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AnteayerInternacionales

Prognostic uncertainty in multiple sclerosis: A concept analysis

Abstract

Aim

To report an analysis of the concept of prognostic uncertainty in patients with multiple sclerosis (MS).

Background

The complexity and ambiguity involved in a diagnosis of MS lead to the occurrence of prognostic uncertainty among patients. A concept analysis is presented that analyses what prognostic uncertainty means to those experiencing the transition between relapsing-remitting multiple sclerosis and secondary progressive multiple sclerosis.

Design

Concept analysis.

Data sources

PubMed, Ovid Medline, Cumulative Index for Nursing and Allied Health Literature databases were searched for literature published within the last 10 years using combinations of the terms prognostic and diagnostic uncertainty, and multiple sclerosis along with archival referencing.

Methods

The Walker and Avant method was used to analyse the concept of prognostic uncertainty in patients with MS.

Results

The defining attributes identified that provide additional context to prognostic uncertainty are illness uncertainty, intolerance of uncertainty and progressive dwindling. Related, contrary, model and borderline cases are presented to further discuss the application of the key attributes to the concept.

Conclusion

There are limited data on prognostic uncertainty and multiple sclerosis; however, patients and physicians express uncertainty in understanding one's disease trajectory and determining when a patient with relapsing-remitting multiple sclerosis has entered the secondary progressive multiple sclerosis disease course leading to ineffective communication and frustration.

Relevance to clinical practice

Genetics and genomics have the potential to provide a prognostic factor for addressing the concept of uncertainty as it relates to persons with multiple sclerosis. Moving beyond the concept analysis, a case is made for nurse involvement in genetic and genomic research to conduct trials, translate, and apply these findings to clinical practice and nursing curricula, addressing the uncertainty experienced by those afflicted with chronic illnesses, such as multiple sclerosis.

Workplace interventions to prevent or reduce post‐traumatic stress disorder and symptoms among hospital nurses: A scoping review

Abstract

Objectives

The aim of this study was to identify literature on evaluated workplace interventions to prevent or reduce the prevalence or impact of work-related post-traumatic stress disorder (PTSD) and PTSD symptoms among hospital nurses. A second objective was to summarise and compare the characteristics and effectiveness of these interventions.

Background

A substantial proportion of nurses report PTSD symptoms. Previous reviews have synthesised interventions to address PTSD in military and other high-risk populations, but similar work focusing on nurses has yet to be conducted.

Methods

We conducted a scoping review with the question: What interventions have been studied to prevent or treat PTSD symptoms or PTSD among nurses working in hospitals? We followed the PRISMA Scoping Review Checklist using an unregistered protocol. We searched in twelve academic and grey literature databases (e.g. MedLine, CINAHL) with no language restrictions. We included publications reporting on interventions which were evaluated for measurable impacts on PTSD and PTSD symptoms among nursing staff working in inpatient settings from 1980 to 2019, and charted study characteristics in a spreadsheet.

Results

From 7746 results, 63 studies moved to full-text screening, and six studies met inclusion criteria. Methodologies included three randomised controlled studies, one quasi-experimental study, one pre-post feasibility study and one descriptive correlational study. Four studies reported a significant reduction in PTSD scores in intervention groups compared with baseline or comparison, when using debriefing, guided imagery or mindfulness-based exercises.

Conclusions

This review identified six studies evaluating hospital-based interventions to reduce PTSD and PTSD symptoms among hospital nurses, with some positive effects reported, contributing to a preliminary evidence base on reducing workplace trauma. Larger studies can compare nurse subpopulations, and system-level interventions should expand the focus from individuals to organisations.

Relevance to clinical practice

This review can inform nursing and hospital leaders developing evidence-based interventions for PTSD among nurses.

Frailty measurements in hospitalised orthopaedic populations age 65 and older: A scoping review

Abstract

Aims and Objectives

To identify and compare frailty instruments used with hospitalised orthopaedic patients aged over 65.

Background

Frailty predicts clinical events in orthopaedic patients aged over 65. However, the strengths and limitations of different approaches to measuring frailty in this population are rarely discussed. As such, a comprehensive review to address the gap is needed.

Design

Scoping review using Arksey and O’Malley framework.

Methods

PubMed, CINAHL, PsycINFO, Scopus and EMBASE databases were searched to identify studies published from 2006 to 2020 regarding frailty instruments in older orthopaedic patients. The Preferred Reporting Items for Systematic Reviews and Meta-analyses were followed.

