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AnteayerEvidence-Based Nursing

Use of personal protective equipment reduces the risk of contamination by highly infectious diseases such as COVID-19

Por: Dos Santos · W. M.

Commentary on: Verbeek JS, Rajamaki B, Ijaz S, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2020; Apr 15;4(4):CD011621. doi:10.1002/14651858.

Implications for practice and research

  • The use of a powered, air-purifying respirator with coverall may protect against the risk of contamination better than an N95 mask and gown but was more difficult to don.

  • The creation of future studies is necessary to compare the risk of contamination during removal of personal protective equipment, PPE).

  • Context

    Currently more than 59 million people are employed in the health sector worldwide, who are at risk of developing life-threatening infectious diseases due to contact with patients’ blood or body fluids.1 Due to the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic, as well as other infectious diseases, healthcare workers (HCW) must...

    Complex interactions between provider, organisation and patient level characteristics influence the effect of pressure ulcer preventive care interventions

    Por: Urrutia-Bastardo · R. · Turin · T. C.

    Commentary on: Baernholdt M, Yan G, Hinton ID, et al. Effect of preventive care interventions on pressure ulcer rates in a national sample of rural and urban nursing units: longitudinal associations over 4 years. Int J Nurs Stud 2019:103455. doi:

    Implications for practice and research

  • Organisational structures that support an improved work environment and workflow for nurses are important contributors towards the prevention of pressure ulcers.

  • Future research on pressure ulcer prevention needs to consider the complex interactions between the characteristics patients, care providers and care organisations.

  • Context

    Pressure ulcers develop due to persisting pressure on a bony site leading to obstruction of the blood flow in healthy capillaries resulting in tissue injury.1 These commonly occur in patients with limited mobility such as those in hospitals or long-term care settings.1 2 The key components in...

    Increased sedentary behaviour is associated with increased depression symptoms in adults

    Por: Hardy · S.

    Commentary on: Del Pozo Cruz B, Alfonso-Rosa RM, McGregor D, et al. Sedentary behaviour is associated with depression symptoms: compositional data analysis from a representative sample of 3233 US adults and older adults assessed with accelerometers. J Affect Disord 2020;265:59–62. doi: 10.1016/j.jad.2020.01.023.

    Implications for practice and research

  • Nurses using a comprehensive 24-hour lifestyle management approach with their patients, rather than targeting individual sedentary behaviours, could contribute to effectively preventing and/or reducing depression symptoms.

  • Further research is required to find out whether holistic interventions that target sedentary time, physical activity and appropriate sleep prevent and improve depression symptoms.

  • Context

    There is evidence to support the individual connections between sedentary behaviours and depression symptoms,1 but the codependency between physical activity, sedentary behaviours and sleep in a given 24-hour period is often overlooked. This study2 aimed to examine the association between sedentary behaviour...

    Patients need more than just verbal instructions upon discharge from the emergency department

    Por: Chen · Y. · Shen · Y. · Zhu · Y. · Gao · Y. · Zhao · D. · XI · L. · Li · S. · Liu · J. · Yang · Y. · Qu · J. · Qin · J. · Lee · A. J.

    Commentary on: Hoek AE, Anker SCP, van Beeck EF, et al. Patient discharge instructions in the emergency department and their effects on comprehension and recall of discharge instructions: a systematic review and meta-analysis. Ann Emerg Med 2019;1–10.

    Implications for practice and research

  • Clinicians need to offer written and video formatted information as adjunct to verbal instructions on discharge from emergency departments.

  • Further research is required to identify best practices in discharge management and information sharing with patients.

  • Context

    Patient discharge instructions are important tasks for healthcare professionals in emergency departments (EDs).1 Yet patients’ understanding and recall of their ED discharge instructions is limited.2This systematic review with meta-analysis evaluated the use and efficacy of discharge instructions in the ED.3


    The study provided a systematic review and meta-analysis of 51 articles.4 Data were retrieved to...

