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The teach-back method is an effective approach for reinforcing patient education by clarifying and reviewing misunderstood concepts.
To examine the effect of discharge training based on the teach-back method on discharge readiness and satisfaction in patients undergoing lumbar disc herniation surgery.
A randomized controlled trial using a pre-test–post-test design was conducted at two state hospitals in Northern Cyprus from November 2022 to December 2023. A total of 64 patients were randomly assigned to either the intervention group (n = 32) or the control group (n = 32). Data were collected using the Discharge Education Satisfaction Scale, the Readiness for Hospital Discharge Scale, and the Discharge Education Knowledge Test. The CONSORT 2010 flow diagram was followed.
The mean ages of the intervention and control groups were 51.26 ± 11.92 years and 46.50 ± 11.73 years, respectively. Following the intervention, patients who underwent lumbar disc herniation surgery in the intervention group showed significantly higher scores compared to the control group (p < 0.05). These improvements were observed in overall discharge education satisfaction, discharge education knowledge, and all subdimensions of discharge readiness–including personal status, knowledge, and coping ability.
Discharge education delivered using the teach-back method enhances satisfaction, knowledge, and discharge readiness in patients undergoing lumbar disc herniation surgery.
Trial Registration: The full research protocol is available at ClinicalTrials.gov (NCT05695014)
The interaction between dementia and changes in health status accelerates the progression of dementia and health deterioration. Although health indicators exist for older adults, comprehensive ones for dementia are lacking.
To (1) establish core health indicators for older adults with dementia, (2) develop an integrated health assessment toolkit for older adults with dementia, and (3) test the feasibility and applicability of the integrated health assessment toolkit.
This study involved two phases. In the first phase, using the Delphi method, opinions from 10 experts were synthesized to establish core health indicators for older adults with dementia. In the second phase, with a descriptive research approach, an integrated health assessment toolkit was developed, evaluated by 10 daycare case managers for feasibility, and then pilot tested with 50 older adults with dementia across three daycare centers.
The core health indicators for older adults with dementia covered 18 indicators in five domains: (1) cognitive and behavioral impairment, (2) sensory and perceptual impairment, (3) disease and dysfunction, (4) functional fitness deterioration, and (5) social isolation. After two rounds of assessments, experts rated the criteria's importance and clarity at 0.94 and 0.89 on the scale-level content validity index/universal agreement (S-CVI/UA), respectively. In the second phase, the integrated health assessment toolkit was developed, which integrated five observational assessment scales and six physical function measures. The average applicability scores ranged from 7.80 to 9.90 out of 10. In the pilot test, the assessment process proceeded smoothly without any adverse events. However, 10 participants did not comply with wearing the actigraphy device.
The core health indicators and the corresponding health assessment toolkit are feasible to assess the health of older adults with dementia that could provide valuable insights and guide future interventions to enhance their well-being.
Nurse leaders at every level are needed to help organizations achieve strategic goals and deliver safe patient care. Nurse leaders can find fulfillment in their roles; however, they are often prone to poor work-life balance due to the complexity and demands of their jobs. Professional well-being, consisting of an individual's overall health and the perception of good work-related quality of life, is at risk for being compromised in these nurses. Research exploring variables associated with psychosocial well-being in nurse leaders is limited.
To describe variables related to psychological well-being in nurse leaders, explore associations among these variables, and identify potential demographic and psychosocial predictors of resilience and burnout.
Participants were a convenience sample of nurse leaders from two hospitals located in the southwestern United States. We used a prospective observational design to describe the incidence of and relationships between self-compassion, satisfaction with life, resilience, perceived stress, and burnout. We then sought to identify predictors of disengagement and exhaustion (subscales of burnout) and resilience.
Participants (n = 105) were mostly female (82.7%) and white (57.7%), while one-third were charge nurses. Most reported normal to high levels of satisfaction with life (86%), self-compassion (90%), and resilience (93.3%) and 72.4% reported high stress levels. Moderately high levels of disengagement (46.4%) and exhaustion (59.1%) were also present. Higher self-compassion levels predicted higher levels of resilience. Lower satisfaction with life and self-compassion together predicted high disengagement scores, while lower self-compassion scores predicted high exhaustion scores.
