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To evaluate the effectiveness of multidisciplinary transitional care interventions on functional status, quality of life and readmission rates of stroke patients.
Quantitative systematic review and meta-analysis.
Studies with interventions to ease the hospital-to-home transition of stroke patients that were delivered by multidisciplinary teams consisting of registered healthcare professionals from at least two disciplines were included. Cochrane Risk of Bias tool was used for quality appraisal.
Seven electronic databases (PubMed, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Scopus and Web of Science) were searched for randomised controlled trials delivering transitional care interventions to hospitalised stroke patients.
Thirty-one randomised controlled trials were included in the final review. The studies featured multidisciplinary teams of two to nine professionals, most commonly nurses, physicians and physiotherapists. Although multidisciplinary care improved functional status and quality of life scores, the impact on readmission rates was inconclusive. Meta-analysis revealed significant improvements in functional status when care involved physicians, care coordinators (often nurses) or had teams of more than two healthcare professionals. Significant improvement in quality of life was also reported when care involved physicians or in teams with more than two healthcare professionals.
Multidisciplinary transitional care interventions show promise in improving functional status and quality of life after stroke. Their effectiveness depends on team composition and coordination, particularly the inclusion of physicians and care coordinators. Future research should address reporting gaps and evaluate broader strategies to reduce hospital readmissions.
Impact (Addressing)
What problem did the study address? ○
The effectiveness of multidisciplinary transitional care interventions for stroke patients.
○Evaluated the role of various healthcare professionals within these teams.
What were the main findings? ○
Multidisciplinary transitional care interventions significantly enhance stroke patients' functional status, especially within the first 3 months.
○Teams with care coordinators (often nurses) and supportive physicians improve functional outcomes, with effective communication being crucial despite underreporting of specific practices.
○Teams comprising of more than two health professionals can significantly improve stroke patients' functional status.
Where and on whom will the research have an impact? ○
Healthcare institutions and providers: The findings can guide healthcare institutions in developing and implementing effective transitional care services for stroke patients.
○Stroke patients: Patients receiving multidisciplinary transitional care are likely to experience enhanced functional recovery and improved ability to perform daily activities.
○Policymakers and researchers: The study highlights the need for more detailed reporting and research on communication practices within multidisciplinary teams and the importance of evaluating underreported outcomes like readmission rates.
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) checklist.
No Patient or Public Contribution.
To describe newly graduated nurses' experiences of reflection as a support for professional development during the initial months of their transition while caring for patients in a hospital setting.
A qualitative descriptive design.
Four focus groups with 20 newly graduated nurses participating in a professional development programme at aregion in Sweden were conducted in 2023. The data were analysed using qualitative content analysis.
The analysis identified one main category: Reflection supports newly graduated nurses' professional development during their transition. This main category includes three generic categories: (1) Reflection with peers in a regularly structured dialogue group strengthens the professional role; (2) reflection with experienced healthcare instructors in learning activities enhances the mastery of care tasks; and (3) reflection with experienced colleagues in the workplace enhances task performance. Structured reflection in dialogue groups and interactive learning activities within the Professional Development Programme facilitated deeper reflections on caring experiences.
Newly graduated nurses reported that regularly structured reflection, adequate space, and established trust were essential to their professional development. While the professional development programme provided opportunities, variations in the workplace environment led to unequal conditions for reflective practice.
Addressing the need for reflection among newly graduated nurses is crucial for organisations to facilitate their transition. Establishing structures for reflection on caring experiences within introduction programmes can support their professional development.
Reflective practice in complex and challenging hospital settings can support the professional development of newly graduated nurses.
The Consolidated Criteria for Reporting Qualitative Research (COREQ) was adhered to.
No patient or public contributions.
To develop and validate a screening tool to identify patients with cardiovascular disease at risk of poor oral health and requiring referrals.
This study was part of a larger pilot study involving a cross-sectional survey and an oral health assessment conducted with patients with cardiovascular disease.
A four-item screening tool was developed by an expert panel and validated through a cross-sectional survey of patients with cardiovascular disease. The survey contained the tool and the oral health impact profile (OHIP-14) (first gold standard). Additionally, all survey participants were provided a clinical oral health assessment (second gold standard). Sensitivity and specificity analysis was undertaken comparing the tool to the two gold standards to assess patients with cardiovascular disease at risk of poor oral health.
