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Missed nursing care is defined as care that is delayed, partially completed, or not completed at all. The scenario created by the COVID-19 pandemic may have influenced multifactorial determinants related to the care environment, nursing processes, internal processes, and decision-making processes, increasing missed nursing care.
This scoping review aimed to establish the quantity and type of research undertaken on missed nursing care during the COVID-19 pandemic.
This review was conducted following the Joanna Briggs Institute methodology for scoping reviews. We searched CINAHL, MEDLINE, Scopus, two national and regional databases, two dissertations and theses databases, a gray literature database, two study registers, and a search engine from November 1, 2019, to March 23, 2023. We included quantitative, qualitative, and mixed studies carried out in all healthcare settings that examined missed nursing care during the COVID-19 pandemic. Language restrictions were not applied. Two independent reviewers conducted study selection and data extraction. Disagreements between the reviewers were resolved through discussion or with an additional reviewer.
We included 25 studies with different designs, the most common being acute care cross-sectional survey designs. Studies focused on determining the frequency and reasons for missed nursing care and its influence on nurses and organizational outcomes.
Missed nursing care studies during the COVID-19 pandemic were essentially nurses-based prevalence surveys. There is an urgent need to advance the design and development of longitudinal and intervention studies, as well as to broaden the focus of research beyond acute care. Further research is needed to determine the impact of missed nursing care on nursing-sensitive outcomes and from the patient's perspective.
Nurses have long received recommendations to employ self-care behaviors to ensure their ability to remain in the profession; however, nurses are rarely asked what self-care behaviors are beneficial. This literature review aimed to map studies on nurses' self-care strategies to provide an understanding of how these strategies are addressed in the literature and to identify gaps in need of additional exploration.
Searches were conducted in accordance with published mapping review methodologies across MEDLINE, Embase, CINAHL, Scopus, PsycINFO, Web of Science, and identified influential nursing journals. Included studies were from the United States, peer-reviewed, and described self-care strategies related to nurses or the nursing profession.
Thirty-five articles were identified for inclusion and were evaluated based on agreed-upon criteria to define how the concept of self-care was studied and applied to nurses. Three main categories were identified in this review: self-care and stress; self-care and burnout; and self-care and leadership, workplace factors, and physical activity.
This mapping review revealed an abundance of literature related to self-care recommendations for nurses; however, there remains a dearth of studies investigating how nurses utilize self-care behaviors independently to improve their own professional well-being. Recommendations for next steps in research in this area are included.
Patient safety is one of the cornerstones of high-quality healthcare systems. Evidence-based practice is one way to improve patient safety from the nursing perspective. Another aspect of care that directly influences patient safety is missed nursing care. However, research on possible associations between evidence-based practice and missed nursing care is lacking.
The aim of this study was to examine associations between registered nurses' educational level, the capability beliefs and use of evidence-based practice, and missed nursing care.
This study had a cross-sectional design. A total of 228 registered nurses from adult inpatient wards at a university hospital participated. Data were collected with the MISSCARE Survey-Swedish version of Evidence-Based Practice Capabilities Beliefs Scale.
Most missed nursing care was reported within the subscales Basic Care and Planning. Nurses holding a higher educational level and being low evidence-based practice users reported significantly more missed nursing care. They also scored significantly higher on the Evidence-based Practice Capabilities Beliefs Scale. The analyses showed a limited explanation of the variance of missed nursing care and revealed that being a high user of evidence-based practice indicated less reported missed nursing care, while a higher educational level meant more reported missed nursing care.
Most missed nursing care was reported within the subscales Planning and Basic Care. Thus, nursing activities are deprioritized in comparison to medical activities. Nurses holding a higher education reported more missed nursing care, indicating that higher education entails deeper knowledge of the consequences when rationing nursing care. They also reported varied use of evidence-based practice, showing that higher education is not the only factor that matters. To decrease missed nursing care in clinical practice, and thereby increase the quality of care, educational level, use of evidence-based practice, and organizational factors must be considered.
Continuity of patient care ensures timely and appropriate care and is associated with better patient outcomes among cancer patients. However, the impact of nurse staffing grade changes on patient outcomes remains unknown.
This retrospective cohort study aimed to evaluate the effect of fragmented care and changes in nurse staffing grade on the survival of colorectal cancer patients who underwent surgery.
This study included 2228 newly diagnosed colorectal cancer patients. Fragmented care was defined as the receipt of treatment in multiple hospitals and was divided into three categories based on changes in nurse staffing grade. Five-year survival rates were used to evaluate the effect of fragmented care and nurse staffing grade on outcomes of cancer patients. Survival analysis was performed by adjusting for covariates using the Cox proportional hazards model for 5-year mortality.
