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Caring for the carers in a public health district: A well‐being initiative to support healthcare professionals

Abstract

Aims and Objectives

To assess the impact of the proactive organisational resource allocation in terms of a 6‐week well‐being initiative to support public healthcare professionals' workplace engagement, well‐being and job satisfaction.

Background

Burnout of healthcare professionals can be a major cost to the Australian economy and public healthcare sector. According to the social exchange theory, when healthcare professionals perceive that their organisation proactively allocates resources to caring for its employees, then they are more likely to reciprocate and become more engaged in their work roles.

Design

The study used a pre‐ and postsurvey of healthcare professionals who participated in the well‐being initiative.

Methods

Between February–June 2019, 172 healthcare professionals were surveyed before and after a well‐being initiative. The survey included questions on workplace engagement, workplace well‐being and job satisfaction. Paired t tests were used to determine whether the difference between before and after averages was significant. The TREND statement was used to ensure the quality reporting of this study.

Results

The well‐being initiative had a positive impact on the healthcare professionals involved in the initiative. Nursing staff benefitted the most from the well‐being initiative, while the full‐time staff members and highly experienced demonstrated an increase in engagement.

Conclusion

Well‐being initiatives can be a targeted strategy to help alleviate burnout amongst healthcare professionals and build a mutually beneficial relationship between management and employees.

Relevance to clinical practice

This study shows how implementing a staff well‐being initiative increases workplace engagement, which benefits both the individual and the organisation.

Self‐management programs for cirrhosis: a systematic review

Abstract

Background and aims

Liver cirrhosis severely decreases patients' quality of life. Since self‐management programs have improved quality of life and reduce hospital admissions in other chronic diseases, they have been suggested to decrease liver cirrhosis burden.

Methods

We performed a systematic review and meta‐analysis to evaluate the clinical impact of self‐management programs in patients with liver cirrhosis, which followed the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Primary outcomes include health‐related quality of life (HRQOL) and hospitalization. We searched MEDLINE, CENTRAL, EMBASE, CINAHL, PsycINFO and two trial registers to July 2017.

Results

We identified four randomized trials (299 patients) all rated at a high risk of bias. No difference was demonstrated for HRQOL (Standardized Mean Difference ‐0.01, 95% CI: ‐0.48 to 0.46) and hospitalization days (Incidence Rate Ratio 1.6, 95% CI: 0.5 to 4.8). For secondary outcomes, one study found a statistically significant improvement in patient knowledge (Mean Difference (MD) 3.68, 95% CI: 2.11 to 5.25) while another study found an increase in Model for End‐Stage Liver Disease scores (MD 2.8, 95% CI: 0.6 to 4.9) in the self‐management group. No statistical difference was found for the other secondary outcomes (self‐efficacy, psychological health outcomes, healthcare utilization, mortality). Overall, the quality of the evidence was low. The content of self‐management programs varied across studies with little overlap.

Conclusions

The current literature indicates that there is no evidence of a benefit of self‐management programs for people with cirrhosis.

Relevance to clinical practice

Practitioners should use self‐management programs with caution when delivering care to patients living with cirrhosis. Further research is required to determine what are the key features in a complex intervention like self‐management. This review offers a preliminary framework for clinicians to develop a new self‐management program with key features of effective self‐management interventions from established models.

"The challenge of joining all the pieces together"‐Nurses’ experience of palliative care for older people with advanced dementia living in residential aged care units

Abstract

Aims and objectives

To describe nurses’ experiences of palliative care for older people with advanced dementia living in residential aged care units.

Background

Dementia is a global health problem and the number of older people with dementia who need palliative care is increasing. Previous research has revealed that care for older people with dementia in the final stage of life is usually complex. However, little is known about how nurses experience palliative care for older people with advanced dementia living in residential aged care units.

Method

Nine individual, semi‐structured face‐to‐face interviews with nurses working in residential aged care units for older people with advanced dementia in palliative care in western Sweden were analysed using qualitative inductive content analysis. The COREQ checklist was followed.