    A workplace sales ban and motivational intervention can reduce sugar-sweetened beverage intake and improve cardiometabolic health

    Por: Duong · T. V.

    Commentary on: Epel ES, Hartman A, Jacobs LM, et al. Association of a workplace sales ban on sugar-sweetened beverages with employee consumption of sugar-sweetened beverages and health. JAMA Intern Med 2019;180:9–16.

    Implications for practice and research

  • The impact of a workplace sales ban and motivational interventions on reducing sugar-sweetened beverages (SSBs) consumption and health should be investigated in other settings.

  • SSB sales bans and brief motivation may be a useful combination within public health strategy.

  • Context

    The interventions targeting SSB intake reduction have been implemented in different settings, for example, schools, retailing and food service establishments.1 The environmental interventions include labelling, nutrition standards in public institutions and economic tools (eg, taxes). The association between taxes on SSB consumption has been investigated previously.2 Epel et al sought to explore the potential benefits of an environmental intervention (sales ban, a brief motivation)...

    Survivorship care plans have minimal impact on health actions

    Por: Howell · D.

    Commentary on: Hawkins-Taylor C, Anderson DG, Carlson A, et al. Survivorship care plans: health actions taken and satisfaction after use. Oncol Nurs Forum 2019;46:585–94.

    Implications for practice and research

  • Survivorship Care Plans should be a standard of nursing practice and as essential preparatory patient education alongside health promotion counselling at treatment end.

  • Nursing research should shift towards robust research to test the effects of behavioural interventions as an adjunct to Survivorship Care Plans on survivors’ health actions.

  • Context

    Survivorship Care Plans (SCPs) are an element of quality survivorship care.1 Several reports2 and guidelines3 recommend SCPs at end of cancer treatment as a standard of care. SCPs are personalised records of the care that outline follow-up (FU) surveillance, long-term symptoms, signs of recurrence, community resources and lifestyle modifications to reduce late effect risks.4 SCPs help survivors as...

    Shorter intervals and sequential administration of adjuvant chemotherapy are effective in reducing the 10-year risk of recurrence and death in early breast cancer women without detrimental effects

    Por: Catania · G.

    Commentary on: Early Breast Cancer Trialists’ Collaborative Group. Increasing the dose intensity of chemotherapy by more frequent administration or sequential scheduling: a patient-level meta-analysis of 37 298 women with early breast cancer in 26 randomised trials. Lancet 2019;393:1440–52. doi:10.1016/S0140-6736(18)33137-4. Epub 8 February 2019.

    Implications for practice and research

  • Oncology nurses are in the key role to put in practice a proactive approach to determine successful completion of dose-intense regimens.

  • This meta-analysis provides support for nursing research on the effect of nursing interventions delivered to women receiving a dose-intense regimen (eg, symptoms and quality of life).

  • Context

    Researchers have demonstrated that anthracycline and taxane regimen reduce mortality by a third compared with no chemotherapy in early breast cancer, independently of tumour characteristics.1 A previous report suggested that dose-intensification strategies including chemotherapy administration every 2 weeks or giving higher dose of drugs sequentially rather than...

    Cannabis use in pregnancy: a harm reduction approach is needed with a focus on prevention and positive intervention

    Por: Dennis · C.-L. · Vigod · S.

    Commentary on: Corsi DJ, Walsh L, Weiss D, et al. Association between self-reported prenatal cannabis use and maternal, perinatal, and neonatal outcomes. JAMA 2019;322:145–52.

    Implications for practice and research

  • Pregnant and pregnancy-planning women and their partners require education about the potential for increased risk of a preterm birth and other adverse perinatal outcomes following in-utero exposure to cannabis.

  • Future research examining the impact of the specific timing of cannabis exposure and whether there is a dose–response relationship between exposure and outcomes will serve to help determine causality.

