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Assessing care dependence status and associated influencing factors among middle‐aged hemiplegic stroke patients during the post‐acute rehabilitation phase: A correlational study

Abstract

Aims

To comprehensively examine the prevailing condition of care dependence among middle-aged individuals who have experienced hemiplegia subsequent to a stroke and were currently undergoing post-acute rehabilitation. Additionally, the study sought to analyse the determinants that impacted this phenomenon.

Design

A single-centre, cross-sectional study design.

Methods

During the period from January 2020 to October 2022, a cohort of 196 hemiplegic stroke patients, aged between 40 and 65, and within 6 months of their stroke onset, was selected from the cerebrovascular outpatient clinic at a tertiary hospital in Hangzhou. The demographic and disease-related data, care dependence level, mental state, nutrition and depression status were collected. Furthermore, all collected data were analysed by descriptive and correlative statistical methods.

Results

The care dependence level was 51.04 ± 9.42, with an incidence of care dependence of 78.1%. Multivariate regression analysis showed that age, history of falls, physical dysfunction, chronic comorbidities, depression, nutritional status and cognitive dysfunction were influencing factors for care dependence in the participants after a stroke.

Conclusion

The incidence of care dependence among hemiplegic patients aged from 40 to 65 years old in the early stage after a stroke was high. Nursing staff should focus on these patients with a history of falling, physical dysfunction, comorbidity, depression status, nutritional status and cognitive dysfunction in clinical practice.

Relevance to Clinical Practice

The incidence of care dependence in middle-aged hemiplegic patients following a stroke is significantly increased. Some risk factors should be assessed, monitored, and controlled by nursing staff as early as possible in order to reduce the dependence levels in post-acute rehabilitation period and improve the quality of life of hemiplegia patients.

Reporting Method

Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross-sectional studies (see Table S1).

Patient or Public Contribution

No patient or public contribution.

Predictive value of the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure score (TRIAGES) for the short-term mortality of older patients with isolated traumatic brain injury: a retrospective cohort study

Por: Jiang · D. · Chen · T. · Yuan · X. · Yang · Y. · Shen · Y. · Huang · Z.
Objectives

This study aimed to evaluate the effectiveness of the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure score (TRIAGES) in predicting 24-hour in-hospital mortality among patients aged 65 years and older with isolated traumatic brain injury (TBI).

Design

A retrospective, single-centre cohort study.

Setting

This study was conducted at a government-run tertiary comprehensive hospital.

Participants

This study included 982 patients aged 65 years or older with isolated TBI, who were admitted to the emergency department between 1 January 2020 and 31 December 2021.

Interventions

None.

Primary outcome

24-hour in-hospital mortality was the primary outcome.

Results

Among the 982 patients, 8.75% died within 24 hours of admission. The non-survivors typically had higher TRIAGES and lower GCS scores. Logistic regression showed significant associations of both TRIAGES and GCS with mortality; the adjusted ORs were 1.98 (95% CI 1.74 to 2.25) for TRIAGES and 0.72 (95% CI 0.68 to 0.77) for GCS. Receiver operating characteristic (ROC) analysis indicated an area under the ROC curve of 0.86 for GCS and 0.88 for TRIAGES, with a significant difference (p=0.012). However, precision–recall curve (PRC) analysis revealed an area under the PRC of 0.38 for GCS and 0.47 for TRIAGES, without a significant difference (p=0.107).

Conclusions

The TRIAGES system is a promising tool for predicting 24-hour in-hospital mortality in older patients with TBI, demonstrating comparable or slightly superior efficacy to the GCS. Further multicentre studies are recommended for validation.

Barriers and facilitators to patient education provided by nurses: A mixed‐method systematic review

Abstract

Aim

To investigate the factors that facilitate or hinder nurses in providing patient education.

Design

A mixed-method systematic review.

Data Sources

Six databases (Cochrane Library, PubMed, EMBASE, Web of Science, MEDLINE and ERIC) were systematically searched for relevant publications.

