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Routine replacement versus replacement as clinical indicated of peripheral intravenous catheters: A multisite randomised controlled trial

Abstract

Aims and objectives

To compare the safety of replacing peripheral intravenous catheter as clinically indicated versus routine replacement on patient outcomes in the Chinese context.

Background

Some evidence from developed countries recommend replacing peripheral intravenous catheter as clinically indicated; however, there is limited evidence from developing countries.

Design

A multisite randomised controlled trial.

Methods

The 3050 participants from three hospitals in China were randomly assigned to clinically indicated or routine replacement groups. Patients in the clinically indicated group had the catheters kept in situ until any of the following clinical signs appeared: phlebitis, infiltration, occlusion, displacement, local infection and diagnosed catheter-related bloodstream infection. Patients in the routine replacement group had their peripheral intravenous catheters replaced every 96 hours. The outcomes of phlebitis, infiltration, occlusion, displacement; catheter-related bloodstream infection, all-cause bloodstream infection, and local infection were compared. CONSORT checklist was used to guide the reporting of this RCT.

Results

The risk of phlebitis, phlebitis per 1000 catheter days, occlusion, dislodgement, all bloodstream infections, local infection and mortality between the two groups were not significantly different. The risk of infiltration was increased in the clinically indicated group (HR 1.29). There was no catheter-related bloodstream infection reported in either group. Patients’ first peripheral intravenous catheter dwelling time and cumulative indwelling time of all peripheral intravenous catheters in the clinically indicated group were significantly longer than the routine replacement group. There was no statistical significant difference in survival times from phlebitis between the two groups.

Conclusions

In the Chinese context, removing peripheral catheters as clinical indicated did not increase the risk of phlebitis, occlusion, catheter displacement and catheter infection; however, there was an increased infiltration incidence.

Relevance to clinical practice

In developing countries, removing peripheral catheters as clinical indicated is feasible, but more frequent observations of infiltration are highly recommended.

A time‐saving method of creating AVF buttonholes: indwelling trocar technique

Abstract

Aims and Objectives

This study aims to explore the convenience and practicality of the method of establishing buttonholes with indwelling trocars.

Background

Compared with rope-ladder technique, buttonhole cannulation has better applicability for haemodialysis patients, and the method of buttonhole establishment is particularly important.

Design

Prospective, observational and cohort study.

Methods

We conducted a 12-month observational study on 30 patients who used sharp needles to establish buttonholes and 33 patients who used indwelling trocars to establish buttonholes, and compared the differences between the two groups in the buttonhole formation time, patient-reported cannulation pain, buttonhole success rate, AVF-related infection and patency of AVF. The study adhered to STROBE guidelines.

Results

The buttonhole formation time of the indwelling trocar group is less than that of the sharp needle group (5.48 ± 0.51 vs. 23.23 ± 3.07, p < .01). When the buttonhole was used for the first time, the cannulation pain of the indwelling trocar group was less than that of the sharp needle group (4.94 ± 1.50 vs. 6.03 ± 1.13, p = .002), but there was no significant difference in this result after 1 month (sharp needle group with 4.50 ± 0.94 vs. indwelling trocar group with 4.12 ± 1.19, p = .169). Compared with all the buttonholes in the indwelling trocar group were established successfully, there were 5 unsuccessful buttonholes in the sharp needle group (p = .02). Three cases of unsuccessful buttonhole patients in the sharp needle group developed AVF-related infection, this result did not appear in the indwelling trocar group (p = .102). The difference in arterial pressure and venous pressure between the two groups was not significant (p = .061, p = .222).

Conclusions

Our new method can help buttonhole patients get less track formation time, less cannulation pain, and less fistula infection, thereby bringing them a more comfortable dialysis experience.

Relevance to clinical practice

The new method used in this study not only meets the needs of patients to protect AVF, but also provides convenience for clinical work. In addition, this study analyzed the causes of the AVF infection in buttonhole patients, and provided directions for future research.

‘Owning the space’—person‐centred practice in a 100% single‐room acute‐care environment: an ethnographic study

Abstract

Aims and Objectives

Exploring the influence of the 100% single-room environment on staff and patient experience of person-centred practice in an acute-care setting.

Background

Current building guidance for the NHS advocates increasing the single-room inpatient environment. There is little evidence of the impact of this design in adult acute-care settings on the experience and delivery of person-centred care.

