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Interventions to Reduce Surgical Site Infection in Transmetatarsal Forefoot Amputations: A Feasibility Survey

ABSTRACT

Surgical site infection (SSI) following transmetatarsal amputation (TMA) is common and associated with significant morbidity. However, there is limited evidence to guide perioperative strategies for SSI prevention in this population. A prospective, cross-sectional survey was conducted among vascular specialists. The questionnaire assessed current practice in SSI prevention for TMA, perceptions of evidence gaps, and willingness to participate in future research. Responses were analysed descriptively. Eighty-four valid responses were analysed, with 64.3% from consultant vascular surgeons and 84.5% from UK centres. Most respondents (84.5%) considered SSI after TMA to be a significant issue. The majority preferred primary closure in clean wounds (78.6%) and commonly used short-course antibiotics and interrupted sutures. Over 70% agreed no clear best practice exists, and 65.5% felt high-quality randomised trials are needed. Ninety-three percent expressed willingness to engage in future studies. Equipoise existed regarding interventions including antibiotic duration, wound adjuncts, and closure techniques. Opinion varied regarding whether TMA and major lower limb amputation should be pooled when undertaking research into SSI prevention. Current practice in SSI prevention for TMA is highly variable. This survey demonstrates broad support for rigorous trials to establish effective strategies and highlights the feasibility of future research in this area.

Help‐Seeking Behaviours for Mental Health in East Asian American Informal Caregivers of People Living With Alzheimer's Disease and Related Dementias

ABSTRACT

Aim(s)

To explore mental health help-seeking behaviours among East Asian American dementia caregivers and construct a theory grounded in their behaviour patterns.

Design

Qualitative using constructivist grounded theory design.

Methods

We recruited 20 East Asian American dementia caregivers between August 2023 and March 2024 using purposive sampling. We conducted one-on-one interviews and analysed the data using constructivist grounded theory coding.

Results

We constructed a theory including six concepts and 22 categories. While ‘providing care’, caregivers manage caregiving tasks and personal life, experiencing caregiving challenges. ‘Individual capacity’ is a key to perceiving caregiving situations and ‘considering seeking support’. Various factors can affect ‘using support’. Different types of support can be used separately or in combination. When receiving adequate support, caregivers can ‘gain benefits from support’. These benefits, alongside individual capacities, can shape caregivers' ‘outlook on the present and the future’.

Conclusion

This study explains the mental health help-seeking process within East Asian culture, broadening perspectives on diverse populations and highlighting insights into culturally tailored services.

Implications for the Profession and/or Patient Care

This study offers clinicians and communities insights into the mental health help-seeking process among East Asian American dementia caregivers and highlights strategies to encourage their use of mental health services.

Impact

This theory incorporates aspects of East Asian culture, addressing a research gap in studies of Asian Americans. It may enhance understanding of culturally tailored approaches and facilitate future funding for research and services, considering cultural diversity.

Reporting Method

The Standards for Reporting Qualitative Research.

Patient or Public Contribution

No Patient or Public Contribution.

Psychological Safety of Culturally and Linguistically Diverse Nurses in Healthcare Work Environments—Systematic Review of Mixed‐Methodology

ABSTRACT

Background

The international mobility of nurses is a significant component of healthcare systems worldwide, resulting in the global recruitment and adaptation of culturally and linguistically diverse nurses into diverse work environments. CALD nurses face integration challenges, which can potentially compromise their well-being and adjustment to the new setting. Psychological safety is a key component to promoting individual well-being and effective organisational integration.

Objective

This systematic review aimed to identify the current evidence on the psychological safety of culturally and linguistically diverse nurses in healthcare work environments and the factors associated with it.

Methods

This systematic review was conducted using JBI guidelines. PiCo/PEO format was utilised for inclusion and exclusion criteria, including English/Finnish, without time limitations. The screening process was conducted by two independent researchers, with a third researcher resolving the conflicts. The PRISMA checklist was utilised in reporting. Data were analysed using content analysis for qualitative and data synthesis for quantitative.

Data Sources

CINAHL, PubMed, ProQuest, Scopus and Medic. Search period: 24.10.2024–23.1.2025.

Results

The systematic review yielded 15 qualitative, one mixed-methods and one quantitative article. The content analysis produced 270 codes, 67 subcategories, seven categories and two main categories. Professional growth and acceptance captured inclusion, professional competence and support from colleagues and managers in creating job satisfaction. Marginalised disempowerment reflected factors linked to low psychological safety, contributing to reduced job satisfaction in the workplace.