Methods

The study was conducted following the JBI for mixed-method systematic reviews, and the reporting followed the PRISMA guideline. Two researchers independently performed literature screening, literature evaluation, data extraction and synthesis. PROSPERO registration number: CRD42023427451.

Results

Twenty-six eligible articles were included, including 15 quantitative articles, 10 qualitative articles and 2 mixed-methods articles. The resultant synthesis of key findings led to the identification of these barriers and facilitators, categorised into five distinct levels: nurse-related factors, organisational factors, patient-related factors, the nurse–patient relationship and interdisciplinary collaboration.

Conclusions

The findings highlight the factors that facilitate or hinder nurses in providing patient education, suggesting that multifaceted interventions can enhance the practice of patient education in nursing and support the development of appropriate patient education guidelines or public policies.

Relevance to Clinical Practice

This review delineates the facilitators and barriers influencing nurses' provision of patient education, offering an initial framework for nursing managers to craft interventions aimed at enhancing the quality of patient education provided by nurses, consequently elevating the overall quality of nursing.

Development of a supportive care framework for breast cancer survivor's unmet needs: A modified Delphi study

Abstract

Aim

To establish a supportive care framework for addressing unmet needs among breast cancer survivors, providing practical guidance for healthcare providers to assess and manage these needs, ultimately enhancing the health outcomes and quality of life of breast cancer survivors.

Design

We conducted a two-round Delphi survey to gather expert opinions regarding the unmet needs supportive care framework for breast cancer survivors.

Methods

Initial framework identification and inquiry questionnaire creation was achieved via literature search and expert group discussions, which included 15 experts from nursing practice, clinical medicine, nursing management and nursing education was conducted using a Delphi survey. To establish consensus, a two-round Delphi poll was done, using criteria based on the mean (≥4.0), coefficient of variation (CV < 0.25) and percentage for entire score (≥20%).

Results

Experts reached a consensus, leading to six care modules, and 28 care entries: Tumour Detection Support (three care entries), Management of Complications of Antitumor Therapy (seven care entries), Healthy Lifestyle Management (five care entries), Sexual and Fertility Support (four care entries), Psychosocial Support (four care entries) and Resource and Linkage Support (five care entries).

Conclusion

To address breast cancer survivors' unmet needs, a supportive framework was developed to actively enhance their health outcomes. However, further refinement and feasibility testing using mobile devices or artificial intelligence are required.

Implications for the Profession and Patient Care

This pioneering framework prioritises addressing unmet needs and equips healthcare providers to assess and manage these needs effectively, facilitating the implementation of programs aimed at improving the well-being of breast cancer survivors.

Reporting Method

This study was guided by a modified guideline for the Conducting and Reporting of Delphi Studies (CREDES) (Palliative Medicine, 31(8), 684, 2017).

Patient or Public Contribution

No Patient or Public Contribution.

Trial and protocol registration

The Delphi study methodology does not require registration.

Analysis of factors associated with needlestick injuries of clinical nurses by applying a human factor analysis and classification system: A nationwide cross‐sectional survey

Abstract

Aims

This study aims to investigate the current situation of needlestick injuries (NSIs) of clinical nurses and identify associated factors by using the theoretical framework of the human factors analysis and classification system (HFACS).

Design

A nationwide cross-sectional survey was conducted.

Methods

Multi-stage sampling was used to investigate 3336 nurses in 14 Chinese hospitals. Descriptive statistics and univariate and multivariate logistic regression were employed to reveal the rate of NSIs and their associated factors.

Results

A total of 970 nurses (29.1%) reported having experienced at least one NSI in the past year. The multivariate logistic regression analysis showed that good hospital safety climate and clinical nurses in intensive care unit (ICU) and emergency department had protective effects against NSIs compared with nurses in internal medicine department. The nurse, senior nurse, and nurse in charge have significantly increased the risk for NSIs compared with the associate chief nurse or above. Patients with poor vision but wearing glasses and poor vision but not wearing glasses were more prone to have NSIs. Working in the operating room compared with internal medicine, average weekly working time of >45 h compared with ≤40 h and poor general health led to increased risk of NSIs.

