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Anteayer Journal of Advanced Nursing

Long‐term effectiveness of an mHealth‐tailored physical activity intervention in youth with congenital heart disease: A randomized controlled trial

Abstract

Aims

To evaluate the long-term effectiveness of the Care & Organize Our Lifestyle (COOL) programme, a self-regulation theory-based mHealth programme, on improving disease knowledge and physical activity in youth with congenital heart disease (CHD).

Design

A three-arm parallel-group randomized controlled trial.

Methods

A total 143 participants with simple and moderate CHD aged 15–24 years were recruited from June 2016 to February 2018. The 12-month programme compared two active intervention groups to a standard-care control group (n = 47). Participants in one active intervention group (n = 49) were provided with COOL Passport, a mobile healthcare application. Those in the other group (n = 47) were provided with access to the Health Promotion Cloud system and use of game-based interactive platforms along with COOL Passport. Outcomes were the Leuven Knowledge Questionnaire for Congenital Heart Disease and the International Physical Activity Questionnaire—Taiwan Show-Card Version.

Results

After 12 months, 103 participants remained; the overall attrition rate was 28%. No significant differences were observed between the groups in any domain of disease knowledge after 6 months or 1 year. Neither active group exhibited significantly greater physical activity intensity than the standard-care control group in any month during the 1 year.

Conclusion

The mHealth-tailored intervention of the COOL programme did not improve disease knowledge or physical activity in young adults with CHD.

Impact

The application of the COOL Passport and Health Promotion Cloud system and use of game-based interactive platforms must be modified and verified in future studies and may have clinical potential.

Trial registration: The registry of clinical trials was ClinicalTrials.gov: NCT04264650.

Efficacy of prompted voiding for reversing urinary incontinence in older adults hospitalized in a functional recovery unit: Study protocol

Abstract

Aims

To assess the efficacy of a prompted voiding programme for restoring urinary continence at discharge in hospitalized older adults who presented with reversible urinary incontinence (UI) on admission to a functional recovery unit (FRU). To assess the maintenance of the outcomes achieved after hospitalization. To identify modifiable and unmodifiable factors associated with the success of the prompted voiding programme.

Design

Quasi-experimental, pre-/post-intervention study without a control group.

Methods

Participants were aged 65 and over with a history of reversible UI in the previous year who had been admitted to a FRU and were on a prompted voiding programme throughout their hospitalization period. The sample consisted of 221 participants. A non-probabilistic sampling method, in order of recruitment after signing the informed consent form, was used. The primary outcomes were UI assessed at discharge and 1 month, 3 months and 6 months after discharge. Funding was granted in July 2019 by the Spain Health Research Fund (PI19/00168, Ministry of Health). The proposal was approved by the Spanish Research Ethics Committee.

Discussion

The prompted voiding programme described can reverse UI or decrease the frequency and amount of urine loss in hospitalized older adults.

Impact

Urinary incontinence is highly prevalent in hospitalized older adults. There is a need for care aimed at prevention, recovery and symptom control. Prompted voiding is a therapy provided by the nursing team during hospitalization and can also be provided by family caregivers at home after receiving proper training by the nursing team. Prompted voiding will enhance the health, functional ability and quality of life of older adults with UI, resulting in the reduction of associated healthcare costs and the risk of developing complications.

Singapore's health outcomes after critical illness in kids: A study protocol exploring health outcomes of families 6 months after critical illness

Abstract

Aim

To explore and understand the impact of paediatric intensive care unit (PICU) admission on longitudinal health outcomes, experiences and support needs of children and their parents in the first 6 months after PICU discharge and to examine the role of ethnicity.

Design

This study uses a prospective, longitudinal design.