Approximately 18.5% of patients died within 5 years; the mortality rate during cancer treatment was higher in patients who received fragmented care, especially in those transferred to hospitals with fewer nurses. Patients who received fragmented care had shorter survival times, and those transferred to hospitals with fewer nurses had higher risks of 5-year mortality (hazard ratio: 1.625; 95% CI: [1.095, 2.412]). Transfers to hospitals with fewer nurses were associated with increased mortality rates in low-income patients, hospitals located in metropolitan and rural areas, and high-severity groups.
Receipt of fragmented care and change in nurse staffing grade due to patients' transfer to different hospitals were associated with increased mortality rates in cancer patients, thus underlining the importance of ensuring continuity and quality of care. Patients from rural areas, from low-income families, and with high disease severity may have better outcomes if they receive treatment in well-staffed hospitals.
Breast cancer survivors are increasing in South Korea, and resilience has become very important in their life.
This study aimed to examine the relationships among anxiety, depression, family support, problem-focused coping, emotion-focused coping, self-efficacy, and resilience, and the factors influencing the resilience of breast cancer survivors.
A cross-sectional descriptive design was employed. Participants were 153 breast cancer survivors after completion of treatment who were 5 years or less after diagnosis in South Korea. Measures were the general characteristics list, Korean version of Connor-Davidson Resilience Scale, Korean version of Hospital Anxiety and Depression Scale, family support scale, Korean version of Ways of Coping Checklist, and Self-Efficacy Scale.
The strongest predictor that influenced resilience was depression (β = −0.32), followed by family support (β = 0.23) and problem-focused coping (β = 0.15). Resilience levels in breast cancer survivors after completion of treatment were relatively low.
Interventions using problem-focused coping, including family members, could increase resilience, thus, moving away from focusing solely on the perspectives of cancer survivors when developing and implementing support interventions. Nurses should pay attention to influencing factors to help improve the resilience of breast cancer survivors during the extended survivorship phase.
Fatigue is a common symptom in cancer patients receiving radiotherapy. However, previous studies report inconsistent patterns of fatigue change.
The aim of this study was to estimate changes in fatigue among patients with cancer before, during, and after radiotherapy.
Five databases (PubMed, SDOL, CINAHL Plus with Full Text, Medline [ProQuest], and ProQuest Dissertations) were searched for studies published from January 2006 to May 2021. Three effect sizes of fatigue change (immediate, short-term, and long-term) were calculated for each primary study using standardized mean difference. A random-effect model was used to combine effect sizes across studies. Subgroup analyses and meta-regression were performed to identify potential categorical and continuous moderators, respectively.
Sixty-five studies were included in this meta-analysis. The weighted mean effect size for immediate, short-term, and long-term effects was 0.409 (p < .001; 95% CI [0.280, 0.537]), 0.303 (p < .001; 95% CI [0.189, 0.417]), and 0.201 (p = .05; 95% CI [−0.001, 0.404]), respectively. Studies with prostate cancer patients had a significantly higher short-term (0.588) and long-term weight mean effect size (0.531) than studies with breast (0.128, −0.072) or other cancers (0.287, 0.215). Higher radiotherapy dosage was significantly associated with a higher effect size for both immediate (β = .0002, p < .05) and short-term (β = .0002, p < .05) effect.
Findings from this meta-analysis indicated that radiotherapy-induced fatigue (RIF) exist for more than 3 months after the completion of treatment. Assessment of radiation-induced fatigue in cancer patients should extend long after treatment completion, especially for patients with prostate cancer and patients receiving a higher radiation dose. Interventions to reduce fatigue tailored for different treatment phases may be developed.
Nurses' lack of clinical judgment often leads to adverse patient outcomes due to failure to recognize clinical deterioration, intervene, and manage complications. Teaching clinical judgment through a nursing process can help nursing students provide safe and competent patient care with improved health outcomes and to pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN).
The aim of this study was to examine the effect of tutoring on clinical judgment of undergraduate nursing students utilizing Lasater's Clinical Judgment Rubric (LCJR). This study also compared the clinical judgment of male and female nursing students and students from different semester levels.
This quasi-experimental study utilized a single group pretest, posttest design. A convenience sample of n = 40 undergraduate nursing students from the Los Angeles County College of Nursing and Allied Health participated in the study. The participants underwent a pretest simulation, four sessions of the Clinical Judgment Model (CJM)-based tutoring, and a posttest simulation.