Conclusion

Healthcare organisations should confront existing inequities on psychological safety in culturally diverse healthcare environments that are structured around professional inequalities to create equitable spaces for CALD nurses. More research is needed to understand psychological safety experiences from the CALD nurse perspective, exploring the equitability of facilitating factors amid systemic disadvantages in the healthcare workplace.

Patient or Public Contribution

No patient or public involvement.

Trial Registration

Prospero registration: CRD42024581860

Thriving in Nursing Work: The Association Between Self‐Reports and Biomarkers of Stress, Inflammation and Neuroplasticity

ABSTRACT

Aim

To examine whether self-reported thriving at work is associated with biomarkers of stress, inflammation, neuroplasticity and neurodegeneration in nurses.

Design

A cross-sectional study.

Methods

An online questionnaire measuring thriving at work was administered to nurses in a teaching hospital in Michigan, U.S. over 5 weeks in 2024. A subsample of 100 questionnaire respondents provided blood samples for biomarker analysis. Multiple regression was used to identify self-reported and biomarker predictors of nurse thriving. Cluster analysis was used to distinguish between nurses with high and low levels of thriving based on a combination of self-report and biomarker data.

Results

Higher self-reports of individual and work-related resources predicted higher thriving. Cortisol, a stress hormone, was significantly and inversely associated with thriving. No blood-based biomarkers of inflammation or neuroplasticity predicted thriving. Neurofilament light chain, a marker of neurodegeneration, was not a direct predictor but modified the effects of interpersonal and work resources on thriving.

Conclusion

Biological markers do play a role in nurses' thriving at work and may contribute important complementary information to that provided by nurse self-reports.

Implications for the Profession and/or Patient Care

Nurses thrive in a work situation characterised by positive reports of individual, interpersonal and work resources and lower levels of stress. Efforts to enhance thriving could positively impact nurses' well-being and conditions for providing high-quality patient care.

Impact

This study addressed the question of whether self-reported thriving at work among nurses is reflected in biomarkers of stress, inflammation, and neurocognitive health. A profile of high self-reported work-related resources and low cortisol distinguished higher levels of nurses' thriving from lower levels. Organisational efforts to enhance nurses' thriving can positively impact nurses' health, their work environment, and patient care.

Reporting Method

We followed the STROBE checklist in reporting this study.

Patient or Public Contribution

No Patient or public contribution.

Assessing the Clinical and Cost Effectiveness of Dialkylcarbamoylchloride (DACC) Coated Post‐Operative Dressings Versus Standard Care in the Prevention of Surgical Site Infection in Clean or Clean‐Contaminated, Vascular Surgery (DRESSINg Trial): Study

ABSTRACT

Surgical site infections (SSI) in vascular surgery have a huge impact on patients’ morbidity and mortality and healthcare systems worldwide. Dialkylcarbamoylchoride (DACC) is a synthetically produced material that can irreversibly bind and inactivate bacteria that exhibit cell-surface hydrophobicity (CSH). The DACC in the Reduction of Surgical Site Infection (DRESSINg) trial is a multicentre randomised controlled trial which aims to assess the effectiveness of DACC-coated post-operative dressings in the prevention of SSI in vascular surgery. Seven hundred and eighteen participants undergoing clean or clean-contaminated lower limb vascular surgery will be randomised in a 1:1 ratio to either DACC-coated dressings or standard dressings for their postoperative wounds. The primary outcome is the incidence of SSI defined by the Centers for Disease Control and Prevention (CDC) criteria or total ASEPSIS score of 21 or more within 30 days of surgery. The secondary outcomes include satisfactory wound healing with a total ASEPSIS score of 10 or less, quality of life pre and post surgery, Bluebelle wound healing scores, resource use and financial (£), and environmental (KgCO2e) cost analyses. This multicentre randomised controlled trial will provide level 1 evidence on the effectiveness of preventing SSI in lower limb vascular surgery.

