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Commentary on: Hua Y, Lu H, Dai J, et al. Self-management challenges and support needs among patients with primary glaucoma: a qualitative study. BMC nursing. 2023 Nov 14;22(1):426.
Healthcare professionals should provide personalised and comprehensive support, addressing the medical, emotional and social challenges faced by patients with primary glaucoma. Further research is needed to explore the effectiveness of tailored self-management support programmes in improving the quality of life and treatment outcomes for patients with glaucoma.
Glaucoma is a chronic disease characterised by progressive visual field defects. It is the most common cause of irreversible blindness and is associated with a decrease in quality of life.
Commentary on: Ali MR, Lam CSP, Strömberg A, et al. Symptoms and signs in patients with heart failure: association with 3-month hospitalisation and mortality. Heart. 2023 Dec 1. doi: 10.1136/heartjnl-2023-323295.
Implications for practice and research In primary care consultations, symptoms reported by patients with heart failure (HF) could be valuable in identifying patients at risk of hospitalisation or death. Further research needs to investigate how best can support patients to monitor and report symptoms and test new patient-centred prognostic models including HF signs and symptoms.
Hospitalisation in patients with HF is associated with impaired quality of life, increased mortality and excessive medical costs.
To identify implementation strategies that effectively facilitate the adoption of social needs care coordination activities using enabling technologies among care management teams serving patients in community-based health centres.
Modified Delphi process.
Discrete, feasible implementation strategies were identified through literature review and semi-structured interviews with care management staff and subject matter experts in clinical informatics, workflow redesign, and product engineering. A modified Delphi was conducted with eight subject matter experts and nine health centre care management staff. Iterative rounds of online surveys were used to achieve consensus on the most relevant implementation strategies and their delivery methods.
The modified Delphi process achieved consensus on nine discrete implementation strategies needed to advance care management teams' ability to screen, refer and track social needs. Prioritised strategies included developing champions, enhancing quality improvement capacity, training staff on using enabling technologies and providing tailored technical assistance for workflow refinement. Consensus was also reached on a monthly cadence for most of the implementation strategies.
Consensus was reached on strategies to enhance care management teams' implementation of social needs screening, referrals and tracking using enabling technologies. These strategies will comprise an intervention to be pilot tested, refined and assessed in a cluster randomised clinical trial.
Findings from this study will inform the development of strategies to further the adoption of enabling technologies to support social needs care coordination.
This work is key to the design of a type 2 hybrid implementation-effectiveness trial that will assess whether user-informed, evidence-based implementation strategies can improve care management teams' adoption of enabling technologies to facilitate social needs care coordination for patients.
The research team includes a patient advisor with community-based nursing expertise and a nurse practitioner-clinical informaticist leader who was involved in data collection and interpretation of findings.
Trial registration: Clinicaltrials.gov registration # NCT06489002. Registered July 5, 2024, https://clinicaltrials.gov/study/NCT06489002?term=NCT06489002&rank=1.
To explore which regularly prescribed medications are most commonly administered to older adults in aged care facilities in Australia, by whom and when, and to identify the prevalence of polypharmacy in this population group.
Retrospective descriptive study.
This study involved exploratory analysis of de-identified medication administration records from March 17, 2023–March 18, 2024. Older adults' demographic and medication administration data were requested from two electronic medication chart providers in Australia. For inclusion, older adults must have been living in an aged care facility for the entire timeframe. Data were analysed using descriptive statistics, activity pattern analysis, Welch two sample t-tests, ANOVA and independent sample t-tests. The STROBE checklist was used to report this study.
In all, 12,438 older adults were included, with a median age of 87, spanning 287 aged care facilities across Australia. Nervous system medications (over 16 million doses) and alimentary tract/metabolism medications (over 12 million doses) were the most administered. Within these, paracetamol 500 mg tablets and docusate sodium 50 mg + sennoside B 8 mg tablets were the most common. Quetiapine, a strong anticholinergic medication, was also present in the top 30 most administered medications. Certified nursing staff were the primary administrators of medication (66% of actions), followed by non-nursing staff (27%). Medications were predominantly administered before 10 am and after 10 pm. With a median of 8 regular medications administered per older adult per day, 78% experienced polypharmacy.