When disengagement, exhaustion, and perceived stress are elevated, nurse leaders are at risk for low professional well-being and may be more prone to resignation ideation or turnover. Evidence-based interventions designed specifically for nurse leaders promoting professional well-being and emphasizing self-compassion skills are needed along with high-quality research on program outcomes.
Integrating evidence-based interventions in services by midwives and public health nurses (PHNs) has the potential to improve public health. Attitudes and individual readiness to change can influence the implementation of evidence-based interventions, but there is limited research in community nursing and maternity and child health care services (MCHCs).
To examine attitudes toward evidence-based practice and readiness to change in midwives and PHNs in MCHCs before implementing the “Mamma Mia” intervention (an evidence-based intervention to improve maternal mental health).
A survey-based, multisite cross-sectional study following the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guideline. Data were collected from 190 midwives and PHNs from 42 MCHCs across 33 municipalities in Norway (2021–2022). Six subscales of the Evidence-Based Practice Attitude Scale (EBPAS) assessed attitudes toward evidence-based practice, and the Brief Individual Readiness for Change Scale (BIRCS) measured individual readiness. Descriptive and inferential statistics using frequency tables, Pearson correlation coefficient, and linear regression were used for data analysis. Open-ended responses were analyzed using content analysis.
Sixty-five midwives and 125 PHNs completed the baseline survey (mean age 46.8, all female). Mean EBPAS subscales scores were 2.99 to 3.58 (SD = 0.46–0.77) mean BIRCS score was 3.16 (SD = 0.49) (possible range 0–4). Scores were slightly higher than typically reported in clinical settings, with no significant differences based on demographics (all p-values ≥ 0.166). EBPAS subscores and the BIRCS score showed a moderate positive association. The most frequently reported positive factors influencing readiness were “enhanced care and positive gain” (42.6%), “organizational support” (26.3%), and “receiving training and implementation support” (23.2%). Negative factors included “time constraints and workload” (58.4%), and “research participation and implementation demands” (27.9%).
Midwives and PHNs showed positive attitudes toward EBP and a high degree of individual readiness. Our findings align with previous research highlighting barriers such as time constraints and workload, offering insights to inform strategies for more effective EBP adoption and implementation. These results can guide nurse managers, administrators, policymakers, professional associations, implementers, and intervention developers in enhancing EBP integration into practice.
Evidence-based practice (EBP) should be implemented in clinical settings and practiced by registered nurses as it improves healthcare quality, safety, costs, and patient outcomes. For this to occur, nurses need to be skilled and acculturated. An EBP culture needs to be developed and sustained, both in initial academic programs and in clinical settings. Implementation models already exist and are being used, but outcomes are not consistently measured.
The aim of this scoping review was to gather and map the use of EBP implementation models as well as their implementation strategies and outcomes.
The methodology for the JBI Scoping Reviews was applied. The databases queried were PubMed, CINAHL, EMBASE, EMCARE, AMED, BNI, HMIC, PsycInfo. Inclusion criteria were as follows: Any primary study that describes the implementation of EBP in nursing, clinical, or academic settings. Studies using the following EBP implementation models were included: the ARCC Model, ARCC-E Model, IOWA Model, Stetler Model, Johns Hopkins Nursing EBP Model, ACE Star Model as well as PARIHS and i-PARIHS. They must have used Proctor's taxonomy for implementation outcomes as well as described implementation strategies according to the ERIC classification. Data extraction was performed by four independent reviewers in February 2024. There was no language or date limitation. Three independent reviewers performed an initial selection on titles and abstracts. Reading of the full texts was carried out by two independent reviewers using the JBI SUMARI.
A total of 2244 articles were retrieved. After removing duplicates and applying the inclusion criteria, 26 articles were reviewed, and data extracted. The most used implementation model was the PARiHS or i-PARiHS model followed by the IOWA model, the ARCC model combined with the JHNEBP model and the Stetler model. Nearly all studies used the implementation strategy domain “Use evaluative and iterative strategies” of ERIC classification. Overall, the selected studies used between 1 and 2 outcomes from Proctor's eight available.
The underuse of existing taxonomies (Proctor, ERIC) prevents an exhaustive mapping of the use of implementation models. The vocabulary used is too vague, and the implementation strategies are sometimes poorly described. An effort needs to be made to report on all work done to transfer the results to other settings and thus improve health care practices.