Comparison of laboratory-based and non-laboratory-based WHO and GLOBORISK CVD risk scores: A cross-sectional analysis of the APCAPS cohort

by Hemant Mahajan, Poppy Alice Carson Mallinson, Judith Lieber, Santhi Bhogadi, Santosh Kumar Banjara, Anoop Shah, Vipin Gupta, Gagandeep Kaur Walia, Bharati Kulkarni, Sanjay Kinra

Background and Aim

Cardiovascular diseases (CVDs) represent a growing public-health challenge in India, where nearly one in four deaths is CVD-related. Accurate risk stratification underpins targeted prevention, yet laboratory-dependent tools are often impractical in resource-limited settings. The World Health Organization (WHO) and GLOBORISK initiatives both offer non-laboratory-based 10-year CVD risk algorithms alongside their laboratory-based counterparts. We aimed to compare laboratory- and non-laboratory-based WHO and GLOBORISK CVD risk scores, assess their concordance, and examine relationships with sub-clinical atherosclerosis in a rural Indian cohort.

Materials and Methods

We conducted a cross-sectional analysis of 2,465 adults (1,184 men, 1,281 women) aged 40−74 years from the third wave (2010−12) of the Andhra Pradesh Children and Parents Study (APCAPS). Participants with prior CVD were excluded. Ten-year CVD risk was calculated using sex-specific WHO (South Asia) and India-calibrated GLOBORISK models, both laboratory-based (age, sex, smoking, systolic blood pressure, diabetes, total cholesterol) and non-laboratory-based (age, sex, smoking, systolic blood pressure, BMI) algorithms. Categorical agreement was quantified via percentage agreement and quadratic weighted kappa (κ); continuous agreement by Bland-Altman analysis. We also evaluated linear associations between each risk score (categorical and continuous) and three sub-clinical atherosclerosis markers: carotid intima-media thickness (CIMT), pulse-wave velocity (PWV), and augmentation index (AIx), through sex-stratified multi-level linear regression with random intercept at the household level, adjusting for multiple testing (p  Results

Median WHO-CVD-risk was 6.0% (IQR 4% − 9%) in men and 3.0% (2% − 4%) in women for both lab and non-lab models; median GLOBORISK-CVD-risk was 12.0% (9% − 16%) for lab-model vs. 15.0% (10% − 16%) for non-lab-model in men and 5.0% (3% − 9%) for lab-model vs. 5.0% (3% − 9%) for non-lab-model in women. Categorical agreement was substantial to almost perfect: WHO κ = 0.82 (overall), GLOBORISK κ = 0.72. Bland-Altman analyses demonstrated mean differences Conclusion

Non-laboratory-based WHO and GLOBORISK CVD risk scores exhibit high overall agreement with laboratory-based models and correlate strongly with subclinical atherosclerosis in rural India. However, modest underestimation in high-risk subgroups (diabetics, hypercholesterolemia) warrants cautious interpretation. These findings support the feasibility of non-lab risk assessment in resource-constrained settings, while underscoring the need for prospective validation against hard cardiovascular outcomes prior to large-scale implementation.

Intergenerational Influence on Hypertension Prevention and Management: A Discursive Paper

ABSTRACT

Background

Hypertension remains a critical health disparity among Black older adults, driven by factors such as socioeconomic inequities, chronic stress and barriers to healthcare access. Within this population, family relationships, particularly intergenerational interactions, significantly influence health behaviours and the management of hypertension remain understudied.

Aim

To explore intergenerational factors influencing hypertension prevention and management among Black older adults, focusing on how family relationships impact health behaviours, knowledge transfer and treatment adherence.

Methods

A discursive paper applying the Transtheoretical Model of Change and Self-Determination Theory as guiding frameworks to examine the role of family dynamics in hypertension management. PubMed, Scopus and Google Scholar were searched for peer-reviewed papers published from 2015 to 2025.

Discussion

The role of family in health behaviours is examined, including the transmission of health knowledge, caregiving dynamics and emotional support. Both barriers and facilitators to effective hypertension management are identified, including cultural beliefs, community resources and the impact of intergenerational role modelling.

Implications for Practice

The discussion underscores the need for nurses to adopt family-centred approaches in hypertension management, considering the intergenerational influences on health outcomes. Recommendations for integrating these insights into clinical practice and nursing education are provided.

Conclusion

Understanding the intergenerational context of hypertension management can enhance patient care by improving adherence and prevention strategies. Future research should further explore the role of family in managing hypertension among Black older adults.