Conclusion

The rate of NSIs in clinical nurses was high in China. Individual factors including professional title, department, visual acuity and general mental health and organisational factors including weekly working hours and hospital safety atmosphere were significantly correlated with the occurrence of NSIs.

Relevance to Clinical Practice

Nursing managers should focused on physical and psychological conditions of clinical nurses, and organisational support is required to enhance the hospital safety atmosphere.

No Patient or Public Contribution

Contributions from patients or the public are irrelevant because this study aims to explore current situation and factors associated with NSIs in clinical nurses.

Novice nurses' transition shock and professional identity: The chain mediating roles of self‐efficacy and resilience

Abstract

Aims and Objectives

The aim of this study was to explore the association between transition shocks and professional identity and the mediating roles of self-efficacy and resilience among Chinese novice nurses.

Background

Novice nurses experience transition shock when they start their careers, which might lead to decreased professional identity and ultimately turnover. By contrast, self-efficacy and resilience are excellent psychological resources that may be associated with higher professional identity. It is unclear how transition shock affects professional identity by influencing these two internal resources.

Design

A cross-sectional survey.

Methods

The STROBE guidelines were followed to report this study. Convenience sampling was used to recruit participants, and 252 novice nurses completed the Transition Shock of Novice Nurses Scale, the Professional Identity Assessment Scale, the General Self-Efficacy Scale and the Connor-Davidson Resilience Scale between April 2022 and May 2022. Influencing factors were primarily identified using independent-sample t-tests and a one-way ANOVA. Structural equation modelling was used to detect the mediating effects of self-efficacy and resilience.

Results

Differences in novice nurses' levels of professional identity were found across age groups, hospitals and departments. Transition shock was negatively related to professional identity. Self-efficacy and resilience mediated the complete chain relationship between transition shock and professional identity.

Conclusion

To our knowledge, this study is the first to explore the mediating effect of self-efficacy and resilience on transition shock and professional identity. Higher transition shock may lead to lower professional identity by reducing self-efficacy and resilience.

Relevance to Clinical Practice

Nursing managers ought to emphasise the significant role of psychological resources in the work adaptation process of novice nurses. It may be more effective to improve professional identity and maintain the stability of the health care system.

Patient or Public Contribution

Nursing administrators working at seven preselected hospitals actively assisted us in the process of collecting self-report questionnaires from novice nurses, such as by booking appointments and providing access for questionnaire administration. In addition, the participants were actively involved in the data collection process.

Effects of cluster nursing interventions on the prevention of pressure ulcers in intensive care units patients: A meta‐analysis

Abstract

A meta-analysis was conducted to comprehensively evaluate the impact of cluster nursing interventions on the prevention of pressure ulcers (PUs) in intensive care unit (ICU) patients. Computer searches were performed in databases including Embase, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure for randomized controlled trials (RCTs) implementing cluster nursing interventions for PUs prevention in ICU patients, with the search period covering the database inception to November 2023. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Overall, 17 RCTs involving 1463 ICU patients were included. The analysis showed that compared with conventional nursing, cluster nursing interventions significantly reduced the incidence of PUs (odds ratio: 0.24, 95% confidence intervals [CI]: 0.17–0.34, p < 0.001) and also significantly improved the levels of anxiety (standardized mean difference [SMD]: −1.39, 95% CI: −1.57 to 1.22, p < 0.001) and depression (SMD: −1.64, 95% CI: −2.02 to 1.26, p < 0.001) in ICU patients. This study indicates that the application of cluster nursing interventions in ICU patients can effectively reduce the incidence of PUs, as well as improve patients' anxiety and depression levels, thereby enhancing their quality of life, which is worth clinical promotion and application.

