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Alterations in the structural characteristics of rectus abdominis muscles caused by diabetes and pregnancy: A comparative study of the rat model and women

by Giovana Vesentini, Angélica M. P. Barbosa, Débora C. Damasceno, Gabriela Marini, Fernanda Piculo, Selma M. M. Matheus, Raghavendra L. S. Hallur, Sthefanie K. Nunes, Bruna B. Catinelli, Claudia G. Magalhães, Roberto Costa, Joelcio F. Abbade, José E. Corrente, Iracema M. P. Calderon, Marilza V. C. Rudge, The DIAMATER Study Group

Background and objective

In the present study, we compared the effect of diabetic pregnancy on the rectus abdominis muscle (RAM) in humans and rats. We hypothesized that our animal model could provide valuable information about alterations in the RAM of women with Gestational Diabetes (GDM).

Method

Newborns female rats (n = 10/group) were administered streptozotocin (100 mg/kg body weight) subcutaneously and were mated on reaching adulthood, to develop the mild hyperglycemic pregnant (MHP) rat model. At the end of pregnancy, the mothers were sacrificed, and the RAM tissue was collected. Pregnant women without GDM (non-GDM group; n = 10) and those diagnosed with GDM (GDM group; n = 8) and undergoing treatment were recruited, and RAM samples were obtained at C-section. The RAM architecture and the distribution of the fast and slow fibers and collagen were studied by immunohistochemistry.

Results

No statistically significant differences in the maternal and fetal characters were observed between the groups in both rats and women. However, significant changes in RAM architecture were observed. Diabetes in pregnancy increased the abundance of slow fibers and decreased fast fiber number and area in both rats and women. A decrease in collagen distribution was observed in GDM women; however, a similar change was not observed in the MHP rats.

Conclusion

Our results indicated that pregnancy- associated diabetes- induced similar structural adaptations in the RAM of women and rats with slight alterations in fiber type number and area. These findings suggest that the MHP rat model can be used for studying the effects of pregnancy-associated diabetes on the fiber structure of RAM.

Analyses of medical coping styles and related factors among female patients undergoing in vitro fertilization and embryonic transfer

by Liwen Shen, Lanfeng Xing

Objective

This study investigated the medical coping styles of female patients treated with in vitro fertilization and embryonic transfer (IVF-ET), and analyzed the effects of alexithymia and social support on their choice of coping style.

Methods

A survey was conducted with 285 female patients undergoing IVF-ET in a reproductive medical center of a third-grade class-A hospital in China using the Medical Coping Modes Questionnaire, the Social Support Rating Scale, and the Toronto Alexithymia scale.

Results

Patients who underwent IVF-ET treatment had a higher score for avoidance as a coping mode than did normal controls. Utilization of social support predicted the use of confrontation as a coping style. Difficulty identifying feelings, objective support, and utilization of social support were factors in the choice of avoidance as a coping style, and length of infertility treatment, difficulty identifying feelings, and subjective support predicted patients’ use of the acceptance-resignation as a coping style.

Conclusion

Patients who undergo IVF-ET generally select the coping style of avoidance, which is not conducive to treatment. Targeted intervention strategies should be developed based on the factors influencing patients’ choice of coping style(s) to guide them in choosing positive coping methods, improve compliance, and achieve successful pregnancy outcomes.

An in-depth survey of the microbial landscape of the walls of a neonatal operating room

by Dieunel Derilus, Filipa Godoy-Vitorino, Hebe Rosado, Edgardo Agosto, Maria Gloria Dominguez-Bello, Humberto Cavallin

Bacteria found in operating rooms (ORs) might be clinically relevant since they could pose a threat to patients. In addition, C-sections operations are performed in ORs that provide the first environment and bacterial exposure to the sterile newborns that are extracted directly from the uterus to the OR air. Considering that at least one third of neonates in the US are born via C-section delivery (and more than 50% of all deliveries in some countries), understanding the distribution of bacterial diversity in ORs is critical to better understanding the contribution of the OR microbiota to C-section- associated inflammatory diseases. Here, we mapped the bacteria contained in an OR after a procedure was performed; we sampled grids of 60x60 cm across walls and wall-adjacent floors and sequenced the V4 region of 16S rRNA gene from 260 samples. The results indicate that bacterial communities changed significantly (ANOSIM, p-value