Nursing Perspectives on Factors That Influence Provision of Patient‐Centered Care for Autistic Patients in a Large Urban Hospital System: A Qualitative Study

ABSTRACT

Aim

To characterise nurses' perspectives on factors that influence their ability to provide patient-centered nursing care for autistic patients in a large urban hospital setting.

Design

Qualitative exploratory study.

Methods

We conducted semi-structured interviews via Zoom with nurses from a large urban hospital serving primarily adult patients. We analysed interviews using codebook/template analysis. Two researchers coded each interview and resolved discrepancies through discussion.

Results

Twelve nurses (3 males) with 2–20 years of professional experience across research, management, and patient care roles were interviewed. Three primary themes were generated: (1) barriers to patient-centered care, including lack of formal autism education, factors related to the hospital setting, and specific nurse characteristics, such as inflexible adherence to care routines; (2) facilitators of patient-centered care, including experiential autism knowledge, caregiver involvement, and specific nurse characteristics, such as showing respect for all patients; and (3) missed opportunities for patient-centered care, including underuse of behavioural care teams, inadequate time for planning and preparation, and reliance upon restraints and security personnel for behaviour management.

Conclusion

Nurses identified several areas where consistent implementation of existing processes could improve care. A key finding was the need to explore more patient-centered alternatives to the use of restraints and security personnel in response to aggressive or self-injurious behaviour. Overall, our results support the need for competency training to facilitate increased nursing comfort and ability to provide patient-centered care for autistic patients.

Implications for the Profession

This work suggests nurses gain much of their autism-related knowledge through patient care experiences. Despite providing the majority of hands-on care, nurses receive little to no formal training about caring for the growing autistic population.

Impact

This work has identified targeted areas to improve education and processes in caring for autistic patients.

Patient or Public Contribution

No patient or public contribution.

Tensions and Opportunities in Nurse, Midwife, and Peer Worker Collaborations in Healthcare Delivery: A Scoping Review and Narrative Synthesis

ABSTRACT

Aim

To explore the published literature on nurse/midwife and peer worker collaborations in healthcare services.

Design

Scoping review and narrative synthesis.

Methods

The framework proposed by Levac et al. was used. PubMed, CINAHL, MEDLINE, Scopus, and Embase databases were systematically searched, and results uploaded to Covidence for screening against inclusion criteria. A critical narrative synthesis of included studies was conducted, guided by Popay et al.

Results

Sixteen studies from five countries met the inclusion criteria. They examined peer worker and nurse/midwife collaboration across diverse settings including cancer, HIV, mental health, and community services. Findings indicated that nurse/midwives and peer workers valued the distinct forms of expertise they contributed, which enhanced care. Tensions in collaboration related to clinical dominance and control in hierarchical structures, challenges navigating scope and role boundaries, and mistaken notions of what constitutes ‘successful’ peer work. Peer workers and nurses/midwives could be ‘close strangers’ with little opportunity to build genuine rapport.

Conclusion

Successful collaboration requires attention to power dynamics within healthcare cultures and opportunities to connect and understand each other's disciplinary expertise. Identifying strategies to optimise partnership and mobilise collective strengths has the potential to further enhance care.

Implications for the Profession/Patient Care

Peer worker or ‘lived experience’ roles within healthcare services have rapidly expanded. Our study highlights the benefits of peer worker and nurse/midwife collaborations and areas that require attention, including recognition of peer worker and nurse/midwife roles and responsibilities in the healthcare setting and effective integration of peer workers into existing healthcare teams. Importantly, strategies should be developed to address disparate power dynamics between nursing/midwifery staff and peer workers as these impact workforce relations and capability. Addressing these key areas will strengthen collaboration between nurses/midwives and peer workers, improve healthcare provision, and ultimately benefit service users.

Impact

This study highlights the tensions arising when nurses/midwives and peer workers carry out duties alongside each other, as well as factors that can promote effective collaboration. Successful collaboration in healthcare necessitates addressing power differentials, fostering mutual understanding, and providing the tools, training, and inclusive environments needed for nurses/midwives and peer workers to work together effectively.

Reporting Method

This scoping review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) extension for scoping reviews.

Patient or Public Contribution

Our authorship team includes experts with experience in peer work and supervision of peer workers, and designing and implementing peer-led interventions within health and community service settings.

Development and Psychometric Evaluation of the Thriving in Nursing Questionnaire (THINQ)

ABSTRACT

Aim

To develop and evaluate a questionnaire for measuring factors that contribute to thriving at work among nurses.

