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Anteayer Journal of Advanced Nursing

Patient empowerment and self‐management behaviour of chronic disease patients: A moderated mediation model of self‐efficacy and health locus of control

Abstract

Aims

To explore the role of self-efficacy (SE) in the effect of patient empowerment on self-management behaviours among patients with chronic illness and to investigate the moderating effect of three types of health locus of control (HLC) in this moderated mediation model.

Design

Cross-sectional design.

Methods

Data were collected in a general tertiary hospital, and a sample of 254 patients was recruited between August and October 2020. The effect of moderation and mediation was tested by the PROCESS macro (Model 4 and Model 8) for SPSS 25.0 by Hayes using 5000 bootstrap samples.

Results

Self-efficacy significantly mediated the relationship between patient empowerment and self-management behaviour with a 95% confidence interval excluding zero. The chance HLC demonstrated a moderating effect, and the interaction effect on SE and self-management behaviour was significant.

Conclusion

Patient empowerment may improve confidence and adherence to self-management among people with chronic illness, and such benefits were conditional on the HLC of patients.

Impact

This study addresses the relationship between patient empowerment and self-management behaviour in patients with different personality characteristics. This result indicated that classifying the type of HLC may enable the identification of subgroups of patients who may subsequently benefit from patient empowerment. In a patient-centred programme, nurses and other healthcare professionals correctly identifying patients’ HLC type and understanding the implications and then providing appropriate health care plans for patients with different health beliefs may be useful to tailor the decision-making process.

Investigating the relationship between workplace stressors and caring behaviours of nursing staff in inpatient wards: A cross‐sectional study

Abstract

Aim

The present study aimed to investigate the effects of various job stressors on caring behaviours of nursing staff.

Design

A cross-sectional nationwide study.

Methods

This cross-sectional, descriptive-correlational study was conducted on 260 nurses employed in the inpatient wards of seven teaching hospitals in Tehran, Iran during December 2019–February 2020. The participants were selected via convenience sampling. Data were collected using a demographic questionnaire, the nursing stress scale and the caring behaviours inventory. Data analysis was performed in SPSS version 20 using descriptive statistics and linear regression analysis.

Results

The results of regression analysis indicated that job stress is correlated with nurses' caring behaviours (β = −.36; p = .001). Factors such as workload (β = −.27; p = .001), uncertainty about patient treatment (β = −.26; p = .017) and lack of emotional preparation (β = −.20; = .017) were the important stressors associated with nurses' caring behaviours.

Conclusions

According to the results, high levels of perceived job stress due to workload, uncertainty about patient treatment and lack of emotional preparation are associated with lower levels of nurses' caring behaviours.

Impacts

The findings of this study showed that to provide patients with optimal caring behaviours, hospital and nursing managers should design interventions to reduce nurses' job stressors, especially in terms of their interactions with their colleagues and physicians.

Association between perceived health and adherence to treatment after percutaneous coronary intervention: A long‐term follow‐up study

Abstract

Aims

To identify associations between perceived health and treatment adherence six years after percutaneous coronary intervention.

Design

A non-experimental descriptive long-term follow-up study.

Methods

Baseline data (n = 416) were collected in 2013, with follow-up data collected in 2019 (n = 154), using the EuroQoL scale, EuroQoL visual analogue scale, and Adherence of Patients with Chronic Disease Instrument. Data were analysed using descriptive statistics and multivariate methods.

Results

The average age of the 154 respondents was 68.5 years (SD 7.01), with a majority males (n = 118, 86.6%). Adherence to a healthy lifestyle, good perceived results of care, support from nurses, high sense of normality, low fear of complications, motivation, older age, and duration of coronary artery disease were associated with better general perceived health as well as its dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression).

Conclusion

Support from nurses is a key factor to ensuring high perceived health among post-percutaneous coronary intervention patients. This support must be continuous and motivate the patient to adhere to a healthy lifestyle. Patients should feel comfortable sharing their problems and fears. This type of relationship will allow health care professionals to assess the patient's current situation and address potential problems about mobility, pain and discomfort, as well as anxiety and depression to strengthen the patient's sense of normality and enable them to confidently lead a normal life.

