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How do three components of professional commitment influence nurse‐reported patient‐centred care and care quality?

Abstract

Aims and Objectives

To test how the three components of professional commitment (i.e. affective, continuance and normative professional commitment) are associated with nurse-reported patient-centred care and care quality.

Background

Patient-centred care and care quality are the two critical care outcomes. However, no study has yet examined how the three components of professional commitment are related to nurse-reported patient-centred care and care quality, showing a research gap.

Design

This study adopted a two-wave design (first wave in 2017 and second wave in 2019), which is known to reduce the possibility of reverse causality, and which was conducted in a large hospital in Northern Taiwan.

Methods

Proportionate random sampling was used. Full-time nurses were surveyed, while nursing students, interns, nurse practitioners and nursing supervisors were excluded. The first wave included 524 nurses, and 438 nurses were retained in the second wave. We used confirmatory factor analysis to verify the psychometric properties of the measures. Structural equation modelling was used to implement hypothesis testing. We used the Professional Commitment Scale of Meyer et al. (Journal of Applied Psychology, 1993, 78, 538), the Patient-Centered Care Scale of Laird-Fick et al. (Patient Education and Counseling, 2011, 84, 90) and the Care Quality Perceptions Scale of Teng et al. (Journal of Nursing Management, 2010, 18, 275). The STROBE statement was chosen as the EQUATOR checklist.

Results

Affective professional commitment was positively associated with nurse-reported patient-centred care (β = .18, p = .002 and .01), which was positively associated with nurse-reported care quality (β = .85, p < .001). Affective and normative professional commitment were also positively associated with nurse-reported care quality (β = .17, p < .001).

Conclusions

Our findings offer insights for nursing managers that nurses’ affective and normative professional commitment could help upgrade care outcomes. Hospital managers should consider professional commitment as relevant to their workforce.

Relevance to clinical practice

Nursing managers could publicise reports documenting nurses’ significant contributions to public health. This could strengthen affective professional commitment among nurses.

Characteristics and risk factors of nasal mucosal pressure injury in intensive care units

Abstract

Aims and Objectives

This study aimed to understand the risk factors that contribute to medical device-related (MDR) nasal mucosal membrane pressure injuries (MM PI) in ICU patients.

Background

ICU patients require substantial tube-based life support such as oxygen tubes, tracheal intubation and indwelling gastric tubes. As a result, there is an increased risk of PI occurrence; however, few studies have assessed the risk factors associated with nasal mucosal MDR-MMPI in ICU patients.

Design

A cross-sectional study design was performed.

Methods

From January 2019 to June 2020, data from 912 patients treated in the ICU of a tertiary first-class a hospital in China were collected. The occurrence of PI of the nasal mucosa was obtained by nasopharyngoscope when replacing the nasal catheter fixation patch every day. The study methods were followed by the STROBE guidelines.

Results

The incidence of nasal mucosal MDR-MM PI was 10.9%. The degree of nasal mucosal MM PI was mainly grade 1 (62cases, 62.6%), and no grade 4 were observed. The columella (58 cases, 58.6%) was the most common site of nasal mucosal MM PI followed by the anterior septum (18 cases, 18.2%). A high patient APACHE-Ⅱ score, the disturbance of consciousness, a history of diabetes, days of gastric tube indwelling, hypoproteinemia, fever (T > 37.5℃) and the use of vasoconstrictors were identified as significant influencing factors of nasal MM PI in ICU patients (p < .05).

Conclusions

A high APACHE-Ⅱ score, disturbance of consciousness, history of diabetes, days of gastric tube indwelling, hypoproteinemia, fever (T > 37.5℃) and use of vasoconstrictive drugs were risk factors for nasal mucosal MDR-MM PI in ICU patients. This study informs on the risk factors of nasal mucosal MM PI that will allow medical support staff to carry out key interventional measures to prevent nasal mucosal MM PI.

Relevance to clinical practice

This study illustrates the characteristics and risk factors of nasal mucosal pressure injury in intensive care units, potentially contributing to the prevention of the incidence of nasal mucosal MDR-PI in ICU patients.