The most common regular medications administered in aged care facilities were non-opioid analgesics and laxatives. Many medications were administered in the late evening, where staffing levels were likely to be limited. There was a high prevalence of polypharmacy, and non-nursing staff were involved in medication administration.
This study offers important insights and new knowledge around use of regular medications in aged care facilities, using a nationally representative sample from Australia. It highlights the high volume of non-opioid analgesics and laxatives administered to older adults, some of which may be optimised, modified or replaced with nonpharmacological alternatives to reduce medication burden. This study also notes that not all regular medications are being administered in Australia by certified nursing staff, and that medication administration activity peaks during both breakfast and late evening rounds. These are important considerations for aged care facilities when assessing staffing ratios, rostering, and how to reduce competing demands for aged care staff. Although much attention has been placed on reducing polypharmacy and optimising medications for older adults, this study also identifies that polypharmacy is prevalent, with 78% of older adults experiencing this through use of regular medications alone. The findings of this study will enable more informed discussions between nursing staff, prescribers, pharmacy and potentially older adults and their families around regular medication and its administration in aged care facilities.
The STROBE checklist was followed.
No patient or public contribution.
Commentary on: Chen S, Marshall T, Jackson C, et al. Sociodemographic characteristics and longitudinal progression of multimorbidity: A multistate modelling analysis of a large primary care records dataset in England. PLoS Med 2023;20(11): e1004310. doi: 10.1371/journal.pmed.1004310
Collecting data about different physiological, psychological and sociodemographic factors is crucial to better understand the progression of multimorbidity, rather than single disease-oriented approaches. Factors that influence the development of multimorbidity seem to precede a subject’s engagement with health services, thus the implementation of preventive strategies should take place early in the disease trajectory, aiming to reduce inequalities between groups with diverse socioeconomic backgrounds and ethnicities.
Multimorbidity is the concomitant presence of ≥2 long-term chronic health conditions in a subject, it is increasingly prevalent with the ageing process and leads to poor health outcomes.
Commentary on: Feeling like I’m failing a test, parents’ and adolescents’ opinions of diabetes clinic appointments.
Implications for practice and research Developing communication skills is essential for healthcare professionals to enhance practice and avoid alienating adolescent patients. Further research should be completed with patients who disengage from the clinic to understand how to best improve services and health outcomes.
Diabetes is a long-term health condition that requires continuous high-intensity self-management to prevent complications. This can be challenging for teenagers striving for independence and developing a sense of self. Maintaining engagement with adolescents with diabetes has favourable outcomes. Coyne et al
Commentary on: Yeji Hwang, Miranda V. McPhillips, Liming Huang, G. Adriana Perez and Nancy A. Hodgson, Better caregiver mastery is associated with less anxiety in individuals with cognitive impairment, BMC Nursing. 2023; 22:307.
Implications for practice and research Anxiety is one of the common neuropsychiatric symptoms (NPs) in individuals with cognitive impairment. Considering the fluctuating and variable course of NPs in dementia, studies with longer follow-up periods are required to understand the relationship between caregiver mastery and anxiety in patients with dementia. Dementia, an umbrella condition, encompasses various neurogenerative diseases that can cause behavioural problems, movement problems, autonomic dysfunction, gait and balance problems, as well as cognitive impairment. Hence, it is important to develop caregiver skills with different strategies for each type of dementia.
As the population ages, the prevalence of dementia has increased.
To synthesize approaches used to evaluate nurse-led clinics (NLCs) and student-led clinics (SLCs) delivering community-based primary healthcare.
A scoping review based on Joanna Briggs Institute (JBI) guidelines.
This review included articles evaluating the impact of NLCs and SLCs, published between 2013 and 2023. The Quadruple Aim Framework for health systems quality improvement was a reference point for thematic analysis.
