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To (1) examine the attitudes of community-dwelling adults towards death and their ability to cope with death, as well as (2) understand the influence of advance care planning on community-dwelling adults' death attitudes and coping with death.
A sequential explanatory mixed-methods study was conducted in Singapore.
In Phase I, a case–control study was conducted to examine the differences in death attitudes and coping with death ability between community-dwelling adults who have completed advance care planning and those who have not. A univariate general linear model was used to compute the mean difference in death attitudes and coping with death scores. In Phase II, a descriptive qualitative study was conducted to provide an in-depth understanding of the influence of advance care planning among community-dwelling adults. Thematic analysis was used for qualitative analysis. Mixed-methods analysis was conducted to integrate the quantitative and qualitative data.
In Phase I, 80 community-dwelling adults who had completed advance care planning and 81 community-dwelling adults who did not have advance care planning were included. Adults who had completed advance care planning had significantly higher coping with death scores (t = 4.14, p < 0.01). In Phase II, a purposive sample of 24 adults who had completed advance care planning was selected for individual semi-structured interviews. From the thematic analysis, three themes were developed: (1) Advance care planning enables coping with death, (2) overcoming fear of death with advance care planning and (3) confronting death with advance care planning.
Advance care planning may influence death attitudes and coping with death. Further work on longitudinal designs and among individuals from different age groups should be used to gain further in-depth understanding of the impacts of advance care planning.
Strategies to enhance one's coping abilities with death and death attitudes should be developed to stimulate the uptake of advance care planning.
This paper was reported according to the Good Reporting of A Mixed Methods Study framework.
Community-dwelling adults participated in the survey and interviews.
To evaluate the effectiveness of multidisciplinary transitional care interventions on functional status, quality of life and readmission rates of stroke patients.
Quantitative systematic review and meta-analysis.
Studies with interventions to ease the hospital-to-home transition of stroke patients that were delivered by multidisciplinary teams consisting of registered healthcare professionals from at least two disciplines were included. Cochrane Risk of Bias tool was used for quality appraisal.
Seven electronic databases (PubMed, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Scopus and Web of Science) were searched for randomised controlled trials delivering transitional care interventions to hospitalised stroke patients.
Thirty-one randomised controlled trials were included in the final review. The studies featured multidisciplinary teams of two to nine professionals, most commonly nurses, physicians and physiotherapists. Although multidisciplinary care improved functional status and quality of life scores, the impact on readmission rates was inconclusive. Meta-analysis revealed significant improvements in functional status when care involved physicians, care coordinators (often nurses) or had teams of more than two healthcare professionals. Significant improvement in quality of life was also reported when care involved physicians or in teams with more than two healthcare professionals.
Multidisciplinary transitional care interventions show promise in improving functional status and quality of life after stroke. Their effectiveness depends on team composition and coordination, particularly the inclusion of physicians and care coordinators. Future research should address reporting gaps and evaluate broader strategies to reduce hospital readmissions.
Impact (Addressing)
What problem did the study address? ○
The effectiveness of multidisciplinary transitional care interventions for stroke patients.
○Evaluated the role of various healthcare professionals within these teams.
What were the main findings? ○
Multidisciplinary transitional care interventions significantly enhance stroke patients' functional status, especially within the first 3 months.
○Teams with care coordinators (often nurses) and supportive physicians improve functional outcomes, with effective communication being crucial despite underreporting of specific practices.
○Teams comprising of more than two health professionals can significantly improve stroke patients' functional status.
Where and on whom will the research have an impact? ○
Healthcare institutions and providers: The findings can guide healthcare institutions in developing and implementing effective transitional care services for stroke patients.
○Stroke patients: Patients receiving multidisciplinary transitional care are likely to experience enhanced functional recovery and improved ability to perform daily activities.
○Policymakers and researchers: The study highlights the need for more detailed reporting and research on communication practices within multidisciplinary teams and the importance of evaluating underreported outcomes like readmission rates.
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) checklist.
No Patient or Public Contribution.
This study aims to explore the negative emotions experienced by nurses following medication errors.
