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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.

Nurses' perceptions and beliefs related to the care of adults living with multimorbidity: A systematic qualitative review

Abstract

Aims and objectives

To identify and synthesise the available qualitative evidence on nurses’ perceptions and beliefs related to the care of adults living with multimorbidity.

Background

The rising prevalence of adults living with multimorbidity has increased demand for health care and challenges nursing care. No review has been conducted to date of the studies of nurses’ perceptions and beliefs related to the provision of care to guide policy makers, practitioners and further research to identify and deliver quality care for persons living with multimorbidity.

Design

Systematic review of qualitative studies conducted in line with the PRISMA checklist.

Methodology

Eight electronic publication databases and sources of grey literature were searched to identify original qualitative studies of the experience of nurses caring for adults with multiple chronic conditions with no restrictions on the date of publication or study context. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data were extracted using the Joanna Briggs Institute standardised data extraction tool for qualitative research. Data synthesis was undertaken through meta-aggregation.

Results

Eleven qualitative studies were included in the review. All studies met eight or more of the 10 assessment criteria of the JBI Critical Appraisal Checklist for Qualitative Research. Four synthesised findings were generated from the aggregated findings: (i) the challenge of providing nursing care; (ii) the need to deliver holistic and person-centred nursing care; (iii) the importance of developing a therapeutic nurse–patient relationship, and (iv) delivering nursing care as part of an interprofessional care team.

Conclusions

The complexity of multimorbidity and the predominant single-disease model of chronic care present challenges for the delivery of nursing care to adults living with multimorbidity.

Relevance to clinical practice

The nursing care of persons with multimorbidity needs to incorporate holistic assessment and person-centred care principles as part of a collaborative and interprofessional team approach.

PROSPERO Registration

CRD42020186773.

Effect of a Nurse-Led Community Health Worker Intervention on Latent Tuberculosis Medication Completion Among Homeless Adults

imageBackground Tuberculosis (TB) disproportionately affects marginalized and impoverished homeless adults. Although active TB can be prevented by treating latent TB infection (LTBI), individual factors, such as high prevalence of depression and anxiety, drug and alcohol use, and unstable housing, lead to poor LTBI treatment adherence and completion among homeless adults. Objectives We hypothesized that the delivery of a tailored nurse-led, community health worker (RN/CHW) program across the LTBI continuum of care (e.g., screening, diagnosis, and treatment) that delivers 3HP treatment (3HP: rifapentine plus isoniazid) for homeless adults (e.g., sheltered and unsheltered) and is tailored to their health and social service needs will overcome existing treatment completion barriers. We also hypothesized that mental health symptoms (e.g., depression and anxiety), drug use score, and problematic alcohol use will decline over time among clients receiving this treatment. Methods We assessed the effect of delivering a theoretically guided, RN/CHW-based, single-arm study among eligible LTBI-positive homeless adults (N = 50) on completion of a weekly, directly observed, 12-dose 3HP LTBI treatment in Central City East (Skid Row). Completing 3HP treatment was compared to the only known historical, clinic-based control that obtained 65% completion among homeless adults. Secondary outcomes included drug and alcohol use, depression, and anxiety. Results The RN/CHW program achieved a 91.8% 3HP treatment completion rate among homeless adults. Younger homeless adults (

CATALYST trial protocol: a multicentre, open-label, phase II, multiarm trial for an early and accelerated evaluation of the potential treatments for COVID-19 in hospitalised adults

Por: Veenith · T. · Fisher · B. A. · Slade · D. · Rowe · A. · Sharpe · R. · Thickett · D. R. · Whitehouse · T. · Rowland · M. · Scriven · J. · Parekh · D. · Bowden · S. J. · Savage · J. S. · Richards · D. · Bion · J. · Kearns · P. · Gates · S. · CATALYST Trial Investigators · On behalf of CA
Introduction

Severe SARS-CoV-2 infection is associated with a dysregulated immune response. Inflammatory monocytes and macrophages are crucial, promoting injurious, proinflammatory sequelae. Immunomodulation is, therefore, an attractive therapeutic strategy and we sought to test licensed and novel candidate drugs.