  • Context

    Cannabis use is increasing in North America among young people aged 15 to 24 years including women who are pregnant. With recent legalisation in multiple jurisdictions, and discussion about its medical benefits for a variety of conditions, it is anticipated that cannabis use may further increase during pregnancy. Cannabinoids can readily cross the placenta and may...

    Social media is a source of health-related misinformation

    Por: Rolls · K. · Massey · D.

    Commentary on: Wang Y, McKee M, Torbica A, et al. Systematic review on the spread of health-related misinformation on social media. Soc Sci Med.2019;240:112552.doi: 10.1016/j.socscimed.2019.112552. [Epub ahead of print 18 Sep 2019].

    Implications for practice and research

  • When nurses and midwives encounter misinformation on social media, they should provide or direct individuals to sources of accurate information.

  • Cross-disciplinary research to understand factors that influence the uptake of health-related (mis)information is required.

  • Context

    Over the past 25 years, the Internet and social media have rapidly become ubiquitous in daily life, and despite improved access to information there are increasing concerns that these social channels are also spreading health-related false information or misinformation.1 2


    The aim of this systematic review1 was to investigate health-related misinformation content on social media and how this was disseminated online including (1)...

    Delirium occurrence in hospitalised older people is positively associated with development of dementia postdischarge

    Por: Mitchell · G. · Crooks · S.

    Commentary on: Garcez FB, Apolinario D, Campora F et al. Delirium and post-discharge dementia: results from a cohort of older adults without baseline cognitive impairment. Age Ageing 2019;48:845–51.

    Implications for practice and research

  • As many as one in three older people who experience delirium in a hospital setting may go on to develop dementia.

  • Delirium is associated with longer term cognitive impairment but there has been limited research or evidence about its impact on older people.

  • Future research on dementia prevention should consider delirium as a modifiable risk factor.

  • Context

    Delirium is a disorder that is characterised by a rapid deterioration of mental function triggered by a medical disorder or environmental change.1 Delirium has distressing effects and can lead to long-lasting physical and cognitive impairment.2 It affects a person’s behaviour, attention, thinking and memory.1 2...

    Bariatric surgery could reduce the risk of specific types of breast cancer

    Por: Kerin · U.

    Commentary on: Feigelson HS, Caan B, Weinmann S, et al. Bariatric surgery is associated with reduced risk of breast cancer in both premenopausal and postmenopausal women. Ann Surg 2019 [Epub ahead of print 13 Apr 2019].

    Implications for practice and research

  • Preliminary evidence suggests that bariatric surgery reduces the risk of postmenopausal oestrogen-positive and premenopausal oestrogen-negative breast cancer.

  • International, prospective, longitudinal studies using power calculations are required.

  • Context

    Obesity influences the development, prognosis and mortality rates of many types of cancer including that of the breast.1 Research correlates weight gain in adulthood with an increased risk of breast cancer.2 The International Agency for Research on Cancer contends that the relationship between intentional weight loss and cancer risk is yet to be determined.1 Winder and colleagues3 suggest that bariatric surgery (an intentional weight loss...

    Family caregivers expect a patient and family centric approach in holistic end-of-life provision

    Por: Lin · Y. P. · Loi · J. N.

    Commentary on: Gonella S, Basso I, De Marinis MG, et al. Good end-of-life care in nursing home according to the family carers’ perspective: a systematic review of qualitative findings. Palliat Med 2019;33(6):589-606. doi: 10.1177/0269216319840275

    Implications for practice and research

  • Evidence suggests that family caregivers desire a need for greater family involvement in end-of-life care provision.

  • More research is required to determine the best approach to involve family caregivers in end-of-life decision making in a culturally sensitive environment.

  • The development of an end-of-life practice framework centred within the caregiver–patient dyad could improve family experiences of good end-of-life care.