La evaluación clínica objetiva estructurada ECOE, una oportunidad para el aprendizaje en Enfermería

La evaluación clínica objetiva estructurada (ECOE, Objective Structured Clinical Examination/OSCE) fue descrita inicialmente por Harden et al (1975). Es un método de evaluación de la competencia clínica con evidencia de validez, objetividad y confiabilidad. En España, la ECOE en Medicina tiene unos 20 años de historia, implantándose en dicho grado a partir del impulso liderado por la Conferencia Nacional de Decanos de Facultades de Medicina (CNDFME), como una prueba que deben realizar todos los alumnos del sexto curso del grado. Otras titulaciones universitarias, como el grado en Fisioterapia, con experiencias en simulación, han comenzado a implantarlo en los últimos cursos académicos, cual es el caso de la Facultad de Medicina y Enfermería de la Universidad de Córdoba (UCO) [fragmento del contenido, continuar leyendo en el PDF].

Effects of multicomponent exercise on the muscle strength, muscle endurance and balance of frail older adults: A meta‐analysis of randomised controlled trials

Abstract

Objectives

This study aims to evaluate the effects of multicomponent exercise on the muscle strength, muscle endurance and balance of frail older adults living in the community and provide the latest evidence from published randomised controlled trials (RCTs).

Background

The number of frail older adults is rapidly increasing. Previous studies have reported that multicomponent exercise is one of the best types of intervention for increasing muscle strength, muscle endurance and balance for frail older adults. However, due to the small sample size and lack of evidential support, a meta-analysis of RCTs remains necessary.

Methods

RCTs reporting the effects of multicomponent exercise on the muscle strength, muscle endurance and balance of frail older adults, published in English, were retrieved from five electronic databases: PubMed, CINAHL, Web of Science, Embase and Cochrane Library available from their inception up to January 2021. RevMan5.3 software was adopted for statistical analysis. This study followed the PRSIMA checklist.

Results

A total of 10 articles and 667 patients were included in this study. Meta-analysis showed that multicomponent exercise could improve the muscle strength [MD = 2.46, p = .007], muscle endurance [MD = 2.16, p = .03] and balance [MD = .39, p = .03] of frail older adults, and subgroup analysis showed the muscle endurance of frail older adults was significantly improved as the intervention lasted for >12 weeks.

Conclusions

RCTs provided in this study show the latest evidence that multicomponent exercise can improve the muscle strength, endurance and balance of frail older adults and that long-duration (>12weeks) multicomponent exercise is more effective for improving muscle endurance.

Relevance to clinical practice

Multicomponent exercise contributes to improving the muscle strength, muscle endurance and balance of frail older adults, so it can be considered as a complement to the physical function management programme for frail older adults.

Colorectal cancer survivors’ experience of continuity of care provided by different health professionals: A qualitative evidence synthesis

Abstract

Aims and objectives

To systematically identify, synthesise and characterise the available qualitative evidence on the experience of adult colorectal cancer survivors with continuity of care led by different health professionals.

Background

The limited evidence base for effective continuity of care led by different medical staff who assist colorectal cancer survivors with their unique survivorship care hampers the development of effective interventions. Synthesising the data on survivors’ experience of care led by different health professionals is critical to develop such interventions.

Design

A qualitative evidence synthesis using the Thomas and Harden method and the PRISMA 2020 checklist provided by the EQUATOR network were used.

Methods

PubMed, Web of Science, Embase, Cochrane, CINAHL and PsycINFO were searched through November 2020 for qualitative and mixed methods studies in English. JBI-QARI was used to undertake a quality review of the identified studies. The review findings were synthesised by a team of researchers, and the level of confidence was evaluated using GRADE-CERQual.

Results

Eleven studies met the criteria for inclusion in the review. The identified analytical themes included experience of diversity, preference for health professionals and space for enhancement to facilitate improved medical care delivery. Colorectal cancer survivors report diverse experiences regarding continuity of care led by different providers. Specifically, they attach substantial importance to trusted relationships with providers that are closely associated with their overall care experience.

Conclusion

Effective communication and good rapport among stakeholders are cornerstones for addressing the complexity of ongoing care. Future interventions should include adjusting the percentage of care from different providers to deliver cost-effective and personalised continuity of care.

Relevance to clinical practice

Synthesising data on survivors’ experience facilitates the development of practical approaches to increase the quality of continuity of care and may also foster the integration of providers’ advantages to enable more cost-effective intervention. The limited capacity of primary care providers may be enhanced by better cooperation and communication with specialists and by additional professional cancer-related training.