Mixed-method systematic review.
A systematic search was conducted in PubMed, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Google Scholar for studies published in English between January 2013 and October 2024. The Joanna Briggs Institute critical appraisal tool was used to assess article quality and data were analysed through qualitative content analysis.
From 1619 screened studies, 19 were selected: 14 qualitative, 3 quantitative and 2 mixed-method. The negative emotions experienced by nurses, as second victims of medication errors, can be categorised into 8 groups: Fear, anger, disturbance, sadness, shame, guilt, low self-esteem and depression. Additionally, the following 11 types of fear were identified: Fear of judgement, disrespect, losing one's job, getting scolded and contempt, retaliation and punishment, reaction, consequences, disciplinary actions and lawsuits, patient's well-being, reporting a medication error and losing patient's/their families' trust. Furthermore, two types of shame were identified: Internal and external shame.
The negative emotions that nurses experience as second victims can persist long after the error occurs. It underscores the need for structured psychological support systems to foster a culture of ‘responsibility without blame’.
Addressing nurses' emotional challenges as second victims enhances their well-being and improves global healthcare safety and quality.
These findings highlight the need for healthcare leaders and policymakers to implement interventions that foster a supportive, non-punitive workplace with the aim of improving the emotional well-being of nurses following medication errors.
The study adhered to PRISMA guidelines.
None.
Prospero code: CRD42023439304.
To identify barriers and facilitators to implementation of new evidence-based nursing policies among nurse educators.
Evidence-based practice promotes safe patient care through the combination of the best available research, clinical expertise and patient preferences. Policies are utilised by nursing to drive patient care and thus should be evidence-based. Nurse educators are identified as champions of evidence-based practice and policy dissemination. Therefore, understanding nurse educators' perceptions surrounding barriers and facilitators to nursing policy implementation and attitudes regarding evidence-based practice can help drive successful policy implementation and foster evidence-based practice in patient care.
Descriptive, cross-sectional.
A 7-item survey was electronically distributed to all nurse educators within a large pediatric healthcare system to assess barriers and facilitators to policy implementation as well as attitudes surrounding evidence-based practice and policies.
The most significant barriers were lack of time and poor understanding of policy development. The most significant facilitators were a standardised policy dissemination process and leadership support of policy implementation efforts. Most nurse educators agreed that evidence-based practice is valuable to patient care. However, nurse educators report that they have a neutral to poor understanding of evidence-based practice.
Findings were consistent with the literature, thus adding to the body of literature that supports the need for further development around policy dissemination and evidence-based practice education for nurse educators.
This paper supports the need for professional development for nurse educators, standardisation of policy dissemination and leadership support of policy dissemination and promotion of evidence-based practice.
No patient or public contribution.
This paper adheres to the SQUIRE 2.0 guidelines.
Synthesise evidence on advanced practice nurses' impact on health services utilisation, healthcare costs, access and quality of care globally.
Scoping review.
A scoping review guided by the Joanna Briggs Institute Manual for Evidence Synthesis and the PRISMA-ScR checklist.
PubMed, CINHAL and Embase for articles between 2016 and 2023.
Eighteen studies were included (14 from the United States, two from the Netherlands and one from Australia and New Zealand each). Outcomes included health services utilisation, healthcare costs, access, and quality of care. Most studies reported advanced practice nursing patients had fewer emergency department (9 of 11 studies), fewer hospital (re-)admissions (9 of 10 studies) and primary care visits (3 of 3 studies). Seven (of eight) studies found advanced practice nursing care was associated with significantly lower healthcare costs. For access and quality of care, advanced practice nursing care was associated with lower consultation rates, similar mean number of patients seen, higher protocol adherence, more rural patient care and lower-to-similar quality delivery of chronic disease management.
Majority of the studies reported that advanced practice nursing care was associated with lower emergency department visits, hospital readmissions and costs. Access to care outcomes varied under advanced practice nursing care.
Advanced practice nursing care can improve patient outcomes, reduce costs and impact access and quality of care. Practices need supportive work environments for advanced practice nurses to deliver high-quality, effective care.