The posttest clinical judgment scores (35.70 ± 3.6) were significantly different from the pretest scores (25.78 ± 5.20). The tutoring had a significant effect on the clinical judgment of nursing students t(39) = −11.64, n = 40, p < .001, at 95% CI of the mean difference.
Enhancing nursing students' clinical judgment is crucial to provide high-quality, safe patient care with improved health outcomes. The CJM-based tutoring is an effective strategy for developing clinical judgment in nursing students. This new teaching approach can train students to critically think, develop clinical judgment, and prepare for the complex healthcare environment. Therefore, nurse educators should focus on integrating clinical judgment into the prelicensure nursing program curriculum as a priority.
Extensive literature has shown the effectiveness of cognitive behavioral therapy in treating perinatal depression, but little is known about the effectiveness of its technology-based version.
The aim of this review was to examine the effectiveness of technology-based cognitive behavioral therapy in reducing depressive and anxiety symptoms in women suffering from or at risk of experiencing perinatal depression.
Six electronic databases were searched until February 2023 for articles published in English. Random-effect meta-analyses were conducted. Heterogeneity was assessed using the I 2 statistics and Cochran's Q chi-squared test. Sensitivity analyses and subgroup analyses were also performed, and quality appraisals at the study and outcome levels were conducted.
A total of 16 randomized controlled trials were included in the review. Results from meta-analyses suggest that technology-based cognitive behavioral therapy has a medium effect in reducing perinatal depressive symptoms and a small effect in reducing perinatal anxiety symptoms. Overall, women suffering from or at risk of perinatal depression may benefit from technology-based cognitive behavioral therapy.
Future interventions can be improved by addressing both perinatal depression and anxiety, paying more attention to antenatal women to prevent postnatal mental health issues, and using self-guided mobile applications for accessibility.
Australia has been confronted with a severe nursing deficit, making it difficult to maintain a strong healthcare workforce capable of meeting the mounting demands of healthcare organizations.
This study aimed to understand how personal and organizational resources influence career optimism and job-related affective well-being of Australian nurses during a pandemic using the Conservation of Resource Theory.
A cross-sectional online survey was emailed to 123 Australian nurses from January to February 2021. The survey consisted of self-reported measures, including mindfulness, career optimism, job-related affective well-being, personal and job resources measures, and the Dirty Dozen scale. Correlations, independent sample t-test, and a series of hierarchical regressions were conducted on the cross-sectional data with SPSS Version 27. The STROBE checklist was used to report the results.
Findings suggested that mindfulness, perceived supervisor support, and job autonomy were significant predictors of job-related well-being, whereas mindfulness, perceived supervisor support, and opportunities for professional growth contributed more to career optimism of nurses during a health crisis. Male nurses in this study reported significantly higher mindfulness, career optimism, and job-related well-being levels than female nurses.
Developing mindfulness among nurses, allocating organizational resources to facilitate more supervisor support, and providing job autonomy may enhance career optimism and job-related well-being of nursing staff who work in disruptive and high-demand work environments such as those experienced during the COVID-19 health crisis. Supervisors should also facilitate and encourage nurses to reflect and be mindful of their behaviors with their peers and patients which can help to reduce exploitative or arrogant behaviors in the workplace.
Having robust power sources and employing effective influence tactics are essential leadership skills for nurse managers in managing human resources, providing quality care, and managing workplace conflict among nurses.
The present study aimed to investigate how bedside nurses perceived their nurse managers' power bases, influence tactics, and conflict management styles. Furthermore, the study investigated the relationship among power bases, influence tactics, and conflict management styles.
A descriptive correlational study was conducted at the inpatient care unit of a Saudi hospital. A convenient sample of n = 230 nurses completed the Power Base scale, Influence Behavior Questionnaire (IBQ-R), and Rahim Organizational Conflict Inventory-II (ROCI-II).
Nurses believed their managers were most likely to use referent, legitimate, and expert sources to exercise their power; appreciation and consultation tactics to influence others; and an integrative style to manage conflict. Significant positive correlations were found between the perceived overall power bases and each of the influence behaviors and conflict management styles (r = .466, r = .383, p < .05, respectively). The values of the regression coefficient of power bases significantly contribute to the prediction of 67.8% and 42.2% of the explained variance of influence behaviors and conflict management styles, respectively. In addition, influence behaviors can play a mediating role in this prediction.
Nurse managers should be able to demonstrate the benefit of controlling a wide range of power bases and know how to use influence behaviors and conflict management styles skillfully in each situation to achieve desired goals.
As pharmacotherapy often leads to adverse reactions, mind–body exercise (MBE) treatments have become a more popular option for treating depression in people living with breast cancer (BC). However, the most effective type of MBE treatment for this population remains unclear.
