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Development and validation of the patient centeredness index for primary care


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.


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.


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


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.


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.


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

A Quasi‐experimental study on prevention and reduction of involuntary treatment at home (PRITAH) in people with dementia


Aim and objectives

To examine the implementation (reach, dose, fidelity, adaptations, satisfaction), mechanisms of impact (attitude, subjective norm, perceived behavioural control and intention) and context of the PRITAH intervention.


Involuntary treatment, defined as care provided against one's will, is highly prevalent in home care. The PRITAH intervention comprises policy, workshops, coaching and alternative measures for professional caregivers to prevent and reduce involuntary treatment in home care.


Quasi-experimental study.


Eight home care teams from two care organisations participated in this study. Guided by the Theory of Planned Behavior, the mechanisms of impact were evaluated with questionnaires. Implementation and context were assessed using attendance lists, evaluation questionnaires, focus groups and logbooks. The study adhered to the TREND checklist.


124 of 133 eligible professional caregivers participated (93%). All four components were delivered with minor deviations from protocol. Participants' subjective norms and perceived behavioural control changed over time in favour of the intervention group. No effects were seen for attitude and intention. Barriers included an unclear policy and lack of communication between stakeholders. The multidisciplinary approach and possibility to discuss involuntary treatment with the specialised nurse were described as facilitators.


Prevention and reduction of involuntary treatment at home is feasible in home care practice and contributes to changing professional caregivers' subjective norms and perceived behavioural control, prerequisites for behavioural change in order to prevent and reduce involuntary treatment. A follow-up study on the effectiveness of PRITAH on actual use, prevention and reduction of involuntary treatment in home care is needed. Future studies should emphasise the role of family caregivers and GPs and actively involve them in the prevention and reduction of involuntary treatment.

Relevance to clinical practice

Involuntary treatment is commonly used in dementia home care and professional and family caregivers need to be supported in prevention and reduction of involuntary treatment in people with dementia.

A multi‐centre study of learning styles of new nursing students



To describe beginning nursing student learning styles and to determine whether there are relationships between learning style and sociodemographic or educational background. We also aim to compare these data with the normative values of the 3.1 version of the Kolb learning style inventory and verify its reliability.


Learning style is related to the way in which an individual interacts with learning conditions, involving cognitive, affective, physical and environmental aspects. In nursing education, few studies have focused on knowing the learning styles of beginning nursing students, despite the need for students to develop critical thinking skills required of nurses.


Descriptive, cross-sectional, correlational, multi-site study.


The study took place at five universities in Brazil and one university in the United States. Data were collected from a sample of beginning nursing students (n = 176) in 2019, using the Portuguese and English 3.1 versions of Kolb's learning style inventory.


Most students’ learning styles were classified as divergers (34.10%), while 28.41% were assimilators, 23.86% were accommodators and 13.63% were convergers. Kolb describes learning as a four-stage cyclical process grounded in experience. The mean score of one learning stage, the concrete experience, showed those who attended public high schools compared with private high schools was higher (mean = 26.22; p = .0019), and there were different results between Brazilian state universities, Brazilian federal universities and the American university (p = .0149).


The diverger style was the most common among beginning nursing students in Brazil and the United States. There was a significant relationship between learning style, the educational background of students, the type of institution they attend and their previous experience with some active learning methodologies.

Relevance to clinical practice

Aligned with Kolb's experiential learning theory, nurse educators must be aware of student learning styles so they may use teaching strategies to meet their students’ needs.

Fall Prevention and Injury Reduction Utilizing Virtual Sitters in Hospitalized Patients: A Literature Review

imageFalls and fall-associated injuries continue to occur in hospitals worldwide. Video monitoring using virtual sitters is a novel, cost-effective concept that has emerged as an intervention to address falls and maintain safety for hospitalized patients. This literature review examines the evidence regarding hospital-associated falls and fall-related injuries when video monitoring and virtual sitters were included as an intervention. Ten observational studies and two quasi-experimental studies (N = 12) were identified for inclusion from the Cumulative Index of Nursing and Allied Health Literature, Scopus, and PubMed databases. Overall, current evidence is focused on fall rates and cost savings. Eight studies demonstrated a fall reduction and the remaining three showed no statistical difference in fall rates with the use of video surveillance or virtual sitters. Cost savings for these interventions are based on the transition from 1:1 observation to virtual sitters; all 12 studies reported decreased overall costs transitioning to virtual sitters. Small sample size and limited studies are the primary limitations of current published evidence. As the novel clinical practice evolves and more hospitals are equipped with video capability, future research with virtual sitters should include expanded patient populations, a focus on fall-related injuries, and examinations of staff safety.