Effectiveness of clown intervention for pain relief in children: A systematic review and meta‐analysis

Abstract

Background

Pain is common in children receiving medical procedures, and there is a lack of adequate awareness and management. In addition, children who undergo medical procedures involving pain may also experience stress, crying and prolonged hospitalisation. Clown intervention is a promising nonpharmacological intervention. However, studies on the effectiveness of clown intervention in pain management have reported conflicting findings.

Objective

To evaluate the effectiveness of clown intervention in relieving pain in children, as well as its effects on cortisol levels, crying duration and length of hospital stay.

Design

Systematic review and meta-analysis of randomised controlled studies.

Data sources

PubMed, Web of Science (SCI), Embase, PsycINFO, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Weipu (VIP), Wanfang Data and SinoMed were systematically searched from inception date to December 31, 2020.

Review methods

Two reviewers independently used the Cochrane risk of bias tool to assess the risk of bias of the included studies. Meta-analysis was conducted when data were available, otherwise, a narrative description was provided. Data were analysed using Review Manager 5.3. The review process is reported according to PRISMA.

Results

Nine studies including 852 children met the inclusion criteria. The results showed that compared with standard care, clown intervention was beneficial for relieving pain. Further subgroup analysis showed that it was more effective with children aged 2–7 years. The duration of crying after the procedure and the length of stay were shortened, but there was no significant difference in cortisol levels.

Conclusion

Clown intervention may be a promising way to relieve acute pain in children, especially those aged 2–7 years. It also seems to shorten the duration of crying and the length of hospital stays, but the effect on cortisol levels is still uncertain. More high-quality randomised controlled trials are needed to confirm these results and take into account different age groups, cultural backgrounds and specific populations.

Psychological interventions for sexual function and satisfaction of women with breast cancer: A systematic review and meta‐analysis

Abstract

Aims and objectives

To systematically evaluate the effectiveness of psychological interventions for women with breast cancer on sexual function, sexual satisfaction, sexual relationships, sexual distress and sexual quality of life.

Background

Sexual dysfunction is common in women with breast cancer and seriously affects their quality of life and marital harmony. Several studies have explored the effects of psychological interventions related to sexual function of women with breast cancer, but results were inconclusive.

Design

A systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Method

A search of PubMed, EMBASE, PsycINFO, Web of Science, the Cochrane Library, Scopus, CINAHL, ProQuest Dissertations and Theses Global, ClinicalTrials.gov. and Open Grey was conducted from inception to 9 May 2021. Two reviewers independently screened studies, extracted data and conducted a quality appraisal of included studies using the Joanna Briggs Institute critical appraisal checklists.

Results

Fifteen studies involving 1307 participants were included. The current study showed that psychological interventions made statistically significant improvements in sexual function (SMD = 0.82; 95% CI = [0.43, 1.20]; p < .001), sexual satisfaction (SMD = 0.95; 95% CI = [0.19, 1.72]; p = .01), sexual relationships (SMD = 0.37; 95% CI = [0.15, 0.60]; p = .001) and sexual distress (MD = −5.05; 95% CI = [−7.88, −2.22]; p = .0005) of women with breast cancer. A subgroup analysis regarding the types of psychological interventions indicated that cognitive behavioural therapy and psychoeducational therapy were beneficial to sexual function and satisfaction, and psychosexual counselling could also improve sexual function.

Conclusion

Psychological interventions, especially psychoeducational therapy and cognitive behavioural therapy, are effective for improving the sexual health of women with breast cancer.

Relevance to clinical practice

This current study provides evidence for the application of psychosexual interventions in women with breast cancer.

Registration

The study has been registered on the PROSPERO on 6 June 2021, with the registration number CRD42021253493.

Development and validation of the patient centeredness index for primary care

Abstract

Aims and Objectives

To describe the development of the Patient Centeredness Index (PCI), evaluate its psychometric characteristics and evaluate the relationships between scores on the PCI and an established measure of empathy.

Background

Patient centeredness helps patients manage multiple chronic conditions with their providers, nurses and other team members. However, no instrument exists for evaluating patient centeredness within primary care practices treating this population.