Results

The nurses considered that palliative care for older people with advanced dementia is a complex and challenging form of care. In particular, they identified three challenges that must be met: developing specialised knowledge and skills, developing teamwork as a working method, and creating a caring relationship.

Conclusions

The results of our analysis indicate that if nurses are aware of and understand that the challenges are essential for ‘joining all the pieces together’, the palliative care for older people with advanced dementia may become a positive experience for nurses and may increase their sense of satisfaction and security in their professional role.

Relevance to clinical practice

For the palliative care to be successful the nurses need to ‘join all the pieces together’, i.e. succeed in developing specialised knowledge and skills, developing teamwork as a working method, and creating a caring relationship to establish a person‐centred care with the older person with advanced dementia and with his or her relatives.

Ranking Cuiden Citación de Re-vistas de Enfermería más citadas en Iberoamérica: resultados del año 2019

El objetivo es analizar los resultados del Ranking Cuiden Citación-2019 con las revistas de Enfermería más citadas en Iberoamérica. Se incluyen 51 publicaciones procedentes de seis países (Brasil, Colombia, España, Uruguay, Portugal y Cuba) que han registrado impacto bibliométrico en el último periodo analizado. Se analizan dos indicadores: Repercusión Inmediata Cuiden (RIC) e Índice de Inmediatez. Además se identifican otras revistas de enfermería citadas dentro y fuera del Espacio Científico Iberoamericano (ECI). Destacan las revistas brasileñas, que ocupan las principales posiciones del repertorio, siendo la revista Esc Anna Nery R Enferm la más citada con una RIC de 2,216. El mayor índice de imediatez lo registra la revista Enferm Clínica. Aparecen cinco revistas citadas con posibilidades de incorporarse como revistas fuente en siguientes análisis. Se aprecia un cierto estancamiento en el ritmo de crecimiento de citas en los últimos años, sin que aún podamos hablar de saturación. El número de revistas con repercusión permanece estable, con una ligera tendencia al decrecimiento.

Cover Images

Cover Images

The cover image © Shriners Hospitals for Children‐Canada is based on the Original Article The day‐to‐day experiences of caring for children with Osteogenesis Imperfecta : A qualitative descriptive study by Aimee Castro, Argerie Tsimicalis et al.,https://doi.org/10.1111/jocn.15310..


Attrition from specialised rehabilitation associated with an elevated mortality risk: results from a vital status tracing study in Swiss spinal cord injured patients

Por: Chamberlain · J. D. · Eriks-Hoogland · I. E. · Hug · K. · Jordan · X. · Schubert · M. · Brinkhof · M. W. G.
Introduction

Study drop-out and attrition from treating clinics is common among persons with chronic health conditions. However, if attrition is associated with adverse health outcomes, it may bias or mislead inferences for health policy and resource allocation.

Methods

This retrospective cohort study uses data attained through the Swiss Spinal Cord Injury (SwiSCI) cohort study on persons with spinal cord injury (SCI). Vital status (VS) was ascertained either through clinic medical records (MRs) or through municipalities in a secondary tracing effort. Flexible parametric survival models were used to investigate risk factors for going lost to clinic (LTC) and the association of LTC with subsequent risk of mortality.

Results

1924 individuals were included in the tracing study; for 1608 of these cases, contemporary VS was initially checked in the MRs. VS was ascertained for 704 cases of the 1608 cases initially checked in MRs; of the remaining cases (n=904), nearly 90% were identified in municipalities (n=804). LTC was associated with a nearly fourfold higher risk of mortality (HR=3.62; 95% CI 2.18 to 6.02) among persons with traumatic SCI. Extended driving time (ie, less than 30 min compared with 30 min and longer to reach the nearest specialised rehabilitation facility) was associated with an increased risk of mortality (HR=1.51, 95% CI 1.02 to 2.22) for individuals with non-traumatic SCI.