The aim of this systematic review and network meta-analysis (NMA) was to compare the efficacy of the different MBE modes for depression in people with BC.
A systematic search for randomized controlled trials (RCTs) from inception to March 25, 2023, was conducted in the following database: EMBASE, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, China Biology Medicine, OpenGrey, and ClinicalTrials.gov. A traditional meta-analysis was conducted using the random-effects model to directly assess the effectiveness of various MBE interventions. Stata 16.0 software was used for performing the NMA.
The NMA was performed in 32 eligible RCTs including 2361 participants. The efficacy of MBE treatments on depression was ranked as the following: Liuzijue (surface under the cumulative ranking curve [SUCRA] = 95.4%) > Tai chi (SUCRA = 76.9%) > yoga (SUCRA = 55.0%) > Baduanjin (SUCRA = 53.9%) > Pilates (SUCRA = 38.6%) > dance (SUCRA = 30.2%) > Qigong (SUCRA = 28.1%) > control (SUCRA = 21.9%).
Our research showed that Liuzijue and Tai chi might be the most significantly effective MBE intervention for mitigating depression among BC survivors. Healthcare professionals could consider recommending Liuzijue and Tai Chi as a complementary therapy for BC survivors who experience depression.
Daily huddles positively influence staff satisfaction and perception; standardization of a daily huddle should be prioritized to benefit from its effects.
The aim of this project initiative was to implement an evidence-based, standardized daily huddle on an inpatient medical-surgical oncology unit.
A searchable question was developed, and the identified literature was critically appraised and synthesized for evidence-based recommendations. The recommendations for the structure and content of a daily huddle were implemented using a standardized format.
Pre-implementation and post-implementation staff perception and satisfaction surveys yielded positive results. Improvements in effective communication and staff satisfaction were identified.
An effective daily huddle is essential for communicating pertinent information that can affect workflows and patient safety, as well as promoting teamwork and staff satisfaction.
It has been suggested that nursing shift-to-shift handover should be a more team-based dialogue with and for the patient rather than about a patient.
The aim of this study was to evaluate patient participation in relation to the implementation of the person-centered handover (PCH).
A pretest–posttest design was used without a comparison group, including patients from nine units in a university hospital at pretest (n = 228) and after implementing PCH (posttest, n = 253) per the framework integrated-Promoting Action on Research Implementation in Health Services. The PCH is inspired by an Australian bedside handover model. The Patient Preferences for the Patient Participation tool was used to rate the preference for and experience of participation on 12 items, combined into three levels of preference-based participation (insufficient–fair–sufficient).
There were no differences regarding experience or preference-based participation between patients at pretest–posttest; however, posttest patients experienced participation in the item Reciprocal communication to a lesser extent than the pretest patients. Only 49% of the posttest group received PCH; of those not receiving PCH, some would have wanted PCH (27%), while some would have declined (24%). Patients receiving PCH had sufficient participation (82%), to a greater extent, regarding the item Sharing one's symptoms with staff than patients at pretest (72%). Patients receiving PCH also had sufficient participation, to a greater extent, than patients at posttest who did not receive, but would have wanted PCH, regarding four items: (1) sharing one's symptoms with staff, (2) reciprocal communication, (3) being told what was done, and (4) taking part in planning.
Most patients want to be present at PCH. Therefore, nurses should ask for the patients' preferences regarding PCH and act accordingly. Not inviting patients who want PCH could contribute to insufficient patient participation. Further studies are needed to capture what assistance nurses would want in identifying and acting in alignment with patient preferences.
Individuals with atrial fibrillation (AF) are at an increased risk for stroke. Early detection of undiagnosed AF by screening is recommended. Single-lead electrocardiogram (ECG) is the most widely used technology in AF detection. Several systematic reviews on the diagnostic accuracy of single-lead ECG devices for AF detection have been performed but have yielded inconclusive results.
The aim of this study was to synthesize the available evidence on the effectiveness of single-lead ECG devices in detecting AF.
An overview of systematic reviews was conducted. Five English databases (Cochrane Database of Systematic Reviews, PubMed, Embase, Ovid, and Web of Science) and two Chinese databases (Wanfang and CNKI) were searched from inception to July 31, 2021. Systematic reviews that examined the accuracy of tools based on single-lead ECG technology for detecting AF were included. A narrative data synthesis was performed.
Eight systematic reviews were finally included. Systematic reviews with meta-analysis showed that single-lead ECG-based devices had good sensitivity and specificity (both ≥90%) in detecting AF. According to subgroup analysis, the sensitivities of tools used in populations with a history of AF were all >90%. However, among handheld and thoracic placed single-lead ECG devices, large variations in diagnostic performance were observed.