Results

The initial search resulted in 1,471 articles. After review against inclusion and exclusion criteria, a final set of 31 articles containing 15 unique frailty instruments were evaluated. Most of the articles were from Western countries. Fried's phenotype and Frailty Index were commonly used. The frailty index was mostly modified to measure frailty. In hip fracture, physical function items were frequently modified in the measurement of frailty. Trained physicians and nurses administered most frailty instruments. Frailty screening was commonly conducted at hospital admission and used to prognosticate both postoperative complications and hospital outcomes. Most instruments could be completed within 10 min. Reported psychometrics had acceptable reliability and validity.

Conclusion

Many reliable frailty measures have been used in the inpatient orthopaedic settings; however, evidence is still lacking for a gold standard frailty instrument. More research is needed to identify the best-performing measure. Frailty evaluation in patients with physical limitations is challenging with existing instruments. Clinical context, resources required and instrument quality are essential factors in selecting a frailty instrument.

Relevance to clinical practice

Musculoskeletal symptoms in older patients may bias frailty assessment. Proactive frailty screening with valid and practical instruments is vital to strengthen preoperative risk stratification and improve post-surgical outcomes.

Proactive risk assessment of intrahospital transport of critically ill patients from emergency department to intensive care unit in a teaching hospital and its implications

Abstract

Aims and objectives

To explore the effects of the health failure mode and effect analysis (HFMEA) used in intrahospital transport (IHT) of critically ill patients from emergency department (ED) to the intensive care unit (ICU).

Background

Patients who were transported from ED to ICU is highly critical. IHT of these patients is potentially risky, which may associate with adverse events (AEs). The concern of safe IHT can be addressed by performing proactive risk assessments using HFMEA and implementing the findings after the ED of our hospital being reconstructed.

Design

A qualitative action research study combined with a quantitative cross-sectional method.

Methods

According to the HFMEA method, the failure modes of IHT were identified and analysed, and the effect of alterations was verified. We built a project team, drawn up a IHT flow chart, defined steps of IHT, classified the failure modes, calculated risk priority number and analysed by the decision tree, then formulated an action plan and verified the effects of the alterations. Incidence of AEs of transport was compared before and after HFMEA.SQUIRE 2.0 checklist was chosen on reporting the study process.

Results

The HFMEA outlined a total of 5 major steps and 16 sub-steps in the IHT process. From this, 64 potential failure modes were identified, with 17 modes having a RPN score higher than 8. Determined by the decision tree, there were 20 priority control failure modes, of which 16 involved 8 IHT alterations. Notable work-flow alterations included use of a three-stage hierarchical transport strategy based on patients’ condition assisted by the intelligent assessment system. Incidence of AEs was significantly decreased from 19.64% to 7.14% after the implementation of HFMEA (p < 0.05).

Conclusion

Application of the HFMEA in optimising IHT process can improve the safety of transportation, which is worthy of promotion. Hierarchical transport scheme can reduce the incidence of AEs in IHT of critical emergency patients, which mainly includes the integration and construction of the transport team, equipment configuration and patient information system based on the classification of patients’ condition.

Relevance to clinical practice

Nurses play a crucial role in the IHT process. HFMEA can be adopted for proactive risk assessment of critically ill patients’ IHT from ED to ICU which involves multiple processes. The IHT hierarchical strategy based on the results of failure mode analysis should be more widely used to further verify its clinical effects.

Local complications of insulin administration sites and effect on diabetes management

Abstract

Background

Administration of insulin may be associated with substantial cutaneous adverse effects, such as lipoatrophy and lipohypertrophy (LH), which can cause glycemic excursions above and below the target levels for blood glucose. Our aim was to evaluate the effect on compliance with the use of insulin administration site, dermatological complications and diabetes management in children with type 1 diabetes (T1D).

Methods

Patients aged 021 years who were followed up with the diagnosis of T1D for at least one year were included. A 14-question survey including demographic characteristics and a subjective opinion of skin-related complications of insulin administration was given. Data were obtained from the medical records to evaluate the effect of dermatological complications on diabetes management. This study was checked with the STROBE checklist.