New application of traditional S retractor in collecting wound flushing fluid after skin tumour resection

Abstract

After Skin tumour resection, there may be residual tumour cells on the wound surface, washing the wound surface with sterilized water can mediate tumour cell lysis and improve patient prognosis. We observed that when the patient is lying behind the operating table, both the limbs and trunk will form an inclined plane with a high centre and a low periphery. Fit the hook of the traditional S retractor onto the low end of the inclined surface, and apply appropriate pressure to make the fitting tight. This way, the flushing fluid will converge at the low end of the fitting surface and will not leak out. Combined with a negative pressure aspirator, it can reduce the splashing of flushing fluid. The traditional S retractor is common in the operating room, which is easy to operate and do not increase medical costs. The method of using a traditional S retractor to collect flushing fluid is worth further promotion.

Effects of clinical nursing pathway on the surgical site wound infection in patients undergoing knee or hip replacement surgery: A meta‐analysis

Abstract

To explore the effect of clinical nursing pathway on wound infection in patients undergoing knee or hip replacement surgery. Computerised searches of PubMed, Web of Science, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database, China National Knowledge Infrastructure databases were conducted, from database inception to September 2023, on the randomised controlled trials (RCTs) of application of clinical nursing pathway to patients undergoing knee and hip arthroplasty. Literature was screened and evaluated by two researchers based on inclusion and exclusion criteria, and data were extracted from the final included literature. RevMan 5.4 software was employed for data analysis. Overall, 48 RCTs involving 4139 surgical patients were included, including 2072 and 2067 in the clinical nursing pathway and routine nursing groups, respectively. The results revealed, compared with routine nursing, the use of clinical nursing pathways was effective in reducing the rate of complications (OR = 0.17, 95%CI: 0.14–0.21, p < 0.001) and wound infections (OR = 0.29, 95%CI: 0.16–0.51, p < 0.001), shortens the hospital length of stay (MD = −4.11, 95%CI: −5.40 to −2.83, p < 0.001) and improves wound pain (MD = −1.34, 95%CI: −1.98 to −0.70, p < 0.001); it also improve patient satisfaction (OR = 7.13, 95%CI: 4.69–10.85, p < 0.001). The implementation of clinical nursing pathways in clinical care after knee or hip arthroplasty can effectively reduce the incidence of complications and wound infections, and also improve the wound pain, while also improving treatment satisfaction so that patients can be discharged from the hospital as soon as possible.

Relationship between fear of progression and quality of life in inflammatory bowel disease: Mediating role of health literacy and self‐care

Por: Xin Hu · Liyuan Xu

Abstract

Aims

The increasing prevalence of inflammatory bowel disease is emerging as a significant global healthcare concern due to its recurrent episodes of intestinal inflammation. This study aims to explore the relationship between fear of progression and health-related quality of life in inflammatory bowel disease patients, investigating the sequential mediating roles of health literacy and self-care.

Design

A cross-sectional study.

Methods

Eligible participants diagnosed with inflammatory bowel disease were recruited through convenience sampling method at a tertiary hospital in Shenyang, China, between May 2022 and May 2023. A total of 241 participants completed the questionnaires regarding fear of progression, health literacy, self-care and quality of life. Data analysis was conducted using SPSS 25.0 and PROCESS plug-ins.

Results

(1) Fear of progression was found to be negatively associated with quality of life and had a directly predictive effect on quality of life. (2) Health literacy and self-care could independently mediate the relationship between fear of progression and quality of life. (3) There was a significant chain mediating effect of health literacy and self-care in the relationship between fear of progression and quality of life.

Conclusion

Fear of progression could not only directly predict the quality of life in inflammatory bowel disease patients but also indirectly affect their quality of life through the chain mediation of health literacy and self-care.

Impact

This study highlights the importance of nursing staff focusing on the interplay between fear of progression, health literacy, self-care and quality of life in caring for inflammatory bowel disease patients. Understanding the potential correlation mechanism underlying quality of life may help develop targeted care interventions to synergistically enhance health literacy and self-care in these patients.

Reporting Method

STROBE guidelines.

Patient or Public Contribution

No public or patient contribution.