Physicians' norms and attitudes towards substance use in colleague physicians: A cross-sectional survey in the Netherlands

by Pauline Geuijen, Marlies de Rond, Joanneke Kuppens, Femke Atsma, Aart Schene, Hein de Haan, Cornelis de Jong, Arnt Schellekens

Introduction

Substance use disorders (SUD) in physicians often remain concealed for a long time. Peer monitoring and open discussions with colleagues are essential for identifying SUD. However, physicians often feel uncomfortable discussing substance use with a colleague. We explored physicians’ attitudes and norms about substance use (disorders) and their (intended) approach upon a presumption of substance use in a colleague.

Materials and methods

An online cross-sectional survey concerning “Addiction in physicians” was administered by the Royal Dutch Medical Association physician panel. Overall, 1685 physicians (47%) responded. Data were analyzed by logistic regression to explore factors associated with taking action upon a substance use presumption.

Results

Most physicians agreed that SUD can happen to anyone (67%), is not a sign of weakness (78%) and that it is a disease that can be treated (83%). Substance use in a working context was perceived as unacceptable (alcohol at work: 99%, alcohol during a standby duty: 91%, alcohol in the eight hours before work: 77%, and illicit drugs in the eight hours before work: 97%). Almost all respondents (97%) intend to act upon a substance use presumption in a colleague. Of the 29% who ever had this presumption, 65% took actual action. Actual action was associated with male gender and older age (OR = 1.81; 95% CI = 1.20–2.74 and OR = 1.03; 95% CI = 1.01–1.05, respectively).

Conclusions

About one-third of physicians reported experience with a presumption of substance use in a colleague. Whilst most physicians intend to take action upon such a presumption, two-thirds actually do act upon a presumption. To bridge this intention-behavior gap continued medical education on signs and symptoms of SUD and instructions on how to enter a supportive dialogue with a colleague about personal issues, may enhance physicians’ knowledge, confidence, and ethical responsibility to act upon a presumption of substance use or other concerns in a colleague.

Co-culture of induced pluripotent stem cells with cardiomyocytes is sufficient to promote their differentiation into cardiomyocytes

by Axel J. Chu, Eric Jiahua Zhao, Mu Chiao, Chinten James Lim

Various types of stem cells and non-stem cells have been shown to differentiate or transdifferentiate into cardiomyocytes by way of co-culture with appropriate inducer cells. However, there is a limited demonstration of a co-culture induction system utilizing stem cell-derived cardiomyocytes as a stimulatory source for cardiac reprogramming (of stem cells or otherwise). In this study, we utilized an inductive co-culture method to show that previously differentiated induced pluripotent stem (iPS) cell-derived cardiomyocytes (iCMs), when co-cultivated with iPS cells, constituted a sufficient stimulatory system to induce cardiac differentiation. To enable tracking of both cell populations, we utilized GFP-labeled iPS cells and non-labeled iCMs pre-differentiated using inhibitors of GSK and Wnt signaling. Successful differentiation was assessed by the exhibition of spontaneous self-contractions, structural organization of α-actinin labeled sarcomeres, and expression of cardiac specific markers cTnT and α-actinin. We found that iCM-iPS cell-cell contact was essential for inductive differentiation, and this required overlaying already adherent iPS cells with iCMs. Importantly, this process was achieved without the exogenous addition of pathway inhibitors and morphogens, suggesting that ‘older’ iCMs serve as an adequate stimulatory source capable of recapitulating the necessary culture environment for cardiac differentiation.

Long-term total hip arthroplasty rates in patients with acetabular and pelvic fractures after surgery: A population-based cohort study

by Tzu-Chun Chung, Tzu-Shan Chen, Yao-Chun Hsu, Feng-Chen Kao, Yuan-Kun Tu, Pao-Hsin Liu

Background/objective

Osteoarthritis typically develops after surgery for traumatic fractures of the acetabulum and may result in total hip arthroplasty (THA). We conducted a population-based retrospective study to investigate the incidence of THA after treatment of acetabular, pelvic, and combined acetabular and pelvic fractures with open reduction-internal fixation surgery compared with that in the control group.