Results

Two hundred and fifty-four patients were included and 53% of these were female. The mean age was 14.9 ± 4.7 years and the duration of T1D was 7.3 ± 4.1 years. The mean HbA1c level was 8 ± 1.4% and the mean total insulin dose was 0.84 ± 0.25 units/kg/day. More than half of the individuals (57%) were receiving multiple daily injections (MDI) and 43% were on insulin pump therapy (IPT). Of the participants, 11.8% reported LH, 7.5% wound, 21.7% allergy, 55.5% bleeding, 41.3% bruising and 47.2% pain. LH rates varied significantly by regimen, 17.1% in MDI and 4.6% with IPT (p = .001). Those with LH were using higher median doses of insulin (0.97 U/kg/day) than those who did not (0.78 U/kg/day; p = .016). LH was reported more frequently (18.3%) in patients with frequent hypoglycemia (p = .007). Positive correlation between BMI-SDS and LH in patients aged <18 years was found (p = .043). LH rates by site were: right arm 20.8%, left arm 26.4%, right abdomen 26.4%, left abdomen 22.6% and 1% in the right and left leg.

Conclusions

Local complications of insulin therapy are common in young patients with T1D. The complication with the most impact on metabolic control was LH, present in nearly 12% of patients. Users of IPT have a significantly lower risk of LH. The results emphasise the importance of individualised education for young T1D patients and their families about injection site preference and rotation techniques.

Relevance to clinical practice

The diabetes team should check the insulin administration sites of children with type 1 diabetes at each visit and provide repeated education about the dermatological complications of insulin.

Rotating between day and night shifts: Factors influencing sleep patterns of hospital nurses

Abstract

Aims and Objectives

This study aimed to investigate sleep patterns of hospital nurses using a wearable electronic device and determine the influence of rotating day and night shifts and lifestyle factors on their sleep efficiency.

Background

Nurses working in shifts are vulnerable to sleep disturbances. However, little is known about the influence of rotating day and night shift schedules and healthy lifestyle on nurses’ daily sleep patterns.

Design

Descriptive correlational design.

Methods

Thirty-two hospital nurses working in shifts and 32 hospital nurses not working in shifts participated in data collection. Their sleep patterns were measured for six consecutive days using Fitbit Charge 3, and information on alcohol consumption, exercise, and eating habits were assessed using a questionnaire. Data were analysed using repeated measures analysis of variance with post hoc Scheffe's test and hierarchical multiple regression analysis. The study was conducted in accordance with the STROBE guideline.

Results

Overall, nurses working on rotating day and night shifts had significantly shorter total sleep time, longer sleep onset latency, and lower sleep efficiency than those not working in shifts. In particular, nurses working for 3 or 4 consecutive night shifts had significantly shorter total sleep time, lower sleep efficiency and longer sleep onset latency than those working for 0–2 consecutive night shifts. Rotating day and night shifts and alcohol consumption significantly influenced sleep efficiency.

Conclusions

A work schedule of ≥3 consecutive night shifts and the habit of alcohol consumption before bed time influence nurses’ sleep efficiency.

Relevance to Clinical Practice

Given the poor sleep pattern among nurses working in shifts, particularly those working on ≥2 consecutive night shifts, it is necessary to develop an optimal shift schedule and a program to promote healthy lifestyle among hospital nurses.

An integrative literature review of the implementation of advance care planning in hospital settings

Abstract

Aims and Objectives

To identify and synthesise existing literature about action research in the implementation of advance care planning in a hospital setting.

Background

Despite the proven added value of advance care planning, there is a lack of wide integration of this concept. There are several obstacles known for the implementation but it remains unclear how these can be overcome. Action research is described in the literature as a plausible way to overcome obstacles to the implementation of quality enhancing projects.

Design

An integrative literature review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and reported in accordance with the PRISMA statement.

Methods

We searched databases MEDLINE, EMBASE, CINAHL and Web of Science to identify executed action research for the implementation of advance care planning programs within a hospital setting, from January 2005 until November 2019. Studies were assessed for comprehensiveness and were supplemented by studies in reference lists of included articles. A quality appraisal and a thematic synthesis were performed on all included studies.

Results

Five studies met inclusion criteria. Interventions focused on both nurses, physicians and hospitalised patients. Interventions targeted three different themes: identifying at-risk patients, adapting documentation to the local context and using communication improvement tools.

Conclusions

A Supportive and Palliative Care Indicators Tool is proposed to identify patients in need of advance care planning to work more efficiently. Furthermore, adapting documentation and instruments to a specific care context are shown to make advance care planning more effective. Communication challenges can be addressed by promoting communication skills and increase stakeholder self-confidence.