Methods

The sample will include children (N = 110) and at least one parent (N = 110) admitted to the PICU (KKH-AM start-up fund, October 2020). Quantitative study: Participants will be recruited at PICU admission. Data will be collected at five time points: during PICU admission (T0), at PICU discharge (T1), 1 month (T2), 3 months (T3) and 6 months (T4) after PICU discharge. Questionnaires will assess physical and cognitive outcomes of the child survivor. Emotional and social health outcomes will be assessed for both the child and the parents. Qualitative study: At least 12 parents will take part in a semi-structured interview conducted at both 1 and 6 months after PICU to explore their experiences and support needs after PICU discharge. All interviews will be audio-recorded with verbatim transcription. We will use framework analysis for qualitative data analysis.

Discussion

Understanding of Singapore health outcomes after critical illness in kids (SHACK) and their families is limited. There is an urgent need to comprehensively understand the health trajectory and consequences of the PICU child survivors and their families. This research will be the first to explore the health outcomes, needs and experiences after paediatric critical illness in Asia.

Impact

This study will provide an understanding of the health outcomes and trajectory of children and parents in the first 6 months after PICU discharge and examine the association between race and outcomes after PICU discharge. Identification of modifiable pre-disposing risk factors during the PICU admission will inform future interventions to improve long-term outcomes of children and parents following paediatric critical illness.

Trial registration: Clinicaltrial.gov: ClinicalTrials.gov Identifier: NCT04637113.

Effects of a simulation‐based education programme on delirium care for critical care nurses: A randomized controlled trial

Abstract

Aims

To evaluate the effects of a simulation-based education programme on critical care nurses’ knowledge, confidence, competence and clinical performance in providing delirium care.

Design

Single-blinded randomized controlled trial.

Methods

Registered nurses who work in intensive care units were recruited from a university-affiliated acute major metropolitan teaching hospital. The intervention group received: (i) five online-learning delirium care videos, (ii) one face-to-face delirium care education session and (iii) a simulation-based education programme with a role-play scenario-based initiative and an objective structured clinical examination. The control group received only online videos which were the same as those provided to the intervention group. Delirium care knowledge, confidence, competence, and clinical performance as outcomes were collected at: baseline, immediately after intervention, and within 6 weeks post-intervention to test whether there were any changes and if they were sustained over time. Data were collected between 2 October and 29 December 2020. The repeated-measures analysis of variance was used to examine for changes in delirium care knowledge, confidence, and competence within groups.

Results

Seventy-two critical care nurses participated with 36 each allocated to the intervention group and control group. No statistically significant difference was observed between the two groups in outcome variables at 6 weeks post-intervention. In the intervention group, significant within-group changes were observed in terms of delirium care knowledge, confidence, and competence over time. By contrast, no significant changes were observed in outcome measures over time in the control group.

Conclusion

The simulation-based education programme is an effective and feasible strategy to improve delirium care by enhancing the knowledge, confidence, competence and clinical performance of critical care nurses.

Impact

Our findings provide evidence regarding the development and implementation of a simulation-based education programme in hospitals for health professional education in Taiwan.

Examining the expectations of healing care environment of hospitalized children with cancer based on Watson's theory of human caring

Abstract

Aim

To describe the expectations of children with cancer about the healing care environment during hospitalization based on Watson's Theory of Human Caring.

Design

A descriptive qualitative research design was used in this study.

Methods

Data were collected between December 2019 and February 2020 from purposively selected children with cancer in a paediatric haematology and oncology clinic at a university hospital in Turkey. Twelve participants (7 females and 5 males) aged 10–17 were recruited to carry out individual semi-structured interviews. All interviews were recorded via a digital audio recorder and transcribed verbatim. The content analysis method was used to analyse the data.

Findings

As a result of the analysis, three main themes with related sub-themes were identified that revealed the expectations of children with cancer: ‘healing care behaviors’, ‘creating the physical environment of the hospital’ and ‘support from the social environment’.

Conclusion

Watson's Theory of Human Caring may be a useful and applicable guide for drawing a conceptual framework of the expectations of children with cancer regarding a healing care environment. The study revealed these children's need for humanistic, compassionate, honest and problem-focused care. In addition, participants wished for improvements in the physical environment. They also stated that they feel lonely and need social support from their family, peers and society.