Design

A cross-sectional study.

Methods

An online questionnaire was administered in March 2024 to nurses in a community teaching hospital in Michigan, US. Questionnaire content was based on a literature search and was pilot tested among nursing professionals within the hospital system. Questionnaire factor structure was examined with exploratory and confirmatory factor analyses with split-half sample validation.

Results

Based on exploratory and confirmatory factor analysis, a three-factor solution presented the best model, with factors comprised of 15 items measuring individual resources (3 items), work resources (6 items) and interpersonal aspects of the nursing work environment (6 items). Reliability estimates for all three factors exceeded 0.80, indicating good internal homogeneity. The questionnaire also demonstrated acceptable split-half validity and reliability.

Conclusion

The questionnaire presented here provides a potentially useful tool for measuring and evaluating thriving at work among nurses.

Implications for the Profession and/or Patient Care

A better understanding of factors that enhance nurse thriving would lay the foundation for targeted interventions aimed at improving the nursing work environment and nurse well-being. Enhancing nurse thriving could have a potentially positive impact on patient care.

Impact

This study addressed the need to understand factors that contribute to thriving in nursing work. The questionnaire that was developed revealed a three-factor solution measuring individual nurse resources, work environment resources and work interpersonal resources. By measuring thriving among nurses, hospitals and other healthcare organisations are taking an important first step in identifying interventions to enhance the nursing work environment, nurse well-being and potentially the quality of patient care.

Reporting Method

We followed the STROBE checklist in reporting this study.

No patient or public contribution.

Automatic uterus segmentation in transvaginal ultrasound using U-Net and nnU-Net

by Dilara Tank, Bianca G. S. Schor, Lisa M. Trommelen, Judith A. F. Huirne, Iacer Calixto, Robert A. de Leeuw

Purpose

Transvaginal ultrasound (TVUS) is pivotal for diagnosing reproductive pathologies in individuals assigned female at birth, often serving as the primary imaging method for gynecologic evaluation. Despite recent advancements in AI-driven segmentation, its application to gynecological ultrasound still needs further attention. Our study aims to bridge this gap by training and evaluating two state-of-the-art deep learning (DL) segmentation models on TVUS data.

Materials and methods

An experienced gynecological expert manually segmented the uterus in our TVUS dataset of 124 patients with adenomyosis, comprising still images (n = 122), video screenshots (n = 472), and 3D volume screenshots (n = 452). Two popular DL segmentation models, U-Net and nnU-Net, were trained on the entire dataset, and each imaging type was trained separately. Optimization for U-Net included varying batch size, image resolution, pre-processing, and augmentation. Model performance was measured using the Dice score (DSC).

Results

U-Net and nnU-Net had good mean segmentation performances on the TVUS uterus segmentation dataset (0.75 to 0.97 DSC). We observed that training on specific imaging types (still images, video screenshots, 3D volume screenshots) tended to yield better segmentation performance than training on the complete dataset for both models. Furthermore, nnU-Net outperformed the U-Net across all imaging types. Lastly, we report the best results using the U-Net model with limited pre-processing and augmentations.

Conclusions

TVUS datasets are well-suited for DL-based segmentation. nnU-Net training was faster and yielded higher segmentation performance; thus, it is recommended over manual U-Net tuning. We also recommend creating TVUS datasets that include only one imaging type and are as clutter-free as possible. The nnU-Net strongly benefited from being trained on 3D volume screenshots in our dataset, likely due to their lack of clutter. Further validation is needed to confirm the robustness of these models on TVUS datasets. Our code is available on https://github.com/dilaratank/UtiSeg.

Enhancing Breast Cancer Survivorship Care: The Role of Nurses in Post‐Treatment Follow‐Up—A Scoping Review

ABSTRACT

Aim

To examine the role of nurses in providing post-treatment follow-up care to breast cancer survivors, and to assess the impact of this care on survivors' satisfaction.

Methods

Scoping review.

Data Sources

An electronic literature search from PubMed and CINAHL databases was conducted, covering the period from 2013 to November 2023.