Methods and analysis

The CATALYST trial is a multiarm, open-label, multicentre, phase II platform trial designed to identify candidate novel treatments to improve outcomes of patients hospitalised with COVID-19 compared with usual care. Treatments with evidence of biomarker improvements will be put forward for larger-scale testing by current national phase III platform trials. Hospitalised patients >16 years with a clinical picture strongly suggestive of SARS-CoV-2 pneumonia (confirmed by chest X-ray or CT scan, with or without a positive reverse transcription PCR assay) and a C reactive protein (CRP) ≥40 mg/L are eligible. The primary outcome measure is CRP, measured serially from admission to day 14, hospital discharge or death. Secondary outcomes include the WHO Clinical Progression Improvement Scale as a principal efficacy assessment.

Ethics and dissemination

The protocol was approved by the East Midlands-Nottingham 2 Research Ethics Committee (20/EM/0115) and given urgent public health status; initial approval was received on 5 May 2020, current protocol version (V.6.0) approval on 12 October 2020. The MHRA also approved all protocol versions. The results of this trial will be disseminated through national and international presentations and peer-reviewed publications.

Trial registration numbers

EudraCT2020-001684-89, ISRCTN40580903.

Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis

Por: Fowler · T. J. · Aquilina · A. L. · Blom · A. W. · Sayers · A. · Whitehouse · M. R.
Objective

To investigate the association between surgeon grade (trainee vs consultant) and implant survival following primary hip and knee replacement.

Design

A systematic review and meta-analysis of observational studies.

Data sources

MEDLINE and Embase from inception to 6 October 2021.

Setting

Units performing primary hip and/or knee replacements since 1990.

Participants

Adult patients undergoing either a primary hip or knee replacement, predominantly for osteoarthritis.

Intervention

Whether the surgeon recorded as performing the procedure was a trainee or not.

Primary and secondary outcome measures

The primary outcome was net implant survival reported as a Kaplan-Meier survival estimate. The secondary outcome was crude revision rate. Both outcomes were reported according to surgeon grade.

Results

Nine cohort studies capturing 4066 total hip replacements (THRs), 936 total knee replacements (TKRs) and 1357 unicompartmental knee replacements (UKRs) were included (5 THR studies, 2 TKR studies and 2 UKR studies). The pooled net implant survival estimates for THRs at 5 years were 97.9% (95% CI 96.6% to 99.2%) for trainees and 98.1% (95% CI 97.1% to 99.2%) for consultants. The relative risk of revision of THRs at 5 and 10 years was 0.88 (95% CI 0.46 to 1.70) and 0.68 (95% CI 0.37 to 1.26), respectively. For TKRs, the net implant survival estimates at 10 years were 96.2% (95% CI 94.0% to 98.4%) for trainees and 95.1% (95% CI 93.0% to 97.2%) for consultants. We report a narrative summary of UKR outcomes.

Conclusions

There is no strong evidence in the existing literature that trainee surgeons have worse outcomes compared with consultants, in terms of the net survival or crude revision rate of hip and knee replacements at 5–10 years follow-up. These findings are limited by the quality of the existing published data and are applicable to countries with established orthopaedic training programmes.

PROSPERO registration number

CRD42019150494.

Defining CD4 T helper and T regulatory cell endotypes of progressive and remitting pulmonary sarcoidosis (BRITE): protocol for a US-based, multicentre, longitudinal observational bronchoscopy study

Por: Koth · L. L. · Harmacek · L. D. · White · E. K. · Arger · N. K. · Powers · L. · Werner · B. R. · Magallon · R. E. · Grewal · P. · Barkes · B. Q. · Li · L. · Gillespie · M. · Collins · S. E. · Cardenas · J. · Chen · E. S. · Maier · L. A. · Leach · S. M. · OConnor · B. P. · Hamzeh · N. Y.
Introduction

Sarcoidosis is a multiorgan granulomatous disorder thought to be triggered and influenced by gene–environment interactions. Sarcoidosis affects 45–300/100 000 individuals in the USA and has an increasing mortality rate. The greatest gap in knowledge about sarcoidosis pathobiology is a lack of understanding about the underlying immunological mechanisms driving progressive pulmonary disease. The objective of this study is to define the lung-specific and blood-specific longitudinal changes in the adaptive immune response and their relationship to progressive and non-progressive pulmonary outcomes in patients with recently diagnosed sarcoidosis.