Impact

This study presents a comprehensive picture of the expectations regarding a healing care environment (caring behaviours and physical and social aspects) of hospitalized children with cancer undergoing treatment. The qualitative findings generated by our study have the potential to facilitate these children's healthy adjustment to the hospital environment and procedures during hospitalization. Knowledge acquired through this study may be used to shape nursing care, enhance the healing care environment, and ensure that hospital design and setting are acceptable to and appropriate for paediatric patients.

Issue Information

Journal of Advanced Nursing, Volume 77, Issue 8, August 2021.

Effect of leader mindfulness on hindrance stress in nurses: The social mindfulness information processing path

Abstract

Aim

This study aimed to explore the influence of leader mindfulness on hindrance stress in nurses. Based on the social mindfulness framework, the mediating effects of nurses’ perceptions of their leaders’ perspective taking and empathic concern and how they are moderated by mindfulness of nurses were investigated.

Design

A time-lagged cross-sectional survey was conducted.

Methods

The convenience sampling method was adopted. Data were collected at three time points from January to September 2020. A total of 393 paired datasets of nurses and their leaders were collected from 28 Chinese 3A grade hospitals. SPSS 23.0 and AMOS 23.0 were used for data analysis and hypotheses testing.

Results

(1) Leader mindfulness significantly reduced nurse hindrance stress. (2) Both nurses’ perceptions of their leaders’ perspective taking and empathic concern mediated the relationship between leader mindfulness and nurse hindrance stress. Empathic concern was more effective than perspective taking in the process of leader mindfulness for reducing nurse hindrance stress. Nurses’ perceptions of their leaders’ perspective taking completely mediated the relationship between empathic concern and nurse hindrance stress. (3) Nurse mindfulness moderated the relationship between leader mindfulness and nurses’ perceptions of their leaders’ empathic concern but had no significant effect on the relationship between leader mindfulness and nurses’ perceptions of their leaders’ perspective taking.

Conclusion

Leader mindfulness was an important interpersonal factor for reducing nurse hindrance stress. Nurses’ perceptions of their leaders’ perspective taking and empathic concern were pivotal mechanisms underlying the effectiveness of leader mindfulness. Nurse mindfulness is a situational factor that contributes to the effectiveness of leader mindfulness.

Impact

Hospitals can benefit from mindfulness interventions by improving the mindfulness of leaders and nurses. Nurse managers are encouraged to promote social mindfulness, which will enable perspective taking and empathic concern by nurses and thus reduce hindrance stress on nurses during the pandemic.

Relationships between dyadic coping, intimate relationship and post‐traumatic growth in patients with breast cancer: A cross‐sectional study

Abstract

Aim

To investigate the relationships and pathways between dyadic coping, intimate relationship and post-traumatic growth (PTG) in Chinese patients with breast cancer.

Design

A cross-sectional study.

Methods

Between November 2019 and November 2020, 133 patients with breast cancer who received therapy in tertiary grade-A hospitals at Dalian, China completed questionnaires including demographic and clinical questionnaires, Locke–Wallace Marriage Adjustment Test, Chinese version of the Dyadic Coping Inventory and Chinese version of the Post-traumatic Growth Inventory. Structural equation modelling was used to analyse the pathways.

Results

Dyadic coping was positively interrelated with PTG and intimate relationship (r = .355, p < .01; r = .213, p < .05); intimate relationship was negatively interrelated with PTG (r = −.207, p < .05). The structural equation model demonstrated adequate fit. Dyadic coping and intimate relationship directly affected PTG (β = .469, p < .05; β = −.309, p < .05). Dyadic coping indirectly affected PTG through intimate relationship (β = −.066, p < .05).

Conclusions

Dyadic coping was a stimulus factor, but intimate relationship was an obstructive factor in enhancing PTG for the Chinese patients with breast cancer. Furthermore, intimate relationship may have significant mediating effects in the link between dyadic coping and PTG. Strategies that improve dyadic coping level and avoid excessive intimacy relationships between couples contribute to the development of PTG among patients with breast cancer.