Conclusion

The differential risk of LTC according to sociodemographic and SCI lesion characteristics underscores the importance of accounting for attrition in cohort studies on chronic disease populations requiring long-term care. In addition, given the associated risk of mortality, LTC is an issue of concern to clinicians and policy makers aiming to optimise the long-term survival of community-dwelling individuals with traumatic SCI. Future studies are necessary to verify whether it is possible to improve survival prospects of individuals LTC through more persistent outreach and targeted care.

Prospective randomised controlled trial using the REthinking Clinical Trials (REaCT) platform and National Surgical Quality Improvement Program (NSQIP) to compare no preparation versus preoperative oral antibiotics alone for surgical site infection rates

Por: Apte · S. S. · Moloo · H. · Jeong · A. · Liu · M. · Vandemeer · L. · Suh · K. · Thavorn · K. · Fergusson · D. A. · Clemons · M. · Auer · R. C.
Introduction

Despite 40 randomised controlled trials (RCTs) investigating preoperative oral antibiotics (OA) and mechanical bowel preparation (MBP) to reduce surgical site infection (SSI) rate following colon surgery, there has never been an RCT published comparing OA alone versus no preparation. Of the four possible regimens (OA alone, MBP alone, OA plus MBP and no preparation), randomised evidence is conflicting for studied groups. Furthermore, guidelines vary, with recommendations for OA alone, OA plus MBP or no preparation. The National Surgical Quality Improvement Program (NSQIP) has automated data collection for surgical patients. Similarly, the ‘REthinking Clinical Trials’ (REaCT) platform increases RCT enrolment by simplifying pragmatic trial design. In this novel RCT protocol, we combine REaCT and NSQIP to compare OA alone versus no preparation for SSI rate reduction in elective colon surgery. To our knowledge, this is the first published RCT protocol that leverages NSQIP for data collection. In our feasibility study, 67 of 74 eligible patients (90%) were enrolled and 63 of 67 (94%) were adherent to protocol. The ‘REaCT–NSQIP’ trial design has great potential to efficiently generate level I evidence for other perioperative interventions.

Methods and analysis

SSI rates following elective colorectal surgery after preoperative OA or no preparation will be compared. We predict 45% relative rate reduction of SSI, improvement in length of stay, reduced costs and increased quality of life, with similar antibiotic-related complications. Consent, using the ‘integrated consent model’, and randomisation on a mobile device are completed by the surgeon in a single clinical encounter. Data collection for the primary end point is automatic through NSQIP. Analysis of cost per weighted case, cost utility and quality-adjusted life years will be done.

Ethics and dissemination

This study is approved by The Ontario Cancer Research Ethics Board. Results will be disseminated in surgical conferences and peer-reviewed journals.

Trial registration number

NCT03663504; Pre-results, recruitment phase.

Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis

Por: Li · J. · Ji · F. · Song · J. · Gao · X. · Jiang · D. · Chen · G. · Chen · S. · Lin · X. · Zhuo · C.
Objectives

Anxiety has been suggested to be associated with poor outcomes in patients with acute coronary syndrome (ACS). However, results of previous follow-up studies were inconsistent. The aim of this meta-analysis was to evaluate the association between anxiety and clinical outcomes in patients with ACS, and to investigate the potential role of depression underlying the above association.

Design

A meta-analysis of prospective follow-up studies.

Setting

Hospitals.

Participants

Patients with ACS.

Interventions

We included related prospective follow-up studies up through 20 July 2019 that were identified by searching PubMed and Embase databases. A random-effect model was used for the meta-analysis. Anxiety was evaluated by validated instruments at baseline.

Primary and secondary outcome measures

We determined the association between anxiety and risks of mortality and adverse cardiovascular events (MACEs) in patients with ACS.