CINAHL Complete, ProQuest Nursing & Allied Health, PubMed, Scopus, Health Systems Evidence, Ovid Emcare and grey literature repositories were searched in March–June 2023.
Our search yielded a total of 891 articles and 43 articles were included in this scoping review. Diverse quantitative and qualitative methods and concepts of interest were evident in the evaluations of NLCs (n = 15), medical SLCs (n = 15) and interprofessional SLCs (n = 13). Extracted data spoke to the evaluation of either client experience, health of communities, systems of care delivery or provider experience, with systems of care delivery being the most consistently evaluated domain across all clinic types.
Traditional and non-traditional evaluation measures spanning the Quadruple Aim Framework were used to study community-based NLCs and SLCs. Opportunities remain for broadening the range of indicators and methods used to capture clinic impact on health equity.
Numerous transferable research approaches are available to students and clinical professionals for supporting the design and iterative improvement of innovative primary healthcare clinics.
The results highlight ways in which NLCs and SLCs may be evaluated for their concurrent impact on healthcare service delivery and clinical education systems.
PRISMA-ScR.
Feedback amassed during presentations to nursing audiences informed the enclosed discussion points.
Review protocol was published with the Open Science Framework under ID 10.17605/OSF.IO/FP6S4
Obesity is health epidemic associated with health conditions specific to women’s health. Healthcare providers must identify and develop a follow-up plan for patients with a body mass index of greater than 30 kg/m2 to meet the Merit-Based Incentive Payment System Quality Program rate for body mass index screening and follow-up. Barriers to addressing obesity in this population by healthcare providers include time available for counseling and knowledge about appropriate diagnosis and treatment options. This is a quality improvement project that implements a clinical template within an existing electronic health record platform that includes a treatment order set and prepopulated counseling prompts to improve the rate of which healthcare providers address obesity within the women’s health clinic. After 12 weeks, 27 patients started a weight management plan, and the Merit-Based Incentive Payment System rate increased from 59% to 67%. Implementation of order set templates into electronic health record platforms with counseling guidance provides a framework for providers to develop a plan to address obesity to meet their patient’s health goals and reduce health disparities related to obesity in women.
This study aimed to use wearable technology to predict the sleep quality of family caregivers of people with dementia among underrepresented groups. Caregivers of people with dementia often experience high levels of stress and poor sleep, and those from underrepresented communities face additional burdens, such as language barriers and cultural adaptation challenges. Participants, consisting of 29 dementia caregivers from underrepresented populations, wore smartwatches that tracked various physiological and behavioral markers, including stress level, heart rate, steps taken, sleep duration and stages, and overall daily wellness. The study spanned 529 days and analyzed data using 70 features. Three machine learning algorithms—random forest, k nearest neighbor, and XGBoost classifiers—were developed for this purpose. The random forest classifier was shown to be the most effective, boasting an area under the curve of 0.86, an F1 score of 0.87, and a precision of 0.84. Key findings revealed that factors such as wake-up stress, wake-up heart rate, sedentary seconds, total distance traveled, and sleep duration significantly correlated with the caregivers' sleep quality. This research highlights the potential of wearable technology in assessing and predicting sleep quality, offering a pathway to creating targeted support measures for dementia caregivers from underserved groups. The study suggests that such technology can be instrumental in enhancing the well-being of these caregivers across diverse populations.
To explore and validate an end of shift survey with a low response burden, practical application and generated evidence of related associations between workload, quality of work and patient care, missed care and job satisfaction.
A retrospective cross-sectional survey of the experiences of nursing staff.
Data were collected from 265 nurses who responded to a questionnaire at the end of their shift in 2022. Exploratory factor analysis was undertaken using IBM SPSS v.27 and confirmatory factor analysis was undertaken using IBM AMOS v27. Hypotheses testing was undertaken using IBM SPSS v.27 using multiple regression analyses.