Impact

The research provides new ideas and intervention entry points for global nurses and psychotherapists so that they can enact and implement targeted PTG intervention plans for patients with breast cancer worldwide.

The experience of becoming a mother following successful in vitro fertilization: A grounded theory

Abstract

Aim

To develop a theory to explain women's experiences about becoming a mother following successful in vitro fertilization treatment.

Design

This study is a qualitative study based on a constructivist grounded theory approach.

Methods

Data were collected using a semi-structured interview guide initially that was later to be changed to a flexible interview guide between June 2018 and 2019. Interviews were conducted with 18 women, who became pregnant and mothers following successful in vitro fertilization treatment. Data collection and analysis were performed in a cyclic manner using open, axial and selective coding. This study was reported based on consolidated criteria and was used to report qualitative research data.

Findings

The core category, ‘non-spontaneous path to motherhood’, involved the following four categories: ‘the treatment process is exhausting’, ‘leaving the infertility world’, ‘pregnancy under the shadow of fear’ and ‘getting stuck between fertile and infertile worlds’ with 10 sub-categories.

Conclusion

This study provides valuable insight into experiences of these women about becoming a mother. Unlike the Becoming a Mother Theory, it can be said that the anticipation stage, the first stage in the Becoming a Mother Theory, begins at the moment of embryo transfer in these women. Furthermore, the personal stage, the final stage in the Becoming a Mother Theory, is not completed within the first year after birth, even women were found to conceal experiences of in vitro fertilization treatment from the social environment even after birth.

Impact

This study will provide potential support for obstetric healthcare professionals in better understanding women's experiences about becoming a mother following successful in vitro fertilization treatment.

Entrepreneurship and nurse entrepreneurs lead the way to the development of nurses’ role and professional identity in clinical practice: A qualitative study

Abstract

Aims and objectives

To explore the experiences and perspectives of nurses’ transition into entrepreneurship in a clinical and cultural nursing setting and the impact of entrepreneurship on the nurses’ role and professional identity.

Background

Entrepreneurship is a relatively unknown phenomenon in international nursing research, and the prevalence of entrepreneurial nurses is only 0.5–1% of all working nurses globally. Unfortunately, several barriers occur within the healthcare system and existing nursing culture that may affect the potential of bringing entrepreneurship into the nursing profession.

Design

The qualitative study used a phenomenological–hermeneutical approach based on an interpretative phenomenological analysis and COREQ-guided reporting.

Methods

Nine individual, semi-structured interviews were conducted face to face (n = 6) and by telephone (n = 3) with Danish nurse entrepreneurs between February and March 2019.

Results

The analysis revealed four themes: (a) prejudice towards entrepreneurship; (b) to become an entrepreneur in a nursing culture; (c) rebellion against the traditional role as employee and (d) challenged professional identity and new professional roles.

Conclusion

Nurse entrepreneurs are caught between traditional and new ways of viewing nursing identity, norms, values and roles, and they face a conflict of professional values and a stereotyped view of ‘real’ nursing. Our findings show that entrepreneurship entails a huge learning process that develops nurses’ ability to think outside the box in a broader health perspective and challenge the existing nursing culture and role. However, nurse entrepreneurs’ ability to engage in entrepreneurship is compromised by professional values, the duty to behave as a good nurse and their own prejudices towards entrepreneurs.

Impact

Entrepreneurship and nurse entrepreneurs pose a huge potential development of the nursing role and identity, as they challenge the current view on the nursing profession. This development is important for patients and health professionals, as future health challenges call for new ways of thinking and acting.