Results

Our analysis included 17 studies involving 39 038 patients wqith ACS. Anxiety was independently associated with increased mortality risk (adjusted risk ratio (RR) 1.21, 95% CI 1.07 to 1.37, p=0.002) and MACEs (adjusted RR 1.47, 95% CI 1.24 to 1.74, p

Conclusions

Anxiety is associated with increased risk of mortality and MACEs in patients with ACS. However, at least part of the association may be confounded by concurrent depressive symptoms in these patients.

Understanding key mechanisms of successfully leading integrated team-based services in health and social care: protocol for a realist synthesis

Por: Harris · R. · Fletcher · S. · Sims · S. · Ross · F. · Brearley · S. · Manthorpe · J.
Introduction

As systems of health and social care in England move towards more integrated and collaborative models, leaders will need different skills than their predecessors to enable system leadership, building partnerships and working across organisations and sectors. There is little understanding of what the mechanisms for effective leadership across integrated health and social care systems might be, the contexts that influence good leadership, or the nature of the resulting outcomes. This review aims to identify, refine and test programme theories of leadership of integrated team-based services in health and social care, exploring what works, for whom and in what circumstances.

Methods and analysis

This study uses a realist synthesis approach, following RAMESES guidelines, supported by stakeholder consultation. Stage 1 will develop initial programme theories about leadership of integrated health and social care based on a review of the scientific and grey literature and a stakeholder consultation workshop. Stage 2 will involve focused searching of empirical literature, data extraction and synthesis to refine the initial programme theories and identify relationships between identified contexts, mechanisms and outcomes. A second stakeholder event will guide the focus of the review. Stage 3 will further refine and interrogate the theories testing them against substantive theory on leadership of complex systems and through the experiences and expertise of the stakeholder group.

Ethics and dissemination

Our study does not require ethics committee approval. This research will contribute to building an in-depth understanding of what aspects of leadership of integrated team-based services work, for whom and in what circumstances. It will identify the professional development needs of leaders and provide recommendations about optimal organisational and interorganisational structures and processes that support effective leadership in integrated health and social care systems. Findings will be disseminated through peer-reviewed journal publications, conference presentations and formal and informal reports.

PROSPERO registration number

CRD42018119291

Dyadic teams and nursing care: a critical incident study of nurses in the emergency medical service

Abstract

Aim and objectives

The aim of the study was to describe EMS nurses’ experiences of and coping with critical incidents, when providing nursing care as a member of a dyadic team.

Background

Nursing care in EMS is a complex task, taking into account the physical, psychological as well as existential dimensions of the patient’s suffering. In this, EMS nurses are dependent on the dyadic team. Teams in EMS are described as essential for providing safe medical care. However, nursing care also comprises relationships with patients as a means of reducing patient suffering.

Design

The study has an inductive descriptive qualitative design, in adherence to the COREQ‐checklist.

Methods

A critical incident technique was used. Thirty‐five EMS nurses were interviewed individually, with a focus on dyadic teams providing nursing care. The interviews were analysed with the aim of defining main areas, categories and sub‐categories.

Results

The experiences of critical incidents emerged to form two main areas; ‘Functional co‐operation’ and ‘Dysfunctional co‐operation’, comprising seven categories and sixteen sub‐categories. Their coping with critical incidents encompassed two main areas; ‘Adapting oneself’ and ‘Adapting nursing care and the colleague’, comprising four categories and nine sub‐categories.

Conclusions

Reflection as part of the daily practice emerges as important for the development of nursing care both in relation to individual team‐members and also the dyadic team as a unit. In addition, the results highlight consensus within dyadic teams regarding the objectives of nursing care, as well as the importance of defined roles.

Relevance to clinical practice

This study underlines the importance of strengthening the dyadic EMS team’s ability to co‐operate using common goals and knowledge within clinical nursing care. The individual team members’ different roles have to be explicit. In addition, clinical care has to be organised to generate preconditions for mutual performance monitoring through collegial feedback and reflection.