What is and what ought to be: A meta‐synthesis of residential aged care staffs’ perspectives on quality care

Abstract

Background

As places of both residence and work, what constitutes “good quality care” in residential aged care requires consideration of staffs’ perspectives.

Objective

A meta-synthesis of the qualitative literature was conducted exploring residential aged care staff perspectives on “quality of care.”

Methods

Six electronic databases were searched for articles that met the screening inclusion criteria. This meta-synthesis was informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and included studies were critically appraised using JBI SUMARI. Two independent reviewers conducted thematic network mapping and analysis of included articles, with oversight from three additional reviewers.

Results

Forty-seven articles were included, with findings summarised into four organising themes and nine basic themes. The four organising themes about quality care from staff perspectives include direct care, professional values and competence, the care environment and organisational/regulatory factors.

Conclusion

Staff describe a wide range of factors that they perceived to influence the quality of care. Some may feel motivated to leave employment in aged care, due to organisational pressures that make staff unable to uphold what they perceive as an acceptable standard of care. There is tension between professional values and organisation/regulatory factors—regulation should be enacted at a level that supports good practice and staff's moral integrity.

Relevance to clinical practice

This review found that while person-centred care is now well established as the benchmark of quality care in residential aged care homes, achieving it in reality remains challenged by limitations on staff members’ time, resources and sometimes their competencies and the regularity of their employment.

Nursing interventions for the promotion of tracheostomy self‐care: A scoping review

Abstract

Aims and objectives

To map nursing interventions, their characteristics, and outcomes, in promoting self-care of the person with a tracheostomy.

Background

The development of competencies in self-care of a person with a tracheostomy is recognised as one of the most significant nursing intervention areas for the promotion of autonomy, prevention of complications and adaptation. Identifying nursing interventions for the promotion of self-care of the person with a tracheostomy enables enhanced clinical practice knowledge within different care contexts and the identification of gaps in the available evidence.

Design

The Joanna Briggs Institute (JBI) methodology was used to perform this scoping review.

Method: A search was conducted on the CINAHL, Scopus, Web of Science, PubMed, JBI Database of Systematic Reviews and Implementation Reports, and Cochrane Database of Systematic Reviews. The search for grey literature included Portugal´s Open Access Scientific Repository, OpenGrey, and ProQuest Dissertations and Theses. Studies published in Portuguese, English, Spanish and French were included. The PRISMA-ScR checklist was used.

Results

From a total of 4,224 identified articles, 31 were included in this review. Multiple nursing interventions were identified and grouped into four types of action: informing, managing, determining and attending. Although most interventions are implemented with the face-to-face method, there is a growing interest in using technologies for this purpose. The dose is the characteristic most poorly described in interventions. Various results were obtained; however, valid assessment tools were not always used.

Conclusions

Designing and testing intervention programmes for the promotion of self-care of the person with a tracheostomy is necessary, based on available and robust evidence to guide clinical practice.

Relevance to clinical practice

This review allowed to systematise nursing interventions to promote self-care of the person with a tracheostomy. The use of combined interventions and methodologies is likely to be more effective in care delivery.

A narrative inquiry approach to understanding senior intensive care nurses’ experiences of working with new graduate nurses

Abstract

Aims and objectives

To report a qualitative inquiry exploring senior registered nurses’ stories of experience working with new graduate nurses in the intensive care unit.

Background

While new graduate nurses’ perceptions of transitioning into professional practice in the intensive care unit have been examined, few studies have explored the experiences of the senior registered nurses working alongside them.

Design

A narrative inquiry methodology informed by Dewey's (1938) theory of experience.

Methods

Individual in-depth, unstructured, interactive interviews were conducted with five senior registered nurses. The inquirer co-composed individual narrative accounts with each participant. Narrative inquiry's three commonplaces of temporality, sociality and place formed the lens of analysis.

Thematic analysis identified two overarching threads that resonated across the narrative accounts. This inquiry adheres to COREQ checklist reporting.

Results

The overarching threads ‘Reverberations’ and ‘Caring’ depict the experiences of senior registered nurses. ‘It's Dangerous’, ‘Patrolling Like Surf Lifesavers’, ‘We Carry Them’, ‘Survival Mode’ and ‘Enjoyable Moments’ are minor threads describing the challenges, while ‘I’ve Been There’, ‘They Must Ask Questions’ and ‘Not In My Backyard’ reveal their insights.