Moderating effects of task interdependence on interaction behaviours and creativity for nursing students on interdisciplinary teams

Abstract

Aims

Nursing students in Taiwan often study in interdisciplinary teams that must create healthcare products. Creativity is imperative for the students’ success, but studies have not explored the relational precursors to team creativity in nursing education. Therefore, the relationship was examined between task interdependence, interaction behaviours (constructive controversy, helping behaviours and spontaneous communication) and creativity for nursing students on interdisciplinary teams in Taiwan to investigate whether high task interdependence moderates the correlations between interaction behaviours and creativity.

Design

Descriptive, cross-sectional, quantitative study.

Methods

Participants were nursing students (N = 99) attending interdisciplinary capstone courses in 2- or 4-year nursing programmes at a university for science and technology in Taiwan. Self-report questionnaires were used to collect the students’ demographics and perceptions of their teams’ task interdependence, interaction behaviours and creativity between January 2018 and January 2019. Pearson's correlation coefficient revealed variable associations. SPSS PROCESS macro displayed moderating effects.

Results

Task interdependence had significant positive correlations with all three interaction behaviours and team creativity. Each interaction behaviour also had significant positive correlations with team creativity. High task interdependence negatively moderated the relationships between team creativity and (a) constructive controversy, and (b) spontaneous communication, but not (c) helping behaviours.

Conclusion

The empirically validated moderation model and study results suggest that nursing educators can foster creativity in their students by encouraging task interdependence and helping behaviours, and teaching students to build constructive controversy and spontaneous communication into their collaborative plans.

Impact

In Taiwan, nursing students must demonstrate creativity in interdisciplinary capstone courses. Their ability to do so requires them to cooperate with students in other disciplines who have unique skills or knowledge. This study provides insights into the relational factors that may improve creativity for nursing students on interdisciplinary teams.

Developing a conceptual model of older patients’ decision‐making process in choosing dialysis or conservative care using meta‐ethnography

Abstract

Aims

To systematically review and synthesize qualitative evidence related to decision-making for treatment modalities among older adults with end-stage renal disease.

Design

A meta-synthesis of the qualitative research was conducted.

Data sources

A comprehensive literature review using PubMed, CINAHL, PsycINFO, Embase, Web of Sciences and Cochrane was systematically conducted. Qualitative studies published in English from January 2010 to October 2020 were considered.

Review methods

Qualitative studies were systematically identified and critically appraised. Data synthesis was performed independently by two reviewers. This review followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement.

Results

Seven qualitative studies, with publication years ranging from 2015 to 2019, were included in the analysis. Overall, the review comprised studies with a total of 133 participants aged between 61 and 93 years. Through meta-synthesis, three themes were identified: ‘reflecting on treatment options’, ‘confronting difficult decisions’ and ‘maintaining hope in everyday life’.

Conclusion

Our findings reflect that older adults have varying preferences for treatment options. These preferences are influenced by various factors such as considering the possibility of opting for dialysis and the practical applicability of treatment options. The synthesized conceptual model serves as the first step towards the conceptualization of the treatment-related decision-making process facilitated by adequate communication, in which patients should be encouraged to speak up, and healthcare providers should listen actively to their patients. This review can provide a strategy for providers to communicate treatment options with older patients with ESRD.

Impact

Healthcare providers should be sensitive to older adults’ preferences, priorities and treatment goals related to worrying about burdening their families and their outlook on life before deciding treatment modality. Our findings highlight that shared decision-making should be tailored to each of the older patients to provide comprehensive and individualized patient-centred care.

Did rest breaks help with acute fatigue among nursing staff on 12‐h shifts during the COVID‐19 pandemic? A cross‐sectional study

Abstract

Aim

This study aimed to explore whether 30-min rest breaks were as effective at lowering acute fatigue among 12-h shift hospital nursing staff who cared for patients with COVID-19 as among those who did not.

Design

The study was cross-sectional in design.

Methods

Data from the SAFE-CARE study collected online between May and June 2020 were used. A subsample (N = 338) comprised of nursing staff who reported working 12-h shifts, and providing direct patient care in hospitals was used in this study. Data on socio-demographics, work and rest breaks, and subjective measures of fatigue, psychological distress, sleep and health were used. Hierarchical multiple linear regression followed by stratified analyses was conducted to explore the relationships between rest breaks and acute fatigue among nursing staff groups with and without COVID-19 patient care.