  • Context

    Although end-of-life care is focused primarily on the needs of the patient, informal family caregivers are often neglected as key stakeholders in holistic end-of-life care. This is despite the potential of informal family caregivers to shape end-of-life care practices. With increasing emphasis on promoting optimal...

    Current state of knowledge around nurse-led cardioversion: a launchpad for future projects

    Por: Fournier · J.

    Commentary on: Manoj S, Moore Z, Patton D, et al. The impact of a nurse-led elective direct current cardioversion in atrial fibrillation on patient outcomes: a systematic review. J Clin Nurs 2019;28:3374–85. doi: 10.1111/jocn.14852.

    Implications for research and practice

  • Nurse-led cardioversion clinics demonstrate promising potential in terms of patient safety, reducing wait times, decreasing costs and increasing patient satisfaction.

  • The review suggests the need for further quantitative, outcomes focused studies on nurse and nurse practitioner led cardioversion clinics.

  • Context

    Direct current cardioversion is an electrical cardiac treatment used to reset heart rhythms in some patients with atrial fibrillation.1 While direct current cardioversion had historically been medically led, increased demand for the treatment has led to the development of nurse-led services.2 Nurse and nurse practitioner led cardioversion clinics will be seen more often as our populations age. It is important to...

    Frailty is associated with a higher use of potentially inappropriate medications among community-dwelling older adults

    Por: Wernham · C. · Welsh · T.

    Commentary on: Bolina AF, Gomes NC, Marchiori GF, et al. Potentially inappropriate medication use and frailty phenotype among community-dwelling older adults: a population-based study. J Clin Nurs 2019;28:3914–22. doi: 10.1111/jocn.14976.

    Implications for practice and research

  • Health professionals working in the community should engage in targeted medication review as part of routine practice.

  • Future research should prioritise testing methods of reducing potentially inappropriate medication (PIM) and their effectiveness in community populations.

  • Context

    Frailty and the use of potentially inappropriate medications are a growing concern across the globe. A number of national and international studies have found an association between frailty and PIM use. This study seeks to add to the pool of findings by investigating this association in a community-dwelling population already participating in a longitudinal study of health conditions. The authors set out to assess the association between frailty (as defined by the Fried...

    Assertiveness training during early undergraduate years has the potential to increase students confidence and ability to act as patient advocates

    Por: Rohsig · V. · de Souza · A. B.

    Commentary on: Hanson J, Walsh S, Mason M, et al. Speaking up for safety’: a graded assertiveness intervention for first year nursing students in preparation for clinical placement: thematic analysis. Nurse Educ Today 2020;84:104252.

    Implications for practice and research

  • Improvement of nurses’ confidence to act as patient advocates should begin during undergraduate training and may rely on structured tools to develop assertiveness.

  • Research should determine the best training framework for nursing curricula and evaluate the impact of assertiveness training on safety outcomes at the workplace.

  • Context

    The importance of patient safety as a healthcare priority and goal has grown steadily in the past years. Nevertheless, specific patient safety training provided to nurses and other healthcare professionals is still incipient—especially in terms of communication skills to challenge unsafe practice within multidisciplinary teams. In situations in which patient safety is endangered by the behaviour of healthcare...

    Relational care in older persons nursing is not just a consideration but an organisational priority

    Por: Oliver · E.

    Commentary on: Bridges J, Flatley M, Meyer J. Older people's and relatives' experiences in acute care settings: systematic review and synthesis of qualitative studies. Int J Nurs Stud 2010;47:89–107. doi: 10.1016/j.ijnurstu.2009.09.009.

    Implications for practice and research

  • Older people continue to have negative experiences of care in hospital settings.

  • The interpersonal aspects of care mediate the negative experience of hospital stays that are caused by bureaucratic system working indoctrinated in nursing work.

  • Older people’s experience of care will be improved through organisational commitments to relational care, and this should be the focus for further research/practice.