Impact

The research aimed to gain knowledge about how perceived health is associated with treatment adherence six years after percutaneous coronary intervention. The results emphasise that a nurse's support of patients is crucial to the care process, as adherence to treatment showed a clear positive association with perceived health in the analysed sample of post-PCI patients.

A qualitative study of young childhood cancer survivors and their parents’ experiences with treatment‐related late effects in everyday life post‐treatment

Abstract

Aims

The purpose of this secondary analysis was to explore how young cancer survivors and their parents experience and manage treatment-related late effects in daily life post-treatment.

Design

A phenomenological-hermeneutic explorative study.

Methods

Using purposive sampling, we included 15 childhood cancer survivors (aged 11–18 years) and their parents who participated in semi-structured interviews from September 2019 through May 2020. We analysed the interviews paired using a thematic approach focused on meaning.

Results

The central theme, ‘Negotiation daily life’, emerged as well as three interrelated sub-themes, that is ‘A changed everyday life’, ‘Physical activity as a tool’ and ‘Friends as a tool’. The childhood cancer survivors and their parents experienced, understood and interpreted the late effects differently. The difference between the survivors’ perceptions and those of their parents in managing treatment-related late effects in everyday life resulted in a continuous negotiation process between the parties. Parents highlighted the negative impact of late effects on their child's daily life in relation to physical activity, school and socialization while the survivors wished to leave the cancer experience behind and ‘move on’ with their friends. As a result, most of the survivors developed strategies to manage their social activities while their parents felt that the survivors neglected the late effects.

Conclusion

The ongoing negotiation process between the childhood cancer survivors and their parents show the complexity of the new family dynamics on returning to everyday life post-treatment. For clinical nurses, that means that there should be focus on family dynamics and how the childhood cancer survivors and parents, respectively, manage the childhood cancer survivors’ late effects.

Impact

Healthcare providers should distinguish between the needs of the survivors and those of their parents as they transition from treatment to everyday life, and especially in the management of late effects caused by the treatment.

Qualitative study of Stroke Survivors’ Perceptions of Secondary Prevention

Abstract

Aims

To understand how survivors of stroke perceive secondary prevention and explore their perceived barriers and facilitators using the Theoretical Domains Framework.

Design

A qualitative descriptive study.

Methods

Nineteen survivors of stroke from three hospitals were recruited and interviewed from April 2019 to April 2020. The data were analysed deductively and inductively by content analysis strategies.

Results

Three main themes of perception of secondary prevention were identified, these being active treatment-seeking, attention to taking medications and negative attitude towards lifestyle changes. Using deductive analysis, eight domains of the Theoretical Domains Framework were reported to be relevant in the secondary prevention behaviour of survivors of stroke that mapped to five ‘barrier’ domains (i.e. knowledge, physical skills, beliefs about capability, beliefs about consequences and optimism) as well as six ‘facilitator’ domains (i.e. knowledge, interpersonal skills, beliefs about capability, intention, emotion and social influences). Using inductive analysis we identified two additional important factors not falling in the domains of the Theoretical Domains Framework. These comprised female spouses’ support and patients’ economic autonomy, both of which could be classified as a facilitator or barrier.

Conclusion

Survivors of stroke perceive seeking treatment and using preventive medication as more important than modifying lifestyle behaviours. Knowledge and insight into the barriers and facilitators of secondary prevention in this specific context provides a theoretical and practical basis for the design of future secondary prevention interventions.

Impact

Stroke survivors’ perceptions of secondary prevention, barriers and facilitators were explored in the context of a developing country. These findings highlight the need to better communicate the importance of improving lifestyle modification and medication adherence, and provide evidence for designing relevant interventions for stroke management in the community.

Medication dose calculation errors and other numeracy mishaps in hospitals: Analysis of the nature and enablers of incident reports

Abstract

Aims

To investigate medication dose calculation errors and other numeracy mishaps in hospitals and examine mechanisms and enablers which lead to such errors.

Design

A retrospective study using descriptive statistics and thematic analysis of the nature and enablers of reported incidents.

Methods

Medication dose calculation errors and other numeracy mishaps were identified from medication-related incidents reported to the Norwegian Incident Reporting System in 2016 and 2017. The main outcome measures were medications and medication classes involved, severity of harm, outcome, and error enablers.