Evidence-based practice (EBP) is essential for clinical decision-making, integrating the best available evidence, clinical expertise, and stakeholder values. In Italy, interest in EBP is growing, and a key step in its promotion is adopting tools to assess nurses' beliefs and behaviors toward EBP. While the EBP Beliefs Scale has been translated and validated in multiple languages, it has yet to be adapted for the Italian context.
This study aims to adapt EBP measurement tools for the Italian context and evaluate their psychometric properties.
This study used an observational cross-sectional design. The process of cross-cultural translation, adaptation, and validation was adopted. A panel of experts culturally adapted the Beliefs Scales (long and short version) through the item and scale content validity (I-CVI, S-CVI). To test the psychometric properties, 409 nurses were asked to complete the two scales. Confirmatory factor analysis was conducted to validate the factor structure within the Italian context. Convergent validity between the long and short versions of the scale was assessed using the correlation coefficient (r), and the reliability was assessed by computing Cronbach's alpha.
The I-CVI and S-CVI for the long and short version ranged from 0.75 to 1.00. The CFA model performed for the long and short version reported a good fit without the need for further refinements. The Cronbach's alpha was higher than 0.80 for both scales. The correlation of 0.615 (p < 0.01) indicated a moderate to strong positive relationship supporting the convergent validity of the short version in relation to the long version.
In time-constrained settings, the short scale should be utilized for efficient assessments and longitudinal tracking of changes. The long version serves as a complementary tool for in-depth analysis, facilitating a deeper understanding of underlying factors and informing targeted interventions to address specific barriers.
Work-related stressors have been associated with physician suicide. Physician burnout and depression were exacerbated by the COVID-19 pandemic, remain unresolved and of national concern. Future pandemics are predicted. This study is the first to characterize professional and pandemic-related stressors in physician suicides during the COVID-19 pandemic.
This study aimed to evaluate whether there was a change in reported job-related stressors after the beginning of the COVID-19 pandemic.
Physician suicides were identified within the National Violent Death Reporting System dataset (March 1, 2020 to December 31, 2021). Free-text law enforcement and medical examiner notes for physician suicides were analyzed using reflexive thematic analysis.
Of 307 physician suicides, 70 included professional or pandemic-related stressors associated with death. Themes included pandemic-related dysregulation, financial distress, relationship issues, mental/physical/substance use problems, grief, and discipline.
While loss of employment, physical, mental health, legal, and substance use issues continue to be associated with suicide, grief and pandemic-specific stress were novel findings. Fear of disease, quarantine, and prolonged illness due to contracting COVID warrant psychological support. Psychological support is also indicated for recent discharge, grief management, transition into retirement, and during disciplinary processes. The stress of a pandemic may exacerbate previous risks. Proactive physician suicide prevention measures remain indicated.
The mental health and well-being of nurses are critical issues in health care, particularly following the increased stressors introduced by the COVID-19 pandemic. Nurses frequently experience burnout, stress, and emotional exhaustion due to systemic issues such as staffing shortages, heavy workloads, and limited access to mental health resources. These challenges not only affect nurses' well-being but also impact the quality of patient care. Organizational support plays a pivotal role in mitigating these issues, yet the lived experiences of nurses regarding such support remain underexplored.
This Study Aimed to Explore Nurses' Lived Experiences of Organizational Support and Its Impact on Their Mental Health Recovery, With a Focus on Identifying Actionable Strategies for Improvement.
A qualitative phenomenological approach was employed, using Interpretative Phenomenological Analysis (IPA) to gain deep insights into nurses' experiences. Twenty nurses from various healthcare facilities in the Asir region, Saudi Arabia, were recruited through purposive sampling. Data were collected through face-to-face semi-structured interviews and analyzed using thematic analysis to identify recurring patterns and themes.
Three main themes emerged: (1) Supportive Leadership, highlighting the critical role of empathetic and communicative leadership in fostering well-being; (2) Systemic Barriers, including staffing shortages, heavy workloads, and limited access to mental health resources; and (3) Workplace Wellness Culture, reflecting the influence of stigma, peer support, and the practicality of wellness programs on mental health recovery. These themes underscore the interconnected nature of leadership, systemic issues, and workplace culture in supporting nurses' mental health.
