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

Abstract

Aims and Objectives

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

Background

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

Design

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

Methods

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

Results

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

Conclusion

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

Relevance to clinical practice

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

Information concerning ICU patients’ families in the handover – the clinicians’ «game of whispers»: a qualitative study

Abstract

Aims and objectives

To explore how information concerning ICU patients´ families is included in the ICU clinicians’ daily handover.

Background

Handover refers to the transfer of information and care responsibility between clinicians. An effective and precise handover is of great importance to ensure quality of care. Although improvements in handovers have received increasing attention in recent decades, little is known about how information about ICU patients’ family members is included in handovers.

Design

A qualitative study using Charmaz’ constructivist grounded theory approach.

Methods

Data were gathered through participant observation, focus groups, dyadic and individual interviews of physicians and nurses from four ICUs in different Norwegian hospitals. The data consists of 270 observation hours, seven focus groups, three dyadic interviews and two individual interviews. Field notes and transcribed interview data were analysed using constructivist grounded theory approach. COREQ checklist was applied as reporting guideline for this study.

Findings

“A game of whispers” emerged as the core category, representing missing information about the patient’s family during the handover. Together with three subcategories: “documentation dilemmas”, “being updated” and “talking together”, the core category explains how transfer of family‐related information between clinicians is continually processed and resolved.

Conclusions

This study indicates challenges related to appropriate and high‐quality handover concerning ICU patients´ families. Oral handovers are essential in terms of clinicians’ need to elaborate on written information and update each other. However, oral transmission involves a high risk of information loss during the handover. Written documentation about the family seems to be inadequate and poorly structured.

Relevance to clinical practice

The study findings suggest a need for increased awareness in practice and research of the importance of transferring appropriate and reliable information about patients’ families between ICU clinicians. User‐friendly handover tools and patient records that include information on patients’ family members should be developed.

Self‐management programs for cirrhosis: a systematic review

Abstract

Background and aims

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

Methods

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

Results

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

Conclusions

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

Relevance to clinical practice

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

Nurses’ knowledge of the routine care and maintenance of adult vascular access devices: a scoping review

Abstract

Background

Vascular access devices(VAD), centrally CVAD) or peripherally(PIV) located, are common in the nursing profession. A high proportion of admitted patients require a VAD to enable administration of intravenous treatments or diagnostic modalities. As the primary caregivers for these patients, nurses are responsible for ongoing care and maintenance of these devices.

Objective

This scoping review examines the current state of practicing nurses knowledge around routine care and maintenance of adult VADs.

Methods

In the fall of 2018, the following databases were searched: Medline‐Ovid 1946 to current, Embase‐Ovid 1947 to current, Ebsco CINAHL Plus with full text, and ProQuest Nursing & Allied Health database and articles were selected according to the PRISMA‐ScR checklist. Inclusion criteria: original research published in peer‐reviewed journals; in English or French; focused on practising nurses’ knowledge about the routine care and maintenance of adult VADs.

Results

Of the 4099 abstracts identified, 36 full‐text articles were included. Study characteristics are reported in addition to themes found in the literature: the relationship between demographic data and CVAD/PIV knowledge, the state of nurses’ CVAD/PIV knowledge, and nurses’ CVAD/PIV knowledge scores. Overall, significant gaps in nurses’ knowledge on the care and maintenance of VADs are noted.

Conclusion

The variability in nurses’ knowledge around both CVAD and PIV led the authors to conclude that there is room for improvement in the educational preparation of nurses and a need for workplace training.

Relevance to Clinical Practice

This scoping review intends to highlight the knowledge gap of nurses with regards to best practices for VAD routine care and maintenance and demonstrate the need for education, both in educational and healthcare institutions, to ensure high quality care and improved patient outcomes related to VADs.

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

Abstract

Aims and objectives

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

Background

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

Method

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

Results

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

Conclusions

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

Relevance to clinical practice

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

Parents' experiences of transition from hospital to home of a child with complex health needs: A systematic literature review

Abstract

Aims and objectives

To critically appraise primary research on the views and experiences of parents of children with complex health needs during the transition from hospital to home.

Background

Children with complex health needs frequently transition across and within healthcare systems, due to their age, care needs and ongoing health conditions. Repeated and unplanned admissions are significantly higher for children with complex health needs. Yet parents, as the primary providers of care, report being unsupported and unprepared during the transition from hospital back to home due to poor communication, inadequate discharge planning and education, resulting in stress and anxiety within the home environment.

Design

Systematic review following PRISMA guidelines.

Methods

A systematic search was completed of the databases CINAHL, MEDLINE, PsycINFO, EMBASE and the Cochrane Library Review between January 2009 and September 2019. Data were extracted, categorised and analysed using a thematic analysis approach. An adapted CASP qualitative assessment tool was utilised for quality assessment. All included articles were marked for validity and relevance to current research with an overall score from 0–20.

Results

A total of 13 studies of mixed quality were identified. CASP quality scores ranged from 13–18. Four themes emerged highlighting parents' experiences of the emotional processes, communication, coordination and support and resources when transitioning from hospital to home.

Conclusions

Hospital discharge and transition from hospital to home is a complicated and at times frustrating process for parents of children with complex health needs. Parents report being exhausted and stressed during this often‐challenging period of adjustment which was perceived as a difficult and emotional process. There is a clear lack of support available for parents both from hospital and community services.

The impact of inflammatory bowel disease on sexual health in men: A scoping review

Abstract

Aims and objectives

To review the literature on the impact of inflammatory bowel disease on the sexual health of men, and make recommendations for nursing practice and research.

Background

Inflammatory bowel disease is a chronic condition of the gastrointestinal tract, causing symptoms that may impact upon sexual health. Specialist nurses are well positioned to assess and manage sexual health, but there is a lack of clinical guidance, especially in relation to men.

Design

A systematic scoping review following the Arksey and O’Malley (2005) framework reported in line with the PRISMA‐ScR checklist (Tricco et al. 2018).

Methods

OVID MEDLINE ALL [R], OVID EMBASE [R], OVID PsychINFO, EBSCO CINAHL Complete, The Cochrane Library and ProQuest were searched. Inclusion and exclusion criteria were applied independently by two reviewers. Data was extracted, charted and summarised from eligible studies.

Results

Thirty‐one studies met the inclusion criteria. These were synthesised under three categories: mediators, moderators, and descriptors of sexual health. Depression, disease activity and surgery were the most commonly cited disease‐related factors to affect sexual health in men. The most commonly used assessment tool was The International Index of Erectile Function. Descriptors of function included; frequency of intercourse, libido and the ability to maintain a desired sexual role.

Conclusions

The effect of inflammatory bowel disease on sexual health in men involves a complex interaction of physical and psychosocial factors. Researchers must explore areas outside of erectile function to understand how the disease impacts sexuality, sexual well‐being and masculinity. This can be achieved through qualitative exploration of patient, partner and health professional experiences.

Relevance to clinical practice

A holistic nursing assessment of men with inflammatory bowel disease should include sexual health. Developing understanding of how the disease influences sexual interaction and expression will facilitate support that is relevant, accessible and of value to men living with the disease.

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

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

Best of colleagues, worst of times

Journal of Wound Care, Volume 29, Issue 7, Page 377-377, July 2020.

Cover Images

Cover Images

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


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

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

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

Methods

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

Results

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

Conclusion

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

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

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

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

Methods and analysis

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

Ethics and dissemination

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

Trial registration number

NCT03663504; Pre-results, recruitment phase.

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

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

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

Methods and analysis

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

Ethics and dissemination

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

PROSPERO registration number

CRD42018119291

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