Design

Ethnography, underpinned by McCormack and McCance's Person-centred Practice Framework.

Methods

Data collection took place between March and June 2018. Staff and patients in a National Health Service hospital in the United Kingdom took part in observations of practice (n = 108 hours); face to face inpatient interviews (n = 9); and participatory reflective staff groups (n = 3). A reflexive journal was kept by the researcher throughout the study. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Results

Themes relating to care delivery and interactions were identified. Staff and patients’ views converged around visibility and isolation. Patients appreciated the privacy afforded by the single rooms, while staff experienced a psychological shift, being viewed (and viewing themselves) as ‘visitors’. There was space for more sympathetic presencing, encouraging patients to speak more openly, to facilitate knowing and authentic engagement. However, time remained an issue resulting in more task-focused care.

Conclusion

Changes to the physical environment have an impact on the delivery and experience of person-centred practice. While the facilities enhance patient experience, the interweaving of engagement, emotional support and the development of therapeutic relationships remain challenging.

Nurses’ perspectives on workarounds in clinical practice: A phenomenological analysis

Abstract

Aims and objectives

To explore the phenomenon of workarounds in clinical practice through the nurses’ perspective and identify which factors according to their experience contribute to activities carried forth non-compliantly to procedures, protocols and rules defined by an Institution.

Background

A workaround in clinical practice is a non-compliance and a violation of an organisation's defined procedures, regulations or rules that may prevent adverse events. Its increasing recurrence in the workplace calls for a deeper analysis of the phenomenon.

Design

A phenomenological descriptive design, following Colaizzi's analysis.

Methods

In-depth interviews were conducted with 16 nurses about their experience of workarounds. The interviews were digitally audio-recorded and transcribed verbatim. Two researchers conducted data analysis independently and followed three phases: extracting significant statements, creating formulated meanings and aggregating them into themes. The process employed NVivo 12 software. COREQ checklist was used for reporting.

Results

Data analysis identified 17 sub-themes falling into the four macro-themes: (i) living the profession in saved times; (ii) Perceiving contingencies as a guide to action; (iii) sense of personal responsibility; and (iv) emotional aspects.

Conclusions

From a nurses’ perspective, a workaround is often triggered by the need to overcome problems interfering with efficient and timely patient care in everyday clinical practice. This will of undertaking responsibilities favouring gained efficiency is closely linked to their confidence acquired over years of experience in the field.

Relevance to clinical practice

The results of this study can help clinical leadership to acknowledge workaround, understand the underlying triggers and work towards reconciling official procedures with real-world situations. They can help nurses working in clinical practice to reflect and understand how to reconcile the needs related to the demands of organisations with the need to live their profession, which is more patient-oriented.

Consistent practices in pressure ulcer prevention based on international care guidelines: A cross‐sectional study

Abstract

The use of consistent and evidence-based practices is essential in terms of patient safety and quality of care. The purpose of this study was to describe the use of consistent practices in PU prevention based on international care guidelines and to assess the validity and reliability of the pressure ulcer prevention practice (PUPreP) instrument. The data (n = 554) were collected between 2018 and 2019 from nursing professionals working at two hospital districts in Finland using the PUPreP instrument. The instrument consisted of 42 items assessing participants' perceptions of the frequencies of pressure ulcer prevention practices with the following scale: never, sometimes, often, always. The data were analysed using statistical analysis. According to the results, the use of pressure ulcer prevention practices was more frequently described as often. The most frequently used prevention practice was repositioning, and the least frequently used practice was nutrition. Factors related to nursing professionals' pressure ulcer prevention practices were the working sector, education and working frequency in pressure ulcer prevention, and early identification of pressure ulcers. The study results suggest that the evidence-based pressure ulcer prevention practices were followed at a moderate level by nurses. The PuPreP instrument demonstrated validity and reliability, but further development is needed.