The findings suggest several actionable strategies, including leadership training programs to foster empathy and communication, policies to address systemic barriers, tailored and accessible wellness programs, and initiatives to reduce mental health stigma. These interventions are essential for creating supportive environments that prioritize nurses' well-being and enhance their ability to deliver high-quality care.
Nurse managers are essential in mitigating burnout among staff nurses; however, they are also susceptible to burnout due to overwhelming workloads and emotional exhaustion. This study examines the effectiveness of interventions designed to increase burnout awareness among nurse managers and promote proactive strategies to combat it.
The study aimed to enhance nurse managers' awareness of burnout using a technology-based solution and assess the impact of targeted interventions.
Data were collected over 8 months utilizing self-report assessment, reflective journaling, a pre–post burnout survey (MBI-GS), individual coaching, and postintervention focus groups.
Postintervention analysis showed improvement across all MBI-GS subscales and a notable improvement in burnout awareness. Twenty-eight percent of nurse managers remained unaware or blocked postintervention, compared to 43% preintervention. Overall, burnout awareness improved by 21%.
This study highlights the importance of burnout awareness for nurse managers, demonstrating that a technology-based solution, combined with targeted human-centered interventions, supports technology adoption, burnout awareness, and the development of adaptive behaviors.
Evidence-based interventions (EBI) can reduce nursing burnout and improve retention and healthcare quality. Nursing school is an ideal time to implement EBI to mitigate burnout and increase resilience in pre-professional populations.
The current study tested whether Mindfulness-Based Stress Reduction (MBSR) significantly improved stress, burnout, and wellness in a university-based nursing school.
Using a non-randomized clinical trial design, multilevel modeling for repeated measures tested intervention effects over time in MBSR participants (n = 73) and matched controls (n = 73), as well as potential moderation of intervention effects by modality (online vs. in-person MBSR) and subpopulation (students vs. faculty/staff).
MBSR effectively reduced perceived stress, exhaustion, and total burnout and increased positive affect and frequency of using two key mindfulness skills: observing and nonreactivity. No significant effects of the intervention were observed for disengagement from work, satisfaction with life, negative affect, or the mindfulness skills of describing, acting with awareness, and nonjudgment. Effects were similar across modality and subpopulation.
MBSR increases stress resilience and can be delivered effectively online and in person. Moreover, MBSR appears equally impactful for nursing students and faculty/staff. Implications for integrating EBI into schools of nursing to improve well-being are discussed.
Nursing school causes immense stress for students, and the attrition rate is high. Nurse educators have long been aware of the documented relationship between well-being and academic success, as well as the anxiety, depression, insomnia, fear, and exhaustion that result in student burnout. However, there has been little change in the nursing curriculum, and few nursing curricula include student well-being education.
This scoping review aimed to search the literature for student well-being education concepts integrated into the nursing curriculum.
This scoping review was performed on Scopus 20, American Psychological Association's (APA) PsychNet database, and CINAHL database using Arksey and O'Malley's 6-step methodology. Search terms included nursing AND student AND well-being AND curricula OR education OR curriculum. Articles were excluded if they were graduate-level education, not faculty or student-focused, not in an academic setting, or if the study was completed in a foreign country or was COVID-19 pandemic-related. Other limitations were the years 2020–2024 and in the English language.
A total of 19 articles were chosen for inclusion in the scoping review. Ninety-nine articles were found on Scopus 20 and limited by careful analysis to 16. No eligible articles were found on APA PsychNet. The CINAHL database produced four articles, with two chosen for inclusion after a full-text review. One article was found through hand-searching during the literature search process. Articles discussed using one well-being course, integrating a specific well-being program, utilizing multiple well-being activities, developing faculty training skills for the integration of well-being, and creating a shared agenda for the design of well-being activities within the nursing curriculum.
The nursing curriculum should include well-being activities in each nursing course. Supporting nursing students' well-being will enhance their academic success and decrease burnout.
Nurse leaders are at a higher risk for burnout post-pandemic. Resilience skills training incorporating mind–body awareness and self-compassion practices significantly improved stress, self-compassion, and mindfulness in medical professionals by the end of the training.