Design

A retrospective population-based cohort study.

Setting

Data were gathered from the Taiwan National Health Insurance Research Database.

Participants

We enrolled 3041 patients with acetabular fractures, 5618 with pelvic fractures, and 733 with combined pelvic and acetabular fractures between January 1, 1997, and December 31, 2013, totaling 9392 individuals. The control group comprised 664,349 individuals. Study participants were followed up for the occurrence of THA until death or the end of the study period.

Results

The THA rates after surgical intervention were 17.82%, 7.28%, and 18.01% in patients with acetabular, pelvic, and combined acetabular and pelvic fractures, respectively. Moreover, they were significantly higher for the acetabular fracture, pelvic fracture, and combined-fracture groups (adjusted hazard ratios [aHRs] = 58.42, 21.68, and 62.04, respectively) than for the control group (p p Conclusion

The incidence rates of THA after surgical intervention in the pelvic fracture, acetabular fracture, and combined-fracture groups were significantly higher than that of the control group.

Household food insecurity and early childhood development: Longitudinal evidence from Ghana

by Elisabetta Aurino, Sharon Wolf, Edward Tsinigo

The burden of food insecurity is large in Sub-Saharan Africa, yet the evidence-base on the relation between household food insecurity and early child development is extremely limited. Furthermore, available research mostly relies on cross-sectional data, limiting the quality of existing evidence. We use longitudinal data on preschool-aged children and their households in Ghana to investigate how being in a food insecure household was associated with early child development outcomes across three years. Household food insecurity was measured over three years using the Household Hunger Score. Households were first classified as “ever food insecure” if they were food insecure at any round. We also assessed persistence of household food insecurity by classifying households into three categories: (i) never food insecure; (ii) transitory food insecurity, if the household was food insecure only in one wave; and (iii) persistent food insecurity, if the household was food insecure in two or all waves. Child development was assessed across literacy, numeracy, social-emotional, short-term memory, and self-regulation domains. Controlling for baseline values of each respective outcome and child and household characteristics, children from ever food insecure households had lower literacy, numeracy and short-term memory. When we distinguished between transitory and persistent food insecurity, transitory spells of food insecurity predicted decreased numeracy (β = -0.176, 95% CI: -0.317; -0.035), short-term memory (β = -0.237, 95% CI: -0.382; -0.092), and self-regulation (β = -0.154, 95% CI: -0.326; 0.017) compared with children from never food insecure households. By contrast, children residing in persistently food insecure households had lower literacy scores (β = -0.243, 95% CI: -0.496; 0.009). No gender differences were detected. Results were broadly robust to the inclusion of additional controls. This novel evidence from a Sub-Saharan African country highlights the need for multi-sectoral approaches including social protection and nutrition to support early child development.

Potential endocrine disrupting properties of toys for babies and infants

by Christian Kirchnawy, Fiona Hager, Veronica Osorio Piniella, Mathias Jeschko, Michael Washüttl, Johannes Mertl, Aurelie Mathieu-Huart, Christophe Rousselle

Plastic toys mouthed by children may be a source of exposure to endocrine active substances. The purpose of this study was to measure hormonal activity of substances leaching from toys and to identify potential endocrine disruptors causing that activity. For this purpose, migration experiments of toys were conducted in saliva simulants. The CALUX® assays were used to detect (anti-) estrogenic and (anti-) androgenic activity of 18 toys. Chemical trace analysis–namely, GC-MS and HPLC-MS- was used to identify which compounds may be responsible for endocrine activity in the sample migrates. Nine out of 18 tested toys showed significant estrogenic activity. For two samples, the detected estrogenic activity could be well explained by detecting the known endocrine active substance bisphenol A (BPA). For all identified substances, including BPA, a risk assessment for human health was performed by comparing the exposure dose, calculated based on the determined substance concentration, to toxicological reference values. Using worst-case scenarios, the exposure to BPA by mouthing of the two estrogen active, BPA-containing toys could be above the temporary TDI that EFSA has calculated. This demonstrates that some toys could significantly contribute to the total exposure to BPA of babies and infants. For seven out of nine estrogen active samples, the source of the estrogen activity could not be explained by analysis for 41 known or suspected endocrine active substances in plastic, indicating that the estrogen activities were caused by currently unknown endocrine active substances, or by endocrine active substances that would currently not be suspected in toys.