Epidemiology, aetiology and knowledge, attitudes, and practices relating to burn injuries in Palestine: A community‐level research

Abstract

The aim of this study was to identify the epidemiology, aetiology as well as the knowledge, attitudes, and practices relating to burn injuries in Palestine. A mixed-method approach was used. A survey was distributed to a total of 1500 households selected by randomised approach. The survey was standardised based on World Health Organisation's guidelines for conducting community surveys on injury. Additionally, there were 12 focus group discussions and 10 key informant interviews to collect rich qualitative data. In the West Bank and Gaza, 1.5% of Palestinians had experienced serious burn injuries in the 12 months. The total sample of 1500 yields a margin of error (plus/minus) = 2.5% at a 95% level of confidence and a response distribution (P = 50%) with 3% non-response rate. Of the 1500 households approached, 184 reported a total of 196 burn injuries, with 87.2% occurring inside the home: 69.4% were females and 39.3% were children. The main source of reported cause of burn was heat and flame (36%), electric current (31.6%), hot liquid (28.6%), and chemicals (2.7%). The most common first aid for burns was pouring water (74.7%). People in rural, refugee, and Bedouin settings had the highest incidence of burns. This study provides the burn prevalence rate, explanatory factors that contribute to the frequency of burns in Palestine. Making burn prevention a higher priority within the national policy is crucial.

Early diagnosis of craniofacial necrotising fasciitis: Analysis of clinical risk factors

Abstract

Necrotising fasciitis (NF) is a rapidly progressing fatal disease. Craniofacial necrotising fasciitis (CNF) is limited to the region above the mandibular margin, and early diagnosis is particularly difficult in the absence of related studies. Ten-year data of patients with craniofacial infection were collected from four separate hospitals. Based on the diagnostic criteria, patients were classified into abscess and CNF. The risk factors for early diagnosis were analysed by comparing the two groups. Simple abscess was found in 176 patients, and CNF was detected in 25 patients. The risk factors associated with CNF include old age, presence of odontogenic infection, elevated white blood cell count (WBC), increased C-reactive protein (CRP), high levels of creatinine (Cr) and glucose (Glu) and low levels of haemoglobin (Hb) and albumin (Alb). In addition, fever above 38°C and sinusitis at the time of admission and progressive sepsis after admission were also risk factors. Among the statistically significant risk factors, low Alb level showed the greatest association with CNF progression. Appropriate management of CNF via early diagnosis and extensive surgical intervention based on identified risk factors can reduce the mortality rate, complications and unnecessary medical expenses. Clinical question/level of evidence: Diagnostic, III.

A service evaluation to examine the use of compression strapping for the management of patients with retromalleolar leg ulcers in a specialist community setting

Abstract

Leg ulcers are costly to the NHS, and they have a significant impact on patients' physical, social, and psychological well-being. Compression therapy is traditionally the “gold-standard” treatment for the management of venous leg ulcers and can be beneficial for those individuals with mixed ulcer aetiology. Evidence suggests that the application of standard, strong, graduated compression bandaging does not apply therapeutic compression to the retromalleolar fossa. The addition of compression strapping has been found to increase sub-bandage pressure, promote healing, reduce pain and increase quality of life in patients with retromalleolar leg ulcers. This service evaluation aimed at evaluating the use of compression strapping with patients with retromalleolar leg ulcers. The service evaluation included 24 patients with 41 ulcers treated with compression strapping by a specialist team. Patients treated with CS had multiple comorbidities and shared common characteristics including foot and ankle oedema, previous ulceration, reduced mobility, and failure to heal despite the application of “gold-standard” compression therapy. Following application of compression strapping, 17 patients (n = 27/41 ulcers) healed, mean pain scores decreased, and mean quality of life scores increased. The compression strapping was tolerated well, and patients reported a positive experience. This service evaluation has contributed towards a growing evidence base that supports the use of CS for the management of patients with retromalleolar leg ulcers.

Developing Algorithm Based on Activity and Mobility for Pressure Ulcer Risk Among Older Adult Residents: Implications for Evidence‐Based Practice

ABSTRACT

Background

A pressure ulcer (PU) is a localized injury to the skin or underlying tissue usually over a bony prominence. The prevention PU per patient per day is costly; therefore, the detection of a PU at its earliest stage is imperative to afford timely interventions. Currently, there are very few clinically useful tools to assist with early PU detection and prevention.

Aim

There were two primary aims of this study: (1) to investigate the relationship between activity, mobility, and PU development; and (2) to ascertain the next steps for delineating an algorithm based on activity and mobility for detecting PU risk among older adult residents in long-term care.