Capacity of nurses working in long‐term care: A systematic review qualitative synthesis



The United Nations calculates there were 703 million adults 65 years and older globally as of 2019 with this number projected to double by 2050. A significant number of older adults live with comorbid health conditions, making the role of a nurse in long-term care (LTC) complex. Our objective was to identify the challenges, facilitators, workload, professional development and clinical environment issues that influence nurses and nursing students to seek work and continue to work in LTC settings.


Eligibility criteria included being a nurse in a LTC setting and research with a substantial qualitative component. Multiple databases (including Medline and CINAHL) were searched between 2013 and 2019 along with grey literature. Covidence was used to organise a team of 10 into a paired review of titles and abstracts to the final full text screening, extraction and appraisal with the CASP Qualitative Studies Checklist. Analysis involved a thematic synthesis approach. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist informed the writing of the review.


The search resulted in 18 articles and dissertations. Areas investigated included recruitment, resilience, employment and retention, how nurses perceived their professional work, rewards and difficulties, supervision, student preceptorship and career aspiration, nurses' perceptions of occupational status, along with leadership, education and development needs, and intentions to manage resident deteriorating health. The five themes were (1) perspectives of nursing influenced by the organisation, (2) pride in, and capacity to build relationships, (3) stretching beyond the technical skills, (4) autonomy, and (5) taking on the challenge of societal perceptions.


This review revealed what is required to recruit nursing students to careers in LTC and retain nurses. To be explored is how staff can work to their full scope of practice and the resultant impact on resident care, including how to maximise a meaningful life for residents and their families.


National Institute for Health Research UK (Prospero ID: CRD42019125214).

Skin tear prevalence in an Australian acute care hospital: A 10‐year analysis


Hospital-acquired skin tear prevalence is under-reported; thus, the aim of this study was to analyse skin tear point prevalence and characteristics in a tertiary acute care hospital in Queensland, Australia, over a 10-year period. All consenting adult inpatients received a full skin inspection and skin tear category, site, cause, treatment, and whether it was documented as hospital- or community-acquired were recorded. Eleven prevalence audits were analysed with a total sample of 3626 patients. An overall pooled prevalence of 8.9% (95% confidence interval [CI] 7.5-10.4) with an associated hospital-acquired pooled prevalence of 5.5% (95% CI 4.5-6.7) was found. In total, 616 skin tears were reported, of which 374 (60.7%) were hospital-acquired. Over a third of patients (38.7%) had multiple skin tears and most patients (84.8%) with at least one skin tear were aged ≥70 years. The largest proportion of skin tears (40.1%) was those with no skin flap. Of those documented, most were caused by falls or collisions, suggesting combined skin tear and falls prevention strategies may be effective. Over a decade, there was a downward trend in hospital-acquired skin tear, which is encouraging. Skin tear prevalence is recommended as a measure of care quality with an emphasis on good quality documentation.

Which factors influence the prevalence of institution‐acquired falls? Results from an international, multi‐center, cross‐sectional survey



Falls are a highly prevalent problem in hospitals and nursing homes with serious negative consequences such as injuries, increased care dependency, or even death. The aim of this study was to provide a comprehensive insight into institution-acquired fall (IAF) prevalence and risk factors for IAF in a large sample of hospital patients and nursing home residents among five different countries.


This study reports the outcome of a secondary data analysis of cross-sectional data collected in Austria, Switzerland, the Netherlands, Turkey, and the United Kingdom in 2017 and 2018. These data include 58,319 datapoints from hospital patients and nursing home residents.


Descriptive statistics, statistical tests, logistic regression, and generalized estimating equation (GEE) models were used to analyze the data.


IAF prevalence in hospitals and nursing homes differed significantly between the countries. Turkey (7.7%) had the highest IAF prevalence rate for hospitals, and Switzerland (15.8%) had the highest IAF prevalence rate for nursing homes. In hospitals, our model revealed that IAF prevalence was associated with country, age, care dependency, number of medical diagnoses, surgery in the last two weeks, and fall history factors. In nursing homes, care dependency, diseases of the nervous system, and fall history were identified as significant risk factors for IAF prevalence.