Methods and analysis

The BRonchoscopy at Initial sarcoidosis diagnosis Targeting longitudinal Endpoints study is a US-based, NIH-sponsored longitudinal blood and bronchoscopy study. Enrolment will occur over four centres with a target sample size of 80 eligible participants within 18 months of tissue diagnosis. Participants will undergo six study visits over 18 months. In addition to serial measurement of lung function, symptom surveys and chest X-rays, participants will undergo collection of blood and two bronchoscopies with bronchoalveolar lavage separated by 6 months. Freshly processed samples will be stained and flow-sorted for isolation of CD4 +T helper (Th1, Th17.0 and Th17.1) and T regulatory cell immune populations, followed by next-generation RNA sequencing. We will construct bioinformatic tools using this gene expression to define sarcoidosis endotypes that associate with progressive and non-progressive pulmonary disease outcomes and validate the tools using an independent cohort.

Ethics and dissemination

The study protocol has been approved by the Institutional Review Boards at National Jewish Hospital (IRB# HS-3118), University of Iowa (IRB# 201801750), Johns Hopkins University (IRB# 00149513) and University of California, San Francisco (IRB# 17-23432). All participants will be required to provide written informed consent. Findings will be disseminated via journal publications, scientific conferences, patient advocacy group online content and social media platforms.

The effectiveness of goal setting on glycaemic control for people with type 2 diabetes and prediabetes: A systematic review and meta‐analysis

Abstract

Aim

This review assessed the effectiveness of interventions using a goal-setting approach on glycaemic control for people diagnosed with prediabetes or type 2 diabetes.

Design

A systematic review guided by the Joanna Briggs Institute methodology for conducting systematic reviews of primary research studies was conducted.

Data Sources

Randomized controlled trials and experimental studies with a minimum follow-up period of 6 months were considered for inclusion. The primary outcome was change in glycaemic control as measured by glycated haemoglobin (%) and/or fasting plasma glucose (mg/dl). A systematic search of seven electronic databases was completed in October 2020.

Review Methods

Papers meeting the inclusion criteria were critically appraised using the Joanna Briggs Institute tools for critical appraisal followed by data extraction. A Grading of Recommendations Assessment, Development and Evaluation assessment was conducted to assess the overall certainty of the evidence. Fixed-effect meta-analyses were completed to demonstrate the mean effect for each outcome of interest.

Results

Twenty one studies were included in this review. Goal setting was more effective than usual care for glycaemic control in prediabetes at 6 months and at 12 months for fasting plasma glucose (mg/dl) and glycated haemoglobin (%). Goal setting was more effective than usual care for glycaemic control in type 2 diabetes for fasting plasma glucose (mg/dl) at 6 months, fasting plasma glucose (mg/dl) at 12 months, glycated haemoglobin (%) at 6 months and glycated haemoglobin (%) at 12 months.

Conclusion

The evidence suggests goal setting is effective in supporting people to achieve glycaemic targets in prediabetes and type 2 diabetes.

Health impacts of climate change on gender diverse populations: A scoping review

Abstract

Purpose

To determine what is known about climate change health effects for gender diverse (GD) populations, and identify gaps in research, practice, education, and policy.

Design/Methods

A scoping review was conducted.

Findings

Twenty-seven information sources met inclusion criteria. Natural disasters and inadequate disaster relief responses were identified as an overarching health threat for GD populations. Within this theme, four sub-themes emerged. No other climate-related health impacts for GD populations were mentioned in the sources reviewed.

Conclusions

There are major gaps in knowledge about health implications of climate change for GD populations. Gender-sensitive data must be collected in order to better understand these threats and detect disparities. Currently most practice and policy recommendations focus on disaster relief. More research on the broad effects of climate change on GD populations is urgently needed to inform practice and policy.