Results

The sample, on average, had high acute fatigue. Around 72% reported providing care to patients with COVID-19, and 71% reported taking rest breaks ‘sometimes’, ‘often’ or ‘always’. In the group that cared for patients with COVID-19, there was no significant relationship between rest breaks and acute fatigue (p = .507). In the group that cared for patients hospitalized for other reasons, rest breaks were associated with lower acute fatigue (p = .010).

Conclusion

Our findings showed both the importance and inadequacy of rest breaks in reducing acute fatigue. The process of within-work recovery is complex, and routine rest breaks should be facilitated by nursing management on hospital units during and after the COVID-19 pandemic.

Impact

Rest breaks may present an effective strategy in lowering fatigue. Although rest breaks were not associated with less fatigue among staff caring for patients with COVID-19, other co-workers experienced some fatigue recovery. For frontline nursing staff, routine rest breaks are encouraged, and a systematic evaluation pertaining the sufficiency of rest breaks during high work demands in future research is needed.

How and when organization identification promotes safety voice among healthcare professionals

Abstract

Aim

The aim of this study is to examine the effect of organizational identification on safety voice behaviour, focusing on the mediating role of safety motivation and the moderating role of management commitment to safety and psychological safety.

Design

The study used a cross-sectional questionnaire and a convenience sampling method.

Method

Data were collected online during November 2019 from 165 staff members from a disability healthcare organization in Australia that employs over 800 staff. Nearly 80% of the study sample were healthcare workers without supervisory responsibilities, and the remainder were senior staff with some operational duties. Measures of organizational identification, safety motivation, perceived management commitment to safety, psychological safety and safety voice were collected. Data were analysed using a moderated mediation model available with the SPSS PROCESS macro.

Results

Findings show that organizational identification interacted with management commitment to safety to predict safety motivation, such that only healthcare employees who identified with their organization and perceived that their management cares about safety would feel that safety was personally important to them. In turn, safety motivation predicted safety voice. However, the effect of safety motivation on safety voice was only significant when psychological safety was low.

Conclusion

These findings offer initial evidence for the important role of organizational identification in prompting safety voice, how the relationship is contingent on management commitment to safety and psychological safety.

Impact

Healthcare professionals' discretionary sharing of ideas and suggestions are crucial to organizational performance and both staff and patient safety. However, safety voice involves inherent social risks because speaking up might not always be perceived positively by co-workers and leaders. We recommend that managers implement specific strategies to cultivate employee identification with the organization and demonstrate a genuine and visible commitment to safety so that employees will be motivated to raise safety concerns.

A multi‐level examination of nursing students' resilience in the face of the COVID‐19 outbreak: A cross‐sectional design

Abstract

Aims

To examine nursing students' stress and coping with the coronavirus disease 2019 (COVID-19) pandemic through an ecological model of resilience. Specifically, to examine the relative contribution of different resilience levels in decreasing nursing students' strain symptoms: at the individual level, resilience trait; at the relational level, students' coping strategies; at the university level, nursing students' perceptions on their university's readiness to handle the virus outbreak; and at the national level, nursing students' trust in policymakers' decisions.

Design

The study used a cross-sectional design.

Methods

Undergraduate students of five universities were recruited via an electronic link sent to their emails during the first months of the COVID-19 outbreak: May–July 2020. Of them, 492 participants completed the research questionnaire.

Results

Hierarchical Regression Analysis revealed that nursing students' resilience, as a multi-level factor, decreased the students' level of strain symptoms above and beyond their stress levels and control variables. Specifically, the nursing students' trait resilience, perceptions of their university's positive response to the pandemic and trust in their national policymakers were negatively associated with their strain symptoms. Conversely, disengagement-in-emotion coping strategies was positively associated with the students' strain symptoms.