Results

In total, we identified 100 numeracy errors, of which most involved intravenous administration route (n = 70). Analgesics were the most commonly reported drug class and morphine was the most common individual medication. Overall, 78 incidents described patient harm. Frequent mechanisms were 10- or 100-fold errors, mixing up units, and incorrect strength/rate entered into infusion pumps. The most frequent error enablers were: double check omitted or deviated (n = 40), lack of safety barriers to intercept prescribing errors (n = 25), and emergency/stress (n = 21).

Conclusion

Numeracy errors due to lack of or improper safeguards occurred during all medication management stages. Dose miscalculation after dilution of intravenous solutions, infusion pump programming, and double-checking were identified as unsafe practices. We discuss measures to prevent future calculation and numeracy errors.

Impact

Our analysis of medication dose calculation errors and other numeracy mishaps demonstrates the need for improving safety steps and increase standardization for medication management procedures. We discuss organizational, technological, and educational measures to prevent harm from numeracy errors.

Virtual reality interventions and the outcome measures of adult patients in acute care settings undergoing surgical procedures: An integrative review

Abstract

Aims

To evaluate the different types of virtual reality (VR) therapy received by adult patients undergoing surgical procedures in acute care settings and the outcome measures, as well as to highlight the acceptability and feasibility of VR approaches among patients and healthcare workers.

Design

Whittemore and Knafl's integrative review method guided the analysis.

Data sources

Searches were conducted in ScienceDirect, ProQuest, Wiley Online Library, Medline, PsycINFO and PubMed and Google Scholar from 2000 to June 2021.

Review methods

A systematic search on articles published in English was carried out with electronic databases and hand search references. Keywords searched included primary qualitative and quantitative studies that utilized VR therapy in surgical care settings.

Results

Eighteen articles were reviewed, which reported the use of two main strategies: guided and interactive imagery therapy. The findings identified: (i) patient-clinical outcome measures including the use of analgesics, vital signs, functional capacity and length of hospital stay; and (ii) patient-reported experience measures including pain, anxiety and satisfaction level. Comfort, age, knowledge and attitude were key factors influencing the acceptability of VR among the patients, whereas cost-effectiveness and infection control were two main factors affecting the feasibility of use among the health care workers.

Conclusion

VR therapy demonstrated potential improvements in both the patient-clinical outcomes and patient-reported experiences of those undergoing surgical procedures. However, the findings were inconsistent, which required further research to explore and establish the effectiveness of using VR in the context of acute care settings.

Impact

VR distraction has been increasingly used as a non-pharmacological method in managing pain, easing anxiety and optimizing other associated outcomes in patients undergoing surgical procedures. It is essential to examine the effectiveness of VR therapy on the adult patients’ outcomes in acute care settings with surgical procedures, as well as its acceptability and feasibility of use.

Young Adults Rehabilitation Needs and Experiences following Stroke (YARNS): A review of digital accounts to inform the development of age‐appropriate support and rehabilitation

Abstract

Aims

To explore younger adults' experiences of stroke rehabilitation to inform practice, education and future health policy.

Design

Qualitative analysis of digital and other media sources on public platforms.

Methods

Between March and June 2020, the experiences of younger adult stroke survivors aged 18 to 45 at the time of the stroke were collected. Data were gathered from publicly available sources, including social media, and from English-speaking users. In total, 117 accounts from 103 participants were identified from films, autobiographical books, blogs, websites, videos, Twitter and Instagram. Data analysis followed narrative and multimodal analysis with a focus on rehabilitation needs.

Results

Younger adult stroke survivors make sense of their experience by reflecting on how stroke has impacted their lives. Accounts reflected an emotional journey between the past self, the present self and evolving self, as well as associated challenges such as the impact on relationships and careers. The majority of accounts presented transitions as problematic, including the receipt of the initial diagnosis, or sometimes misdiagnosis, to returning home and achieving long-term rehabilitation goals. Specialist stroke nurses were considered essential in the rehabilitation process.

Conclusion

A complex process of recovery follows stroke for younger adult stroke populations. Challenges to the rehabilitation process need to be better understood and the role of nursing highlighted in future service provision. A series of age-related challenges were highlighted that require attention to improve the care and support offered.

Impact

This article informs clinicians, educators, and policymakers of the age-related needs of young adult stroke survivors. Focusing on the individual and the development of age-appropriate person-centred stroke care is important. The study highlights the role of stroke nursing and challenges the current policy focus on older stroke populations as well as arguing for greater awareness of age-appropriate stroke rehabilitation in younger adults following stroke.