Effect of right internal mammary artery versus radial artery as a second graft vessel in coronary artery bypass grafting on postoperative wound infection in patients: A meta‐analysis

Abstract

Few studies have shown that radial artery (RA), which is used as a secondary arterial graft, offers superior results compared with right internal thoracic artery (RIMA) in coronary artery bypass grafting (CABG). In a meta-analysis of observational studies starting in 2023, we looked at the effect of re-operation on postoperative infection and haemorrhage in CABG with RA vs. RIMA. The electronic database up to October 2023 was examined in the course of the research. Analysis was carried out on the clinical trials of postoperative wound infections and haemorrhage re-surgery. Among 912 trials associated with CABG, we selected 8 trials to be included in the final data analysis. The main results were secondary wound infection and re-operation after surgery. The odds ratios (OR) and confidence intervals (CIs) were computed on the basis of a randomized or fixed-effect model of wound infection and re-operation. Seven trials showed a significant reduction in the risk of wound infection in RA treated as a secondary artery transplant compared with RIMA (OR, 1.60; 95% CI, 1.03, 2.47 p = 0.04); Four trials showed that RIMA was not significantly different from RA in the rate of re-operation for postoperative bleeding (OR, 1.31; 95% CI, 0.60, 2.88 p = 0.50). In CABG, RA is used as a secondary arterial conduit graft to lower the risk of wound infection in CABG patients.

Prevention strategies for the recurrence of venous leg ulcers: A scoping review

Abstract

Venous leg ulcer (VLU) is the most severe manifestations of chronic venous disease, which has characterized by slow healing and high recurrence rates. This typically recalcitrant and recurring condition significantly impairs quality of life, prevention of VLU recurrence is essential for helping to reduce the huge burden of patients and health resources, the purpose of this scoping review is to analyse and determine the intervention measures for preventing recurrence of the current reported, to better inform healthcare professionals and patients. The PubMed, Embase, Web of Science, Cochrane Library databases, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wan Fang Data and Chongqing VIP Information (CQVIP) were accessed up to June 17, 2023. This scoping review followed the five-steps framework described by Arksey and O'Malley and the PRISMA extension was used to report the review. Eleven articles were included with a total of 1503 patients, and adopted the four effective measures: compression therapy, physical activity, health education, and self-care. To conclude, the use of high pressure compression treatment for life, supplementary exercise therapy, and strengthen health education to promote self-care are recommended strategies of VLU prevention and recurrence. In addition, the importance of multi-disciplinary teams to participate in the care of VLU in crucial.

Association of nurse managers' paternalistic leadership and nurses' perceived workplace bullying: The mediating effect of organizational climate

Abstract

Aims

To explore the association between nurse managers' paternalistic leadership and nurses' perceived workplace bullying (WPB), as well as to examine the mediating role of organizational climate in this association.

Background

There is a lack of empirical evidence regarding the relationship between nurse managers' paternalistic leadership, organizational climate and nurses' perceived WPB. Clarifying this relationship is crucial to understand how paternalistic leadership influences WPB and for nursing managers to seek organizational-level solutions to prevent it.

Methods

A cross-sectional survey was performed from 4 January to 10 February 2022, in six tertiary hospitals in mainland China. Demographic information, Paternalistic Leadership Scale, Organizational Climate Scale and Negative Acts Questionnaire-Revised were used in the survey. Descriptive statistics, Spearman correlation analyses and a structural equation model were used for data analysis.

Results

A total of 5093 valid questionnaires were collected. Moral leadership and authoritarian leadership have both direct and indirect effects on WPB through the mediating effect of organizational climate. The former is negatively related to WPB and the latter is positively related to WPB. Benevolent leadership was only negatively associated with WPB via the mediating effect of organizational climate.

Conclusion

The three components of paternalistic leadership have different effects on WPB through the mediating effect of organizational climate. Nurse managers are recommended to strengthen moral leadership, balance benevolent leadership, reduce authoritarian leadership and strive to create a positive organizational climate in their efforts to mitigate WPB among nurses.

Impact

This study enhanced our comprehension of the relationship between different leadership styles and WPB. Greater emphasis should be placed on moral leadership in the promotion of nursing managers and nursing leadership training programs. Additionally, nursing managers should focus on establishing a positive organizational climate that helps to reduce WPB.

Patient or Public Contribution

No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public.