All of the hypotheses were supported. There was a negative association between workload and quality of work and job satisfaction. Quality of work was negatively associated with workload and missed care and positively associated with job satisfaction. The association between missed care and job satisfaction was negative.
The EOSS is a valid and reliable tool with a low response burden. The tool supports previous research which demonstrated there is a negative relationship between level of workload and shift type with satisfaction, quality of work and potentially nurse retention.
In the context of a global nursing shortage nursing leaders must ensure that care we provide is of the highest quality. We must take every action to address high workload to reduce the risk that fundamental care is not sacrificed, job satisfaction is improved and nurses remain in the profession. The EOSS gives nurse leaders a reliable, practical, consistent, applied tool that will better enable associations to be observed between resource configuration, workload and critical impacts on nursing and patient care.
We have adhered to the relevant EQUATOR guidelines using the STROBE reporting method.
No Patient or Public Contribution.
Background
Engagement with self-monitoring of blood pressure (BP) declines, on average, over time but may vary substantially by individual.
Objectives
We aimed to describe different 1-year patterns (groups) of self-monitoring of BP behaviors, identify predictors of those groups, and examine the association of self-monitoring of BP groups with BP levels over time.
Methods
We analyzed device-recorded BP measurements collected by the Health eHeart Study—an ongoing prospective eCohort study—from participants with a wireless consumer-purchased device that transmitted date- and time-stamped BP data to the study through a full 12 months of observation starting from the first day they used the device. Participants received no instruction on device use. We applied clustering analysis to identify 1-year self-monitoring, of BP patterns.
Results
Participants had a mean age of 52 years and were male and White. Using clustering algorithms, we found that a model with three groups fit the data well: persistent daily use (9.1% of participants), persistent weekly use (21.2%), and sporadic use only (69.7%). Persistent daily use was more common among older participants who had higher Week 1 self-monitoring of BP frequency and was associated with lower BP levels than the persistent weekly use or sporadic use groups throughout the year.
Conclusion
We identified three distinct self-monitoring of BP groups, with nearly 10% sustaining a daily use pattern associated with lower BP levels.
Background
Up to 45% of patients report cancer-related cognitive impairment (CRCI). A variety of characteristics are associated with the occurrence and/or severity of CRCI. However, an important gap in knowledge of risk factors for CRCI is the relative contribution of each factor. The multifactorial model of cancer-related cognitive impairment (MMCRCI) is a conceptual model of CRCI that can be used to evaluate the strength of relationships between various factors and CRCI.
Objectives
The purpose of this study was to use structural regression methods to evaluate the MMCRCI using data from a large sample of outpatients receiving chemotherapy (n = 1,343). Specifically, the relationships between self-reported CRCI and four MMCRCI concepts (i.e., social determinants of health, patient-specific factors, treatment factors, and co-occurring symptoms) were examined. The goals were to determine how well the four concepts predicted CRCI and determine the relative contribution of each concept to deficits in perceived cognitive function.
Methods
This study is part of a larger, longitudinal study that evaluated the symptom experience of oncology outpatients receiving chemotherapy. Adult patients were diagnosed with breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding 4 weeks; were scheduled to receive at least two additional cycles of chemotherapy; were able to read, write, and understand English; and gave written informed consent. Self-reported CRCI was assessed using the attentional function index. Available study data were used to define the latent variables.
Results
On average, patients were 57 years of age, college educated, and with a mean Karnofsky Performance Status score of 80. Of the four concepts evaluated, whereas co-occurring symptoms explained the largest amount of variance in CRCI, treatment factors explained the smallest amount of variance. A simultaneous structural regression model that estimated the joint effect of the four exogenous latent variables on the CRCI latent variable was not significant.
Discussion
These findings suggest that testing individual components of the MMCRCI may provide useful information on the relationships among various risk factors, as well as refinements of the model. In terms of risk factors for CRCI, co-occurring symptoms may be more significant than treatment factors, patient-specific factors, and/or social determinants of health in patients receiving chemotherapy. 
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