Conclusions

Working with new graduate nurses increased senior registered nurses’ patient surveillance and workload, contributing to stress, pressure and feeling overwhelmed. However, senior registered nurses felt an obligation to care for new graduate nurses, who they perceived as still acquiring the skills to autonomously care for critically ill patients. Therefore, senior registered nurses require support themselves.

Relevance to clinical practice

Senior registered nurses perceive workplace constraints as impeding their capacity to provide sufficient support and surveillance to new graduate nurses. The gap between new graduate nurses’ clinical capacity and patients’ needs underpins senior registered nurses’ recommendation that new graduate nurses should not be placed in intensive care units unless additional workforce support is provided, safeguarding their development as well as patient safety.

Clinical indicators and aetiological factors of sedentary lifestyle in patients with arterial hypertension

Abstract

Aims

The aim of this study is to verify the clinical validity of clinical indicators and aetiological factors of sedentary lifestyle in individuals with arterial hypertension.

Background

Diagnostic validation is performed to expand nursing taxonomies and to revise or confirm the described concepts. New elements listed in the literature and those identified by the NANDA International definition for sedentary lifestyle need to be evaluated.

Design

This is a cross-sectional and diagnostic validation study. The STROBE guidelines were used in this study.

Methods

Two hundred and fifty subjects aged over 18 years were evaluated. The diagnostic status of the participants was obtained by latent class analysis. Logistic regression was used to identify aetiological factors with the manifestation of sedentary lifestyle, considering a significance level of 5%.

Results

A total of 57.8% of the study participants met the diagnostic criteria for sedentary lifestyle. The clinical indicators with high sensitivity were as follows: "Average daily physical activity is less than recommended for gender and age"; "Does not perform physical activity during leisure time"; "Preference for activity low in physical activity" and "Overweight.” The significantly related factors associated with the diagnosis of sedentary lifestyle were as follows: "Insufficient knowledge on physical activity," "Lack of time," "Negative self-perception of health," "Lack of security," "Lack of appropriate place," "Lack of motivation," "Activity intolerance," "Lack of sports ability," "Having a partner," "Using public transportation," "Perception of physical disability," "Pain," "Having a job/studying," "Laziness," "Impaired mobility," "Living in an urban area," "Education in a public institution," "Female gender," "Lack of confidence to practice physical exercise," "Education level," "Age" and "Lack of social support for the practice of physical exercise."

Conclusion

Four out of eight clinical indicators had a good adjustment by the latent class analysis. Of the 27 aetiological factors, 22 were significantly associated with sedentary lifestyle.

Relevance to practice

The correct identification of sedentary lifestyle and its elements supports care planning, especially for health promotion and disease prevention.

A comparative study of eating behaviours within and between conventional metabolic (bariatric) surgery procedures

Abstract

Aims and Objectives

To compare eating behaviours within and between gastric bypass, sleeve gastrectomy and gastric band procedures and to investigate associations between eating behaviours and body weight.

Background

Eating behaviours are subjective constructs representing physiological need and the hedonic need to eat. After metabolic surgery, eating behaviours have been observed to change. Little is known about whether eating behaviour change differs according to the metabolic procedure performed.

Design

Adults (n = 204) with severe obesity from three countries were followed 1 year after metabolic surgical procedures (n = 121).

Methods

We measured eating behaviours using the Three-Factor Eating Questionnaire and used linear mixed models to compare eating behaviours within and between three procedure groups. We complied with the STROBE checklist for reporting observational studies.

Results

Within groups, there were statistically significant increases in restraint and decreases in disinhibition and hunger. Between groups, we observed differences in disinhibition associated with the band procedure. There were no significant differences between any group for body weight or body mass index a year post-surgery. Disinhibition was the only eating behaviour associated with body weight, body mass index and the per cent of weight loss.

Conclusions

Eating behaviours in adults with severe obesity who underwent any of the three metabolic procedures were associated with eating behaviour change 1 year post-surgery. Disinhibition was the only eating behaviour that was associated with body weight.

Relevance to clinical practice

Irrespective of the procedure, we found participants had a statistically significant increase in restraint and decreases in disinhibition and hunger 1 year post-surgery. Despite the significant reduction in disinhibition within the band group, this behaviour was more pronounced post-surgery compared with other groups. Although the reduction in hunger showed the greatest change, it was not associated with weight outcomes. This is relevant clinical knowledge for nurses who support bariatric surgical patients.