Impacts of income inequality and the mediation role of reporting delays on COVID-19 deaths during 2020 and 2021 in Hong Kong: an observational study

Por: Yuan · H.-Y. · Wong · W. H. · Khairunnasa · F. · Ho · H. C. · Chung · G. K.-K.
Objective

To estimate the impacts of demographic factors and income disparities on the case fatality rate (CFR) of COVID-19 in Hong Kong, taking into account the influence of reporting delays (ie, the duration between symptom onset and case confirmation).

Design

Retrospective observational longitudinal study.

Participants

A total of 7406 symptomatic patients with residence information reported between 23 January 2020 and 2 October 2021.

Main outcome measures

The study examined the disparity in COVID-19 deaths associated with the factors such as age (≥65 vs 0–64 years old groups), gender and the income level of districts (low income vs non-low income). The severe reporting delay (>10 days) was considered as the mediator for mediation analysis. A Cox proportional hazards regression model was constructed.

Results

We found that CFR was 3.07% in the low-income region, twofold higher than 1.34% in the other regions. Although the severe reporting delay was associated with a hazard ratio (HR) of about 1.9, its mediation effect was only weakly present for age, but not for gender or income level. Hence, high CFR in Hong Kong was largely attributed to the direct effects of the elderly (HR 25.967; 95% CI 14.254 to 47.306) and low income (HR 1.558; 95% CI 1.122 to 2.164).

Conclusion

The disparity in COVID-19 deaths between income regions is not due to reporting delays, but rather to health inequities in Hong Kong. These risks may persist after the discontinuation of test-and-trace measures and extend to other high-threat respiratory pathogens. Urgent actions are required to identify vulnerable groups in low-income regions and understand the underlying causes of health inequities.

Knowledge, attitude and practice on ovarian reserve function among women of childbearing age: a prospective cross-sectional study in Chongqing and surrounding regions

Por: Yuan · Y. · Yang · L. · Hu · J. · Deng · Y. · Zhang · H.
Objectives

To evaluate the knowledge, attitudes and practice (KAP) on ovarian reserve function among women of childbearing age in Chongqing and surrounding regions, China.

Design

Cross-sectional study.

Setting

Chongqing and surrounding regions, China.

Participants

Women of childbearing age (18–48 years) by convenience sampling.

Primary and secondary outcome measures

The demographic characteristics of the respondents and their KAP on ovarian reserve function were collected by administering 38-item questionnaires.

Results

A total of 510 valid questionnaires were collected. The mean knowledge score of all respondents was 7.56±2.03 (possible range: 0–10), the mean attitude score was 29.12±3.98 (possible range: 8–40) and the mean practice score was 23.45±3.58 (possible range: 6–30). The multivariable analysis showed knowledge level (OR 1.175, 95% CI 1.049 to 1.317, p=0.002), attitude level (OR 1.249, 95% CI 1.167 to 1.337, p

Conclusions

The women living in Chongqing and surrounding regions had good knowledge, moderate attitude and good practice towards ovarian reserve function. The knowledge aspect can be further improved by education, which in turn might also improve practice among women of childbearing age.

Left atrial appendage occlusion for patients with valvular diseases without atrial fibrillation (the OPINION Study): study protocol for a multicentre, randomised controlled trial

Por: Ju · F. · Yuan · X. · Sun · H.
Introduction

Atrial fibrillation (AF) is a significant cause of perioperative stroke in aortic and mitral valve surgeries. Although several large studies have evaluated surgical left atrial appendage occlusion (SLAAO) during cardiac surgeries, their retrospective nature and an uncontrolled broad spectrum of conditions leave them subject to potential residual confounding. This trial aims to test the hypothesis that opportunistic SLAAO can prevent long-term stroke after cardiac surgery in patients receiving mitral or aortic valve surgeries without a history of AF and with a CHA2DS2-VASc score of 2 or higher.