Clinical relevance

Climate change amplifies existing risks of adverse health outcomes. Because of discrimination, stigma, and violence, gender diverse individuals are particularly vulnerable.

The use of theory in qualitative research: Challenges, development of a framework and exemplar

Abstract

Background

Whilst theoretical grounding is considered important for sound research methodology, consensus on the application of theory in qualitative research remains elusive. Novice researchers may experience challenges in applying theory in qualitative research and these may contribute to the under-use, over-reliance or inappropriate application of theory. Practical guidance on how theory can inform and guide the conduct of qualitative research is needed.

Purpose

The purpose of this paper was to propose a framework for the application of theory in qualitative research and provide an exemplar.

Methods

The Theoretical Application Framework for Qualitative Studies (TAF-QS) was developed from the synthesis of existing literature and the authors' own experience of the application of theory.

Results

The TAF-QS encourages researchers to articulate which theoretical framework or conceptional framework they are drawing on and how this will be applied by reflecting on the purpose and the context of the study.

Conclusion

The TAF-QS provides support for researchers to explore how theory can be applied and how to achieve this in qualitative research.

Tweetable abstract

The use of theory in qualitative research.

Experiences of trial participants and site staff of participating in and running a large randomised trial within fertility (the endometrial scratch trial): a qualitative interview study

Por: Chatters · R. · White · D. · Pye · C. · Petrovic · A. · Sizer · A. · Kumar · P. · Metwally · M.
Objectives

To explore the experiences of endometrial scratch (ES) trial participants and site staff of trial recruitment and participation, in order to improve the experience of participants in future trials.

Design

Qualitative study of a subset of participants in the ES randomised controlled trial and a subset of trial site staff.

Setting

A purposeful sample of 9 of the 16 UK Fertility Units that participated in the trial.

Participants

A purposeful sample of 27 trial participants and 7 site staff.

Results

Participants were largely happy with the recruitment practices, however, some were overwhelmed with the amount of information received. Interviewees had positive preconceptions regarding the possible effect of the ES on the outcome of their in vitro fertilisation (IVF) cycle, which often originated from their own internet research and seemed to be exacerbated by how site staff described the intervention. Some participants appeared to not understand that receiving the ES could potentially reduce their chances of a successful IVF outcome. Those randomised to the control arm discussed feeling discontent; site staff developed mechanisms of dealing with this.

Conclusions

A lack of equipoise in both study participants and the recruiting site staff led to trial participants having positive preconceptions of the potential impact of the ES on their upcoming IVF cycle. Trial participants may not have understood the potential harms of participating in a randomised trial. The trial information sheet did not clearly state this; further research should assess how such information should be presented to potential participants, to proportionately present the level of risk, but to not unduly discourage participation. The amount of information fertility patients require about a research study should also be investigated, in order to avoid participants feeling overwhelmed by the amount of information they receive prior to starting IVF.

Trial registration number

ISRCTN23800982.

Cancer symptom experience and help-seeking behaviour during the COVID-19 pandemic in the UK: a cross-sectional population survey

Por: Quinn-Scoggins · H. D. · Cannings-John · R. · Moriarty · Y. · Whitelock · V. · Whitaker · K. L. · Grozeva · D. · Hughes · J. · Townson · J. · Osborne · K. · Goddard · M. · McCutchan · G. M. · Waller · J. · Robling · M. · Hepburn · J. · Moore · G. · Gjini · A. · Brain · K.
Objectives

To understand self-reported potential cancer symptom help-seeking behaviours and attitudes during the first 6 months (March–August 2020) of the UK COVID-19 pandemic.

Design

UK population-based survey conducted during August and September 2020. Correlates of help-seeking behaviour were modelled using logistic regression in participants reporting potential cancer symptoms during the previous 6 months. Qualitative telephone interviews with a purposeful subsample of participants, analysed thematically.

Setting

Online UK wide survey.