Relationships between the National Early Warning Score 2, clinical worry, and patient outcome at discharge: Retrospective observational study

Abstract

Aims and objectives

To examine the performance of the National Early Warning Score 2 and composite score for clinical worry in identifying patients at risk of clinical deterioration, and to determine relationships between National Early Warning Score 2, clinical worry score, and patient outcome at discharge.

Background

The efficacy of early warning systems depends on patient population and care settings. Based on a theoretical framework on factors affecting clinical deterioration and patient outcomes, studies exploring the relationship between early warning systems and patient outcomes at discharge are sparse.

Design

Retrospective observational study.

Methods

A random sample of 732 medical records were reviewed. The area under the receiver‐operating‐characteristic curve was calculated to evaluate predictive abilities regarding the events of unanticipated in‐hospital mortality, unplanned intensive care unit/ higher‐dependency bed admission, and cardiac arrest. Multiple logistic regression analyses were performed to determine relationships between National Early Warning Score 2, clinical worry score, and patient outcome. Reporting followed the STROBE checklist.

Results

National Early Warning Score 2 and clinical worry score significantly predicted the events within 24 hours of the assessment. After controlling for other patient, treatment, and organizational characteristics, National Early Warning Score 2 was a significant factor associated with patient outcome, but clinical worry score was not. Specifically, patients at high risk based on National Early Warning Score 2 were less likely to have improved outcome.

Conclusions

National Early Warning Score 2 and clinical worry score performed well for predicting deteriorating condition of patients. National Early Warning Score 2 was significantly associated with patient outcome. It can be used for efficient patient management for safe, quality care.

Relevance to clinical practice

National Early Warning Score 2 can be used for early assessment of not only clinical deterioration but also patient outcome and provide timely intervention, when coupled with clinical worry score.

Bedside handover at the change of nursing shift: a mixed methods study

Abstract

Aim

To describe the structures, processes and content of bedside handover at the change of nursing shift in an acute care context.

Background

The handover of patient information and care at the change of nursing shift is an essential, albeit risk laden, time consuming activity in clinical practice.

Design

A convergent parallel mixed methods design was used.

Methods

Thirty episodes of bedside handover were concurrently audio recorded and observed using a researcher developed tool modelled on the five domains of the British Medical Association’s Safe Handover–Safe Patients framework. The audio recordings were analysed using content analysis. Quantitative and qualitative data generated, were then triangulated to develop a more complete interpretation of the structure, process and content of information transferred at the patient’s bedside during the change of nursing shift. This study followed Good Reporting of a Mixed Methods Study guidelines.

Results

Bedside handover was observed to be mainly conducted at a fast pace. However, within this timeframe large volumes of complex information was shared and important nurse–patient interactions occurred. Analysis of the audio recordings provided evidence that the dialogue during handover was nurse dominated and the outgoing nurse appeared to influence the degree of patient participation.

Conclusion

Bedside handover at the change of nursing shift involves three key stakeholders: outgoing nurse, incoming nurse and the patient. A combination of intricate communication skills both verbal and non‐verbal facilitate the rapid sharing of large volumes of complex information which is necessary for the continuity and safety of patient care across nursing shifts.

Relevance to clinical practice

The comprehensive description of the complexities of bedside handover in this study provides an insight into this frequently occurring, important nursing practice and can be used to support nurse education and practice development.

Parental Readiness for Hospital Discharge as a Mediator between Quality of Discharge Teaching and Parental Self‐Efficacy in Parents of Preterm Infants

Abstract

Aims and Objectives

To examine the extent to which parental readiness for hospital discharge mediates the relationship between quality of discharge teaching and parental self‐efficacy in parents of preterm infants.

Background

Parental readiness for hospital discharge and self‐efficacy should be considered to establish if preterm infants and their families are prepared for the discharge. High‐quality discharge teaching could facilitate a smooth discharge transition. However, little is known about how quality of discharge teaching influences parental readiness for hospital discharge and self‐efficacy.