What use are words at a time like this?

Abstract

What use are words at a time like this? I am writing this on 27th March as the world is plunging further into the coronavirus crisis. Like many worldwide, I am in virtual ‘lockdown’ in Australia while the exponential spread of the virus continues. At a follow‐up tele‐consult with my medical consultant recently, he said that he was apprehensive about the ‘calm before the storm’ that our health services face. He was deadly serious.

Testing of the Nursing Evidence‐Based Practice Survey

Abstract

Background

Clinicians’ knowledge and skills for evidence‐based practice (EBP) and organizational climate are important for science‐based care. There is scant literature regarding aligning organizational culture with EBP implementation and even less for unit and organizational culture. The Nursing EBP Survey examines individual, unit, and organizational factors to better understand registered nurses’ (RN) self‐reported EBP.

Aims

Establish and confirm factor loading, reliability, and discriminant validity for the untested Nursing EBP Survey.

Methods

The study employed a descriptive cross‐sectional survey design and was targeted for RNs. The setting included 14 hospitals and 680 medical offices in Southern California. The 1999 instrument consisted of 22 items; 7 items were added in 2005 for 29 items. The questionnaire used a 5 point, Likert‐type scale. The survey website opened in November 2016 and closed after 23 weeks. Psychometric testing and factor determination used parallel analysis, exploratory factor analysis, confirmatory factor analysis (CFA), and ANOVA post hoc comparisons.

Results

One thousand one hundred and eighty‐one RNs completed the survey. All factor loadings in the CFA model were positive and significant (p < .001). All standardized loadings ranged from .70 to .94. The covariance estimate between Factor 1 and Factor 2 was marginally significant (p = .07). All other covariances and error variances were significant (p < .001). Final factor names were Practice Climate (Factor 1), Data Collection (Factor 2), Evidence Appraisal (Factor 3), Implementation (Factor 4), and Access to Evidence (Factor 5). Four of 5 factors showed significant differences between education levels (p < .05 level). All factors showed significant differences (p < .05) between inpatient and ambulatory staff, with higher scores for inpatient settings.

Linking Evidence to Action

Nurses’ knowledge, attitudes, and skills for EBP vary. The 2019 Nursing EBP survey offers RNs direction to plan and support improvement in evidence‐based outcomes and tailors future EBP initiatives.

Exploring the recruitment of men into the nursing profession in the United Kingdom

Abstract

To explore the gendered nature of the nursing working force To consider current initiatives and programmes to encourage men to enter the nursing profession. To understand some of the barriers to recruiting men into the nursing profession.

What is the nature of Mental Capacity Act training and how do health and social care practitioners change their practice post‐training? A narrative review

Abstract

Aim

To identify training strategies and determine how registered health and social care practitioners change their practice post Mental Capacity Act training.

Design

Narrative literature review

Data sources

Seventeen databases were searched up to December 2019; CINAHL, Social Care Online, PubMed, Social Policy and Practice, Discover, Medline, Science Direct, Ovid, PsycINFO, ASSIA, Social Services Abstracts, Science Direct, Academic Search Premier, Web of Science, British Nursing Index, DH‐Data, King’s Fund Library Catalogue.

Review Methods

Empirical studies of any design investigating Mental Capacity Act training were searched and screened. Data were extracted to a bespoke spreadsheet and quality assessed. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses, (PRISMA).

Results

Of 162 papers identified, 16 were included comprising qualitative, quantitative and mixed methods studies. Trainees valued interactive training with close alignment to practice. Training did not lead to demonstrable practice change. Barriers in the context and cultures of care environments were identified.

Conclusion

To facilitate application of Mental Capacity Act legislation, identified barriers should be addressed. Future training should be interactive, scenario‐based and relevant to trainees’ practice.