Design

Multi-site instrument development and validation. STROBE reporting guidelines were followed.

Methods

To identify themes, we consulted literature on patient centeredness and engaged stakeholders who had or were caring for people with multiple chronic conditions (n = 7). We composed and refined items to represent those themes with input from clinicians and researchers. To evaluate reliability and convergent validity, we administered surveys to participants (n = 3622) with chronic conditions recruited from 44 primary care practices for a large-scale cluster randomised clinical trial of the effects of a practice-level intervention on patient and practice-level outcomes. Participants chose to complete the 16-item survey online, on paper or by phone. Surveys assessed demographics, number of chronic conditions and ratings of provider empathy. We conducted exploratory factor analysis to model the interrelationships among items.

Results

A single factor explained 93% of total variance. Factor loadings ranged from 0.55–0.85, and item-test correlations were ≥.67. Cronbach's alpha was .93. A moderate, linear correlation with ratings of provider's empathy (r = .65) supports convergent validity.

Conclusions

The PCI is a new tool for obtaining patient perceptions of the patient centeredness of their primary care practice. The PCI shows acceptable reliability and evidence of convergent validity among patients managing chronic conditions.

Relevance to clinical practice

The PCI rapidly identifies patients' perspectives on patient centeredness of their practice, making it ideal for administration in busy primary care settings that aim to efficiently address patient-identified needs.

Trial registration

Clinicaltrials.org Protocol ID: WLPS-1409-24372. Title: Integrating Behavioural Health and Primary Care for Comorbid Behavioural and Medical Problems (IBHPC).

Incidence, characteristics and risk factors of delirium in the intensive care unit: An observational study

Abstract

Aims and Objective

To investigate the incidence, characteristics and risk factors of delirium in the ICU.

Background

Identifying the risk factors of delirium is important for early detection and to prevent adverse consequences.

Design

An observational cohort study conducted according to STROBE Guidelines.

Method

The study was conducted with patients who stayed in ICU ≥24 h and were older than 18 years. Patients were assessed twice daily using the RASS and CAM-ICU until either discharge or death. Cumulative incidence was calculated. Demographic/clinical characteristics, length of stay and mortality were compared between patients with and without delirium. A logistic regression model was used to investigate risk factors.

Results

The incidence of delirium was 31.8% and hypoactive type was the most frequent (41.5%). The median onset of delirium was 3 days (IQR = 2) with a mean duration of 5.27 ± 2.32 days. Patients with delirium were significantly older, had higher APACHE-II, SOFA and CPOT scores, higher blood urea levels, higher requirements for mechanical ventilation, sedation and physical restraints, longer stays in the ICU and higher mortality than those without delirium. The logistic regression analysis results revealed that a CPOT score ≥3 points (OR = 4.70, 95% CI: 1.05–20.93; p = .042), physical restraint (OR = 10.40, 95% CI: 2.75–39.27; p = .001) and ICU stay ≥7 days (OR = 7.26, 95% CI: 1.60–32.84; p = .010) were independent risk factors of delirium.

Conclusions

In this study, the incidence of delirium was high and associated with several factors. It is critical that delirium is considered by all members of the healthcare team, especially nurses, and that protocols are established for improvements.

Relevance to the clinical practice

Based on the results of this study, delirium could be decreased by preventing the presence of pain, prudent use of physical restraints and shortening the ICU stay.

Association between self‐efficacy and self‐management behaviours among individuals at high risk for stroke: Social support acting as a mediator

Abstract

Aims and objectives

To explore the association between self-efficacy and self-management by modelling three types of social support as mediators among stroke high-risk populations.

Background

Self-efficacy and social support (i.e. objective support, subjective support and support utilisation) are important for self-management among stroke high-risk populations. Self-efficacy activates three types of social support, and the effect of social support on self-management varies by types among chronic patients. Therefore, social support may act as a mediator between self-efficacy and self-management, and the mediating role may vary by types of social support. Disentangling the role of these different types of social support can guide tailored interventions.

Design

A cross-sectional study.

Methods

This study was conducted among 448 Chinese adults at high risk for stroke. Self-efficacy, self-management and social support were assessed using the Self-Efficacy Scale, the Stroke Self-management Scale and the Social Support Rating Scale respectively. The PROCESS SPSS Macro version 3.3, model 4 was used to explore the mediating role of different types of social support in the relationship between self-efficacy and self-management. This study followed STROBE checklist for cross-sectional studies (Appendix S1).