  • Context

    The ageing of the population at a global level has led to an increasing admission rate of people over 65 into general hospitals. Due to this increasing admission rate, high-quality care for this patient population is now a national priority, and there is a growing body of evidence...

    Evidence from randomised trials linking intake of red meat to diseases--including cardiovascular disease and cancer--is weak

    Por: Fletcher · J.

    Commentary on: Zeraatkar D, Johnston BC, Bartoszko J, et al. Effect of lower vs higher red meat intake on cardiometabolic and cancer outcomes: a systematic review of randomized trials. Ann Intern Med 2019. doi: 10.7326/M19-0622. [Epub ahead of print 1 Oct 2019].

    Implications for practice and research

  • Moderate consumption of red meat can be part of a healthy diet, and nurses are well-placed to reinforce health eating messages.

  • Further research into a causative link between red meat intake and the development of disease will inform future health recommendations.

  • Context

    Epidemiological studies have established a link between red meat consumption and the risk of developing various diseases including cardiovascular disease and cancer in humans.1 In a press release in 2015 the International Agency for Research on Cancer summarised available evidence regarding the potential carcinogenicity of red meat.2

    The National Health Service...

    Better patient activation is a precursor to engagement in shared decision making

    Por: Kidd · L.

    Commentary on: Poon BY, Shortell SM and Rodriguez HP. Patient activation as a pathway to shared decision-making in adults with diabetes or cardiovascular disease. J Gen Intern Med 2019. doi:10.1007/s11606-019-05351-6. [Epub ahead of print 23 Oct 2019].

    Implications for practice and research

  • Practitioners and healthcare providers should encourage engagement in shared decision making (SDM) in patients with relatively high levels of activation.

  • Further research would be useful to determine how people low in activation can be supported to engage in SDM and ‘what works, for whom and in what circumstances’.

  • Context

    Patient activation, or a patients’ assessment of their understanding, confidence and readiness to manage their own health,1 has been linked with positive health outcomes such as reduced blood pressure, reduced blood glucose levels2 and may be an important precursor to SDM. The relationship between patient activation and SDM, however,...

    Uncovering the use and misuse of opioid analgesia in a pregnant and non-pregnant female population

    Por: Galligan · M.

    Commentary on: St Marie B, Coleman L, Vignato JA, et al. Use and misuse of opioid pain medications by pregnant and nonpregnant women. Pain Manag Nurs. 2019;S1524-904218:30550-2. doi: 10.1016/j.pmn.2019.05.002.

    Implications for practice and research

  • The use and misuse of opioids in the last year, including pregnancy, is high and this is significantly higher in white women compared to other ethnic groups.

  • Although the incidence of opioid misuse is low within 30 days of pregnancy, there is a need for risk stratification in order to identify opioid use early and to develop approached support and education for this population.

  • Context

    The use of opioids in today’s society has grown significantly in the last decade and, along with this, so has the incidence of opioid misuse, this increase in the use and misuse of opioids has also impacted pregnant woman.1 A large study of...

    Hopelessness during acute hospitalisation is a strong predictor of mortality

    Por: Gruber · R. · Schwanda · M.

    Commentary on: Reichardt LA, Nederveen FE, van Seben R, et al. Hopelessness and other depressive symptoms in adults 70 years and older as predictors of all-cause mortality within 3 months after acute hospitalisation: the Hospital-ADL Study. Psychosom Med 2019;81:477–85.

    Implications for practice and research

  • Being aware of the importance of mental health in acute hospitalisation can be life-saving.

  • In further research data of psychiatric/psychological interventions during the patients hospital stay as well as the cause of death after discharge are necessary to find out more about the relationship between feeling hopeless and mortality.

  • Context

    Late-life depression (LLD) is a very common mental health disorder in elderly people (after age 60) all over the world.

    Increased morbidity and mortality as well as a higher risk for dementia, coronary heart disease or suicide are associated with LLD.1

    Anhedonia and a depressed mood through most of the...