Participants

7543 adults recruited via Cancer Research UK online panel provider (Dynata) and HealthWise Wales (a national register of ‘research ready’ participants) supplemented with social media (Facebook and Twitter) recruitment. 30 participants were also interviewed.

Main outcome measures

Survey measures included experiences of 15 potential cancer symptoms, help-seeking behaviour, barriers and prompts to help-seeking.

Results

Of 3025 (40.1%) participants who experienced a potential cancer symptom, 44.8% (1355/3025) had not contacted their general practitioner (GP). Odds of help-seeking were higher among participants with disability (adjusted OR (aOR)=1.38, 95% CI 1.11 to 1.71) and who experienced more symptoms (aOR=1.68, 95% CI 1.56 to 1.82), and lower among those who perceived COVID-19 as the cause of symptom(s) (aOR=0.36, 95% CI 0.25 to 0.52). Barriers included worries about wasting the doctor’s time (1158/7543, 15.4%), putting strain on healthcare services (945, 12.6%) and not wanting to make a fuss (907, 12.0%). Interviewees reported reluctance to contact the GP due to concerns about COVID-19 and fear of attending hospitals, and described putting their health concerns on hold.

Conclusions

Many people avoided healthcare services despite experiencing potential cancer symptoms during the COVID-19 pandemic. Alongside current help-seeking campaigns, well-timed and appropriate nationally coordinated campaigns should signal that services are open safely for those with unusual or persistent symptoms.

Trial registration number

ISRCTN17782018.

Factors influencing community‐dwelling older adults’ readiness to adopt smart home technology: A qualitative exploratory study

Abstract

Aims

Ageing-in-place for older people could be more feasible with the support of smart home technology. Ageing in-place may maximize the independence of older adults and enhance their well-being and quality of life, while decreasing the financial burden of residential care costs, and addressing workforce shortages. However, the uptake of smart home technology is very low among older adults. Accordingly, the aim of this study was to explore factors influencing community-dwelling older adults’ readiness to adopt smart home technology.

Design

A qualitative exploratory study design was utilized.

Methods

Descriptive data were collected between 2019 and 2020 to provide context of sample characteristics for community-dwelling older adults aged ≥65 years. Qualitative data were collected via semi-structured interviews and focus groups, to generate an understanding of older adult's perspectives. Thematic analysis of interviews and focus group transcripts was completed. The Elderadopt model was the conceptual framework used in the analysis of the findings.

Results

Several factors influenced community-dwelling older adults’ (N = 19) readiness to adopt smart home technology. Five qualitative themes were identified: knowledge, health and safety, independence, security and cost.

Conclusion

Community-dwelling older adults were open to adopting smart home technology to support independence despite some concerns about security and loss of privacy. Opportunities to share information about smart home technology need to be increased to promote awareness and discussion.

Impact

Wider adoption of smart home technology globally into the model of aged care can have positive impacts on caregiver burden, clinical workforce, health care utilization and health care economics. Nurses, as the main providers of healthcare in this sector need to be knowledgeable about the options available and be able to provide information and respond to questions know about ageing-in-place technologies to best support older adults and their families.

The practice of rural and remote nurses in Australia: A case study

Abstract

Aim and Objective

To delineate contemporary practice of registered nurses working in rural and remote areas of Australia.

Background

Despite the implementation of strategies to address challenges reported by rural and remote nurses, concern remains over safety and quality of care, the well-being of nurses and retention of the nursing workforce. Twenty years on, geographically dispersed nurses still experience scarce human and material resources.

Design

A multiple case study design was implemented.

Methods

Nurses were recruited from 240 sites. The study comprised three phases of data collection. First, a content analysis of 42 documents relating to the context of nursing, specifically rural and remote nursing; second, a content analysis of an online questionnaire (n = 75); and third, a thematic analysis of semi-structured interviews (n = 20). COREQ reporting guidelines were used.

Results

Each phase of data collection informed subsequent data collection and analysis within the study. Following triangulation of data from each phase of the study, the major themes reported are “a medley of preparation for rural and remote work”; “being held accountable”; “alone, with or without someone”; and “spiralling well-being.”