Results

Twenty-seven articles were included in this review, highlighting key areas in which nurses play essential roles in the provision of post-treatment care for breast cancer survivors. The identified nursing roles include the surveillance and early detection of relapses, the assessment and support of self-management for late physical and psychosocial effects of cancer, health promotion and care coordination. Regarding satisfaction, survivors reported high overall satisfaction with nursing care. However, satisfaction levels varied with regard to specific needs, particularly in managing the fear of recurrence.

Conclusions

Nurses play a fundamental role in delivering post-treatment care to breast cancer survivors. However, evidence regarding their specific contributions and survivors' satisfaction with long-term care remains limited, underscoring the need for further research to enhance care during the long-term survivorship phase.

Implications for the Profession

Consolidating the diverse roles of nurses in post-treatment care into a unified framework could support comprehensive and personalised care, addressing unmet needs. Evaluating patient satisfaction with nursing follow-up helps identify effective interventions and areas for improvement in future research.

Impact

This review analyses the diverse roles of nurses in the follow-up care of breast cancer survivors and highlights the impact of nursing care on patient satisfaction.

Reporting Method

This study adhered to the PRISMA-ScR reporting guidelines.

Patient or Public Contribution

No patient or public contribution.

Desired dementia care towards end of life: Development and experiences of implementing a new approach to improve person‐centred dementia care

Abstract

Aims

To describe the co-creation of the ‘Desired Dementia Care Towards End of Life’ (DEDICATED) approach to improve person-centred palliative care for individuals with dementia and to describe the experiences of healthcare professionals during the approach's implementation.

Methods

A needs assessment, comprising both qualitative and quantitative studies, informed palliative care needs of healthcare professionals, family caregivers and individuals with dementia. The approach was co-created with healthcare and education professionals, guided by the findings. Then, healthcare professionals were trained to implement the approach in their organizations. From April to June 2022, semi-structured interviews with actively engaged professionals were analysed using Conventional Content Analysis.

Results

The needs assessment yielded six key themes: (1) raising palliative care awareness, (2) familiarization with a person with dementia, (3) communication about future care preferences, (4) managing pain and responsive behaviour, (5) enhancing interprofessional collaboration in advance care planning and (6) improving interprofessional collaboration during transitions to nursing homes. Interviews with 17 healthcare professionals revealed that active involvement in co-creating or providing feedback facilitated implementation. Overall, the DEDICATED approach was perceived as a valuable toolkit for optimizing palliative care for people with dementia and their loved ones.

Conclusion

Co-creating the DEDICATED approach with healthcare professionals facilitated implementation in daily practice. The approach was considered helpful in enhancing person-centred palliative dementia care.

Impact Statement

This study underscores the importance of active involvement of healthcare professionals in the research and development of new interventions or tools for palliative care, which can influence the successful implementation, dissemination and sustained usage of the developed tools.

Implications for the Profession and Patient Care

The developed approach can improve person-centred palliative care for individuals with dementia, ultimately improving their quality of life and that of their loved ones.

Reporting Method

This study used the Consolidated Criteria for Reporting Qualitative Research.

Patient of Public Contribution

No patient or public contribution.

The Association Between Caregiving Context and the Health and Well‐Being of Carers and Their Care Recipients Living With Dementia: A Cross‐Sectional Study

ABSTRACT

Aim(s)

To examine the association between caregiving context and the health and well-being of community-dwelling people with dementia (functional ability, physical function, depression, quality of life and health-related quality of life) and their informal carers (health-related quality of life) at the pre-rehabilitation stage and the potential mediating role of caregiving context variables.

Design

Cross-sectional study.

Methods

Secondary analysis of baseline data from a randomised controlled trial of 130 dementia care dyads—the Interdisciplinary Home-based Reablement Programme (2018–2022). Bivariate analyses were applied to identify key caregiving context variables—co-residence, sole carer status, additional caring responsibilities, client-carer relationship and subjective carer burden (carer burden hereafter)—associated with health outcomes. Subsequently, multivariable linear regression models were developed. To examine carer burden, two models were run for each outcome: one with caregiving context variables and covariates, and the other adding carer burden. The mediating effects of the identified caregiving context variable were examined using post hoc mediation analysis.

Results

Spouse/partner carer relationship was significantly associated with better client well-being, including lower depressive symptoms and higher quality of life scores compared to adult child and other relationships. Higher carer burden was strongly associated with lower functional ability, more depressive symptoms, lower quality of life for clients and lower health-related quality of life for both clients and carers. Including carer burden in regression models explained the greatest variance across most models. Carer burden fully mediated the association between additional caring responsibilities and client functional ability, and partially mediated the association between other carers and client depression.

