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AnteayerEvidence-Based Nursing

Care workers of people with intellectual and developmental disabilities feel the need for soft skills training to accomplish better palliative care deliverance

Por: Pinto · C. · Pinto · S.
Implications for practice and research

  • Direct care workers (DCWs) of people with intellectual and developmental disabilities (PWIDD) need more training regarding effective communication, spiritual, social and emotional needs, cultural competence to support people from diverse cultural backgrounds, as well post-death logistics and legal matters.

  • Useful recommendations are is provided to prepare training programs for DCWs of PWIDD. Future research could include creative and engaging models in developing more personalised training programmes.

  • Context

    DCWs dealing with PWIDD are increasingly required to provide basic palliative care (PC) assistance. Being an active part of the patient’s care team, they should be informed about the care plan and advance directives for the patient and trained to assist in these matters.1 This study2 aims to assess the perceived needs in PC training for DCWs of PWIDD and their training preferences, in order to develop a...

    Strengthening contextual policy and training can empower nurses to reduce their sexual harassment

    Por: Kapoor · S. · Grover · N.

    Commentary on: Lu L, Dong M, Lok GKI, et al. Worldwide prevalence of sexual harassment towards nurses: A comprehensive meta-analysis of observational studies. J Adv Nurs 2020;76(4):980–90. doi: 10.1111/jan.14296 .

    Implications for practice and research

  • Nursing schools must develop and implement simulation-based training modules to empower novice and veteran nurses to recognise and address sexual harassment at work.

  • Research on sexual harassment towards nurses in their local contexts might provide a better understanding of specific risk factors, leading to developing and strengthening precision policy.

  • Context

    Sexual harassment persists in healthcare workplaces. Nurses remain among the largest front-line healthcare workers and are at high risk of experiencing sexual harassment,1 which leads to harmful impacts such as feelings of fear, guilt, shame, and depression as well as increased burn-out, poor patient care and loss of productivity.2 Lu et al’s meta-analysis was an...

    Population cohort study finds high levels of antibiotic use increase the chances of infection-related hospital admissions

    Por: Zhang · N.

    Commentary on: van Staa TP, Palin V, Li Y, et al. The effectiveness of frequent antibiotic use in reducing the risk of infection-related hospital admissions: results from two large population-based cohorts. BMC Med 2020;18:40. doi: 10.1186/s12916-020-1504-5.

    Implications for practice and research

  • There is little evidence for the use of repeat antibiotic treatment in primary care.

  • The repeated use of antibiotics may have limited benefits to clients and can lead to adverse outcomes such as infection-related hospital admissions.

  • Antibiotic usage should be minimised when possible and antibiotics should only be used for common infections within recommended guidelines.

  • Context

    Research has established that individuals prescribed frequent antibiotic treatment have an increased likelihood of developing antimicrobial resistance (AMR).1 There are numerous negative consequences of AMR and attributable deaths.2 Generally, there are broad movements of antimicrobial stewardship to decrease unnecessary antibiotic use and...

    COVID-19: reflections on its impact on nursing

    Por: Barrett · D. · Heale · R.

    One of the characteristics of the COVID-19 pandemic is that much of what is published about it quickly becomes outdated. Such is the rate of change in the pandemic’s course—whether due to the roll-out of the vaccine program globally or the evolution of new variants—that the context in which articles are written may be very different by the time of publication.

    Given that, it’s perhaps important to ‘time-stamp’ this editorial and outline the context at the time of writing. We’re writing this in the late summer of 2021; the UK is experiencing a third wave of the pandemic, while simultaneously removing almost all COVID-19 restrictions (such as limits on public gatherings), having fully vaccinated three-quarters of the adult population and partially vaccinated almost 9 out of 10 adults. Although there are differences, the situation is similar within other countries in Europe and North America, with vaccines seemingly weakening the...

    Involving family in discharge education: A nurse-led intervention to reduce hospital readmissions for older adults with heart failure and cognitive impairment

    Por: McPherson · C. J.

    Commentary on: Agarwal KS, Bhimaraj A, Xu J, et al. Decreasing heart failure readmissions among older patients with cognitive impairment by engaging caregivers. J Cardiovasc Nurs 2020; 35(3):253–61. doi:10.1097/JCN.0000000000000670.

    Implications for practice and research

  • The study provides preliminary evidence that engaging families in discharge education to older patients with heart failure (HF) and cognitive impairment (CI) reduces readmissions.

  • Based on the study, more research is needed to address the limitations and refine the intervention to accommodate patients’ self-care competencies and the capacities of families.