This study aimed to assess if a 6-h resiliency training delivered to nurse leaders would improve measures related to well-being, for example, stress, burnout, life satisfaction, self-compassion, resilience, and mindfulness by the end of the course, and if any improvements would be sustained over time.
We prospectively examined the effects of a 6-h resiliency training on well-being outcomes in nurse leaders in a longitudinal study during Spring 2022 through Fall 2022. Experienced resiliency teachers trained 46 nurse leaders. Participants took pre-, post-, and 2-months-post online surveys measuring well-being-related variables. Only 48% (n = 22) completed the entire course and surveys at all three times.
Nurse leaders were mostly female (n = 38, 83%) and white (n = 27, 59%) with an average age of 44.72 [SD = 9.5] years. Median years of experience were 15.5 [3.5–47]. One-way repeated measures ANOVA demonstrated a significant effect across time on stress (p = 0.02), self-compassion (p = 0.02), mindfulness (p = 0.04), and the exhaustion subscale of burnout (p = 0.008) but the significant changes occurred by the 2-month follow-up. Resilience, life satisfaction, and disengagement scores did not significantly change.
Baseline stress and burnout scores were high in 43.5%–63% of the nurse leaders, indicating a need for continued support of nurse leaders to reduce stress and burnout. Post resiliency training, scores in perceived stress and exhaustion decreased significantly over time, demonstrating the efficacy of this 6-h program to improve key variables related to well-being in nurse leaders. While baseline self-compassion scores were already high in nurse leaders, statistically significant improvements in self-compassion and mindfulness, but not resilience, occurred 2 months after this resiliency training program. Significant changes in key variables related to well-being occurred 2 months post training, indicating the need for further exposure and time with practices taught in the course. Nurse leaders need support to break away from work tasks to participate in psychoeducational trainings and interventions to improve well-being. We need further applied research on how to improve well-being in clinicians from a systems and environmental perspective.
Sudden unexpected infant death (SUID) is a leading cause of infant mortality in the United States. Hospitals have implemented infant safe sleep programs with varying measures and degrees of success, but few have demonstrated improvements in hospital-based and home safe sleep practices with nurse subject matter experts (SMEs) and community SUID prevention campaigns.
This project evaluated the impact of a state-wide, evidence-based infant safe sleep program for birthing hospitals using nurse SMEs and a community awareness campaign on nurse knowledge, safe sleep environments, and trends in infant sleep-related deaths.
Between 2016 and 2021, a pre- and post-test quality improvement intervention-based design was used to enroll hospitals and train and embed SMEs to educate peers, conduct practice surveillance and audits, and address practice deviations. A website housed comprehensive resources, and a large-scale community-based social and print media campaign on safe sleep practices occurred. Nurse and practice data from 12 hospitals that fully implemented the program were compared pre- and post-implementation. State-wide survey data for key safe sleep indicators reported by parents were compared from our 12 birthing hospitals to other facilities.
Of trained nurses (N = 902), 83.4% reported making substantial or exceptional progress in being proactive in surveillance of safe sleep environments. Pre- and post-implementation environmental audits showed a significantly higher proportion of infants in safe sleep positions post-implementation (94.3%) than pre-implementation (89.6%) (p = 0.001). Statewide survey data from birth parents discharged from our program hospitals significantly outperformed those discharged from other state facilities. Multi-media campaigns resulted in over 1.4 million impressions on our website. Sleep-related deaths for infants born at four program hospitals dropped 16.1% from 31 in 2018 to 26 in 2021.
A safe sleep program improved hospital-based nurses' knowledge and practice and birth parent's knowledge and behaviors, and it was associated with a decrease in infant sleep-related deaths.
Nationally and in Hawaii, nurses are in crisis with high rates of distress, burnout, and intent to change jobs. Organizations need evidence-based strategies to support nurse well-being.
Informed by the National Academy of Medicine Factors Affecting Clinician Well-Being Model, this study aimed to identify individual and external factors associated with nurses' well-being.
In December 2023, an online survey of hospital-based nurses from two major hospitals, representing various unit types, was conducted in Hawaii. Survey measures included individual (role, personal characteristics, skills/abilities) and external factors (organizational, environmental) that support clinician well-being. The outcome (well-being) was measured using the well-being index (scores ranged from −2 [excellent] to 9 [very poor]). The analysis included general linear modeling with stepwise backward selection.