Method

This quantitative, prospective, descriptive, non-experimental study was conducted between July 2019 and March 2020 among 53 older adult residents who were followed for 4 consecutive days. Participants’ Braden score, Elderly Mobility Scale (EMS) score, Movement Level, and 6-item Cognitive Impairment Test score were assessed. Further, the sacrum and heels were assessed daily using a non-invasive subepidermal moisture (SEM) scanner and visual skin assessment (VSA). SEM values > 0.5 were considered as indicative of the presence of an SEM-PU.

Results

The incidence rate of VSA-PU was 15.1% (N = 8). There was an incidence of 87.5% (N = 42) of SEM-PU damage. According to the Braden subscale, Mobility Braden, most of the participants (62.2%, N = 33) were assessed as having no limitations/slightly limited mobility, while the EMS indicated that most of the participants (67.9%, N = 36) were classed in an independent category. From the 42 SEM-PUs observed, 62% (N = 26) occurred among the low movers, and 38% (N = 16) occurred among the high movers.

Linking Evidence to Action

Using traditional methods for the assessment of movement does not provide insight into the protective nature of the movement. Given that both low- and high-moving patients can develop tissue damage, it is important to focus on the assessment of movement using more objective measures and algorithms, which enable real-time assessment of the protective nature of the movement. This would enable development of person-centered PU prevention strategies to reduce the burden of this significant healthcare problem.

Evidence‐Based Practice Beliefs, Implementation, and Organizational Culture and Readiness for EBP Among Nurses, Midwives, Educators, and Students in the Republic of Ireland

Abstract

Background

Evidence-based practice (EBP) is an approach to health care that combines best available evidence, healthcare professionals’ expertise, and patient preferences, yielding benefits for patients, healthcare professionals, and organizations. However, globally, EBP implementation remains inconsistent among nurses. Exploring this in an Irish context will establish a national baseline from which progress can be made on system-wide integration of EBP in nurse and midwife (i.e., clinician) practice, nursing/midwifery education, and the Irish healthcare system.

Aim

To establish clinician, educator, and student’s EBP beliefs, knowledge, and implementation, and the organizational culture of the clinical and educational settings within the Republic of Ireland.

Methods

Using a descriptive study design, a national survey with demographic questions, uniquely focused EBP scales, and an open-ended question were administered to clinicians, nursing/midwifery educators, and students. Ethical review was obtained. Descriptive and inferential statistics were used to analyze the quantitative data.

Results

Clinicians, educators, and students reported positive beliefs about EBP (M = 59.98, SD 8.68; M = 87.72, SD = 10.91; M = 55.18, SD = 10.29, respectively). Beliefs regarding their ability to implement EBP were lower overall. EBP implementation was low across all groups (clinicians: M = 12.85, SD = 14; educators: M = 31.09, SD = 16.54; students: M = 16.59, SD = 12.11). Clinicians, educators, and students reported varying perceptions of organizational support and readiness for EBP (M = 74.07, SD = 19.65; M = 86.43, SD = 15.01; M = 93.21, SD = 16.21, respectively). Across all measures, higher scores indicated higher beliefs, implementation, and organizational culture and readiness for EBP.

Linking Evidence to Action

Clinicians have a unique opportunity to facilitate system-wide integration of EBP. Furthermore, given the variable EBP knowledge, beliefs, and implementation, opportunities to enhance these attributes abound, particularly when supported by their organizations. This study established a contemporary baseline in Ireland from which to engage the identified strengths, challenges, and opportunities required to craft an organizational culture and environment that supports and advances an EBP approach to nursing and midwifery practice and education.

The successful use of polylactide wound dressings for chronic lower leg wounds: A retrospective analysis

Abstract

Chronic wounds are a challenging medical entity for patients, medical professionals and healthcare systems. Frequently, patients present themselves to wound specialists after months or even years of unsuccessful treatment. Recent developments have resulted in a multitude of different advanced wound dressings created to treat complex, chronic wounds, one of which is the polylactide dressing Suprathel. This study aimed at investigating the healing potential of Suprathel in chronic wounds and differentiating between old and “young”, diabetic and non-diabetic chronic wounds. A prospective, multicentric, non-controlled intervention study was conducted, treating patients with chronic lower leg ulcers (>3 months) with Suprathel and assessing them weekly. Afterwards, a retrospective analysis was performed analysing the wound size initially, after 4 and after 8 weeks of treatment. Furthermore, a differentiation between diabetic and non-diabetic, and chronic wounds older and younger than 12 months, was assessed. A significant reduction in wound size was observed in the study population after 8 weeks of treatment. The effect size in the diabetic wound and the old chronic wound group even reached more than one, with the other groups still showing a large effect of the intervention. This study shows that Suprathel is a valuable tool in the armamentarium of a wound specialist. Not only could we show a positive effect on chronic wounds, we could even demonstrate a significant wound size reduction in chronic wounds of old and young, as well as diabetic wounds, with the treatment of older chronic and diabetic wounds yielding an even larger effect size. Further randomised, controlled studies are necessary to show the full potential of advanced wound dressing materials in large patient cohorts.