Tenacious team, precarious patient: A phenomenological inquiry into interprofessional collaboration during ICU resuscitations

Abstract

Aims

The study aims to explore the lived experiences of interprofessional collaboration among ICU nurses, doctors, and respiratory therapists in managing resuscitations in the ICUs.

Design

Descriptive phenomenological design, underpinned by Husserl's philosophy.

Methods

ICU nurses, doctors and respiratory therapists who have experience in managing resuscitations with the interprofessional team were recruited through purposive sampling from April to December 2019. Sixteen ICU professionals participated in individual, semi-structured, in-depth interviews which were audio recorded, and transcribed verbatim. Findings were analysed using Colaizzi's 7-step analysis.

Results

The essence of interprofessional collaboration during resuscitations can be described in four main themes. ‘Ruminating about professional boundaries’ signifies how ICU professionals acknowledged the roles and boundaries that surrounded their scope of practice during resuscitations. ‘Rallying the interprofessional team’ illustrates how the interprofessional team rapidly band together amongst the aid and hindrance of contextual enablers and inhibitors. ‘Responding to interprofessional conflicts’ depicts how intra- and interprofessional tensions can occur during resuscitations that can impact patient safety. ‘Reaching collective leadership’ proposes enhanced resuscitation care through the collective leadership of the interprofessional team.

Conclusion

Resuscitations represent a precarious turn of events for the critically ill patient where the interprofessional team undergoes a cyclic sequence of teamwork and conflict while attempting to drive the resuscitation into a positive outcome. As ICU professionals attempt to optimise interprofessional collaboration during resuscitations, findings call for enhanced team training initiatives encompassing the interprofessional team, with an emphasis on collective leadership.

Impact

ICU professionals experience of interprofessional collaboration during resuscitations is poorly understood. By understanding their lived experience, targeted interventions to improve interprofessional collaboration can be conceptualised and implemented. Findings will set pace for future evaluation research on interprofessional collaboration and patient outcomes during resuscitations.

Psychological impacts and online interventions of social isolation amongst older adults during COVID‐19 pandemic: A scoping review

Abstract

Aim

To summarise the psychological impacts of social isolation amongst older adults during COVID-19 and review the benefits and limitations of online interventions used to combat social isolation.

Design

A scoping review was performed.

Data Sources

A systematic search was performed from October 2020 to January 2021 in seven electronic databases: China National Knowledge Infrastructure (CNKI), PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Cochrane Library and Web of Science. A hand search of the reference lists of included papers and WHO publications was performed. Grey literature search was carried out from Scopus, ProQuest Dissertation and Google Scholar.

Review Methods

Studies were screened, appraised and extracted independently by two reviewers. Thematic analysis was used to synthesise data, which were presented in a descriptive manner and organised into categories and themes.

Results

Totally, 33 studies were included. Four themes and eight sub-themes emerged: (1) negative impacts and experiences of older adults during social isolation, (2) adopting coping behaviours in the midst of COVID-19, (3) online interventions to combat the consequences of social isolation, (4) barriers to online intervention.

Conclusion

The COVID-19 pandemic has taken an emotional toll on older adults’ psychological wellbeing and has highlighted the untapped strengths of older adults facing isolation. Online interventions, which could be a new normal in the COVID era, were beneficial in combating social isolation. Strategies by various stakeholders were recommended to tackle the barriers of online interventions.

Impact

With the COVID-19 pandemic still in progress, this review provides insights on the psychological impacts of social isolation amongst older adults. Nurses in the community and long-term care facilities could adopt strategies and online intervention to better support the older adults, contribute to a stronger COVID-19 response and support system, and an overall better road to recovery from this crisis.

A Delphi study identifying operating room nurses’ non‐technical skills

Abstract

Aim

To identify the non-technical skills of operating room nurses. This is the first empirical study that includes scrub and circulating operating room nurses.

Design

A three-round modified online Delphi technique was used for this study.

Methods

Eligible participants (n = 106) with a minimum of 2 years of operating room nursing experience were selected for the expert panel by self-recruitment from a population (N = 1640) of operating room nurses. Data were collected through online surveys, based on crew recourse management theory, between April and September 2020. Descriptive statistics analysis was used for the quantitative data, and deductive thematic analysis for the qualitative data. Consensus was determined using stability between the survey rounds.