Effects of robotic care interventions for dementia care: A systematic review and meta‐analysis randomised controlled trials

Abstract

Background

The role of robotic care has been studied because it may be a care option applicable to dementia care. However, the effects of robotic care in dementia care are still inconclusive.

Aim

To explore the span of the effects of robotic care intervention among patients with dementia.

Design

Systematic review and meta-analysis.

Methods

This study searched systematically using the following databases: Academic Search Complete, CINAHL, Cochrane Library, MEDLINE, PubMed, SocINDEX, UpToDate (OVID) and Web of Science. The eligibility criteria were patients with dementia, randomised controlled trials and publications in English. The PEDro scale was used to assess the methodological quality in the included studies. The meta-analysis was performed using a fixed-effects model to calculate the pooled effects of robotic care interventions. STATA 16.0 was used for statistical analysis. The results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

Results

A total of 15 studies met the eligibility criteria and included 1684 participants. Overall, the robotic care interventions had positive effects on agitation (SMD = 0.09; 95% CI [−0.22–0.33]), anxiety (SMD = −0.07; 95% CI [−0.42–0.28]), cognitive function (SMD = 0.16; 95% CI [−0.08–0.40]), depression (SMD = −0.35; 95% CI [−0.69–0.02]), neuropsychiatric symptoms (SMD = 0.16; 95% CI [−0.29–0.61]), total hours of sleep during daytime (SMD = −0.31; 95% CI [−0.55 to 0.07]) and quality of life (SMD = 0.24; 95% CI [−0.23–0.70]).

Conclusion

Robotic care intervention may be an effective and alternative intervention for improving the health outcomes for people with dementia. The robotic care effect on anxiety should be confirmed. Further studies may consider the frequency, duration of intervention and possible negative outcomes after robotic care interventions.

Relevance to clinical practice

As a non-pharmacological approach, nursing staff may consider the robotic care intervention in providing care for patients with dementia since this intervention has clinical benefits.

Issue Information

Journal of Clinical Nursing, Volume 30, Issue 21-22, Page 3053-3054, November 2021.

Educational interventions and strategies for spiritual care in nursing and healthcare students and staff: A scoping review

Abstract

Aims and objectives

To map existing evidence about educational interventions or strategies in nursing and allied healthcare concerning students’ and staffs’ spiritual care provision.

Background

Spiritual care is an important part of whole person care, but healthcare staff lack competence and awareness of spiritual issues in practice. To rectify this, it is important to identify what educational approaches are most helpful in supporting them to provide spiritual care.

Design

A scoping review using the PRISMA-ScR checklist.

Method

Searches in the databases CINAHL, MEDLINE, ATLA and ERIC were conducted for papers spanning January 2009–May 2020. Search terms were related to spirituality, spiritual care, education and clinical teaching. Appraisal tools were used.

Results

From the 2128 potentially relevant papers, 36 were included. The studies were from 15 different countries and involved nurses, physicians and other health-related professions, and both quantitative, qualitative and mixed methods were used. The results are presented in three themes: Understanding of spirituality, Strategies in educational settings, and Strategies in practice settings. The review points to great diversity in the content, lengths and setting of the educational interventions or strategies.

Conclusions

Courses in spiritual care should be implemented in curricula in both undergraduate and postgraduate education, and several studies suggest it should be mandatory. Courses should also be available for healthcare staff to raise awareness and to encourage the integration of spiritual care into their everyday practice. There is a need for greater consensus about how spirituality and spiritual care are described in healthcare settings.

Relevance to clinical practice

Spiritual care must be included both in monodisciplinary and multidisciplinary educational settings. The main result of spiritual care courses is in building awareness of spiritual issues and self-awareness. To ensure the provision of spiritual care for patients in healthcare practices, continuing and multidisciplinary education is recommended.

Use of traditional therapies in palliative care for Australian First Nations peoples: An integrative review

Abstract

Aims and objectives

To conduct an integrative review of the literature to understand how the incorporation of traditional therapies affect First Nations people's utilisation of palliative care services.

Background

First Nations peoples face many barriers related to accessing and utilising specialised health services such as palliative care. Whilst culturally appropriate care has been shown to improve these outcomes, there is little evidence regarding how this may be achieved.