Methods and design

This study is a single-blinded, multicentre, randomised controlled trial. A total of 2118 patients planning to undergo aortic or mitral surgery without AF will be recruited and equally randomised into intervention or control arms at a 1:1 ratio. In the intervention arm, suture excision of the left atrial appendage (LAA) will be performed during the operation in addition to the original surgery plan. In the control arm, the operation will be performed according to the surgery plan without any intervention on the LAA. The primary outcome is a composite of newly occurred ischaemic stroke or transient ischaemic attack and cardiovascular mortality during a 1-year follow-up. Secondary outcomes include postoperative AF, cardiovascular mortality, newly occurred ischaemic stroke, newly occurred transient ischaemic attack, newly occurred haemorrhagic stroke, bleeding events, and AF-associated health utilisation.

Ethics and dissemination

The Ethics Committee in Fuwai Hospital approved this study. Patients will give informed consent to the study. An information leaflet will be provided to participating patients to introduce the SLAAO procedure. Patients and the public will not get involved in developing the research hypothesis, study design or any other part of this protocol. We plan to publish several papers in peer-reviewed journals about the current research and these will include a description of the study’s development and the main findings of the study.

Trial registration number

ChiCTR2100042238.

Which aspects of patient experience are the 'moment of truth in the healthcare context: a multicentre cross-sectional study in China

Por: Chen · X. · Yuan · J. · Zhao · W. · Qin · W. · Gao · J. · Zhang · Y.
Objective

This study aimed to examine the differential magnitude of associations between specific dimensions of patient experience and overall patient satisfaction.

Design

A descriptive, cross-sectional design was used to collect patient experience and overall satisfaction data.

Setting

Participants were recruited at one tertiary general hospital, one tertiary specialised hospital, and one secondary hospital in Shanghai, China. These three institutes represent the main kinds of hospitals in the Chinese healthcare system.

Participants

1532 inpatients were recruited, and 1469 were included. The inclusion criteria were as follows: (1) having received inpatient service for at least 2 days; (2) able to understand the questions in the questionnaires; and (3) aged>18 years old. Patients who had impaired cognitive function and completed the questionnaires with missing information were excluded.

Primary and secondary outcome measure

Patient experience was measured using the Inpatient Experience with Nursing Care Scale, which is widely used in the China. The overall patient satisfaction was measured with 10-point response option.

Results

The LASSO (least absolute shrinkage and selection operator) regression results showed that as the penalty factor () = 0.0162, age, marriage status, financial status, length of hospital stay and numbers of previous of hospitalisation and six dimensions of nursing care remained in the model. As increases to 0.1862, only four patient experience variables, potentially the most influential on patient satisfaction, remained in the model. Patient experience with emotional support was the most significant dimension explaining patient satisfaction (β=0.1564), the second most significant dimension was admission and discharge management (β=0.1562), and the third was monitoring and coping with the progress of diseases (β=0.0613).

Conclusion

Patient experience with emotional support, admission and discharge management, monitoring and coping with the progress of diseases, and information and education are the most significant dimensions explaining patient satisfaction.

Patient and family engagement interventions for hospitalized patient safety: A scoping review

Abstract

Aim

To summarize existing studies that focused on improving hospitalized patient safety through patient and family engagement interventions to identify priorities and gaps.

Design

A scoping review.

Methods

Eight databases and citations of important reviews were searched on 30 September 2022. Two researchers independently screened the records. Then, two researchers extracted the data and cross-checked. The results were synthesized narratively, and a comparison was performed for studies from China and those from other countries.

Results

Ninety-eight studies were included. The results indicated that patient and family engagement interventions were applied to decrease the incidence of patient safety incidents, and to improve the healthcare providers' and patients' knowledge, attitude or practice of patient safety. Most studies only engaged patients and families at the direct care level, and the engagement strategies at the organization and health system levels were insufficient. For stakeholders, many studies failed to consider patients' perspectives in intervention design and report taking staff training as a supportive strategy. Healthcare providers, especially nurses, were the main implementers of current interventions. Certain differences were observed between studies from China and those from other countries in the above aspects.

Conclusions

International interest in engaging patient and family for patient safety is growing. Future studies should enhance the patient and family engagement as a partner in various patient safety at the direct care level, and further explore the engagement at the organization and health system levels.