Addressing the need for a synthesis of up-to-date evidence, this review highlights the importance of advanced practice nurses in primary care. Findings can inform global workforce development strategies to address health inequalities through effective advanced practice nursing integration.
No patient or public contribution is required for this study.
Artificial intelligence integration into healthcare has gained significant attention in recent years, with its use ranging from disease diagnosis to surgical assistance. While artificial intelligence's potential to improve patient outcomes and optimise patient care is undeniable, concerns regarding privacy, transparency, and the potential for medical errors persist. To take full advantage of artificial intelligence's transformative abilities, understanding patient perceptions and attitudes towards its integration into medicine is crucial for ethical considerations and health outcomes.
This study aimed to describe patients' perceptions of medical artificial intelligence and its integration into the healthcare system, drawing attention to a crucial yet understudied aspect of artificial intelligence adoption in Kazakhstan.
Descriptive qualitative design.
From February to March 2024, the researchers conducted semi-structured interviews amongst 13 patients. The interviews were audio-recorded, transcribed, translated, and then analysed using a thematic analysis approach. The study adhered to the COREQ guidelines.
Five themes emerged from 13 interviews: the benefits of artificial intelligence on patient care, the importance of human factors on patient care over artificial intelligence, revolutionising patient care delivery through artificial intelligence, patient education and artificial intelligence, and balancing technology and human interaction in artificial intelligence-driven intervention.
Patient perceptions of artificial intelligence integration into healthcare were primarily positive. Nevertheless, patients prefer artificial intelligence as a supplementary tool under human supervision due to risks such as possible medical errors and violations of patient privacy.
Patients provided the data for this study. The researchers interviewed them about their perceptions of medical artificial intelligence and its integration into the healthcare system. The patients or the public contributed nothing to the other aspects of the study.
To synthesise stakeholders' experiences and perceptions of animal-assisted intervention (AAI) for people with dementia in community care settings.
Qualitative evidence synthesis.
We systematically searched Medline, CINAHL, Embase, Scopus, Web of Science, PsycINFO and AgeLine for potentially eligible studies. Thematic synthesis was used to analyse the data from included studies. We assessed the methodological limitations of included studies using an adaptation of the Critical Appraisal Skills Programme checklist and used Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) tool to assess confidence in review findings. This review is reported using the ENTREQ checklist.
We included 14 reports from 11 studies and developed three analytical themes incorporating a gardening analogy: planting–connecting with animals, growing–engaging in AAI and nurturing–making AAI work; and six subthemes: willingness to connect, building relationships, a rich experience, the benefits of AAI, individualised and holistic approach and training and support, with 15 key findings.
This review describes people's experiences and perceptions of AAI for people with dementia, and provides recommendations on the development and implementation of AAI, with moderate to high confidence. Nurses need to consider the factors that influence the implementation of AAI identified in this review, to facilitate engagement and long-term impacts while adopting AAI in community care settings.
This review may enhance healthcare professionals' understanding of AAI for people with dementia in community care settings. AAI is a complex intervention that can be delivered in varied manner. A multicomponent, flexible and individualised AAI is important. Additional training and education for staff are needed.
A man with dementia and his wife who share a love of dogs, advised at each step of the review, providing insights and perspectives and contributing as co-authors.
To evaluate the impact of spatial separation on patient flow in the emergency department.
This was a retrospective, time-and-motion analysis conducted from 15 to 22 August, 2022 at the emergency department of a tertiary hospital in Kuala Lumpur, Malaysia. During this duration, spatial separation was implemented in critical and semi-critical zones to separate patients with symptoms of respiratory infections into respiratory area, and patients without into non-respiratory area. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
Patients triaged to critical and semi-critical zones were included in this study. Timestamps of patient processes in emergency department until patient departure were documented.
The emergency department length-of-stay was longer in respiratory area compared to non-respiratory area; 527 min (381–698) versus 390 min (285–595) in critical zone and 477 min (312–739) versus 393 min (264–595) in semi-critical zone. In critical zone, time intervals of critical flow processes and compliance to hospital benchmarks were similar in both areas. More patients in respiratory area were managed within the arrival-to-contact ≤30 min benchmark and more patients in non-respiratory area had emergency department length-of-stay ≤8 h.
