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To evaluate the impact of implementing a prototype of simulation-based educational technology on raising awareness among ICU nurses, improving communication in nursing handover, and promoting patient safety.
Qualitative study based on the conceptual framework of patient safety. The COREQ tool guided the presentation of the research report.
The research was conducted with 18 nurses from the ICU of a public hospital in Rio de Janeiro, Brazil, who worked directly in nursing handover. The technology implemented was developed based on communication failures identified in a previous stage of the macro research project. This evidence supported the development of a simulated scenario of a nursing handover of a critical patient, which was recorded in audio and video. The video addressed content (absence, incompleteness and lack of ordering of information) and behavioural errors (interruptions, distractions, noise and lack of clarity) during communication between intensive care nurses. The video was implemented with nurses through the use of telesimulation with debriefing. Finally, the nurses were subjected to a semi-structured interview to evaluate the potential of the technology, whose data underwent thematic analysis with an inductive model.
The nurses recognised the communication failures portrayed as part of their daily practice, reflected on their mistakes, and on actions to be adopted to change behaviour during the handover.
The simulation-based technology prototype has the potential to promote self-reflection and raise nurses' awareness of the need to change behaviours during the handover.
The simulation-based technology prototype can be applied as an educational strategy to improve communication safety in nursing handover.
No patient or public contribution.
To conceptualise experiences and perceptions of cancer nurses' potential for occupational exposure when dealing with cytotoxic drugs (CDs).
A mixed methods systematic review with framework synthesis.
A literature search was conducted in February 2022 in CINAHL PubMed, Web of Science, Ovid Nursing, and PsycINFO, and it was reported using the PRISMA guidance.
A synthesis of 38 studies revealed new categories of perceived solutions, side effects, and risky behaviour as well as three levels of experience and perception: individual, shared, and cultural, rather than the a priori theory.
The review conclude that individuals espouse safe handling and administration of CDs. Synthesis highlights a complex interplay between self-reported perception and the observed experience of potential occupational exposure to cytotoxic drugs.
The framework synthesis highlights the difference between the perception of espoused practice and the experience of practice. Observation and risk assessment must be used to enhance safe practice. Organisations must take seriously the perception and experience of the adverse effects of administering cytotoxic drugs to support cancer nurses.
Joanna Briggs Institute's (JBI) methodology for systematic reviews and framework synthesis indexed studies deductively and inductively.
No patient or public contribution.
PROSPERO: CRD42022289276
To explore the associations between depression, anxiety, decisional conflict and advance care planning engagement and the potential mediating role of decisional conflict in the associations between depression, anxiety and advance care planning among community-dwelling older adults.
A cross-sectional study was conducted with 262 community-dwelling older Australians across metropolitan, regional and rural communities between August and October 2022.
Validated self-reported questions were used to collect data on anxiety, depression (Hospital Anxiety and Depression Scale), decisional conflict (Decisional Conflict Scale), advance care planning engagement (Advance Care Planning Engagement Survey) and covariates (demographic characteristics, health literacy [Health Literacy Screening Questions]), overall health status (Short form 36). Data analysis included descriptive statistics, bivariate association analysis, general linear modelling and path analysis.
Anxiety and decisional conflict were directly associated with advance care planning engagement even after controlling for potential effects of demographic characteristics, health literacy and overall health status. The model, including age, gender, country of birth, language spoken at home, education, overall health status, anxiety, depression, decisional conflict and interaction between anxiety and decisional conflict, explained 24.3% of the variance in their advance care planning engagement. Decisional conflict mediated the association between anxiety and advance care planning engagement.
Increased anxiety and decisional conflict were associated with reduced advance care planning engagement directly, even among community-dwelling older adults with higher levels of education and health literacy. Increased anxiety was associated with reduced advance care planning engagement indirectly via increased decisional conflict. Healthcare professionals should assess community-dwelling older adults' anxiety and implement interventions to manage their anxiety and decisional conflict, as these may facilitate their engagement in advance care planning.
Understanding factors associated with advance care planning engagement among community-dwelling older adults may inform strategies facilitating their future engagement in advance care planning. Findings from this study may be used as evidence for future implementation to facilitate the engagement of community-dwelling older adults in advance care planning.
The STROBE statement checklist was used as a guide to writing the manuscript.
The study was advertised publicly through social media (e.g. Twitter and Facebook) and newsletters (e.g. Advance Care Planning Australia, Centre for Volunteering, Palliative Care Australia and a large home care service provider with approximately 7000 older clients receiving support or services) to recruit participants. People aged 65 years and older living independently in the Australian community who could communicate in English were invited to participate and answer the questionnaire.
To present the pooled estimated prevalence of adverse events in pronated intubated adult COVID-19 patients.
A systematic review and meta-analysis.
This study used the Cochrane Library, CINAHL, Embase, LILACS, Livivo, PubMed, Scopus, and Web of Science databases as data sources.
The studies were meta-analysed using JAMOVI 1.6.15 software. A random-effects model was used to identify the global prevalence of adverse events, confidence intervals and the heterogeneity data. Risk of bias was assessed using the Joanna Briggs Institute tool, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.
Of the 7904 studies identified, 169 were included for full reading, and 10 were included in the review. The most prevalent adverse events were pressure injuries (59%), haemodynamic instability (23%), death (17%) and device loss or traction (9%).
The most prevalent adverse events in mechanically ventilated pronated patients with COVID-19 are pressure injuries, presence of haemodynamic instability, death and device loss or traction.
The evidence identified in this review can help improve the quality and safety of patient care by helping to design care protocols to avoid the development of adverse events that can cause permanent sequelae in these patients.
This systematic review addressed the adverse events related to prone position in intubated adult COVID-19 patients. We identified that the most prevalent adverse events in these patients were pressure injuries, haemodynamic instability, device loss or traction and death. The results of this review may influence the clinical practice of nurses who work in intensive care units and, consequently, the nursing care provided not only to COVID-19 patients but for all intubated patients due to other reasons in intensive care units.
This systematic review adhered to the PRISMA reporting guideline.
As this is a systematic review, we analysed data from primary studies conducted by many researchers. Thus, there was no patient or public contribution in this review.
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