Design

This was a descriptive cross‐sectional study of 202 parents with preterm infants in a tertiary hospital in Eastern China.

Methods

The key variables of interest were measured using the Chinese versions of the Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale‐Parent Form, and Preterm Parenting and Self‐Efficacy Checklist. Path analyses were conducted to test the mediation models. STROBE checklist was used to compile the study’s report.

Results

Parental readiness for discharge (overall and knowledge dimension) partially mediated the relationship between the quality of discharge teaching and parental self‐efficacy. The two dimensions (content received and delivery) of quality of discharge teaching positively influenced parental self‐efficacy by improving parental readiness for discharge.

Conclusions

Parental readiness for hospital discharge, especially the knowledge dimension, was an important factor in quality of discharge teaching’s association with self‐efficacy in parents of preterm infants. Improving the quality of discharge teaching could increase parental readiness for discharge, and thus promote parental self‐efficacy.

Relevance to Clinical Practice

Improving discharge instructions is essential to help parents of preterm infants prepare for the transition to home care. Assessing readiness and confidence at an early stage and continuing to do so throughout the hospital stay may provide additional ways for nurses to identify parents’ knowledge gaps and to provide tailored interventions at more opportune times before hospital discharge.

Family members’ lived experiences when a loved one undergoes an interhospital intensive care unit‐to‐unit transfer: a phenomenological hermeneutical study

Abstract

Aims and objectives

The aim of the study was to reveal meanings of family members’ lived experiences when a loved one undergoes an interhospital intensive care unit‐to‐unit transfer.

Background

Interhospital intensive care unit‐to‐unit transfers take place between different hospitals and their respective intensive care units. These types of transfers are an increasing phenomenon but are sparsely studied from the family members’ perspective. Indeed, the patient’s critical illness and care can have a major impact on family members. During the transfer process, there is a demand for the involved intensive care health personnel to make family members feel safe and cared for.

Design

A qualitative design based on phenomenological hermeneutics.

Methods

The study was conducted at two Swedish general intensive care units. Data were generated through individual in‐depth interviews with seven family members and analysed using a phenomenological hermeneutical approach. The COREQ principles were applied in the conduct and reporting of this study.

Results

Four themes that reveal meanings of family members’ lived experiences were developed: losing your safe haven, dealing with uncertainty, carrying your own and others’ burdens and a wish to be close.

Conclusions

The study reveals that an interhospital intensive care unit‐to‐unit transfer affects the whole family and is characterised by family members experiencing many negative feelings. The findings also illustrate that being a family member when a loved one is transferred means being exposed to the core existential elements of being human, such as loneliness and searching for meaning.

Relevance to clinical practice

The study highlights the importance of maintaining a family‐centred approach during the transfer process. Our findings can provide deeper knowledge for intensive care health personnel, better preparing them for the delicate task of providing family‐centred care during the interhospital intensive care unit‐to‐unit transfer process.

Nursing handoffs and clinical judgments regarding patient risk of deterioration: A mixed‐methods study

Abstract

Aims and objectives

To explore how change‐of‐shift handoffs relate to nurses’ clinical judgments regarding patient risk of deterioration.

Background

The transfer of responsibility for patients’ care comes with an exchange of information about their condition during change‐of‐shift handoff. However, it is unclear how this exchange affects nurses’ clinical judgments regarding patient risk of deterioration.

Design

A sequential explanatory mixed‐methods study reported according to the STROBE and COREQ guidelines.

Methods

Over four months, 62 nurses from one surgical and two medical units at a single Canadian hospital recorded their handoffs at change‐of‐shift. After each handoff, the two nurses involved each rated the patient’s risk of experiencing cardiac arrest or being transferred to an intensive care unit in the next 24 hours separately. The information shared in handoffs was subjected to content analysis; code frequencies were contrasted per nurses’ ratings of patient risk to identify characteristics of information that facilitated or hindered nurses’ agreement.