Conclusions

Regardless of strategies, challenges of nursing in rural and remote areas persist. Issues of isolation, stress, burnout and a lack of organisational commitment to employees affect the retention of rural and remote nurses. While useful, professional development courses and graduate certificates are yet to make an impact on reducing these issues.

Relevance to clinical practice

Registered nurses argue for more experience rather than more education to facilitate transition into this nursing area. The finding that experience is perceived as more valuable than education suggests the need for innovative ways to gain experience to practice in rural and remote nursing. Lack of organisational commitment requires attention to promote the well-being of nurses and patient safety.

Built environments for inpatient stroke rehabilitation services and care: a systematic literature review

Por: Lipson-Smith · R. · Pflaumer · L. · Elf · M. · Blaschke · S.-M. · Davis · A. · White · M. · Zeeman · H. · Bernhardt · J.
Objectives

To identify, appraise and synthesise existing design evidence for inpatient stroke rehabilitation facilities; to identify impacts of these built environments on the outcomes and experiences of people recovering from stroke, their family/caregivers and staff.

Design

A convergent segregated review design was used to conduct a systematic review.

Data sources

Ovid MEDLINE, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched for articles published between January 2000 and November 2020.

Eligibility criteria for selecting studies

Qualitative, quantitative and mixed-methods studies investigating the impact of the built environment of inpatient rehabilitation facilities on stroke survivors, their family/caregivers and/or staff.

Data extraction and synthesis

Two authors separately completed the title, abstract, full-text screening, data extraction and quality assessment. Extracted data were categorised according to the aspect of the built environment explored and the outcomes reported. These categories were used to structure a narrative synthesis of the results from all included studies.

Results

Twenty-four articles were included, most qualitative and exploratory. Half of the included articles investigated a particular aspect of the built environment, including environmental enrichment and communal areas (n=8), bedroom design (n=3) and therapy spaces (n=1), while the other half considered the environment in general. Findings related to one or more of the following outcome categories: (1) clinical outcomes, (2) patient activity, (3) patient well-being, (4) patient and/or staff safety and (5) clinical practice. Heterogeneous designs and variables of interest meant results could not be compared, but some repeated findings suggest that attractive and accessible communal areas are important for patient activity and well-being.

Conclusions

Stroke rehabilitation is a unique healthcare context where patient activity, practice and motivation are paramount. We found many evidence gaps that with more targeted research could better inform the design of rehabilitation spaces to optimise care.

PROSPERO registration number

CRD42020158006.

Prototype Development and Usability Evaluation of a Clinical Decision Support Tool for Pharmacogenomic Pharmacy in Practice

imagePharmacogenetics, a subset of precision medicine, provides a way to individualize drug dosages and provide tailored drug therapy to patients. This revolution in prescribing techniques has resulted in a knowledge deficit for many healthcare providers on the proper way to use pharmacogenetics in practice. This research study explored the potential adoption of clinical decision support system mobile apps by clinicians through investigating the initial usability of the PGx prototype application in an effort to address the lack of such tools used in practice. The study method included usage of a clinical decision support system programmed within our pharmacogenomics drug dosage application (called PGx) in a simulated environment. Study participants completed the System Usability Scale survey to report on the perceived usefulness and ease of use of the mobile app. The PGx app has a higher perceived usability than 85% of all products tested, considered very good usability for a product. This general usability rating indicates that the nurse practitioner students find the application to be a clinical decision support system that would be helpful to use in practice.

Beyond clinical trials: Extending the role of the clinical research nurse into social care and homeless research

Abstract

Aim

Clinical research nurses work at the fulcrum of clinical trials with clearly defined roles and responsibilities. In England, the National Institute for Health Research (the main funder of health research) has broadened its scope to encompass social care research. The expectation is that clinical research nurses will expand their skill set to support these new studies, many of which will employ qualitative and mixed methods. This discussion paper explores the challenges of facilitating this clinical academic workforce development through a case study of a homeless health and social care research project. This was one of the first studies to engage clinical research nurses in this new and expanded role.