Full title: The prevalence of and predictors for perioperative hypothermia in postanaesthesia care unit

Abstract

Background

Hypothermia is a common clinical issue during the perioperative period. The patients with perioperative inadvertent hypothermia are associated with higher risk of postoperative complications and higher hospitalisation costs.

Aims

The aim of this study is to explore the prevalence of and predictors for hypothermia in patients entering postanaesthesia care unit.

Design

Retrospective cohort study.

Methods

A rigorous retrospective cohort study was conducted according to the STROBE reporting checklist. A total of 7216 patients were enrolled in this study. The perioperative variables potentially related to hypothermia were collected. Univariate analysis and multivariate logistic regression analysis were performed to investigate the contributing factors.

Results

The overall prevalence of inadvertent hypothermia in postanaesthesia care unit was 21.3% (n = 1505). The multivariate logistic regression analysis showed that age >65 (OR = 1.561, 95% CI 1.371–1.778, < .001), non-supine position [lateral decubitus position (OR = 1.341, 95% CI 1.133–1.586, = .001), lithotomy position (OR = 1.639, 95% CI 1.295–2.075, < .001)], non-superficial surgery (OR = 2.195, 95% CI 1.566–3.077, < .001), non-open surgery [laparoscopic surgery (OR = 1.205, 95% CI 1.020–1.423, = .029), endoscopic surgery (OR = 1.430, 95%CI 1.084–1.887, = .011)], the volume of intravenous infusion fluid >1000 ml (OR = 1.814, 95% CI 1.500–2.194, < .001), blood transfusion (OR = 1.552, 95% CI 1.159–2.078, = .003), operation performed in the summer or fall (OR = 1.874, 95%CI 1.656–2.122, < .001) and use of dexmedetomidine (OR = 1.147, 95%CI 1.015–1.296, = .028) were associated with increased risk of hypothermia. In contrast, our finding showed that body mass index ≥25 kg/m2 (OR = 0.556, 95%CI 0.491–0.630, < .001), higher baseline body temperature (OR = 0.641, 95%CI 0.541–0.761, < .001) and duration of fasting ≥18 h (OR = 0.487, 95%CI 0.345–0.689, < .001) were associated with decreased risk of hypothermia. Compared with non-hypothermic patients, patients with hypothermia were associated with prolonged length of hospital days (5 vs. 4 days, < .001).

Conclusion

For patients admitted to postanaesthesia care unit after elective procedures, old age, non-supine position, non-open surgery, non-superficial surgery, large volume of intravenous infusion fluid, dexmedetomidine, blood transfusion and Summer or Fall operative season were associated with increased risk of hypothermia, whereas high body mass index, high baseline body temperature and long fasting duration were associated with decreased risk of hypothermia.

Relevance to clinical practice

The outcomes of this study will raise the concerns of perioperative care team on hypothermia in surgical patients. Measures should be taken to improve perioperative hypothermia and clinical outcome.

Oxymatrine promotes hypertrophic scar repair through reduced human scar fibroblast viability, collagen and induced apoptosis via autophagy inhibition