Design

Integrative review.

Methods

A systematic search was conducted using electronic databases CINAHL, Joanna Briggs, Medline, Scopus, ScienceDirect InformitHealth and ProQuest between the years of 20052021 databases were searched for papers with full text available and published in English. Papers were included if they were primary-based research and focused on the topics of the use of traditional therapies in a palliative care context by First Nations persons. The Critical Appraisal Skills Programme principles were used to assess the methodological quality of the selected articles.

Results

Seven studies met the inclusion criteria and were included in the review. The review included six qualitative studies and one quantitative study. From these studies, five themes were identified in the literature: supporting a holistic approach, developing culturally appropriate care, conflict within a Western medical model, regulatory issues, and geographical barriers.

Conclusion

There is a dearth of current literature available discussing the utilization of traditional therapies in palliative care. From the literature analysed, the benefits of including traditional therapies are overall positive, however, there are barriers including conflict with the Western model of medicine and regulation. More research is required in the provision of traditional therapies in palliative care.

Relevance to Clinical Practice

The incorporation of traditional medicines within a palliative care setting could help nurses provide holistic and culturally appropriate care, especially in rural and remote areas where they make up the majority of the healthcare force.

The Manchester Triage System's performance in clinical risk prioritisation of patients presenting with headache in emergency department: A retrospective observational study

Abstract

Objective

Non-traumatic headache is a frequent reason for visits to the emergency department (ED). We evaluated the performance of the Manchester Triage System (MTS) in prioritising patients presenting to the ED with non-traumatic headache.

Methods

In this single-centre observational retrospective study, we compared the association of MTS priority classification codes with a final diagnosis of a severe neurological condition requiring timely management (ischaemic or haemorrhagic stroke, subarachnoid haemorrhage, cerebral sinus venous thrombosis, central nervous system infection or brain tumour). The study was conducted and reported according to the STROBE statement. The overall prioritisation accuracy of MTS was estimated by the area under the receiver operating characteristic (ROC) curve. The correctness of triage prediction was estimated based on the “very urgent” MTS grouping. An undertriage was defined as a patient with an urgent and severe neurological who received a low priority/urgency MTS code (green/yellow).

Results

Over 30 months, 3002 triage evaluations of non-traumatic headache occurred (1.7% of ED visits). Of these, 2.3% (68/3002) were eventually diagnosed with an urgent and severe neurological condition. The MTS had an acceptable prioritisation accuracy, with an area under the ROC curve of 0.734 (95% CI 0.668–0.799). The sensitivity of the MTS for urgent codes (yellow, orange and red) was 79.4% (95% CI 74.5–84.3), with a specificity of 54.1% (95% CI 52.9–55.3). The triage prediction was incorrect in only 6.3% (190/3002) of patients with headache.

Conclusion

The MTS is a safe and accurate tool for prioritising patients with non-traumatic headache in the ED. However, MTS may need further specific tools for evaluating the more complicated symptoms and for correctly identifying patients with urgent and severe underlying pathologies.

Relevance to clinical practice

The triage nurse using MTS may need additional tools to improve the assessment of patients with headache, although MTS provides a good safety profile.

Prenatal predictors of postpartum depression trajectories from birth to 24 months amongst smoking women

Abstract

Aims and Objectives

We aimed to identify postpartum depression (PPD) trajectories and examine relevant predictors amongst smoking women.

Background

PPD can adversely affect families. Predictors of PPD trajectories amongst smoking women are understudied.

Design

Longitudinal cohort study.

Methods

A cohort of 49 U.S. women (current or ex-smoking) completed the Edinburgh Postnatal Depression Scale from birth to 24 months postpartum. Latent class growth modelling was used to identify PPD trajectories. Predictors of PPD trajectories were identified, adjusting for confounders. Effect modification by prenatal Patient Health Questionnaire (PHQ) depression score was also assessed. STROBE guidelines were followed in reporting results.

Results

Three PPD trajectories were identified: non-PPD, transient PPD and chronic PPD. In multinomial logistic regression, social support was associated with lower odds of membership in the chronic PPD trajectory compared to non-PPD trajectory: being married or having a partner sharing resources (odds ratio OR = .14 [.02, .85], p-value = .03), greater partner support (OR = .87 [.77, .98], p-value = .02) and greater family/friends support (OR = .53 [.34, .82], p-value = .004). Transient PPD showed no differences with non-PPD on any predictors. In ordinal logistic regression models, social support was associated with lower odds of membership in a more severe PPD depression trajectory when prenatal PHQ depression score was in the low range (being married or having a partner sharing resources: p for effect modification = .06; partner support: p for effect modification = .05; and family/friends support: p for effect modification = .005).