This large-scale study reveals that the most important IAF risk factor is an existing history of falls, independent of the setting. Whether a previous fall has occurred within the last 12 months is a simple question that should be included on every (nursing) assessment at the time of patient or resident admission. Our results guide the development of tailored prevention programs for persons at risk of falling in hospitals and nursing homes.

Characteristics and outcomes of pregnant Black and minority ethnic women admitted to hospital with confirmed SARS-CoV-2 infection in the UK

Por: Alcindor · M. L. · Alcindor · F. · Alcindor · M. A.

Commentary on: Knight M, Bunch K, Vousden N, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population-based cohort study. BMJ 2020;369:m2107. doi:10.1136bmj.m2107

Implications for practice and research

  • Providers managing obstetric patients will need to identify prevalent risk factors in minorities with SARS-CoV-2 and the outcomes.

  • This study can be used to launch a correlational study to investigate the relationship between health disparities and the spread of SARS-CoV-2 in the Black minority obstetric patients.

  • Context

    This national UK cohort study1 described 427 pregnant women admitted with confirmed SARS-CoV-2 infection,1 56% of whom were Black or ethnic minority patients. The study analysed risk factors such as advanced pregnancy and maternal age, obesity and cardiopulmonary comorbidities and their impact on the pregnancy and the newborn.1



    Effect of grief on ageing populations physical and mental well-being

    Por: Dunham · M.

    Commentary on: Aoyama M, Sakaguchi Y, Fujisawa D, et al. Insomnia and changes in alcohol consumption: Relation between possible complicated grief and depression among bereaved family caregivers. Journal of Affective Disorders 2020;275:1-6. doi:10.1016/j.jad.2020.06.023.

    Implications for practice and research

  • Bereaved relatives are at greater risk of physical and psychological disorders and this should be considered as part of bereavement care and health assessment.

  • Longitudinal cohort data about the bereaved health status, across cultures and age groups, could inform better bereavement care and support.

  • Context

    Bereavement is distressing; the effects of grief, including distress and associated insomnia, are known.1 Complex grief2 is characterised by its severity and duration, it can limit normal activity and function. Alcohol consumption and insomnia are both known to be potentially damaging to mental and physical well-being.3 Exploration of the associations between bereavement, alcohol consumption and...

    Clear, consistent and credible messages are needed for promoting compliance with COVID-19 public health measures

    Por: Hung · L. · Lin · M.

    Commentary on: Nivette, A., Ribeaud, D., Murray, A., Steinhoff, A., Bechtiger, L., Hepp, U., Shanahan, L., & Eisner, M. (2020). Non-compliance with COVID-19-related public health measures among young adults in Switzerland: Insights from a longitudinal cohort study. Social science & medicine

    Implications for practice and research

  • Clear, consistent and credible messages are essential for promoting compliance with COVID-19 public health measures in young adults.

  • Research should further investigate the role of communication science in motivating collective emotions and behaviours for future public health measures.

  • Context

    As COVID-19 spreads worldwide, implementation and compliance with public health measures during the pandemic have been the foremost concern globally. The WHO highlighted that young adults had been the primary drivers of the spread of the novel coronavirus in many countries.1 This study by Nivette et al describes patterns of non-compliance with COVID-19 19-related public health measures...

    Hope is a crucial factor for patients facing cancer treatment

    Commentary on: Nierop-van Baalen C, Grypdonck M, Van Hecke A, et al. Associated factors of hope in cancer patients during treatment: a systematic literature review. J Adv Nurs 2020; 00:1–18.

    Implications for practice and research

  • In clinical practice, nurses need to focus on factors related to the management of hope levels in patients undergoing cancer treatment.

  • Cohort studies and clinical trials considering the implications of clinical characteristics and levels of hope, in advanced cancer as well as studies with children, are necessary.

  • Context

    Hope is a multidimensional and dynamic mental process; it consists of the relationship between motivational energy and strategies, visions, plans to achieve long-term goals. All of these components are necessary for the normal functioning of hope. One of the factors that should be considered in assisting patients who are undergoing cancer treatment involves emotional and spiritual aspects, among which hope stands...