The final sample included 552 nurses. Years of experience were evenly distributed, and the majority worked ≥ 36 h/week (85.9%), worked in intensive-focused or other specialties units (53.8%), and identified as female (87.3%). The nurses identified their race/ethnicity as 27% Filipino, 23% White, 14% Japanese, 11% Other Asian, 6.1% Hispanic, 5.1% Native Hawaiian/Pacific Islander (NHPI), and 14% mixed or other race. The average well-being score was 2.8 (SD = 2.3). NHPI had the lowest (Mean ± SD = 2.2 ± 2.2), and Filipino and White nurses had the highest well-being scores (3.0 ± 2.2; 3.0 ± 2.0, respectively), although no significant racial/ethnic difference was found. Several internal and external factors were significantly associated with well-being. For example, working ≥ 36 h/week, reports of experienced burnout, having primary caregiving responsibility outside of work, lower self-reported physical health, and the experience of workplace violence all increased average well-being scores (worsened well-being). In contrast, having higher personal resilience, no leadership responsibilities, the belief that their organization is responsive to complaints and concerns, and appropriate ancillary staff to support their work all decreased average well-being scores (improved well-being).
Healthcare organizational leaders and policymakers must urgently correct system issues contributing to burnout, suboptimal mental health, decreased well-being, and attrition among nurses. Healthcare organizations should cultivate wellness cultures and provide infrastructure that offers evidence-based interventions to support nurses' well-being.
Dissemination of results following clinical trials and community-based research provides value to participants and communities beyond the intent of the primary study. Organizations participating in multi-site research may see similar benefits if local results are shared; however, it is not standard practice. Evaluation of the impact of results sharing in multi-site research is needed.
To assess the benefits of organizational participation in a multi-site pediatric pain study when results were shared, identify how sites applied local results, and the outcomes of participation, including subsequent improvement efforts and scholarship.
Following data collection for a 12-hospital multi-site study, site research teams shared their experiences collecting the data and lessons learned. All sites received a packet with overall results, their local results, and an interpretation guide. 4 years later, the sites were surveyed about initiatives that were undertaken because of the primary study.
Following data collection, 10 of 12 sites described unanticipated benefits of participation, including identifying gaps and strengths of documentation, generation of new practice questions, and identification of new opportunities for improvement. Seven sites answered the follow-up survey 4 years later. Most sites (n = 6, 85.7%) used their data to inform multiple practice changes (M = 2.8, SD 0.75), including changes in pain documentation (n = 5, 83.3%), assessment (n = 4, 66.7%), policy (n = 4, 66.7%), and treatments (n = 4, 66.7%). Five sites reported an average of 2.4 (SD 1.14) additional activities stimulated by participation, but not directly due to data. Three sites used results for American Nurses Credentialing Center Magnet Recognition applications.
When multi-site investigators provide local data, organizations see long-term benefits, including new collaborations, quality improvement efforts, and research. Additional exploration of collaborative strategies between investigators and practice settings in multi-site research is needed for pediatric pain management and beyond.
Evidence-based practice (EBP) is an approach that integrates the best evidence from research. It combines four concepts: patient preferences and values, clinical expertise, available resources, and the best evidence. Models exist and allow for its implementation, and the mentor appears as a facilitator.
To explore the mentor's role and its impact on nursing staff.
Inclusion criteria included sources that report clinical setting, EBP context, nurse, mentor, and related terms. We searched for published and unpublished studies and reports without any language and date limit. The search was conducted on January 25, 2024. Databases searched included MEDLINE, CINAHL, COCHRANE Library, Embase, Emcare, Google Scholar, Web of science, JBI EBP Database, and ProQuest Dissertations and Theses. The search strategy identified a total of 3195 studies and reports. The relevant data were extracted by two reviewers as recommended by the JBI Manual for Evidence Synthesis.
Seventy studies and reports were included in this scoping review. The mentors are mostly advanced practice nurses (APNs) who have completed EBP training. Mentorship programs aim to instill a spirit of inquiry and improve EBP skills of future mentors. As interprofessionality appears as a facilitator, a lack of time and resources is the main barrier. Mentors help teams improve their research skills in different ways to develop a research culture in a sustainable way and significantly improve beliefs and implementation.