Relevance to Clinical Practice

Compared to the general population, chronic PPD trajectories were more common amongst smoking women. Social support was an important predictor of more severe PPD trajectories, especially when prenatal depression is low.

Conclusion

Our findings indicated that social support might decrease likelihood of severe PPD trajectories, especially when prenatal depression was low. Relevant predictors of transient PPD remained elusive.

Hospital work environment, nurse staffing and missed care in Chile: A cross‐sectional observational study

Abstract

Aims and Objectives

To characterise the problem of missed nursing care in Chilean hospitals and to test associations with hospital organisational variables.

Background

Missed nursing care is a common problem in different countries, but it has not been studied in Chile.

Design

Multihospital cross-sectional study (Supplementary file 1: STROBE guideline).

Methods

Study population of 45 adult high-complexity hospitals and 1853 registered nurses (RN) working on medical-surgical units. Primary data were collected through a nurse survey. Nurses reported, out of a list of nursing care activities, the ones left undone during their last shift. The main independent variables were the work environment, measured through the Practice Environment Scale of the Nursing Work Index, patient-to-nurse ratios and RN skillmix. Adjusted logistic regression analyses were used to test associations, accounting for clustering of nurses working in the same hospital.

Results

The hospital response rate was 88.9% and, for nurses, 88.1%. The mean patient-to-nurse ratio was 14.5 (range 6–23). The average skillmix was 31% RN. Eighty-six percent of nurses missed at least one activity. The activities most frequently missed included patient education, comforting patients and surveillance. The adjusted model showed a significant association between the work environment, staffing ratios and missed care. The RN skillmix was not associated.

Conclusions

Missed care is highly prevalent problem in Chilean hospitals. Clinical activities were the least missed. It is necessary to improve work environments and reduce the number of patients per nurse to improve the safety and quality of care.

Relevance for clinical practice

The study results are relevant since they provide new data to Chile. Better work environments and adequate human resources are modifiable factors that can be addressed from a managerial perspective, with low-cost strategies to effectively reduce missed care and improve safety and quality.

Unpacking characteristics of spirituality through the lens of persons of colour living with serious illness: The need for nurse‐based education to increase understanding of the spiritual dimension in healthcare

Abstract

Aims and objectives

To examine the characteristics of spirituality as expressed by persons of colour living with serious illness.

Background

Spiritual, Religious and Existential Care, as specified in the National Consensus Project (NCP) Guidelines, is a core domain of palliative nursing.

Design of the study

A constructionist approach to narrative analysis was used for this study and reported in accordance with the COREQ guideline.

Methods

In-depth narrative interviews were conducted with 20 participants. These participants included persons of colour living with serious illness who were admitted to an acute-care hospital. Through a deductive coding approach, a codebook was created based on a broad definition of spirituality including: religion, self, family, community, nature and art/music/literature.

Results

The major themes expressed were religion, self and family. Subthemes of religion included increased faith, support of the church community and God's intervention in patients' lives. Subthemes of self included increased self-worth, self-awareness of one's place in the world and individualised transition to new meaning in life. Subthemes of family included family adding meaning and purpose to their lives, family as an important source of strength and support, wanting to regain their health to go back to caring for their families, and believing that their illness had brought their family closer together.

Conclusion

The thematic analysis revealed a broader existential aspect of what brought value, meaning and purpose into their lives, despite their progressive physical illness. More research is needed to understand spiritual, religious or existential needs of persons of colour living with serious illness and how nurses can best support these needs. By understanding the components of spirituality, nurses can learn to recognise the signs of spiritual distress. This awareness also helps to know when a spiritual specialist is needed—either the patient's own spiritual guide(s) or the hospital chaplain. Nurses can also use spiritual assessment tools when performing a general assessment on the patient.

Relevance to clinical practice

By understanding the components of spirituality, nurses can learn to recognise the signs of spiritual distress. This awareness also helps to know when a spiritual specialist is needed—either the patient's own spiritual guide(s) or the hospital chaplain. Nurses can also use spiritual assessment tools when performing a general assessment on the patient.

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