Conclusions

Nursing students' resilience should be seen as a flexible resource that can be developed and influenced by their academic and clinical training, and by the intentions and actions of their university and the nursing administration at the Ministry of Health (MOH).

Impact

The findings call for the nursing administration at the MOH and for the university deans and department heads to prepare in advance a crisis plan that could be rapidly and effectively implemented when needed. Furthermore, topics such as developing flexible coping strategies should be integrated into the nursing curricula. These would allow students to prepare and cope better with adversity in their routine and in times of crisis.

Sleep and hypoglycaemia symptom perception in adults with type‐1 diabetes mellitus: A mixed‐methods review

Abstract

Aims

The study aims to review, synthesize and integrate primary research on the relationship between sleep and hypoglycaemia symptom perception in adults with type-1 diabetes.

Design

This mixed-methods review follows a convergent segregated approach to synthesis and integration of qualitative and quantitative evidence.

Data Sources

With assistance of a biomedical librarian, a search of four databases was conducted (PubMed, CINAHL, Embase and PsycINFO) in June 2020. The review included primary research measuring sleep and hypoglycaemia symptom perception in adults (age ≥ 18 years) with type-1 diabetes in English. Studies that exclusively addressed children, type-2 diabetes or outcomes unrelated to sleep and hypoglycaemia symptom perception were excluded.

Review Methods

Screening focused on title and abstract review (n = 624). Studies not excluded after screening (n = 35) underwent full-text review. References of each study selected for inclusion (n = 6) were hand searched with one study added. All studies included in the review (n = 7) were critically appraised with JBI Critical Appraisal tools, and then data were extracted with systematic evaluation.

Results

Quantitative synthesis found sleep reduces the magnitude of detectable symptoms and one's capacity to detect them. Qualitative synthesis found that individuals with type-1 diabetes perceive unpredictable severity, frequency and awareness of symptoms while asleep as an oppressive, lingering threat. Integration of findings highlights the troublesome duality of sleep's relationship with hypoglycaemia symptom perception.

Conclusions

Sleep presents a challenging time for individuals with type-1 diabetes. Further research examining the relationship between sleep and hypoglycaemia symptom perception is recommended as the number of studies limits this review.

Impact

Symptom perception is the main physiologic defense against severe hypoglycaemia in type-1 diabetes. This review found that sleep's relationship with hypoglycaemia symptoms has unique physiological and psychological components to address when providing comprehensive care. This review may inform future lines of inquiry that develop into interventions, improvements in practice and risk reduction for hypoglycaemia-related complications.

The Moral Distress‐Appraisal Scale: Scale development and validation study

Abstract

Aims

Moral distress—arising when one is constrained from moral action—has been receiving increased attention in nursing research. The phenomenon is associated with negative outcomes and is shown to impact a broad range of healthcare professions. The context-specific nature of existing measures, however, makes it difficult, if not impossible, to compare the prevalence and impact of moral distress across nursing settings and healthcare professions. This study presents an appraisal approach to the assessment of moral distress. The aims of this study were to develop and to investigate the reliability and validity of the Moral Distress-Appraisal Scale as a context-independent assessment instrument for moral distress.

Design

This is a cross-sectional correlational validation study.

Methods

Between September 2018 and June 2019, a total of 406 healthcare employees (mainly nurses) completed a quantitative survey consisting of a standard moral distress measure (Moral Distress Scale-Revised) and the Moral Distress-Appraisal Scale. A subsample (n = 164) received extra questions on work characteristics, well-being and attitudinal outcomes. Confirmatory factor analysis, Pearson correlations and regression analyses were conducted in order to evaluate the psychometric properties of the newly developed scale.

Results

Confirmatory factor analysis provided evidence for the predicted structure of the 8-item Moral Distress-Appraisal Scale. As expected, the scale is positively correlated with the Moral Distress Scale-Revised and with job demands, burnout, depressive symptoms, and turnover intentions and negatively with job resources and job satisfaction. Furthermore, the scale showed incremental validity in predicting wellbeing and attitudinal outcomes above and beyond both known predictive work characteristics and the Moral Distress Scale-Revised.