Results

A consensus was obtained to maintain the non-technical skills categories of situation awareness, leadership, decision-making, communication and teamwork. The qualitative data revealed several novel non-technical skills, including independent decision-making and leadership skills.

Conclusion

The non-technical skills of operating room nurses are more extensive than previously identified. This study has contributed to a verbalization of the tacit knowledge and skills of the operating room nurses. In addition, a list of non-technical skills that should be included in the education of operating room nurses to ensure patient safety in the operating room has been prepared.

Impact

This study addresses the lack of research on the non-technical skills of operating room nurses. When exploring the non-technical skills of scrub and circulating nurses, a diversity of novel non-technical skills was uncovered. This research will provide input for the development of a new training, supervision and assessment tool for accelerated development of the non-technical skills of operating room nurses. This contribution to the verbalization of the formerly tacit non-technical skills may facilitate clinical and formal teaching of such skills and may subsequently impact surgery-related patient safety.

Designing a nurse‐led assessment and care planning intervention to support frail older people in primary care: An e‐Delphi study

Abstract

Aim

To identify and establish expert consensus on important and feasible components of a nurse-led, comprehensive geriatric assessment (CGA)-based intervention for community-dwelling older people who live with frailty.

Design

A three-round modified e-Delphi survey.

Methods

An expert panel of 33 UK specialist older people's, primary and community care nurses participated in the three-round e-Delphi survey over a 12-month period in 2017–2018. Data from round 1 were analysed using content analysis. Descriptive statistics were used in the subsequent two rounds to demonstrate convergence of panel opinion and consensus.

Results

In round 1, experts proposed 30 CGA components that were combined with six additional components from a literature review and clustered into six domains. In round 2, components were rated for importance and feasibility. Rating scores for importance were high across all domains, with lower scores for feasibility. Round 3 revealed that 36 components achieved consensus on importance and 11 out of 36 components reached consensus on feasibility.

Conclusion

Based on expert panel opinion, the content of a nurse-led CGA-based intervention was established, with the aim of future feasibility testing in a randomized controlled trial.

Impact

This study provides feasible components of a CGA-based intervention that can be implemented in clinical practice by nurses in partnership with older people who live with frailty. Following further testing and evaluation, the components have the potential to improve clinical outcomes, maximize independence and improve the quality of life for community-dwelling frail older people.

Final clinical practicum shapes the transition experience and occupational commitment of newly graduated nurses in Europe—A longitudinal study

Abstract

Aims

The aim of the study was to examine the association between the characteristics of a nursing student’s final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries.

Design

A longitudinal design with two data collections points (pre- and post-graduate).

Methods

The data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence.

Results

Several associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found.

Conclusion

Having a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession.

Impact

This study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses.

Constructing the advanced nurse practitioner identity in the healthcare system: A discourse analysis

Abstract

Aims

To explore how Advanced Nurse Practitioners (ANP) are positioned within current nursing and health system structures in Ireland by making explicit the discourses that construct ANPs’ identities and how they both enable and constrain their roles.

Background

Ambiguity and confusion characterize debates about the ANP role having a profound impact on ANP identity and how they realize their roles. Without clear definitions, boundaries are difficult to ascertain, the full potential of the ANP is not realized and, consequently, ANPs are underutilized. Although this study is relevant outside Ireland's borders, it is of particular concern in the Irish setting as current policy aims to increase ANP numbers.

Design

A qualitative discourse analysis using Gee's Tools of Inquiry.

Method

Data were collected between April 2019 and January 2020 through seven in-depth interviews and four focus groups and analysed using Gee's Tools of Inquiry. Participants included ANPs, nurses, doctors and allied healthcare professionals.

Findings

Five key discourses emerged. Language-in-use established, first, that ANPs add value to the healthcare system and, second, highlighted the centrality of nursing to ANPs’ identity. The third discourse builds an educated and skilled identity for ANPs, one that, however, lacked the expertise and influence of their medical colleagues. The fourth discourse constructs an identity for ANPs as medical substitutes, lesser roles, yet innovative additions to the system and a threat to existing structures. The final discourse constructs tensions between independence and autonomy, on the one hand, and control, on the other.