The implementation of spatial separation in infection control should address decision-to-departure delays to minimise emergency department length of stay.
The study evaluated the impact of spatial separation on patient flow in the emergency department. Emergency department length-of-stay was significantly prolonged in the respiratory area. Hospital administrators and policymakers can optimise infection control protocols measures in emergency departments, balancing infection control measures with efficient patient care delivery.
STROBE guidelines.
None.
The study obtained ethics approval from the institution's Medical Ethics Committee (MREC ID NO: 20221113–11727).
The author has checked and make sure our submission has conformed to the Journal's statistical guideline. There is a statistician on the author team (Noor Azhar).
Virtual reality-reminiscence therapy (VR-RT) has increasingly been applied to older adults to improve psychological well-being and cognition.
This review aims to identify (1) the design characteristics of conducting a VR-RT and (2) the effects of VR-RT on the user experience, cognitive outcomes and psychological well-being.
Systematic review.
Eligible studies were sourced across nine electronic databases, trial registries, grey literature and hand-searching of the reference list. A narrative synthesis was conducted. Twenty-two studies were included, and most were appraised as high quality. Most of the VR-RTs were highly immersive and personalised, with participants having the autonomy of control. VR-RT has the potential to improve anxiety and depression, and cognitive outcomes for older adults. Overall, VR-RT was reported to be an enjoyable experience for older adults.
VR-RT is a promising innovation that can improve older adults' psychological well-being and cognition without significant side effects, including cybersickness and with the potential for scalability across various settings. More randomised controlled studies are needed to evaluate the effectiveness of VR-RT and its features and treatment dosage. These studies could also examine the effectiveness of VR-RT as an intervention to promote independence in activities of daily living and physical rehabilitation.
VR-RT is a promising intervention for older adults in community settings to enhance psychological well-being and cognition. VR's versatility enables personalised experiences within dynamic virtual environments, possibly enhancing engagement and therapeutic outcomes.
This systematic review did not directly involve patient or public contribution to the manuscript.
Nurses play an essential role in responding to severe viral disease which bring considerable challenges to their personal and professional well-being. This subsequently can affect the delivery of care and healthcare systems' organisational capacity to respond. Understanding nurses' experiences of these challenges will help inform healthcare policies.
To explore the experiences and coping strategies of nurses caring for patients during severe viral disease pandemics.
A mixed-methods systematic review informed by the Joanna Briggs Institute (JBI) methodology.
A mixed-methods systematic review. Five electronic databases Medline, CINAHL, PsychInfo, ASSIA and Scopus were searched on 4th April 2021. Results were reported in accordance with PRISMA. The findings were analysed and reported in the context of the Self-Regulatory Common-Sense Model.
In total, 71 peer-review primary research articles describing nurses' experiences of caring for patients during SARS, MERS, Swine flu H1N1, Avian influenza or SARS-CoV-2 / COVID-19 published in English from 2003 to 2021 were included. We found links between nurses' perception of the health threats, their emotional reactions, and coping strategies. Perceived health threats were influenced by organisational factors including frequent changes in clinical guidelines and workplace protocols, onerous workloads and working hours, unavailability of PPE, and lack of knowledge and training in pandemic management. These impacted nurses' physical, psychological and social well-being. Nurses also reported helpful and unhelpful coping strategies to manage the health threats.
It is vital for stakeholders, policymakers, government and healthcare institutions to recognise and monitor the wider impact on healthcare workers from health emergencies. In addition, support to develop and implement effective systems and individual mechanisms to offset the anticipated impact pre and post pandemics/epidemics is needed. Our findings can inform those strategies for similar future health emergencies.
Nurses are often the first point of contact in providing direct care to patients, hence they are at high risk of being infected. The findings from this review can help managers and policymakers in developing programmes to enhance resilience in the nursing workforce.
This was a literature review study.
FreshRSS 