  • Context

    HF is a highly complex progressive syndrome that accounts for a substantial proportion of morbidity and mortality, particularly in older adults where HF is most prevalent.1 A mainstay of HF management is patient self-care including adherence to multifaceted therapies, lifestyle changes, and monitoring of symptoms so that appropriate actions are taken.2 Multimorbidity adds to the...

    Exploring the challenges of patient flow in acute hospital settings: a Delphi study

    Por: Lawal · M.

    Commentary on: Connell C.J, Plummer V, Crawford K, et al. Practice priorities for acute care nursing: a Delphi study. J Clin Nurs. 2020;00: 1–11. doi: 10.1111/jocn.15284

    Implications for practice and research

  • A better understanding of the current admission modelling techniques is needed.

  • Strategies to address the challenges of efficient patient flow requires a coordinated approach.

  • Context

    There is a global increase in the number of emergency department (ED) admissions due to various factors such as ageing population, comorbidities, winter pressure and emergence of new diseases and infection such as the ongoing COVID-19 pandemic. The impact of rising demand for services include prolonged ED stay, delayed admissions, cancelled elective procedures, lack of bed availability, poor patient experience and pressure on other departments.1–3 To address this growing problem, waiting time is a key measure of performance and a 4 hours target...

    Effectiveness of empathy education for undergraduate nursing students

    Por: Twycross · A. · Barrett · D.
    Background and purpose

  • Empathy is the ability to understand and share other people’s feelings, often described as being able to put yourself in someone else’s shoes.

  • Empathetic healthcare interventions are thought to improve patient outcomes.

  • There is a need for preregistration nursing programmes to teach students how to be empathetic.

  • The purpose of this systematic review was to critically appraise and synthesise the current evidence regarding empathy interventions in undergraduate nurse education.

  • Methods

    Results and areas for future research

  • Twenty-three studies from eight countries; two studies collected longitudinal data while four studies randomised students into intervention and control groups.

  • Nine of the interventions resulted in an increase in empathy among participants.

  • The most effective interventions were immersive and experiential simulations focusing on vulnerable patient groups (eg, wearing a hemiparesis suit) that provided opportunities for guided reflection.

    ...
  • Increasing daily fibre intake positively affects glycaemic control and cardiometabolic factors and reduces premature mortality in people with pre-diabetes and type 1 and type 2 diabetes

    Por: Baruffaldi · I.

    Commentary on: Reynolds AN, Akerman AP, Mann J. Dietary fibre and whole grains in diabetes management: systematic review and meta-analyses. PLoS Med 2020 Mar 6;17(3):e1003053. doi: 10.1371/journal.pmed.1003053. eCollection 2020 Mar.

    Implications for practice and research

  • Increasing daily fibre intake has been shown to reduce premature mortality and to improve glycaemic control.

  • The European Association for the Study of Diabetes guidelines currently emphasise the role of soluble fibre, while this review found that there were benefits from all types of fibre and in all types of diabetes. Despite this, direct evidence supported moving from low-dietary fibre to medium-dietary fibre and high-dietary fibre food.

  • Context

    Uncontrolled studies carried out in the 1970s linked an increased carbohydrate intake to an improvement in glycaemic control. Later controlled trials showed that this association was present when high-carbohydrate food was also high in fibre. Reynolds et al1 conducted...

    The art of staying away from the ageing process

    Por: Shukla · K.

    Commentary on: Masika GM, Yu DSF, Li PWC. Visual art therapy as a treatment option for cognitive decline among older adults. A systematic review and meta-analysis. J Adv Nurs 2020;1–19. doi:10.1111/jan.14362.

    Implications for practice and research

  • There is a recognised need for services to offer Visual Art Therapy as it may be an effective psychosocial treatment option for those who are experiencing difficulties in cognition.

  • Future research could explore the applications of Visual Art Therapy in supporting older adults and those with cognitive decline experiencing symptoms of anxiety and depression.

  • Context

    Dementia is a neurological condition affecting 50 million individuals, with the WHO suggesting an increase of 152 million in the next few decades.1 There is a growing need to find preventive strategies, with recent studies indicating the benefits of Visual Art Therapy (VAT) in supporting cognition.2 VAT is defined as ‘the...

    Loneliness in care homes, is it a phenomenon? And what can we do to improve the situation?

    Por: Schofield · P.

    Commentary on: Clare G, Pete L, Tim H, et al. What is the prevalence of loneliness amongst older people living in residential and nursing care homes? Age & Ageing 2020;49(5):748–57.doi: 10.1093/ageing/afaa049.

    Implications for practice and research

  • Staff working in care homes need to apply strategies to negate the impact of loneliness among their population, underpinned by strong research evidence.

  • New ways of delivery for social interaction need to be explored.