Results

Self-efficacy improved three types of social support, and subjective support and support utilisation promoted self-management, but objective support hindered self-management. The specific indirect effect of objective support and subjective support was significant but not that of support utilisation. Objective support, subjective support and support utilisation attenuated the total effect of self-efficacy on self-management by −23.8%, 23.8% and 7.7% respectively.

Conclusions

Mediating effect of social support in the relationship between self-efficacy and self-management varies by type, and the positive effect of subjective support is offset by the detrimental effect of objective support.

Relevance to clinical practice

Among stroke high-risk populations, interventions should target objective support and subjective support as well as self-efficacy to efficiently improve their self-management.

Modelo de sistemas del con-sumo excesivo de alcohol en estudiantes universitarios

El consumo excesivo de alcohol en estudiantes universitarios entre 18 y 25 años produce muertes involuntarias en accidentes automovilísticos, agresiones sexuales y problemas académicos como pérdida de clases, retardos en clase, desempeño deficiente en exámenes o trabajos y calificaciones bajas. Desarrollar modelos de enfermería para explicar esta conducta aumenta el campo de conocimiento de la disciplina. El objetivo es describir la construcción de la teoría de rango medio Mode-lo de Sistemas del Consumo Excesivo de Alcohol en Universitarios. Este proceso se llevó a cabo la subestructuración de algunos conceptos del Modelo de Sistemas de Neuman. Este modelo es de gran utilidad para tener un acercamiento con la población de jóvenes universitarios y se puede emplear para guiar acciones de prevención del con-sumo excesivo de alcohol.

Prolonged use of paracetamol and the prescribing patterns on rehabilitation facilities

Abstract

Aims and Objectives

The study investigated: (a) the usage patterns of paracetamol, and (b) the association between paracetamol use and patient outcomes such as liver and kidney functions among older people.

Background

Paracetamol is a well-known analgesic and antipyretic drug, with an excellent safety profile when used within its recommended dose. It is a commonly used drug by people aged over 65 years to treat chronic pain. Prolonged use of paracetamol in the elderly is poorly understood. As such, there is a genuine risk among older people of unintentional overdose.

Methods

A retrospective analysis of medical records in rehabilitation wards was undertaken from 1 July 2016 to 30 June 2017. Patients' paracetamol use, prescribing patterns and biochemical results were analysed to assess for differences in admission and discharge biochemistry results. The TREND Statement was utilised to guide study reporting (Enhancing the QUAlity and Transparency Of health Research, 2021).

Results

A total of 1119 patients were admitted for seven or more days in a metropolitan tertiary hospital in Melbourne. Almost three-quarters (74%) of patients were administered paracetamol; 76.1% received Immediate-Release Paracetamol (IRP), and 23.9% were given Sustained-release paracetamol (SRP). A proportion (4.5%) of patients in both the IRP and SRP groups received more than the daily recommended dose. There were limited statistically significant differences between patients' admission and discharge biochemistry results; group or time differences were observed, which were indicative of improvements within the paracetamol group.

Conclusion

Paracetamol was a commonly used medication among long-stay elderly patients. Precaution to ensure paracetamol use does not exceed recommended daily doses is required. This study suggests that paracetamol used at a therapeutic level in older patients had limited, negative associations with liver and kidney function.

Relevance to clinical practice

The clinical practice regarding prolonged use of paracetamol is ambitious. The increased risk of paracetamol toxicity among the frail elderly is a concern. Optimising the dose adjustment in the elderly is important to avoid adverse outcomes.

Framing the time while designing and conducting reviews: A Focused Mapping Review and Synthesis

Abstract

Aims and Objectives

To identify the profile of time restrictions and their justifications as reported on a set of published reviews.

Background

There is a body of methodological knowledge addressing how to design and perform reviews in their different designs. However, how the time restrictions should be set and the justifications that should be provided have received limited attention to date.

Design

A Focused Mapping Review and Synthesis following three steps (Focus, Mapping and Synthesis) was performed on 2021. The ENTREQ checklist was followed to report methods and findings.