Conclusion

This study alerts healthcare professionals to ways in which discourses influence opinion and frame ANPs’ identity. Healthcare professionals should challenge Conversations and Discourses that disparage the ANP role. ANPs need to clearly articulate their role, the value that it adds to the healthcare system and demonstrate how it aligns with and complements other healthcare professionals’ roles.

Impact

By identifying and critiquing extant Discourses and Conversations, healthcare professionals, and health system leaders and managers will gain a better understanding of the issues that both enable and constrain the ANP role.

Latent profile analysis on Korean nurses: Emotional labour strategies and well‐being

Abstract

Aims

To identify the unique profiles of emotional labour management strategies among Korean nurses in regards to the preferences of surface acting (affecting emotions required at the workplace) and deep acting (trying to genuinely experience emotions required at the workplace), a latent profile analysis (LPA) was conducted. In addition, differences in psychological and occupational well-being between the discovered profiles are examined.

Design

An exploratory, cross-sectional LPA design was employed.

Methods

Nurses (N = 204) working in university hospitals in South Korea responded to the survey during November 2019. Participants completed the Emotional Labour Questionnaire, a portion of the Maslach Burnout Inventory, the Minnesota Satisfaction Questionnaire short form and the Turnover Intentions Scale.

Results

As a result of LPA on nurses' surface acting and deep acting, five profiles were discovered: non-actors, surface actors, moderators, regulators and high regulators. In addition, differences in emotional exhaustion, job satisfaction and turnover intentions between profiles were examined. Profiles that used high levels of surface acting had high levels of emotional exhaustion and turnover intentions.

Conclusion

Nurses with characteristics of surface actors, high regulators profiles in emotional labour context are more prone to emotional exhaustion and turnover possibilities, compared with other profiles (non-actors, moderators and regulators).

Impact

Insights from the current study are beneficial to hospitals in preventing potential emotional exhaustion and nurse turnover by responding to high-risk profiles and customizing emotional labour management policies with regards to the different profiles of nurses' emotional labour.

Testing the relationship between patient‐related stressor, psychological distress, work engagement, job satisfaction and recovery attitude among psychiatric nurses in Japan

Abstract

Aims

To test the relationship between patient-related stressor, psychological distress, work engagement and outcomes (job satisfaction and recovery attitude) among psychiatric nurses in Japan. Specifically, we tested the following hypotheses: psychological distress mediates the relationship between patient-related stressor and outcomes and work engagement moderates the direct and indirect effects of patient-related stressor on outcomes.

Design

Cross-sectional study.

Methods

In total, 446 psychiatric nurses in Japan responded to a self-reported questionnaire between August and October 2018. Data on demographics, patient-related stressor, job satisfaction, recovery attitude, psychological distress and work engagement were collected, followed by a moderated mediation analysis using hierarchical regression and structural equation modeling (SEM).

Results

Regression analysis indicated that psychological distress mediated the negative relationship between patient-related stressor and job satisfaction and that work engagement moderated the direct and indirect effects of patient-related stressor on job satisfaction. In particular, the higher the work engagement, the higher the indirect effect, but the lower the direct effect. Additionally, no mediation of psychological distress and moderation of work engagement was observed in the relationship between patient-related stressor and recovery attitude; however, work engagement directly increased recovery attitude. Results of the SEM test showed a satisfactory fit of the final model.

Conclusions

Work engagement facilitates recovery attitude and increases the indirect effect of patient-related stressor on job satisfaction through psychological distress. However, work engagement decreases the direct effect not mediated by psychological distress.

Impact

This study addresses an essential topic, that is, psychiatric nurse job outcomes (job satisfaction and recovery attitude) are negatively influenced by patient-related stressor. Work engagement has multiple beneficial effects on outcomes as both a facilitator and moderator; thus, programs that improve work engagement are useful for psychiatric nurses. Furthermore, programs may be enhanced considering that work engagement decreases the direct effect of patient-related stressor on job satisfaction.

Clinical practice guidelines for the prevention and management of frailty: A systematic review

Abstract

Aims

To systematically search for clinical practice guidelines focusing on the prevention and management of frailty, to evaluate their methodological quality and to synthesize the consensus recommendations.

Design

A systematic review.