  • Context

    The care home population are generally considered the most, frail and vulnerable within our population. Prevalence of severe loneliness among older people living in care homes is at least double that of community-dwelling populations: 22%–42% for the care population compared with 10% for the community population.1 But the evidence highlighting this issue is limited and a neglected area of research. Nevertheless, an awareness that loneliness and deteriorating health are correlated. Staff...

    Call for emergency action to limit global temperature increases, restore biodiversity and protect health

    Por: Atwoli · L. · H Baqui · A. · Benfield · T. · Bosurgi · R. · Godlee · F. · Hancocks · S. · Horton · R. · Laybourn-Langton · L. · Monteiro · C. A. · Norman · I. · Patrick · K. · Praities · N. · Rikkert · M. G. O. · Rubin · E. J. · Sahni · P. · Smith · R. · Talley · N. J. · Turale · S. · Vazq

    Wealthy nations must do much more, much faster.

    The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference (Conference of the Parties (COP)26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature and protect health.

    Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal; a global increase of 1.5°C above the preindustrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.

    Previous healthcare experiences are important in explaining the care-seeking behaviour in heart failure patients

    Por: Pieteraerens · W.

    Commentary on: Ivynian SE, Ferguson C, Newton PJ, et al. Factors influencing care-seeking delayor avoidance of heart failure management: a mixed-methods study, International Journal of Nursing Studies 2020 doi: 10.1016/j.ijnurstu.2020.103603

    Implications for practice and research

  • Healthcare providers and managers should pay more attention to, and invest in the experience of the patient, continuity of care and the relationship between the patient and the provider.

  • Future research should test an approach that focuses on the identification of (a) physical factors, (b) patient-related factors and (c) previous healthcare experiences in order to prevent heart failure-related hospitalisations by using individualised therapy based on the results.

  • Context

    Self-care management has been defined as ‘a naturalistic decision making process of maintaining health through positive health practices and managing illness and disease’.1 Positive health practices are those practices that would normally be defined as treatment adherence (eg, following...

    Families may benefit from spiritual care in acute settings when loved ones are coming to the end of their lives

    Por: Boland · P. · Geddes · Z. · Hill · J.

    Commentary on: Hennessy N, Neenan K, Brady V, et al. End of life in acute hospital setting—A systematic review of families' experience of spiritual care. J Clin Nurs 2020;29:1041–52.

    Implications for practice and research

  • Communication, collaboration and facilitation are essential when providing good spiritual care.

  • Future research should focus on barriers and facilitators of spiritual care within the acute hospital setting.

  • Context

    Over half of the deaths in the UK occur in acute hospital settings.1 However, compared with palliative care in hospices and palliative care settings, evidence for end-of-life care in the acute hospital setting is less consistent and developed,2 with the majority of this research focusing on the experiences of patients and healthcare providers3 rather than from a families’ perspective. Therefore, this review sought to examine families’ experiences of spiritual care at the end of life in...

    Exercise is an effective intervention for reducing blood pressure in adults with hypertension and diabetes: an opportunity for nurses

    Por: Armstrong · N.

    Commentary on: Park S, Kim J, Lee J. Effects of exercise intervention on adults with both hypertension and type 2 diabetes mellitus: a systematic review and meta-analysis. J Cardiovasc Nurs. 2020 Jan 31. doi: 0.1097/JCN.0000000000000651.

    Implications for practice and research

  • Nurses should encourage people living with hypertension and type 2 diabetes to engage in aerobic exercise to aid in the management of hypertension.

  • Future research should address sustainability and adherence to exercise interventions over the long term and assess non-surrogate end points (eg, reduction in mortality vs reduction in blood pressure).

  • Context

    Type 2 diabetes mellitus (T2DM) is a pervasive non-communicable disease resulting in significant mortality and morbidity.1 Hypertension (HTN) is a frequent comorbidity in persons with diabetes.2 The pathophysiology of the two diseases results in an additive risk to cardiovascular mortality and morbidity.3 4 This...

    Telehealth assessment by nurses is a high-level skill where interpretation involves the use of paralanguage as well as objective information

    Por: McGrath · L. · Swift · A.

    Commentary on: Wouters LT, Zwart DL, ErkelensDC, et al. Tinkering and overruling the computer decision support system: working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event. J Clin Nurs 2019; 29:1175–86.

    Implications for practice and research

  • A buddy/peer support system for less experienced telephone triage nurseswith continual training and updates for all telenurseswould guide and support decision making.

  • Further research is needed to explore paralanguage and the creation of mental images in telephone triage, especially their impact on patient outcomes.

  • Context

    The use of telephone triage systems in healthcare is on the increase worldwide especially in remote areas. This research paper1 provides valuable insights into the decision-making process used by staff working in telephone triage with clear discussion on the prescribed process and on nurses’ intuition and experience.

