound care with a convenience sample of nurses were undertaken. The manuscript adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement.

    Results

    In total, 154 nurses undertaking acute wound care and 257 surgical patients who received wound care were observed. Across hospitals, hand hygiene adherence after dressing change was lowest (Hospital A: 8/113, 7%; Hospital B: 16/144, 11%; χ 2: 8.93, p = .347). Most wound dressing practices were similar across sites, except hand hygiene prior to dressing change (Hospital A: 107/113, 95%; Hospital B: 131/144, 91%; (χ2: 7.736, p = .021) and use of clean gloves using nontouch technique (Hospital A: 88/113, 78%; Hospital B: 90/144, 63%; χ 2: 8.313, p = .016). The most commonly documented wound characteristic was wound type (Hospital A: 43/113, 38%; Hospital B: 70/144, 49%). What nurses documented differed significantly across sites (p < .05).

    Conclusions

    Clinical variations in wound care practice are likely influenced by clinical context.

    Relevance to clinical practice

    Using an evidence‐based approach to surgical wound management will help reduce patients’ risk of wound‐related complications.

    General surgical patients’ experience of hospital discharge education: A qualitative study

    Abstract

    Aims and objectives

    To explore adult general surgical patients’ perceptions of, and satisfaction with, discharge education provided by healthcare providers.

    Background

    Discharge education is essential for general surgical patients as it equips them with the required knowledge and skills to engage in their care after discharge. Insufficient knowledge to self‐manage or assess their symptoms can result in postdischarge complications, unplanned hospital readmission and overall dissatisfaction with the hospital experience.

    Design

    A constructivist‐interpretivist paradigm using qualitative interviews.

    Methods

    Telephone interviews were conducted with 13 patients between August 2018 and November 2018 and analysed using inductive content analysis. COREQ guidelines were adopted for the conduct and reporting of the study.

    Results

    Four themes were uncovered: (a) The quality of discharge information influences patients’ postdischarge experience; (b) The negative impact of contextual influences on delivery of discharge education; (c) Patients actively participating in their surgical journey; (d) Patients’ preferences with the delivery of discharge education.

    Conclusion

    Inadequate discharge education leads to patients’ inability to self‐manage their recovery process. Information sharing with patients fosters shared understanding towards goals and expectations.

    Relevance to clinical practice

    Understanding patients’ view may inform the design of patient‐centred discharge education interventions for patients to self‐manage their recovery postdischarge.

    Pressure injury prevalence and predictors among older adults in the first 36 hours of hospitalisation

    Abstract

    Aims and objective

    To describe the prevalence and predictors of pressure injuries among older adults with limited mobility, within the first 36 hr of their hospital admission in Australia.

    Background

    Pressure injuries are significant health, safety and quality of care issues for patients and healthcare organisations. The early implementation of the recommended pressure injury prevention international clinical practice guidelines is a way to reduce hospital‐acquired pressure injuries. There is a paucity of evidence on the number of older persons who are admitted hospital with a pre‐existing pressure injury.

    Design

    Prospective correlational study conducted in eight tertiary referral hospitals across Australia. Our sample comprised of 1,047 participants aged ≥65 years with limited mobility, drawn from a larger Australian pragmatic cluster randomised trial.

    Methods

    Using the STROBE statement, observational data were collected on participants’ age, gender, presence of a pressure injury, Body Mass Index score, number of comorbidities and place of residence. These variables were analysed as potential predictors for pressure injuries within the first 36 hr of hospitalisation.

    Results

    From our sample, 113/1047 (10.8%) participants were observed to have a pressure injury within the first 36 hr of hospital admission. Age, multiple comorbidities and living in an aged care facility predicted the prevalence of pressure injury among older people within the first 36 hr of hospitalisation.

    Conclusions

    Our findings confirm that older adults, those with multiple comorbidities and individuals living in aged care facilities are more likely to come to hospital with a pre‐existing pressure injury or develop one soon after admission.

    Relevance to clinical practice

    Many older patients come to hospital with a community‐acquired pressure injury or develop a pressure injury soon after admission. This highlights the importance of the early detection of pressure injuries among older persons so that timely management strategies can be implemented along with the potential to reduce unnecessary financial penalties.

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