Methods

All Journal of Clinical Nursing reviews published in online or printed version on 2020 (n = 85). Time limits imposed in the literature search, and justifications provided were mapped and synthetised with quantitative and a qualitative analysis.

Results

Time restrictions in reviews are not always reported and, when available, reflect three different profiles: (a) including all studies, to provide a comprehensive review; (b) selecting a period, to provide reviews for a contemporary practice; and (b) including only recent studies for reviews reflecting current practice. Reasons justifying time restrictions are not always reported; when documented, justifications regard changes in the practice, in the research or in the theory occurred over time, recent or ongoing.

Conclusions

In exploring the date restrictions applied in reviews published over the course of a year, it emerged that the time of access to the sources and the justifications are not always indicated. The attributes of the emerging concepts of “comprehensive reviews,” “contemporary practice reviews” and “current practice reviews” might be further developed to support researchers in selecting an appropriate time frame.

Relevance to clinical practice

Reviews require improvements regarding the time restrictions and their justifications. Methodological efforts to standardise the approach ensuring transparency in review protocols and in the following review publication are recommended.

Early recognition method for patients with schizophrenia or bipolar disorder in community mental health care: Illness insight, self‐management and control

Abstract

Aims and objective

To investigate how participating in the early recognition method treatment strategy affect illness insight and management, in patients with schizophrenia or bipolar disorder in community mental healthcare.

Background

The current practice in mental healthcare focus on shared decision-making and self-managing capacity, but poor insight is a predictor of poor adherence and dropout. Engagement in illness management and recovery predict the treatment response.

Design

Semi-structured interviews with a phenomenological-hermeneutic approach.

Methods

We conducted 36 semi-structured interviews with 26 patients. The interviews were conducted before and after participating in the intervention using the early recognition method strategy. The analysis was based on Ricoeur's theory of interpretation: Naive reading, structural analysis, interpretation and discussion. The COREQ checklist was used as reporting guideline.

Results

The experience of participating in treatment as usual and early recognition method revealed two main themes. The first theme ‘patient care’ describes how dialogue and collaboration increase awareness of the illness and how to gain control. The second theme ‘insight and experience’ describes how illness affects personality and self-image, and how insight entails control and self-confidence.

Conclusion

Managing life with severe mental illness is complex and challenging. However, the experience of guidance, support and collaboration between patient and nurse are essential to improve these circumstances.

Relevance to clinical practice

A systematic approach to the patient' symptoms, as in the early recognition method strategy, enhances knowledge of the individual patient' symptoms, both for nurse and patient. A knowledge that is significant for meeting individual treatment needs. Therefore, applying this strategy is likely to enhance collaboration and improve treatment outcome.

Edgework emotion management: A constructivist grounded theory of organ donation nurses’ experiences and practices

Abstract

Aims and Objectives

To explore nurses’ experiences when approaching families for organ donation authorisation to guide nursing practice.

Background

Organ donation after brainstem death implies that bereaved families are approached to discuss organ donation authorisation, and in many countries, specialist nurses do this approach. The literature describes the social, psychological and emotional challenges of health professionals in this role. However, lack of conceptual clarity regarding nurses’ experiences on approaching families to guide nursing practice was found.

Design

Constructivist grounded theory.

Methods

Between October 2017 and July 2019, seven months of observations were conducted across two large public hospitals in Chile. Field notes, documents (n = 80), interviews (n = 27) and focus groups (n = 14) with 71 participants (51 healthcare professionals and 20 bereaved families) were included. Data collection and analysis followed the principles and practices of Charmaz’ constructivist grounded theory. The COREQ checklist was followed in reporting the study.

Results

Edgework emotion management of organ donation nurses was developed as a threefold process: 1) being present to recognise inner and family emotions, 2) being on an emotional edge when approaching families and 3) extending the emotional edge to make sense of their experiences. The grounded theory was conceptualised using edgework emotion management by Lois (2003), which allowed to elucidate organ donation nurses’ experiences and practices on managing their emotions.

Conclusions

Organ donation nurses develop a sophisticated and complex emotional regulation process to approach and care for families when negotiating organ donation authorisation for transplantation.