Conclusion

Carer burden needs to be carefully considered in supporting the health and well-being of dementia carer dyads.

Implications

Addressing carer burden and tailoring support to carers are essential for optimising health impacts for dementia carer dyads.

Reporting Method

STROBE checklist.

Patient or Public Contribution

None.

Trial Registration

ClinicalTrials.gov identifier: ACTRN12618000600246

Feasibility and acceptability of a personalised self-care support programme for primary care patients with diabetic foot ulcers delivered by wound care nurses: the HEALing study protocol

Por: Zhu · X. · Lee · E. S. · Chan · F. H. F. · Yin · R. · Lim · P. X. H. · Koh · R. W. S. · Judith · C. · Wei · L. · Li · S. · Phrommarad · P. · Chin · G. H. Y. · Lim · V. H. · Low · R. S. Y. · Chen · Y. C. · Griva · K.
Introduction

Diabetic foot ulcers (DFUs) are highly prevalent and recurrent complications of diabetes mellitus that have significant health and cost implications. Self-care is critical for preventing or delaying DFU and promoting healing, yet adherence to self-care recommendations is low. Interventions using motivational interviewing (MI) have been effective in supporting behaviour change and emotional adjustment, but evidence for DFU is scarce. This study will assess the acceptability, feasibility and preliminary efficacy of an MI-guided programme, Healing DFU through Empowerment and Active Listening (HEALing), and its integration in usual wound care practice.

Methods and analysis

This single-arm pilot study adopts a mixed-methods approach to assess the feasibility and acceptability of the HEALing intervention. HEALing is a practical, low-intensity, clinic-integrated personalised self-care support intervention, comprising three 30 min face-to-face sessions delivered over 6 weeks by trained wound care nurses, aiming to enhance self-care behaviours and support emotional adjustment in patients with DFU. Data will be collected from a battery of questionnaire-based surveys with patients (n=30), and in-depth individual interviews with both patients (n=30) and wound care nurse facilitators (n=10) from nurse-led wound clinics in a large primary care sector in Singapore.

The primary feasibility outcomes will include enrolment, retention (≥80%), data completion (≥80% of surveys) and participant satisfaction. Secondary outcomes will include self-report measures of illness perceptions, foot care confidence, diabetes distress, foot self-care behaviour, DFU knowledge, autonomy support and health-related quality of life, taken at baseline and post-intervention. Post-intervention interviews with patients and wound care nurse facilitators will be conducted to collect feedback on the programme and its implementation feasibility.

Ethics and dissemination

The study protocol has been approved by the local ethics committee, and written informed consent will be obtained from all participants. Findings will be disseminated through the first author’s PhD thesis, peer-reviewed journals, national and international conferences and public events.

Trial registration number

NCT06540170; Pre-results.

La vida después de un cáncer, experiencias de un grupo de sobrevivientes

Introducción: El cáncer es una enfermedad compleja y desafiante que afecta no solo la salud física, sino también las dimensiones emocionales, sociales y espirituales de los individuos. Objetivo: Describir las experiencias de un grupo de personas sobrevivientes al cáncer. Método: Se llevó a cabo un estudio cualitativo de tipo etnográfico. La saturación teórica se alcanzó con la participación de 15 personas sobrevivientes de cáncer seleccionadas mediante muestreo en bola de nieve. La recolección de datos se realizó mediante entrevistas semiestructuradas, previo consentimiento informado de los participantes, utilizando la guía propuesta por Leininger para el análisis de datos cualitativos. Resultados: La experiencia de los participantes al haber superado el cáncer se describió en cuatro categorías: el cáncer como sinónimo de muerte, el apoyo familiar, la resiliencia como recurso psicológico crucial y la importancia de la fe en Dios como un bálsamo de vida. Conclusiones: La experiencia de recuperación ante un cáncer comienza con incertidumbre y miedo, asociando inicialmente el diagnóstico con la muerte; pero, con el tiempo, los sobrevivientes logran enfrentar la enfermedad desarrollando una actitud resiliente.