Results

Out of 444 recorded handoffs, there were 125 in which at least one nurse judged that a patient was at risk of deterioration; nurses agreed in 32 cases (25.6%) and disagreed in 93 (74.4%). These handoffs generally included information on abnormal vital signs, breathing problems, chest pain, alteration of mental status, or neurological symptoms. However, the quantity and seriousness of clinical cues, recent transfers from intensive care units, pain without a clear cause, signs of delirium, and nurses’ knowledge of patient were found to affect nurses’ agreement.

Conclusions

Nurses exchanged more information regarding known indicators of deterioration in handoffs when they judged that patients were at risk. Disagreements most often involved incoming nurses rating patient risk as higher.

Relevance to clinical practice

This study suggests a need to sensitize nurses to the impact of certain cues at report on their colleagues’ subsequent clinical judgments. Low levels of agreement between nurses underscore the importance of exchanging impressions regarding the likely evolution of a patient’s situation to promote continuity of care.

Nursing teamwork in general ward settings: A mixed‐methods exploratory study among enrolled and registered nurses

Abstract

Aim

This study aimed to examine the perceived level of nursing teamwork and factors influencing teamwork among enrolled nurses (ENs) and registered nurses (RNs) in general ward settings.

Background

The nursing care delivery model includes RNs, ENs and others who work as a team to deliver patient care. The potential impact of teamwork on nursing care highlights the need to explore the work of nursing teams.

Design

A mixed‐methods exploratory study.

Method

Quantitative and qualitative data were collected concurrently from ENs and RNs in 2018. Two hundred and forty‐eight (n = 248) nurses completed the Nursing Teamwork Survey. Sixteen nurses participated in focus group discussions. Qualitative data were reported following COREQ guidelines, while quantitative data followed the STROBE guidelines.

Results

Both ENs and RNs scored highest for the shared mental model subscale but lowest for the team orientation subscale. Factors including qualification level, years of working experience, perceived job staffing adequacy and job satisfaction were found to influence teamwork. Three themes emerged from the qualitative findings: expectations of each other’s role, delegation practices, and interpersonal relationships. ENs and RNs differed in their expectations of their role in basic patient care activities and faced power struggles related to delegation practices. Open and structured communication was deemed essential in building interpersonal relationships.

Conclusion

The ENs and RNs have clear understanding of their personal roles and responsibilities towards achieving a common goal. However, teamwork may be improved with a shared mental model in performing basic nursing care tasks, mutual support for workload management, better delegation practices, effective communication, enhanced interpersonal relationships, and better team orientation.

Relevance to clinical practice

Nurse managers and educators need to work collaboratively to foster positive delegation practices in clinical practice supported by applicable team training that enhances mutual trust, backup behaviors, and collective orientation in nursing teams.

An exploration of the factors influencing career choice in mental health

Abstract

Aims and objectives

To identify the factors that are associated with considering a career in mental health.

Background

The mental health specialty is facing a recruitment crisis in the United Kingdom but there is limited evidence about which factors encourage and discourage people to consider a career in mental health

Design

Quantitative, observational, online survey using a multiple ordinal logistic regression model to identify if there were any significant predictors of the extent to which participants would consider a career in mental health. The design and write up of the study were guided by the STROBE checklist.

Method

We gathered the views of 231 participants (female = 188, 81.7%) aged between 16 and 65 (mean = 22.7, SD = 8.9), using an online survey, the majority of whom were studying on, or graduates of, psychology/social studies degrees. Information was gathered about the extent to which a range of factors influenced consideration of a career in mental health.

Results

The majority (71.2%) of participants reported that they would definitely or probably consider undertaking a career in mental health, and over half (51.4%) would consider a career as a mental health nurse. The ability to help others and receiving appropriate training required for the role were important career choice factors. Being female, having a mental health condition, and greater knowledge of mental health, were associated with a significantly greater likelihood of considering a career in mental health, while having had experience of working with people with mental health difficulties was significantly negatively associated.