Relevance to Clinical Practice

The experiences of specialist organ donation nurses entail a sophisticated emotion management process, which may explain the complexities of a critical role within healthcare institutions. Findings can be locally and internationally used to understand, educate and guide nursing practice, in an area of increasing specialisation and staffing shortages such as organ donation and transplantation.

Predictors of oral chemotherapy adherence at home among Chinese cancer patients: An observational prospective study

Abstract

Aims and Objectives

To explore whether medication non-adherence experience, readiness for hospital discharge, financial toxicity and symptoms predicted oral chemotherapy adherence at home for Chinese cancer patients.

Background

Oral chemotherapy adherence is critical to determine the treatment efficacy among cancer patients. Identifying predictors before discharge from hospital based on transition theory could assist healthcare providers to improve oral chemotherapy adherence at home.

Design

An observational prospective study.

Methods

Between October 2018 and December 2019, self-reported questionnaires were used to collect data among 151 cancer patients with oral chemotherapy at home. At discharge, baseline data of patient-perceived readiness for hospital discharge, financial toxicity and non-adherence experience were collected, while symptoms and adherence of oral chemotherapy at home were collected after finishing one cycle of oral chemotherapy at home (21 days, the first 14 days received oral chemotherapy). Regression analyses were performed for the predictors’ explorations. The STROBE guidelines were followed.

Results

Among 151 participants with oral chemotherapy at home, 30.46% of patients reported medication non-adherence experience at discharge and 82.12% of patients reported adherence to oral chemotherapy at home. Patients with non-adherence experience at discharge were 5.4 times more likely to being non-adhered to oral chemotherapy at home. Numbness were the most frequent and severe symptoms during at home, patients with numbness were 6.6 times more likely to being non-adhered to oral chemotherapy. Although patients reported high level of readiness for discharge and financial toxicity at discharge, which did not predicted oral chemotherapy adherence at home.

Conclusions

Patients with medication non-adherence experience at discharge and symptom of numbness from oral chemotherapy suggested a higher risk of oral chemotherapy non-adherence at home.

Relevance to clinical practice

Preventive interventions should focus on patients with previous medication non-adherence experience at discharge and experiencing numbness to promote oral chemotherapy adherence.

Clinical accuracy and agreement between tympanic and forehead body temperature measurements for screening of patients with COVID‐19

Abstract

Aim

To investigate the accuracy, reliability and agreement between infrared forehead thermometers versus infrared tympanic thermometers temperature, a cross-sectional study was conducted in April 2020.

Methods

The forehead and tympanic temperatures of 615 subjects were measured simultaneously in three exposed SARS-COV-2 groups at one hospital in Iran, during April 2020. These comparisons were evaluated by Bland–Altman Plot, repeatability, Passing–Bablok regression and Lin's concordance correlation coefficient. The receiver operating characteristic (ROC) analysis was done to describe the discrimination accuracy of a diagnostic test. The study adhered to STROBE checklist for cross-sectional studies.

Results

A Bland–Altman plot indicated that the limits of agreement between the forehead and tympanic temperature were −0.259 to +0.19°C. Passing–Bablok regression analysis illustrated that the infrared forehead was not linearly related to tympanic temperatures (reference method), with a slope estimate that was significantly different from 1.00. The infrared forehead thermometer showed poor precision and lower accuracy than the tympanic. The forehead temperature readings had 60.0% sensitivity and 44.4% specificity (> .05) to predict disease.

Conclusion

According to the results of study, there is no evidence that the assessment of temperature by infrared forehead thermometer could discriminate between the two groups (positive and negative).

Leadership of PhD‐prepared nurses working in hospitals and its influence on career development: A qualitative study

Abstract

Aims and objectives

To explore leadership experiences and the influence of leadership on career development of PhD-prepared nurses working in hospitals.

Background

The Doctor of Philosophy (PhD) represents the highest level of education for a career in research and scholarship. PhD-prepared nurses have an important role in advancing the nursing discipline by conducting and implementing research finding. Given the rapidly changing health care environment, there is a clear need for PhD-prepared nurses with strong leadership competences. Currently, there is a dearth of studies exploring leadership of PhD-prepared nurses working in hospitals.

Design

A descriptive qualitative study.

Method

A purposive sample with PhD-prepared nurses employed at clinical departments was used. Twelve interviews were conducted with participants from seven hospitals. Perceptions towards leadership, leadership experiences, leadership barriers and the influence of leadership on career development were discussed. Interviews were thematically analysed. Reporting followed the COREQ guidelines.