Single-lead ECG devices can potentially be used for AF detection. Due to the heterogeneity in the study population and tools, future studies are warranted to explore the suitable circumstances in which each tool could be applied for AF screening in an effective and cost-effective manner.
Weight management is an important part of disease management in patients with heart failure. However, the effectiveness of reported weight management interventions is inconclusive.
The aim of this systematic review and meta-analysis was to assess the effects of weight management on functional status, heart failure-related hospitalizations, and all-cause mortality in patients with heart failure.
PubMed, Web of Science, Embase, and the Cochrane Library were searched on April 3, 2022. This study was registered with PROSPERO (CRD42021283817). Eligible studies assessed functional status, heart failure-related hospitalizations, and all-cause mortality in patients with heart failure. Two researchers independently screened the articles, extracted data, and evaluated the risk bias of each study. Dichotomous variables were presented as OR with a 95% confidence interval (CI). The data were analyzed using a fixed effect or random effect model, and heterogeneity was determined using I 2 statistics. All statistical analyses were conducted using RevMan 5.3.
Among 4279 studies screened, seven randomized controlled trials were included in this study. The results showed that weight management significantly improved functional status (OR = 0.15, 95% CI [0.07, 0.35], I 2 = 52%) and reduced the risk of all-cause mortality (OR = 0.54, 95% CI [0.34, 0.85], I 2 = 0%), but had no significant effect on heart failure-related hospitalizations (OR = 0.72, 95% CI [0.20, 2.66]).
Weight management has effects on improved functional status and reduced all-cause mortality in patients with heart failure. It is necessary to strengthen the weight management interventions of patients with heart failure to improve patients' functional status and reduce all-cause mortality.
The unprecedented exodus of workers from the healthcare system is a patient safety crisis. Organizational compassion in health care is the proactive, systematic, and continuous identification, alleviation, and prevention of all sources of suffering.
This scoping review aimed to describe the evidence regarding the impact of organizational compassion on clinicians, identify gaps, and provide recommendations for future research.
A comprehensive librarian-assisted database search was conducted. Databases searched were PubMed, SCOPUS, EMBASE, Web of Science, PsychInfo, and Business Source Complete. Combinations of search terms regarding health care, compassion, organizational compassion, and workplace suffering were used. The search strategy was limited to English language articles and those published between 2000 and 2021.
Database search yielded 781 articles. After removing duplicates, 468 were screened by title and abstract, and 313 were excluded. One-hundred and fifty-five underwent full-text screening, and 137 were removed, leaving 18 eligible articles, two of which were set in the United States. Ten articles evaluated barriers or facilitators to organizational compassion, four evaluated elements of compassionate leadership, and four evaluated the Schwartz Center Rounds intervention. Several described the need to create systems that are compassionate to clinicians. Lack of time, support staff, and resources impeded the delivery of such interventions.
Little research has been done to understand and evaluate the impact of compassion on US clinicians. Given the workforce crisis in American health care and the potential positive impact of increasing compassion for clinicians, there is an urgent need for researchers and healthcare administrators to fill this gap.
As a devastating neurodegenerative disease, Alzheimer's disease (AD) imposes a considerable direct and indirect financial burden. However, effective drug treatment options are limited. In recent years, game therapy has become a research hotspot in this field.
The purpose of this study was to synthesize the conclusions of existing studies and integrate the data to evaluate the effects of game therapy on people living with dementia (PLWD).
We included randomized clinical trials and quasi-experimental studies which assessed the impacts of game therapy on PLWD and took cognitive function, quality of life, and depression as outcome indicators. Two trained researchers independently screened the studies, evaluated the quality, and extracted the data. Statistical analysis was performed by Review Manager (Revman) 5.3 and STATA16.0 software.
There were 12 studies involving 877 PLWD included, total. The results of the meta-analysis demonstrated that the Mini-Mental State Examination (MMSE) scores of the test group were significantly higher than that of the control group (SMD = 2.69, 95% CI [1.88, 3.51], p < .01), and the Cornell Scale for Depression in Dementia scores of the test group were significantly lower than those of the control group (SMD = −4.28, 95% CI [−6.96, −1.60], p < .01); but in terms of quality of life (SMD = 0.17, 95% CI [−0.82, 1.16], p = .74), the difference was not statistically significant.
Game therapy can improve cognitive function and depression in PLWD. The combination of different types of games can improve the different clinical symptoms of PLWD, and different intervention time also have different effects on the outcome, which shows that we can develop unique, systematic, safe, and scientific game intervention programs for PLWD to improve their cognitive function and depression.
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