Conclusions

Students and graduates of psychology and social studies degrees appear to be a large, untapped recruitment pool for mental health services.

Relevance to clinical practice

The results can inform more targeted recruitment strategies and development of suitable career pathways for those interested in a career in mental health.

Improving Primary Care After Stroke (IPCAS) randomised controlled trial: protocol for a multidimensional process evaluation

Por: Aquino · M. R. J. · Mullis · R. · Kreit · E. · Johnson · V. · Grant · J. · Lim · L. · Sutton · S. · Mant · J.
Introduction

Primary care interventions are often multicomponent, with several targets (eg, patients and healthcare professionals). Improving Primary Care After Stroke (IPCAS) is a novel primary care-based model of long-term stroke care involving a review of stroke-related needs, a self-management programme, a direct point of contact in general practice, enhanced communication between care services, and a directory of national and local community services, currently being evaluated in a cluster randomised controlled trial (RCT). Informed by Medical Research Council guidance for complex interventions and the Behaviour Change Consortium fidelity framework, this protocol outlines the process evaluation of IPCAS within this RCT. The process evaluation aimed to explore how the intervention was delivered in context and how participants engaged with the intervention.

Methods and analysis

Mixed methods will be used: (1) design: intervention content will be compared with ‘usual care’; (2) training: intervention training sessions will be audio/video-recorded where feasible; (3) delivery: healthcare professional self-reports, audio recordings of intervention delivery and observations of My Life After Stroke course (10% of reviews and sessions) will be coded separately; semistructured interviews will be conducted with a purposive sample of healthcare professionals; (4) receipt and (5) enactment: where available, structured stroke review records will be analysed quantitatively; semistructured interviews will be conducted with a purposive sample of study participants. Self-reports, observations and audio/video recordings will be coded and scored using specifically developed checklists. Semistructured interviews will be analysed thematically. Data will be analysed iteratively, independent of primary endpoint analysis.

Ethics and dissemination

Favourable ethical opinion was gained from Yorkshire & The Humber-Bradford Leeds NHS Research Ethics Committee (19 December 2017, 17/YH/0441). Study results will be published in a peer-reviewed journal and presented at relevant conferences.

Trial registration number

NCT03353519; Pre-results.

Individualised risk prediction model for new-onset, progression and regression of chronic kidney disease in a retrospective cohort of patients with type 2 diabetes under primary care in Hong Kong

Por: Yang · L. · Chu · T. K. · Lian · J. · Lo · C. W. · Zhao · S. · He · D. · Qin · J. · Liang · J.
Objectives

This study is aimed to develop and validate a prediction model for multistate transitions across different stages of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus under primary care.

Setting

We retrieved the anonymised electronic health records of a population-based retrospective cohort in Hong Kong.

Participants

A total of 26 197 patients were included in the analysis.

Primary and secondary outcome measures

The new-onset, progression and regression of CKD were defined by the transitions of four stages that were classified by combining glomerular filtration rate and urine albumin-to-creatinine ratio. We applied a multiscale multistate Poisson regression model to estimate the rates of the stage transitions by integrating the baseline demographic characteristics, routine laboratory test results and clinical data from electronic health records.

Results

During the mean follow-up time of 1.8 years, there were 2632 patients newly diagnosed with CKD, 1746 progressed to the next stage and 1971 regressed into an earlier stage. The models achieved the best performance in predicting the new-onset and progression with the predictors of sex, age, body mass index, systolic blood pressure, diastolic blood pressure, serum creatinine, haemoglobin A1c, total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides and drug prescriptions.

Conclusions

This study demonstrated that individual risks of new-onset and progression of CKD can be predicted from the routine physical and laboratory test results. The individualised prediction curves developed from this study could potentially be applied to routine clinical practices, to facilitate clinical decision making, risk communications with patients and early interventions.

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