Relevance to Clinical Practice

The Mental Capacity Act is widely misunderstood and implementation poor. Training is proposed as a solution, but the nature of training that will positively affect practice remains unknown. This review aims to address this gap in the evidence base. Interactive training, using scenarios that reflect practice complexities, has the most positive impact. Cultural norms in care environments may impede application of this legislation.

The review has international relevance as there is a global imperative to adhere to the United Nations Convention on the Rights of Persons with Disabilities. The review will inform training design and delivery to ensure that people with impaired capacity to make decisions are given the best opportunity to act autonomously.

You can’t flight, you need to fight – a qualitative study of mothers’ experiences of feeding extremely preterm infants

Abstract

Aim

To describe mother’s experiences of feeding their extremely preterm infant.

Background

When an infant is born extremely preterm, there is a long rocky road for the mother if she wants to breastfeed. Some manage to reach their goals, others do not. Studies of feeding extremely preterm infants in the neonatal intensive care unit (NICU) are scarce.

Design

A qualitative method with an inductive approach.

Methods

Nine mothers giving birth to extremely preterm infants were interviewed by telephone after discharge from the NICU. The interviews were transcribed verbatim and analysed with qualitative content analysis. The COREQ checklist was followed.

Findings

The overall theme was “you can’t flight, you need to fight”. The theme reflects the mothers will to do the best for their infants even if the struggle with milk expression and breastfeeding practice evoked feelings of helplessness, exposure, worry, and disappointment. The categories forming the theme were: The wish to provide own breastmilk; For the infant’s best; Loss of control; Help to reach the goals.

Conclusion

The mothers had a strong will to provide breastmilk to their infants but requested more support in order to be successful.

Relevance to clinical practice

There is a need for evidence based support programs for mothers of extremely preterm infants to encourage them to persevere with milk expression and breastfeeding over time.

Relationship between symptom burden, medication adherence, and spiritual well‐being in patients with chronic obstructive pulmonary disease

Abstract

Aims and objectives

To investigate the relationship between symptom burden, medication adherence, and spiritual well‐being in patients with chronic obstructive pulmonary disease (COPD).

Background

The relationship between spirituality and medication adherence has been investigated in different chronic conditions. However, the relationship between symptom burden, medication adherence, and spiritual well‐being in patients with COPD has not been explored.

Design

A descriptive correlational study design was adopted.

Methods

A total of 112 patients with COPD were included in the study. Data were collected using the COPD Assessment Test (CAT), the Adherence to Refills and Medications Scale‐7 (ARMS‐7), and the Functional Assessment of Chronic Illness Therapy‐Spiritual Well‐Being Scale (FACIT‐Sp). The data were analyzed using descriptive and correlational statistics. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) Checklist was used.

Results

The CAT score was significantly higher in patients on long‐term oxygen therapy and those who had more than three comorbid conditions (p < 0.05). The mean score of ARMS‐7 was significantly associated with age (p < 0.05). Current smokers had higher ARMS‐7 and lower FACIT‐Sp scores (p < 0.001). The FACIT‐Sp score was negatively and moderately associated with the CAT and ARMS‐7 scores (p < 0.001).

Conclusion

This study concluded that individuals with higher spiritual well‐being had lower symptom burden and higher medication adherence. The need for long‐term oxygen therapy and a high number of comorbid conditions were associated with increased symptom burden. Current smokers had lower spiritual well‐being and medication adherence.

Relevance to clinical practice

Spiritual well‐being should be evaluated when assessing symptom burden and medication adherence in clinical practice. In addition, further studies examining the causal relationship between symptom burden, spiritual well‐being, and medication adherence in different populations are warranted.

Pain Assessment and Interventions by Nurses in the Emergency Department: A National Survey

Abstract

Aim

The aim of this study was to examine the knowledge, perceptions and factors influencing pain assessment and management practices among Australian emergency nurses.

Background

Pain is the most commonly reported symptom in patients presenting to the emergency department, with over half rating their pain as moderate to severe. Patients unable to communicate, such as critically ill intubated patients, are at greater risk of inadequate pain management.

Design

This cross‐sectional exploratory study used survey methodology to explore knowledge, perceptions and factors influencing pain management practices among Australian emergency nurses.