Conclusion

This study provides first empirical evidence for the reliability and validity of the Moral Distress-Appraisal Scale.

Impact

The Moral Distress-Appraisal Scale can be used across healthcare professions and contexts. The proposed appraisal approach may facilitate integration of the scale into occupational health research and practice.

Secondary prevention of coronary heart disease: The effect of a nursing intervention using Cox's interaction model of client health behaviour

Abstract

Aims

Secondary prevention of coronary heart disease is of utmost importance to facilitate people to achieve health outcomes and behaviours. This study was to investigate the effect of a nursing intervention based on Cox's interaction model of client health behaviour to improve health outcomes and behaviours of secondary prevention of coronary heart disease.

Design

This study is a cluster randomised controlled trial.

Methods

Participants were recruited between August and November 2019 in two community settings in Hengyang city, Hunan province, China. Participants in the intervention group received a nursing intervention based on Cox's interaction model of client health behaviour and routine health education, while those in the control group received routine health education only. The outcome variables included selfߚmanagement, physical activity, medication compliance, anxiety, sexual knowledge, the ability to identify sexual health education needs, blood pressure, body mass index (BMI), and lowߚdensity lipoprotein cholesterol (LDLߚC). The influential statistical tests applied to analyse the data included χ 2 tests and t tests.

Results

Seventyߚseven participants completed this study. Compared with the control group (n = 40), the intervention group (n = 37) showed statistically significant better health outcomes and behaviours regarding selfߚmanagement, physical activity (except for high energy consumption), medication compliance, anxiety, sexual knowledge, the ability to identify sexual health education needs, systolic blood pressure, BMI, and LDLߚC. However, there was no statistically significant difference in diastolic blood pressure and high energy consumption for physical activity.

Conclusion

A wellߚdeveloped nursing intervention based on Cox's interaction model of client health behaviour could successfully improve health outcomes and behaviours of secondary prevention of coronary heart disease. Such an intervention may be incorporated into community healthcare practice by nurses to improve patient care.

Impact

This study provides a valuable insight to facilitate further development of effective nursing interventions to improve secondary prevention of coronary heart disease in community settings.

Exploring the experiences of living with Lewy body dementia: An integrative review

Abstract

Aim

Lewy body dementia is a common neurodegenerative dementia with unique challenges in managing day-to-day life. A more in-depth multifaceted picture of the Lewy body dementia lived experience will enable identification of best practice and future research direction. The review aim was to explore experiences of people living with Lewy body dementia and their family carers.

Design

Integrative review method informed by Whittemore and Knafl, supported by the information retrieval framework PALETTE. A convergent integrated approach enabled synthesis of key findings and theme identification.

Data sources

Medline, CINAHL, PsycINFO, AMED, and ALOIS databases were systematically searched to find studies published between 1995 and 2020.

Review Methods

Twenty-six articles from twenty studies were synthesized (from 1583 retrieved). Quality and relevance were appraised using the Mixed-Methods Appraisal Tool and Gough's ‘Weight of Evidence’ framework. Data management was supported by ATLAS.ti 8 and COVIDENCE software.

Results

Four themes were identified: living with an uncertain diagnosis and prognosis; fear of the now – worry for the future; living with behavioural and psychiatric symptoms; and maintaining a social and emotional life. People reported difficulty finding information and support around diagnosis, disease progression and managing complex symptoms. The result is increased caregiver burden, grief and stress and reduced quality of life.

Conclusion

Delayed diagnosis and complex symptom burden means people are not getting the timely support and information they need to live and die well. Current evidence is largely quantitative, with a focus on family caregiver burden and unmet need. The challenge remains in how to capture a more holistic picture of the lived experience for people living with Lewy body dementia and those who care for them.

Impact

This review highlighted current knowledge and identified gaps in exploring the lived experience for people with Lewy body dementia and their families.

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