Percepción del personal de enfermería frente al cuidado durante la pandemia COVID-19

RESUMEN

Objetivo: describir la percepción del personal de enfermería que brinda cuidado durante la pandemia por Covid-19. Metodología: estudio cualitativo descriptivo con análisis de contenido temático e inductivo, la selección de participantes fue por muestreo no probabilístico e intencionado, 50 enfermeros que laboran en la unidad de cuidado intensivo adulto y hospitalización. Se aplicó entrevista para la recolección de datos, que partió de una pregunta central, el análisis se realizó según planteamientos propuestos por Tinto. Resultados: emergieron tres temas con sus unidades de significado. Cuidado de enfermería durante la pandemia: mezcla de emociones. Separación familiar como medida de cuidado. Trabajo en equipo una estrategia de afrontamiento. Conclusión: Los desafíos a los cuales el personal de enfermería se ha enfrentado en esta pandemia ha llevado a la presencia de un sin número de manifestaciones emocionales que deben ser tenidas en cuenta para el manejo psicoemocional y prevención de secuelas a largo plazo.

Papel del equipo de enfermería durante la atención al paciente con sospecha de Infarto Agudo de miocardio

Objetivos: Describir el papel del equipo de enfermería en el cuidado de pacientes con sospecha de infarto agudo del miocardio. Metodo-logía: revisión integradora de la literatura, utilizando las bases de datos MEDLINE, PUBMED, LILACS, CUIDEN, CINAHL, y las Prácticas Recomendadas de la Sociedad Brasileña de Cardiología. Se incluyeron publicaciones de 2010 a 2021, que estuvieran en portugués y de acceso gratuito. Resultados: se obtuvo una muestra final de 26 artículos, siendo seleccionados y agrupados en tres categorías temáti-cas: A) Conocimiento del equipo de enfermeria sobre los protocolos para el atendimiento a los pacientes con sospecha de Infarto agudo de miocardio B) la Sistematización de la asistencia de enfermeria durante el atendimiento inicial; C) Papel del equipo de enfermeria. Conclusiones: el equipo de enfermeria es visto como parte fundamental en las unidades de atención, por lo tanto, es necesario actualizar a estos profesionales para un mejor soporte técnico y científico, basado en la evidencia.

Abordaje del dolor en pacientes con insuficiencia cardíaca

Objetivo: Describir el abordaje del dolor en pacientes con insuficiencia cardíaca, según lo encontrado en la literatura. Metodología: se realizó una investigación bibliográfica con búsqueda en las bases de datos MEDLINE, PUBMED, LILACS, CUIDEN, CINAHL, utilizando los descriptores Manejo del dolor, insuficiencia cardíaca y Automedicación, junto con el operador booleano AND. Se seleccionaron artículos en portugués, publicados entre 2010 y 2020, que respondieron al objetivo de la investigación. Las publicaciones duplicadas fueron ex-cluidas al final de las búsquedas en cada base de datos, obteniendo una muestra final de 31 artículos. Resultados: se encontró que el dolor se puede clasificar: 1) Según su naturaleza en nociceptivo (que puede ser somático y visceral), neuropático y mixto) y 2) Según su intensidad: en agudo, crónico o recurrente. Por lo tanto, el abordaje del dolor dependerá de su origen y de la necesidad del individuo.

Cuidados de enfermería en el pre y postoperatorio de cirugía cardíaca

Objetivo: identificar la producción científica que trate sobre cuidados de enfermería durante el período pre y postoperatorio de pacientes sometidos a cirugía cardíaca. Metodología: Revisión integradora de la literatura con enfoque cualitativo, realizada en las bases de datos CUIDEN, CINAHL, LILACS, LATINDEX, SciELO (Scientific Electronic Library Online) y BDENF (Base de datos bibliográfica especializada en el área de enfermería de Brasil) con un período de tiempo de 2007 a 2020. Resultados: Los principales diagnósticos de enfermería encontrados para el preoperatorio fueron: ansiedad y riesgo de infección, aspiración e integridad de la piel. Los diagnósticos para el postoperatorio fueron: dolor agudo, disminución del gasto cardíaco, alteración del intercambio de gases, riesgo de desequilibrio en el volumen de líquidos y electrolitos, alteraciones en la percepción sensorial, perfusión ineficaz del tejido renal, termorregulación ineficaz y escaso conocimiento sobre las actividades de autocuidados. Conclusión: La sistematización de la atención de enfermería se considera fundamental, para garantizar una atención segura y de calidad a los pacientes sometidos a procedimientos quirúrgicos.

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