Abstract

Scars are common complications of burns and trauma, resulting in mental trauma, physical pain, and a heavy financial burden for patients. Specific and effective anti-scarring drugs are lacking in clinical practice. Phytochemicals are easily accessible, low in toxicity, and have various biological and pharmacological properties. Oxymatrine is a phytochemical that regulates autophagy networks. Autophagy is closely related to the maintenance, activity, differentiation, and life-death of skin fibroblasts during wound repair, which results in pathological scars. We hypothesised that oxymatrine may promote hypertrophic scar repair by inhibiting fibroblast autophagy. In vitro studies showed that inhibition of autophagy by oxymatrine decreased viability and collagen metabolism, and increased apoptosis of human scar fibroblasts (HSFs). In vivo studies showed that inhibition of autophagy by oxymatrine promoted scar repair, resulting in a significantly improved final outcome of the hypertrophic scars, a smaller scar area, decreased epidermal and dermal thickness, and a significant downregulation of CK10, P63, collagen I, α-SMA, and TGF-β1. In summary, oxymatrine promoted hypertrophic scar repair by decreasing HSF viability and collagen, and inducing apoptosis via autophagy inhibition. This study provides a new perspective on the mechanism of hypertrophic burn scar formation, as well as key scientific data for the application of the phytochemical oxymatrine as a new method for the prevention and treatment of hypertrophic scars.

Factors Associated With the Resilience of Nurses During the COVID‐19 Pandemic

Abstract

Background

The delivery of health care during the COVID-19 outbreak imposed significant challenges on the global nursing workforce and placed them at a higher risk of occupational burnout and turnover. In Lebanon, the pandemic hit when nurses were already struggling with an economic collapse caused by government failures. Resilience may play a protective factor against adversity and enable effective adaption to the burden of the pandemic.

Aims

To determine the level of resilience in the nursing workforce and its relationship to burnout, intention to quit, and perceived COVID-19 risk.

Methods

A cross-sectional study was employed among all registered nurses affiliated with the Order of Nurses in Lebanon and working in patient care positions in hospitals. The online survey questionnaire incorporated the Connor–Davidson Resilience Scale and the Copenhagen Burnout Inventory. Quartile scores were used to differentiate levels of resilience and burnout. Multiple logistic regression identified variables significantly associated with resilience.

Results

Five-hundred and eleven nurses responded to the questionnaire. Nurses had a moderate level of resilience (M  = 72 ± 13.5). In multivariate analyses, being male (OR = 3.67; 95% CI [1.46, 9.22]; p = .006) and having a master’s degree (OR = 4.082; 95% CI [1.49, 11.20]; p = .006) were independently associated with higher resilience. Resilience levels decreased with higher personal burnout (OR = 0.12; 95% CI [0.03, 0.435]; p = .001), work-related burnout (OR = 0.14; 95% CI [0.04, 0.46]; p = .001), and client-related burnout rates (OR = 0.09; 95% CI [0.03, 0.34]; p < .001). Nurses reporting the intention to quit their job had lower resilience scores (OR = 0.20; 95% CI [0.04, 0.88]; p = .033).

Linking Evidence to Action

Nursing stakeholders must introduce programs to regularly assess and enhance the resilience of nurses especially at time of crisis. Such programs would protect nurses from the perils of burnout and enhance their retention during times when they are most needed. Protecting nurses from burnout is an ethical imperative as well as an operational requirement.

How are children’s best interests expressed during their hospital visit?—An observational study

Abstract

Aims and objectives

To describe ways in which children's best interests were observed to be expressed in paediatric settings during their hospital visit.

Background

The best interests of the child are embodied in national and international legal systems, although the definition remains problematic. The child's limited autonomy mandates duty bearers to have both a child perspective and the child's perspective when considering what the best interest of the child entails in care situations.

Design

A qualitative descriptive study with overt, non-participant observations fulfilling the COREQ criteria.

Methods

Thirty-two observations of interactions between children aged 2 to 17 years with both acute and chronic conditions, their parents and healthcare professionals were conducted at three paediatric hospitals in Sweden. Inductive and abductive reasoning were used in the content analysis of data, which followed the identification, coding, categorising and abstraction of observed patterns of the best interest of the child.

Results

Findings reveal facilitating and obstructing factors for the child's best interests to be safeguarded in healthcare situations. Children were guided in or hindered from exercising their competence. The observations showed a variation in actions taken by both parents and healthcare professionals to safeguard the best interests of the child.

Conclusions

Determining the best interest of the child requires a case-by-case basis, as it is context-dependent, situational, flexible and dependent on all actors involved and actual decisions made.

Relevance to clinical practice

Healthcare professionals’ actions can facilitate or obstruct observed expressions of the child's best interest. It is essential to enhance healthcare professionals’ communication skills, knowledge awareness and continuing education about the rights of children receiving healthcare services. Reflections and discussions on how to protect the best interests of children may help healthcare professionals to uphold children's best interest in daily clinical practice.