Three hundred and twenty-one participants completed the cross-sectional survey and eighty nine undertook the oral health assessment. Results from both approaches showed that the tool had high sensitivities (OHIP-14 = 89%, Oral assessment = 88%) and low specificities (OHIP-14 = 33% and Oral assessment = 24%).
The four-item screening tool is a simple and valid tool to identify patients with cardiovascular disease at risk of poor oral health and requiring a dental referral. The tool could be incorporated into routine practice of nurses across various cardiac settings.
There is increased interest in implementing structured clinical handover frameworks to improve clinical handover processes. Research postulates that structured clinical handover frameworks increase the quality of handovers; yet inconsistencies enacting these frameworks exist which has a potential to jeopardise the quality of communication during handovers thereby defeating the purpose of these frameworks.
This scoping review aims to analyse and synthesise what is currently known of the nurses' experiences and perceptions in implementing structured clinical handover frameworks and identify knowledge gaps in relation to this topic area.
A scoping review guided by the PRISMA-ScR checklist.
A systematic search of five electronic databases was undertaken to identify peer-reviewed primary research studies which met the predetermined eligibility criteria. In total, 301 studies were imported into COVIDENCE, screened and assessed for eligibility resulting in 23 studies remaining. From the eligible studies, data was extracted, collated, appraised, summarised and interpreted.
MEDLINE, CINHAL, ProQuest, EMCARE, Web of Science and Informit.
Twenty three studies were included in this review which yielded the following major themes: (1) quality and completeness of information transfer; (2) interprofessional collaboration; (3) challenges impacting the experience of implementing the structured clinical handover frameworks and (4) perceived impacts on quality, patient safety and health outcomes.
There are key benefits and issues experienced and perceived by nurses implementing structured clinical handover frameworks and this review identifies opportunities for further improvements. Future research should explore the perceived associations with patient outcomes.
This review highlights the importance of structured clinical handover frameworks, the nurses' experiences in implementing these frameworks and strategies to improve the effectiveness of these frameworks.
No Patient or Public Contributions as this study is a review of published primary evidence.
To provide an in-depth insight into the barriers, facilitators and needs of district nurses and nurse assistants on using patient outcomes in district nursing care.
As healthcare demands grow, particularly in district nursing, there is a significant need to understand how to systematically measure and improve patient outcomes in this setting. Further investigation is needed to identify the barriers and facilitators for effective implementation.
A multi-method qualitative study.
Open-ended questions of a survey study (N = 132) were supplemented with in-depth online focus group interviews involving district nurses and nurse assistants (N = 26) in the Netherlands. Data were analysed using thematic analysis.
Different barriers, facilitators and needs were identified and compiled into 16 preconditions for using outcomes in district nursing care. These preconditions were summarised into six overarching themes: follow the steps of a learning healthcare system; provide patient-centred care; promote the professional's autonomy, attitude, knowledge and skills; enhance shared responsibility and collaborations within and outside organisational boundaries; prioritise and invest in the use of outcomes; and boost the unity and appreciation for district nursing care.
The preconditions identified in this study are crucial for nurses, care providers, policymakers and payers in implementing the use of patient outcomes in district nursing practice. Further exploration of appropriate strategies is necessary for a successful implementation.
This study represents a significant step towards implementing the use of patient outcomes in district nursing care. While most research has focused on hospitals and general practitioner settings, this study focuses on the needs for district nursing care. By identifying 16 key preconditions across themes such as patient-centred care, professional autonomy and unity, the findings offer valuable guidance for integrating a learning healthcare system that prioritises the measurement and continuous improvement of patient outcomes in district nursing.
Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.
No patient or public contribution.
To evaluate the incidence of skin-related complications attributable to incontinence-associated dermatitis (IAD) using an external female urinary catheter device strategy for urinary incontinent (UI) patients in acute care.
Multicenter quality improvement study.