Data Sources

Guideline websites, related professional association websites and electronic databases were systematically searched through 4 November 2020.

Review Methods

We evaluated the methodological quality of the eligible guidelines using the Appraisal of Guidelines Research and Evaluation II (AGREE II). Two reviewers synthesized the consensus recommendations proposed by at least two guidelines.

Results

Eight guidelines met the eligibility criteria and were included in the review. The mean scores of the six domains were as follows: the ‘scope and purpose’ domain scored 88.0%, the ‘clarity of presentation’ domain scored 81.9%, the ‘stakeholder involvement’ domain scored 63.4%, the ‘editorial independence’ domain scored 62.2%, the ‘rigour of development’ domain scored 61.1% and the ‘applicability’ domain scored 57.8%. In total, we synthesized 23 recommendations for the prevention and management of frailty that are consistent among the included guidelines.

Conclusions

The number of clinical practice guidelines for the prevention and management of frailty is limited. The methodological quality of existing guidelines needs to be improved. Our synthesized findings provide an intuitive, convenient and summative reference resource for frailty prevention and management. It’ is worth noting that recommendations described in the included guidelines require additional detail.

Impact

Although the prevention and management of frailty is urgent, there is currently a lack of evidences guiding these processes, especially in the prevention. The methodological quality of existing guidelines is insufficient, and the recommendations described in the guidelines require additional detail. Therefore, users of these guidelines, especially nurses, should make a careful decision according to the specific situation when using. Nurses also have a key role in providing more clinical evidences for the improvement of the quality of the guidelines.

Childhood adversity and mental health among Chinese young adults: The protective role of resilience

Abstract

Aim

The aims of this study were to examine the prevalence of adverse childhood experiences (ACEs) among health science students in China; associations between the number of ACE exposures and severity of depressive and anxiety symptoms; and the extent to which resilience moderates the effect of ACEs on mental health outcomes.

Design

This descriptive, cross-sectional study was conducted May–August 2020.

Methods

Five hundred and sixty-six health science students (18–38 years) from China completed online surveys measuring ACEs using the Simplified Chinese version of the ACE-International Questionnaire, depressive and anxiety symptoms and resilience. Descriptive statistical analysis, ANOVA with Tukey HSD post hoc tests and multiple regression analysis were performed using SPSS 27.

Results

88.5% of participants reported at least one ACE; 42.6% reported four or more ACEs. Higher number of ACEs was associated with more symptoms of depression and anxiety. Four or more ACEs were associated with significantly worse mental health outcomes than those with no ACEs and those with one to three ACEs. Greater resilience significantly attenuated the effects of ACEs on mental health symptoms.

Conclusions

ACEs are highly prevalent among Chinese health science students but their impact on mental health can be buffered by higher levels of resilience.

Impact

Screening for ACEs and strength-based, trauma-informed interventions on fostering resilience is needed to promote mental health among Chinese young adults.

What factors influence nursing home use of hospital avoidance programs? An interview study

Abstract

Aims

To understand why some nursing homes use hospital avoidance programs more frequently than others.

Design

Two hospital avoidance programs, called residential-in-reach services in Victoria, Australia, were evaluated using a qualitative descriptive design.

Methods

Between 2014 and 2018, 127 semi-structured interviews were conducted with staff from nursing homes, general practitioners and staff from the residential-in reach services. The interviews took an average of 45 min and transcripts were thematically analysed.

Results

Nursing home reliance on residential-in-reach services to manage deteriorating residents was evident in both evaluations. Irrespective of the model of service provision, reliance was associated with: the increased care needs of residents; difficulties accessing timely and appropriate medical care; and the reduced numbers of skilled registered nurses to assess and manage deteriorating residents.

Conclusion

The residential-in-reach services are highly regarded by nursing homes. However, some are reliant on these services to provide nursing assessment and management. Using residential-in-reach services to substitute for nursing care, deskills nurses and shifts the cost of providing care from the service provider to other agencies. To provide residents with quality nursing care, the number of skilled registered nurses able to work within their scope of practice needs to be increased in Australian nursing homes.

Impact

The findings highlight the challenges of providing care in older people living in aged care. Increasing the number of skilled registered nurses in Australian nursing homes, would support deteriorating residents to stay in familiar surroundings and reduce reliance on external services to provide nursing care.

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