Methods

Australian emergency nurses were invited to complete an online survey comprising 91‐items. The response rate was 450 of 1,488 (30.2%). STROBE guidelines were used in reporting this study.

Results

Variations in level of acute pain management knowledge, especially in older, cognitively impaired or mechanically ventilated patients were identified. Poor interprofessional communication, workload and staffing negatively impacted on nurses’ intention to administer analgesia. For intubated patients, validated observation pain assessment instruments were rarely used, although respondents recognised the importance of pain management in critically ill patients.

Conclusions

Emergency nurses recognise the importance of pain relief. The ability to nurse‐initiate analgesia, education and training in pain management education is variable. Little education is provided on assessing and managing acute pain in elderly, cognitively impaired or mechanically ventilated patients. Use of validated pain assessment instruments to assess pain in critically ill patients is poor.

Relevance to clinical practice

While pain management is the responsibility of all healthcare professionals, in the emergency department, it is a core role of emergency nursing. This study highlights the variation in ability to nurse‐initiate analgesia, level of acute pain knowledge, education and training, and use of validated pain assessment instruments to guide pain management in critically ill intubated patients.

Nonverbal communication between registered nurses and patients during chronic disease management consultations: observations from general practice

Abstract

Aims and objectives

This study explores nonverbal communication behaviours between general practice nurses and patients during chronic disease consultations.

Background

Nonverbal communication is an important aspect of nurse‐patient lifestyle risk reduction conversations. Despite the growing role of general practice nurses in lifestyle risk modification when managing chronic disease, few studies have investigated how this communication occurs.

Design

Observational study within a concurrent mixed methods project.

Methods

Thirty‐six consultations by 14 general practice nurses were video recorded between August 2017 and March 2018. Video analysis used the Nonverbal Accommodation Analysis System. A STROBE checklist was used to guide this paper.

Results

Joint convergence of nurse‐patient behaviours such as laughing, smiling and eye contact were most common (44%; n=157). Patient‐nurse eye contact time decreased significantly across the consultation, while nurse gesturing increased significantly. No significant relationship between consultation length and convergent to divergent behaviour categorisation or nurse‐computer use across the consultation was found.

Conclusions

The high levels of convergent behaviours are promising for person‐centred care. However, scope exists to enhance nonverbal interactions around lifestyle risk reduction. Supporting nurses with skills and improved environments for lifestyle risk communication has potential to improve therapeutic relationships and patient outcomes.

Relevance to clinical practice

These results indicate that nurses support patients through nonverbal interactions during conversations of lifestyle risk reduction. However, there are opportunities to improve this practice for future interventions.

Satisfaction of Slovak Women with Psychosocial Aspects of Care during Childbirth

The objective of the study is to find out and assess satisfaction of Slovak women with psychosocial aspects of perinatal care.

Dignity, Privacy, Respect and Choice ‐ A Scoping Review of measurement of these concepts within acute healthcare practice

Abstract

Aims and objectives

To synthesize and review literature related to instruments that measure psychosocial aspects of fundamental care in acute hospital care settings.

Background

Psychosocial aspects of care often receive less priority in terms of care provision in acute care environments. At the same time if these elements are overlooked there may be consequences. Despite the availability of many instruments designed to measure specific aspects of care these concepts are often not studied within the broader context of fundamentals of care, but rather coexist as isolated explorations of specific sub elements.

Design

A scoping review was conducted, based on Arksey & O’Malley’s (2005) methodological framework and following the PRISMA checklist.

Methods

Using the five recommended steps ‐identifying the research question; identifying relevant studies; study selection; charting the data; summarizing and reporting the results – three databases were searched: MEDLINE/Pubmed, CINHAL, and EMBASE in February 2019.

Results

Following independent screening by two of the authors, 48 papers were included. From these 48 papers, 33 instruments were identified. Only five of these tools thoroughly assessed psychosocial aspects elements of care (dignity, respect, privacy and patients’ choice) through dedicated items.

Conclusions

This review provides nurses with a synthesis of 33 instruments that assess the psychosocial aspects of care. This provides an important resource to guide measurement of dignity, respect, privacy and patients’ choice. The findings also provide guidance to future research in this field.