Relevance to Clinical Practice

Nurses, as the main formal caregivers for patients, should promote patient and family engagement in patient safety, especially at direct care level. Nurse should also incorporate the perspectives of patients in the design and implementation of interventions.

Reporting Method

PRISMA-ScR Checklist.

Interventions to address parenting stress among caregivers of children with chronic diseases: An umbrella review

Abstract

Background

Caregivers of children with chronic diseases suffer from great parenting pressure, which directly affects the treatment and rehabilitation of children, reduces the quality of life of caregivers and damages family functioning. Existing reviews have not systematically summarized and evaluated interventions for parenting stress in caregivers of children with chronic diseases.

Data Sources

Embase, PubMed, Web of Science, OVID, CNKI, CBM, Wan Fang and Cochrane Library were searched for eligible reviews in November 2021 and October 2022.

Methods

Two reviewers independently screened titles and abstracts, reviewed full texts of articles for eligibility, and appraised the quality of reviews using JBI. The quality of the evidence was assessed using GRADE. Findings are reported in accordance with PRISMA checklist. Narrative summaries grouped findings by intervention types.

Results

Out of 2632 records, we included 21 systematic reviews for a synthesis. Interventions for parenting stress in children with chronic diseases were divided into seven categories. Cognitive behavioural interventions, psychosocial interventions, child behavioural and/or developmental parent interventions and synthesized interventions have shown high-level evidence in reducing parenting stress for caregivers of children with chronic diseases. Furthermore, outcome measures and intervention protocols were highly heterogeneous across interventions.

Conclusions

This umbrella review suggest that reducing the parenting stress of caregivers of children with chronic diseases can directly target caregivers' parenting stress through cognitive behavioural interventions/psychosocial interventions and/or provide guidance to parents on the behavioural and developmental problems of children with chronic diseases. A more standardized approach to outcome measures is essential to assess efficacy and compare interventions across studies.

Relevance to Clinical Practice

The findings provide information and evidence for reducing parenting stress among caregivers of children with chronic diseases to guide the development of comprehensive intervention strategies.

Patient or Public Contribution

Patient or public contribution does not apply to this study.

Best practices for managing malodorous and infected wounds in advanced cervical cancer

Abstract

This cross-sectional study was conducted to examine the most effective strategies for managing malodorous and infected wounds in patients who have been diagnosed with advanced cervical cancer. The research was conducted in Liupanshui, China. The study specifically examined demographic profiles, wound characteristics and effectiveness of wound management approaches. The study incorporated the heterogeneous sample of 289 participants who fulfilled the inclusion criteria. Data collection was conducted via structured questionnaires and medical record evaluations. Descriptive statistics and statistical analyses, such as regression analysis, were utilized to evaluate demographic attributes, wound profiles and effects of different approaches to wound management. The findings unveiled the heterogeneous demographic composition of patients, encompassing differences in socioeconomic standing, educational attainment and age. A wide range of wound characteristics were observed, as 65.7% of lesions during the acute phase with diameter between 2 and 5 centimetres, while 41.5% of lesions had this range. The most prevalent types of infections were those caused by fungi (48.4%), followed by bacterial infections lacking resistance (38.1%). A moderate degree of odour intensity was prevalent, affecting 45.0% of the cases. With maximal odour reduction of 80%, a mean healing time of 25 days and patient satisfaction rating of 4.5 out of 5, Negative Pressure Wound Therapy demonstrated itself to be the most efficacious treatment method. Additional approaches, such as photodynamic therapy and topical antibiotic therapy, demonstrated significant effectiveness, as evidenced by odour reductions of 70% and 75%, respectively, and patient satisfaction ratings of 4.3 and 4.2. Thus, the study determined challenges associated with management of malodorous and infected lesions among patients with advanced cervical cancer. The results underscored the significance of individualized care approaches, drew attention to efficacious wound management techniques and identified critical determinants that impacted patient recuperation. The findings of this study hold potential for advancing palliative care for individuals diagnosed with advanced cervical cancer.

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