Background

Much of what is known about the research nurse workforce has been generated through studies of clinical trials in oncology. The ‘caring-recruiting’ dichotomy has been used as a heuristic device for identifying workforce issues that can impact on study delivery such as how intense pressure to recruit study participants leads to low job satisfaction.

Design

This case study reflects on the authors' experiences of employing a clinical research nurse in a social care research project concerned with the discharge of homeless people from hospital. The ‘caring-recruiting’ dichotomy is used to generate new information about the relationship between workforce development and the successful delivery of social care research.

Conclusion

The case study illuminates how social care research can generate different pressures and ethical challenges for research nurses. The time and skill it took to recruit study participants identified as ‘hard to reach’ was suggestive of the need to move beyond performance measures that prioritise recruitment metrics. The need for different types of staff supervision and training was also warranted as supporting study participants who were homeless was often distressing, leading to professional boundary issues.

Relevance to workforce development

This study highlights that performance management, training and supervisory arrangements must be tailored to the characteristics of each new study coming onto the portfolio to ensure research nurses are fully supported in this new and expanded role.

The effectiveness of nurse‐led interventions to prevent childhood and adolescent overweight and obesity: A systematic review of randomised trials

Abstract

Background

Obesity among children and adolescents continues to rise worldwide. Despite the efforts of the healthcare workforce, limited high-quality evidence has been put forward demonstrating effective childhood obesity interventions. The role of nurses as primary actors in childhood obesity prevention has also been underresearched given the size of the workforce and their growing involvement in chronic disease prevention.

Aim

To examine the effectiveness of nurse-led interventions to prevent childhood and adolescent overweight and obesity.

Design

A systematic review of randomised trials.

Data sources

Medline, CINAHL, EMBASE, Cochrane (CENTRAL), ProQuest Central and SCOPUS were searched from inception to March 2020.

Review methods

This review was informed by the Cochrane handbook for systematic reviews of interventions.

Results

Twenty-six publications representing 18 discrete studies were included (nine primary prevention and nine secondary prevention). Nurse-led interventions were conducted in diverse settings, were multifaceted, often involved parents and used education, counselling and motivational interviewing to target behaviour change in children and adolescents’ diet and physical activity. Most studies did not determine that nurse-led interventions were more effective than their comparator(s) in preventing childhood and adolescent overweight and obesity.

Conclusions

Nurse-led interventions to prevent juvenile obesity are feasible but have not yet determined effectiveness. With adequate training, nurses could make better use of existing clinical and situational opportunities to assist in the effort to prevent childhood obesity.

The impact of nurse staffing methodologies on nurse and patient outcomes: A systematic review

Abstract

Aim

Aim of this study is to systematically review and synthesize available evidence to identify the association between nurse staffing methodologies and nurse and patient outcomes.

Design

Systematic review and narrative synthesis.

Data sources

A search of MEDLINE (EBSCO), CINAHL (EBSCO) and Web of Science was conducted for studies published in English between January 2000 and January 2020.

Review methods

The reporting of this review and narrative synthesis was guided by the preferred reporting items for systematic and meta-analysis guidelines (PRISMA) statement and data synthesis guided by the Synthesis Without Meta-analysis (SWiM) guideline. The quality of each article was assessed using the Mixed Methods Appraisal Tool.

Results

Twenty-two studies met the inclusion criteria. Twenty-one used the mandated minimum nurse-to-patient ratio methodology and one study assessed the number of nurse hours per patient day staffing methodology. Both methodologies were mandated. All studies that reported on nurse outcomes demonstrated an improvement associated with the implementation of mandated minimum nurse-to-patient ratio, but findings related to patient outcomes were inconclusive.

Conclusions

Evidence on the impact of specific nurse staffing methodologies and patient and nurse outcomes remains highly limited. Future studies that examine the impact of specific staffing methodologies on outcomes are required to inform this fundamental area of management and practice.

Nursing Big Data Science

Journal of Nursing Scholarship, Volume 53, Issue 3, Page 259-261, May 2021.
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