    Methods

    The...

    Intervention in family care tends to mitigate the stress-related symptoms of intensive care unit patient family members

    Por: Khan · M. · Nishi · S. E.

    Commentary on: Amass TH, Villa G, OMahony S, et al. Family care rituals in the ICU to reduce symptoms of post-traumatic stress disorder in family members—a multicenter, multinational, before-and-after intervention trial. Crit Care Med. 2020;48(2):176–84.

    Implications for practice and research

  • Family members of intensive care unit (ICU) patients require education about their loved one’s treatment, with information booklets being one suitable approach.

  • Further evidence, based on randomised controlled trials, is required to determine the best approach to family-support care involvement for patients admitted to ICU.

  • Context

    Post-traumatic stress disorder (PTSD) is a common occurrence among ICU patient family members. The causes of PTSD in this context are multifactorial, but can include the critical care environment, communication problems, abrupt decision-taking and anxiety caused by the potential death of loved one.1 The goal of this study was therefore, to determine the viability and effectiveness...

    Increased risk of death by suicide or overdose in patients stopping opioid medications

    Por: Talari · M. P. · Yarra · P.

    Commentary on: Oliva EM, Bowe T, Manhapra A, et al. Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation. BMJ 2020;368:m283. doi: 10.1136/bmj.m283.

    Implications for practice and research

  • Patients who discontinued or started treatment with opioids need closer monitoring due to their increased risk of death due to suicide or overdose, highest in the first 3 months.

  • Future research is needed to better understand the causes of increased risk of death due to suicide or overdose in patients who discontinued or started treatment with opioids.

  • Context

    The opioid epidemic in the USA resulted in a record high of 50 042 overdose deaths in 2019.1 Two out of three of these overdose deaths involved synthetic opioids.2 There has been a major momentum across the health systems in the USA for opioid stewardship...

    Resilience protects against depression in people affected by stroke

    Por: Diaz · M. · Cadet · M. · Etienne · C.

    Commentary on: Zhou X, Liu Z, Zhang W, et al. Resilience is associated with post-stroke depression in Chinese stroke survivors: a longitudinal study. J Affect Disord 2020.

    Implications for research and practice

  • Future research needs to investigate the relationship between resilience and post-stroke depression, how it affects patient care and coping mechanisms during a crisis.

  • In clinical practice, nurses need to better understand how psychological resilience contributes to emotional distress, stress and poststroke anxiety and depression and be prepared to assess a patient's resilience to facilitate early and effective management of poststroke depression.

  • Context

    The Centers for Disease Control and Prevention (2020) acknowledged that after a stroke patients might present with long-term or lifelong disabilities that can take weeks, months or even years to develop.1 One of the long-term conditions associated with stroke is depression.1 Patients may need treatment, therapy...

    Reducing work-related stress to minimise emotional labour and burn-out syndrome in nurses

    Por: Afriyie · D.

    Commentary on: Zaghini F, Biagioli V, Proietti M, et al. The role of occupational stress in the association between emotional labor and burnout in nurses: a cross-sectional study. Appl Nurs Res 2020;54:151277.doi: 10.1016/j.apnr.2020.151277.

    Implications for practice and research

  • Nurses should engage in stress-relieving therapies and maintain emotional resilience to decrease their chances of burn-out syndrome.

  • A longitudinal study on the influences of emotional labour and work-related stress on burn-out syndrome in nurses would ultimately enhance nursing science.

  • Context

    Emotional involvement is the basic element of therapeutic relationship between healthcare professionals and their patients.1 However, emotional involvement exposes healthcare professionals to emotional labour, work-related stress and burn-out.1 These three subjective constructs are related and interconnected to each other. Nurses are mostly affected by these constructs due to the emotional demand of the nursing role.2 This study by Zaghini and...

    Understanding and interpreting regression analysis

    Por: Ali · P. · Younas · A.
    Introduction

    A nurse educator is interested in finding out the academic and non-academic predictors of success in nursing students. Given the complexity of educational and clinical learning environments, demographic, clinical and academic factors (age, gender, previous educational training, personal stressors, learning demands, motivation, assignment workload, etc) influencing nursing students’ success, she was able to list various potential factors contributing towards success relatively easily. Nevertheless, not all of the identified factors will be plausible predictors of increased success. Therefore, she could use a powerful statistical procedure called regression analysis to identify whether the likelihood of increased success is influenced by factors such as age, stressors, learning demands, motivation and education.

    What is regression?

    Regression analysis allows for investigating the relationship between variables.1 Usually, the variables are labelled as dependent or independent. An independent variable is an input, driver or factor that has an impact on...

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