Results

Three themes addressing leadership experiences were found: (1) “Leadership is needed for career development” describes how participants took initiative and received support from colleagues and mentors; (2) “Practicing leadership behaviours” describes leadership behaviours and feelings associated with leadership and (3) “Leadership influenced by the hospital setting” describes the working environment including struggling nursing research cultures and infrastructures with limited positions, managerial support and opportunities for collaboration.

Conclusion

Although participants showed leadership to advance their careers, barriers related to working environment were found. Stakeholders should invest into opportunities to develop and utilise leadership competences and development of strong nursing research cultures and infrastructures with sustainable career frameworks and positions.

Relevance for clinical practice

There is a need for ongoing efforts to build strong leadership competences as well as nursing research cultures and infrastructures with career pathways and suitable positions for PhD-prepared nurses within hospitals to empower them to strengthen nursing.

Home‐based nursing care competencies: A scoping review

Abstract

Aims and objectives

To identify and consolidate the available evidence about nursing-related competencies for home-based care.

Background

Over recent years, the demand for home-based nursing care has increased because of the need to meet the increasing need for chronic disease care to be delivered in patients' homes. However, knowledge is lacking about the expected competencies for home-based care nurses.

Design

A scoping review was conducted in accordance with Arksey and O'Malley's six-step scoping review framework and the PRISMA-ScR guidelines. The review identified literature using five electronic databases (CINAHL, PubMed, Embase, Cochrane and Scopus) and a hand search for grey literature in relevant home-based care journals and online searches. Key search terms and inclusion and exclusion criteria were used as strategies to identify relevant articles.

Results

Sixty-four articles were eligible for inclusion. Mapping and narrative synthesis of 116 elements related to home-based nursing care competencies identified the following 10 competencies: (1) care assessments; (2) performance of nursing procedures; (3) management of health conditions; (4) critical thinking and problem-solving skills; (5) interpersonal relationships and communication; (6) interdisciplinary collaboration; (7) leadership and resource management; (8) professional development; (9) technological literacy; (10) quality and safety.

Conclusion and relevance to clinical practice

This review provides insight into current knowledge about home-based nursing care competencies. These competencies could be used to evaluate nurses’ competence level for home-based care or for development of appropriate professional education. The review also outlines the scope of nursing practice in home-based care, which provides support for some form of standardisation of home-based nursing care expectations across various stakeholders.

Prevalence of distress and its associated factors among caregivers of people diagnosed with cancer: A cross‐sectional study

Abstract

Aims and Objectives

To (i) determine prevalence of distress among caregivers of people living with cancer, (ii) describe caregivers’ most commonly reported problems and (iii) investigate which factors were associated with caregivers’ distress.

Background

The psychological distress associated with a cancer diagnosis jointly impacts those living with cancer and their caregivers(s). As the provision of clinical support moves towards a dyadic model, understanding the factors associated with caregivers’ distress is increasingly important.

Design

Cross-sectional study.

Methods

Distress screening data were analysed for 956 caregivers (family and friends) of cancer patients accessing the Cancer Council Western Australia information and support line between 1 January 2016 and 31 December 2018. These data included caregivers' demographics and reported problems and their level of distress. Information related to their care recipient's cancer diagnosis was also captured. Caregivers' reported problems and levels of distress were measured using the distress thermometer and accompanying problem list (PL) developed by the National Comprehensive Cancer Network. A partial-proportional logistic regression model was used to investigate which demographic factors and PL items were associated with increasing levels of caregiver distress. Pearlin's model of caregiving and stress process was used as a framework for discussion. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed.

Results

Nearly all caregivers (96.24%) recorded a clinically significant level of distress (≥4/10) and two thirds (66.74%) as severely distressed (≥7/10). Being female, self-reporting sadness, a loss of interest in usual activities, sleep problems or problems with a partner or children were all significantly associated with increased levels of distress.

Conclusions

Caregivers of people with cancer reporting emotional or familial problems may be at greater risk of moderate and severe distress.

Relevance to Clinical Practice

Awareness and recognition of caregiver distress are vital, and referral pathways for caregivers are the important area of development.

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