Relevance to clinical practice

This paper reviews and synthesizes these instruments to provide a resource to nurses to inform their decisions and practice around measurement and evaluation of these key aspects of care. This provides a useful guide to measure and monitor the improvement of fundamental care delivery in practice, and points to strengths and weaknesses of the instruments concerned.

Improved quality of care by using the PRISMS form to support self‐management in patients with COPD: A Randomized Controlled Trial

Abstract

Aims and objective

To investigate the effects on the quality of care of the Patient Report Informing Self‐Management Support (PRISMS) form compared with usual care among patients with Chronic Obstructive Pulmonary Disease (COPD) consulting a COPD nurse in primary health care.

Background

Patients with COPD experience symptoms affecting their everyday lives and there is a need for interventions in self‐management support. The delivery of chronic care in an organized, structured, and planned manner can lead to more productive relationships between professionals and patients.

Design

A multicentre randomised controlled trial with a post‐test design, according to the CONSORT checklist, in one intervention group (n=94) and one control group (n=108).

Methods

In addition to usual care, the intervention group (n=94) completed the PRISMS form to indicate areas where they wanted self‐management support before the consultation with the COPD nurse. This form comprises 17 items that patients with COPD commonly experience as problems. The control group received usual care (n=108). The primary outcome was patients’ satisfaction with quality of care, assessed using the Quality from the Patient’s Perspective (QPP) questionnaire. Means and (SD) are presented where applicable. Differences between the intervention and control group were analysed with Student’s t‐test for independent groups for interval data, and the Mann‐Whitney U‐test for ordinal data.

Results

Participants in the intervention group were more satisfied with the QPP domains “personal attention”, regarding both “Perceived reality” (p=0.021) and “Subjective Importance” (p=0.012). The PRISMS form revealed “Shortness of breath” as the most commonly experienced problem and the issue most desired to discuss.

Conclusion

The PRISMS form improved patient satisfaction with quality of care regarding personal attention, which is an important factor in patient participation and improving relationships and communication.

Relevance to clinical practice

The PRISMS form can be a useful tool in improving person‐centred care when delivering self‐management support.

“You’ve got to keep moving, keep going”: Understanding Older Patients’ Experiences and Perceptions of Delirium and Non‐Pharmacological Delirium Prevention Strategies in the Acute Hospital Setting

Abstract

Aims and Objectives

To explore older inpatients’ experiences and perceptions of delirium and non‐pharmacological delirium prevention strategies (NDPS).

Background

Delirium is a distressing and serious complication in hospitalised older adults. NDPS (supporting nutrition, mobility and cognitive participation) have strong supporting evidence. Few studies have explored older inpatients’ perspectives of these strategies. This information may assist staff to better support patient participation in NDPS.

Design

Qualitative study using an interpretive descriptive (ID) methodological approach to explore older patient’s experience of delirium and NDPS.

Methods

Structured interviews of inpatients aged over 65 years across 6 medical and surgical wards explored patients’ experiences and perceptions of delirium and prevention activities related to nutrition, mobility and cognition; and barriers and enablers to participation. Reporting used COREQ.

Results

Twenty‐three participants were included (12 male, 11 reported delirium experience). Participants reported a range of physiological, emotional and psychological responses to delirium, hearing about delirium was different to experiencing it. Most participants were aware of the benefits of maintaining nutrition and hydration, physical activity and cognitive engagement in hospital. Barriers included poor symptom control, inflexible routines and inconsistent communication, while enablers included access to equipment, family involvement, staff encouragement and individual goals. These were organised into themes: outlook, feeling well enough, hospital environment, feeling informed and listened to, and support networks.

Conclusion

A more patient centred approach to delirium prevention requires consideration of older people’s values, needs, preferences and fit within the hospital environment and routines. Feeling informed, listened to and receiving support from staff and family carers can improve older inpatients’ engagement in NPDS to prevent delirium in hospital.

Relevance to Clinical Practice

Nurses are ideally placed to improve patient participation in NDPS through holistic assessment and care, addressing symptoms, providing clear information about delirium and delirium prevention, and facilitating family carer support and patient interactions.

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