This study demonstrated the interest of the mentor l working in interprofessionality while establishing a close link between the clinical environment and the university to combine the skills and resources of the two fields. The implementation of a mentoring program appears to be a necessity to train nurses in EBP daily. An investment in mentoring makes it possible to improve the quality of care, but also the quality of the work environment. APNs and managers must take on this leadership role to drive this culture of research and practice improvement. Managers must free up time for mentors in order to be able to support and carry out EBP projects. As mentors, they are expected to communicate about ongoing research projects, whether through conferences, congresses, informal, or formal meetings.
Previous studies regarding mind–body exercise among people with breast cancer mostly focused on one type of mind–body exercise and provided conflicting results.
This paper aims to systematically synthesize the evidence hierarchy and examine the credibility of previous meta-analyses of different types of mind–body exercises.
We searched PubMed, Embase, Cochrane Library, Web of Science, and Epitemonikos from database inception to February 2nd, 2024, for meta-analyses of randomized controlled trials. Included meta-analyses examined the effects of mind–body exercises on at least one outcome of health-related quality of life, cancer-related fatigue, depression, anxiety, and sleep quality in breast cancer patients. The random effects estimates (Hedges'G), 95% prediction interval, small study effect, and excess significance bias were calculated. Furthermore, we categorized meta-analyses based on the evidence credibility criteria and assessed quality using A Measurement Tool to Assess Systematic Reviews 2.
The umbrella review included a re-analysis of 16 meta-analyses of 9 articles including 134 randomized controlled trials involving 9469 breast cancer patients and survivors. We identified 3 articles as “low” quality and 6 articles as “critically low” quality. Convincing evidence supported the effectiveness of Yoga intervention in reducing depression symptoms (G = −0.77, 95% Confidence Interval [−0.93, −0.61]). However, 11 meta-analyses were supported by weak evidence (1 for Qigong alleviated depression, 4 for Qigong, Baduanjin, Tai Chi Chuan, and Yoga improved health-related quality of life, 3 for multiple mind–body exercises, Tai Chi Chuan, and Yoga reduced cancer-related fatigue, 2 of Baduanjin and Yoga reduced anxiety, as well as 1 of Yoga improved sleep quality).
Mind–body exercises, especially yoga, may be beneficial for improving health-related quality of life and mental health for breast cancer patients. Further high-quality interventions investigating diverse mind–body exercise interventions are warranted to ascertain the effectiveness of health-related quality of life and mental health outcomes.
Over the past three decades, research studies on nurses' engagement in evidence-based practice (EBP) have been widely reported, particularly in high-income countries, with studies from these countries dominating literature reviews. As low- and middle-income countries (LMICs) continue to join the EBP movement, primary research has emerged over the past decade about nurses' engagement with EBP.
The aim of this scoping review was to identify the types and extent of published research regarding nurses' knowledge, skills, attitudes, beliefs, and implementation of EBP in LMICs.
The JBI scoping review methodology was used. Eight databases were searched up to November 2023. The review included primary studies (quantitative, qualitative, and mixed methods) that reported the knowledge, skills, attitudes, beliefs, or implementation of EBP among nurses in LMICs. Included studies focused on registered nurses in all healthcare settings within LMICs. Studies published in English were included with no limit on publication date. Two independent reviewers screened titles, abstracts, and full-text articles of published studies. Data were analyzed quantitatively using frequencies and counts. Textual data from qualitative studies were analyzed using descriptive content analysis.
Fifty-three publications were included, involving 20 LMICs. Studies were published between 2007 and 2023, with over 60% published in the past 7 years. Studies that evaluated familiarity/awareness of EBP showed that in general, nurses had low familiarity with or awareness of EBP. Most studies (60%) described nurses' attitudes toward EBP as positive, favorable, or high, and 31% as moderate. However, over 60% of studies described nurses' EBP knowledge/skills as moderate, low, or insufficient. Approximately 84% of studies described EBP implementation in healthcare settings as moderate, low, poor, or suboptimal.
Studies on nursing EBP have been increasing in LMICs for the past two decades, with findings highlighting opportunities for advancing EBP in nursing within LMICs. Health systems and healthcare organization leaders in LMICs should equip nurses with EBP knowledge and skills while providing the needed resources and support to ensure consistent implementation of EBP to improve health outcomes.
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