Assessing the accuracy of visual blood loss estimation in postpartum hemorrhage in Shanghai hospitals: A web‐based survey for nurses and midwives

Abstract

Aims and objectives

This study aimed at evaluating the accuracy of visual estimated blood loss in postpartum haemorrhage by midwives and nurses, as well as exploring its influencing factors.

Background

Timely recognition of postpartum haemorrhage is critical in saving maternal lives. Yet midwives and nurses can barely distinguish whether the blood loss has reached a life-threatening amount without precise measurement. Understanding their ability to accurately estimate the amount of blood loss and the influencing factors can help improve this ability with effective measures.

Design

This research was a multicenter cross-sectional survey with convenient sampling.

Material and Methods

Using a modified online visual estimation questionnaire of blood loss, the QR code of this survey was sent to midwives and obstetrical nurses engaged in clinical practice in secondary and tertiary hospitals in Shanghai. A descriptive analysis was performed with demographics and the responses of visual estimated blood loss of each volume. The difference and consistency of the responses of each volume were evaluated. The relationship between each demographic characteristic and accuracy was explored. STROBE statement checklist was chosen for reporting the study process.

Results

A total of 361 midwives and nurses participated in the survey. The finding showed an overall accuracy of 30.52% (1763/5776), with 25.3% and 18.0% subjects distinguishing postpartum haemorrhage (500 ml) and severe postpartum haemorrhage (1000 ml), respectively. The Kappa coefficients were slight to moderate (0.037–0.590). There were no differences among the categories of gender, age, academic degree, position, title, working experience in years, working department and reported methods of blood loss estimation with regard to accuracy. However, having institutional guidance for blood loss calculation showed a significant relationship with higher accuracy.

Relevance to clinical practice

While representing a relatively well-developed area in China, the accuracy of visual estimated blood loss was not satisfactory, as suggested in other developed countries around the world. Training and institutional guidance on blood loss quantification should be provided in midwifery settings, regardless of how the level of medical development is advanced.

Conclusions

The accuracy of VEBL was low even with a visual aid, especially when the volume exceeds 500 ml. To improve accuracy, institutions should make standardadized assessment guidance and provide regular training for blood loss quantification.

Psychological responses and coping behaviour of visiting family members during and following unplanned hospital admission

Abstract

Aims

To describe the psychological symptoms and coping behaviours of visiting family members following the unplanned hospitalisation of their relative.

Background

Hospitalisation of a patient is recognised as a stressful time for visiting family members, who experience psychological morbidity and elevated health risk.

Design

This prospective longitudinal evaluation included 40 family members of patients with unplanned admission to coronary or intensive care. Assessments were conducted at 3 timepoints: in-hospital within 1 week of admission and again at 2 weeks and 3 months post-discharge. Measures included symptoms of anxiety, depression, and anger, coping strategies and social support. This paper adhered to STROBE guidelines.

Results

At the initial in-hospital assessment study participants reported higher anxiety, depression and anger symptoms levels compared to community matched control participants. Compared to in-hospital assessment, anxiety and depression levels were lower at 2 weeks and 3 months following hospital discharge. The use of active coping and the use of religion during early hospitalisation were associated with higher anxiety and depression symptoms at 3 months post-discharge. Conversely, use of instrumental support (getting help and advice from others), planning and venting during early hospitalisation were associated with lower depression symptoms at 3 months. Venting during the hospitalisation period was also associated with lower anxiety symptoms at 3 months.

Conclusion

Results demonstrate the significant psychological impact of unplanned hospitalisation on visiting family members both during and following hospitalisation. The finding that prolonged psychological response is associated with individual coping strategies employed in the early hospitalised period informs potential preventative approaches for family members at risk of prolonged psychological morbidity following hospitalisation of their loved one.

Relevance to clinical practice

The reported psychological impact of hospitalisation on family members provides a strong imperative for nurses and health professionals to provide early individualised support to reduce the risk of long-term psychological morbidity.

Core competencies of clinical nurse specialists: A comparison across three Nordic countries

Abstract

Aim

To describe and compare the clinical nurse specialist core competency use in Finland, Denmark and Iceland.

Background

Clinical nurse specialist roles were first developed more than 60 years ago in the United States. Within the Nordic countries, the clinical nurse specialist role emerged around 2000. There is scarcity of clinical nurse specialist competency descriptions outside of North America, and research has been limited to examine or validate established competencies across different countries.