    Malnutrition is a significant predictor of hospitalisation outcomes among older adults with sepsis

    Por: Vyasabattu · M. · Yarra · P.

    Commentary on: Abugroun A, Nayyar A, Abdel-Rahman M, Patel P. Impact of Malnutrition on Hospitalization Outcomes for Older Adults Admitted for Sepsis. Am J Med. 2020 Aug 15:S0002-9343(20)30695-1. doi: 10.1016/j.amjmed.2020.06.044. Epub ahead of print. PMID: 32810466.

    Implications for practice and research

  • Malnutrition is an independent predictor for increased odds of mortality, septic shock and need for intubation among older patients with sepsis during their hospitalisation.

  • Malnutrition is also associated with increased length of stay and higher hospitalisation costs among admitted older patients with sepsis.

  • Context

    Sepsis in older adults aged ≥65 years is detrimental and is a very important contributor to mortality and morbidity, including deconditioning and debility leading to significant health burden.1 Prevalence of malnutrition among older adults ranges from 29% to 61% and a significant determinant of health outcomes in this population.2 The complex inter-relatability of malnutrition and...

    Ineffectiveness and safety concerns of using aspirin and other NSAIDs in preventing dementia

    Por: Steele · D. · James · K. · Cadet · M.

    Commentary on:D. (2020). Aspirin and other non-steroidal anti-inflammatory drugs for the prevention of dementia. Cochrane Database of Systematic Reviews, (4).

    Implications for practice and research

  • Further studies of nonsteroidal anti-inflammatory drugs need to give due attention to the safety concerns arising from these existing studies.

  • Monitoring the risks of bleeding when prescribing aspirin or non-steroidal medications for patients with dementia in clinical practice is important.

  • Context

    According to the Centers for Disease Control and Prevention, 5 million adults were diagnosed with dementia in 2014; projected to rise to approximately 14 million by 2060.1 This is a significant health problem, as dementia prevalence is increasing. Therefore, practitioners need to understand how it can be prevented and treated effectively. To date, no available medication exists to prevent or delay the onset of dementia. It has been reported that the pathogenesis of dementia was associated with inflammation;...

    What are Photovoice studies?

    Por: Smith · E. · Carter · M. · Walklet · E. · Hazell · P.

    Photovoice is a participatory action research method which provides cameras to a group of individuals and asks them to record their experiences over a period of time.1 The photographs taken by participants are subsequently used as catalysts for discussion. ‘Photovoice’ is so called because it aims to allow the photographic image to become the participants’ voice in order to communicate their experiences to a variety of different audiences. Originally developed by Wang and Burris as a way to improve reproductive health policy for women in rural China, Photovoice has three primary goals: (1) to enable participants to record and reflect on their community’s strengths and concerns, (2) to promote critical dialogue and (3) to reach stakeholders (both policy makers and the general public) who are able to enact change.1

    Photovoice is a particularly relevant method for the field of Nursing because of its...

    Critical care survival rates in COVID-19 patients improved as the first wave of the pandemic developed

    Por: Bateson · M. L. · McPeake · J. M.

    Commentary on: Dennis JM, McGovern AP, Vollmer SJ, et al. Improving survival of critical care patients with coronavirus disease 2019 in England: a National cohort study, March to June 2020. Crit Care Med 2021;49:209–14

    Implications for practice and research

  • It is essential that clinicians understand the evolving outcomes of patients admitted to hospital with COVID-19 in order to improve services and undertake further, targeted research.

  • In parallel with research evaluating the treatment of COVID-19, future research must address the impact of care delivery and organisation on patient-centred outcomes.

  • Context

    During the first 12 months, the COVID-19 pandemic affected more than 87 million individuals worldwide and caused almost 2 million deaths.1 Over the course of the first wave of the pandemic, UK national data suggested that there may be an improvement in survival for those patients admitted to hospital with COVID-19.2 However, measurement...

    Prenatal depressive and anxiety symptoms identifying predictors and psychosocial risks

    Por: Ma · L. · Ellis · L. · Cadet · M.

    Commentary on: Wu Y, Zhang C, Liu H Duan, et al. Perinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China. American Journal of Obstetrics and Gynecology.

    Commentary: implications for research and practice

  • Future research is needed on health screening measures to assess if patients have experienced prenatal depression and anxiety symptoms.

  • In clinical practice, an appropriate assessment for depression and anxiety by primary care providers becomes crucial during the prenatal stage of pregnancy.

  • Investigating the prevalence and incidence rates of prenatal depression and anxiety can prepare healthcare providers with adequate knowledge to deliver safe and quality care to patients.

  • Context

    The COVID-19 pandemic has demonstrated a profound negative impact on pregnant mothers with anxiety and depression. Many reported that the COVID-19 pandemic and changes in pregnancy or post partum can cause psychological reactions including, depression,...

    Perceptions and comorbidities interfere with self-efficacy and medication adherence in patients with type 2 diabetes mellitus

    Commentary on: Kim H, Sereika SM, Lingler JH et al . Percepcões de doenca, autoeficácia e autorrelato de adesão à medicacão em pessoas com 50 anos ou mais com diabetes tipo 2. J Cardiovasc Nurs 2020; Publicar antes da impressão (0).

    Implications for practice and research

  • Identification of barriers to medication adherence refers to the formulation of strategies to achieve holistic care considering the patients’ perceptions.

  • Future study design should focus on identifying nursing diagnoses and interventions based on self-care and medication adherence.

  • Context

    Medication adherence is a major public health apprehension and is defined as taking medication precisely as prescribed by health professionals.1 2 This study conducted by Kim et al correlates consequences, treatment, and personal control, identity, concerns and emotional representations were related as predictors of self-efficacy and medication adherence for managing in persons aged 50 and older...

    Experiences of accessing healthcare services by people with hearing loss/impairment (deaf) in sub‐Saharan Africa: An integrative review



    The aim was to review published articles to identify experiences of people with hearing loss/impairment accessing healthcare services in sub-Saharan Africa.

    Design and method

    The study was guided by Cooper's integrative review methodology. Articles published between 2010 and 2020 were identified through electronic databases. The search included: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, EBSCOHOST, MEDLINE, and Psyc INFO and using specific search terms. Ninety-one (91) articles were identified and screened for eligibility, and only seven articles were appraised using relevant tools for qualitative and quantitative designs.


    The articles that met the inclusion criteria were from the following sub-Saharan countries: Ghana (n = 2) South Africa (n = 3) Uganda (n = 1) and Zimbabwe (n = 1). Review analysis revealed seven (7) major themes categorized as: communication, lack of knowledge, discrimination, financial problem, healthcare workers’ attitudes, and a lack of autonomy, security and privacy issues.


    The review provides evidence that indicate the challenges faced by people with hearing loss/impairment in sub-Saharan Africa. Studies suggest that communication, lack of knowledge; financial problems, lack of autonomy and privacy, and a perception of being discriminated against were major impediments in accessing healthcare service. Undesirable attitudes were also a hindrance for healthcare access.

    Clinical relevance

    Communication is a major impediment in accessing healthcare for the hearing impaired people residing in sub-Saharan Africa.

    Identifying womens preferences for treatment of urinary tract infection: a discrete choice experiment

    Por: van der Worp · H. · Brandenbarg · D. · Boek · P. A. · Braams · J. H. W. · Brink · L. J. F. · Keupers · J. · Blanker · M. H.

    To identify the preferences of women regarding management of urinary tract infections (UTIs).


    A discrete choice experiment of the preferences for certain treatment attributes was conducted by survey. Attributes included treatment duration, time to complaint resolution, complication risk, side effect risk and contribution to antimicrobial resistance.


    General population in the Netherlands, recruited via social media.


    Women aged 18 years or older.

    Primary and secondary outcome measures

    The primary outcome was the relative importance of the attributes for treatment choice, using a conditional logit model. The secondary outcome was the heterogeneity in these preferences.


    The discrete choice experiment was completed by 833 women. Most attributes were important to decisions for UTI treatment. Women were willing to accept management with, for example, a higher chance of complications or longer time to resolution, if it could help avoid antimicrobial resistance. However, there was heterogeneity in the preferences. Women who had one previous UTI had a stronger preference for faster symptom resolution compared with those who had no previous UTI. Younger women also preferred faster symptom resolution. Finally, women with a low or middle education level gave less importance to preventing antimicrobial resistance than women with a high education level.


    The current study indicated that a considerable part of women valued alternatives to antimicrobial treatment and were prepared to tolerate management that was less optimal in certain respects to avoid antimicrobial treatment.