Design

A descriptive correlational study.

Methods

An online survey was conducted from May to September 2019. A population sample of clinical nurse specialists in Finland, Denmark and Iceland was recruited. A validated self-report questionnaire of clinical nurse specialist competencies was used. The data were analysed using descriptive and inferential statistics, and the STROBE checklist was used as the reporting guideline.

Results

A total sample of 184 clinical nurse specialists, 52 from Finland, 95 from Denmark and 37 from Iceland, participated in the study (response rate = 72%, 35% and 48%, respectively). Overall, clinical nurse specialists utilised the organisational competency most frequently followed by the patient, clinical nursing leadership and scholarship competency. Univariate analysis of variance test between-country effects showed statistically significant difference in patient competency (= .000) and in organisational competency (< .05). There were no statistically significant differences between counties in the utilisation of clinical nursing leadership and scholarship competency.

Conclusion

A small variability was found in the comparison of the clinical nurse specialist use of core competency in the spheres of patient, nursing, organisation and scholarship within three Nordic countries.

Relevance to clinical practice

The CNS competency scale may be utilised in benchmarking clinical nurse specialist roles and practice within and across countries. The long-term goal for the competency descriptions is to enhance the clinical nurse specialist role clarity, integration and evaluation as well as inform post-graduate education.

Measuring the intensive care experience: A cross‐sectional survey of patient and family experiences of critical care

Abstract

Aims and Objectives

To report patient and family intensive care experiences using the Measuring the Intensive Care Experience (MICE) tool across two intensive care units (ICU).

Background

The patient and family experience of care is an important indicator for quality improvement of ICUs, yet few studies evaluate both patient and family experiences in relation to overall care quality as well as specifically measuring quality of medical care, nursing care and organisational care as well as overall experience of the quality of intensive care.

Design

A cross-sectional survey.

Methods

A 23 item survey was administered to ICU patients and their family members across two ICUs, a regional 189-bed hospital and a metropolitan 227-bed hospital in Queensland, Australia. The response rate was 272 of 394 ICU patients (36.4%). STROBE guidelines were used in reporting this study.

Results

Findings indicate a highly positive overall experience of ICU care among patients and families. However, patients reported areas of unmet needs following their stay in ICU broadly related to (1) symptom management, education and information support, and (2) improving the incorporation of patient and family care ICU-related shared decision-making.

Conclusions

Supportive interventions are needed that target improve symptom management and inform and education ICU patients.

Relevance to clinical practice

The MICE survey facilitated the identification of a range of areas requiring quality improvement. Improving the integration of patients and families into shared decision-making and support is a key aspect for quality improvement.

Creating an Indigenous Māori‐centred model of relational health: A literature review of Māori models of health

Abstract

Aims and objectives

Identify the key concepts, principles and values embedded within Indigenous Māori models of health and wellbeing; and determine how these could inform the development of a Māori-centred relational model of care.

Background

Improving health equity for Māori, similar to other colonised Indigenous peoples globally, requires urgent attention. Improving the quality of health practitioners’ engagement with Indigenous Māori accessing health services is one area that could support improving Māori health equity. While the Fundamentals of Care framework offers a promising relational approach, it lacks consideration of culture, whānau or family, and spirituality, important for Indigenous health and wellbeing.

Design and methods

A qualitative literature review on Māori models of health and wellbeing yielded nine models to inform a Māori-centred relational model of care. We followed the PRISMA guidelines for reporting literature reviews.

Results

Four overarching themes were identified that included dimensions of health and wellbeing; whanaungatanga (connectedness); whakawhanaungatanga (building relationships); and socio-political health context (colonisation, urbanisation, racism, and marginalisation). Health and wellbeing for Māori is a holistic and relational concept. Building relationships that include whānau (extended family) is a cultural imperative.

Conclusions

This study highlights the importance and relevance of relational approaches to engaging Māori and their whānau accessing health services. It signals the necessary foundations for health practitioners to build trust-based relationships with Māori. Key elements for a Māori-centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empathy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (importance of spiritual wellbeing).

Relevance to clinical practice

Culturally-based models of health and wellbeing provide indicators of important cultural values, concepts and practices and processes. These can then inform the development of a Māori-centred relational model of care to address inequity.

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