Randomized allocation of two commercially available external female urinary catheter devices was used in hospitalized UI female patients. Daily nursing skin assessments were documented in the electronic health record before, during and after external catheter device application. Methods and results were reported following SQUIRE guidelines.
Three hundred and eighty-one patients from 57 inpatient care units were included in the analysis. Both catheter devices were associated with an overall low risk (5 %) of new or worsening skin breakdown.
The overall benefit of external catheters is most persuasive for skin integrity, rather than infection prevention.
Significant negative outcomes are associated with UI patients. External female urinary catheters are a non-invasive alternative strategy to reduce exposure of regional skin to urine contamination and IAD-related skin complications. Use of external female urinary catheters in hospitalized UI female patients offers low risk (5%) of new or worsening overall skin breakdown.
Hospitalized UI female patients were screened for external catheter device eligibility by the bedside nurse. The quality improvement review committee waved consent because the intervention was considered standard care.
To explore patient and family narratives about their recognition and response to clinical deterioration and their interactions with clinicians prior to and during Medical Emergency Team (MET) activations in hospital.
Research on clinical deterioration has mostly focused on clinicians' roles. Although patients and families can identify subtle cues of early deterioration, little research has focused on their experience of recognising, speaking up and communicating with clinicians during this period of instability.
A narrative inquiry.
Using narrative interviewing techniques, 33 adult patients and 14 family members of patients, who had received a MET call, in one private and one public academic teaching hospital in Melbourne, Australia were interviewed. Narrative analysis was conducted on the data.
The core story of help seeking for recognition and response by clinicians to patient deterioration yielded four subplots: (1) identifying deterioration, recognition that something was not right and different from earlier; (2) voicing concerns to their nurse or by family members on their behalf; (3) being heard, desiring a response acknowledging the legitimacy of their concerns; and (4) once concerns were expressed, there was an expectation of and trust in clinicians to act on the concerns and manage the situation.
Clinical deterioration results in an additional burden for hospitalised patients and families to speak up, seek help and resolve their concerns. Educating patients and families on what to be concerned about and when to notify staff requires a close partnership with clinicians.
Clinicians must create an environment that enables patients and families to speak up. They must be alert to both subjective and objective information, to acknowledge and to act on the information accordingly.
The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting.
The consumer researcher was involved in design, data analysis and publication preparation.
To synthesise and map current evidence on nurse and midwife involvement in task-sharing service delivery, including both face-to-face and telehealth models, in primary care.
This scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews.
Five databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse-led models.
One hundred peer-reviewed articles (as 99 studies) were deemed eligible for inclusion. Task-sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse-led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost-effective, and increase system efficiencies with supportive training, clinical set-up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy.
Nurse-led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task-sharing models with nurses to be feasible and effective.
Nurse-led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost-effective. Increased utilisation of nurse-led models should be considered to address health system challenges and improve access to essential primary healthcare services globally.
This review is reported against the PRISMA-ScR criteria.
No patient or public contribution.
The study protocol is published in BJGP Open (Moulton et al., 2022).
To determine the frequency, timing, and duration of post-acute sequelae of SARS-CoV-2 infection (PASC) and their impact on health and function.
Post-acute sequelae of SARS-CoV-2 infection is an emerging major public health problem that is poorly understood and has no current treatment or cure. PASC is a new syndrome that has yet to be fully clinically characterised.
Descriptive cross-sectional survey (n = 5163) was conducted from online COVID-19 survivor support groups who reported symptoms for more than 21 days following SARS-CoV-2 infection.
Participants reported background demographics and the date and method of their covid diagnosis, as well as all symptoms experienced since onset of covid in terms of the symptom start date, duration, and Likert scales measuring three symptom-specific health impacts: pain and discomfort, work impairment, and social impairment. Descriptive statistics and measures of central tendencies were computed for participant demographics and symptom data.
Participants reported experiencing a mean of 21 symptoms (range 1–93); fatigue (79.0%), headache (55.3%), shortness of breath (55.3%) and difficulty concentrating (53.6%) were the most common. Symptoms often remitted and relapsed for extended periods of time (duration M = 112 days), longest lasting symptoms included the inability to exercise (M = 106.5 days), fatigue (M = 101.7 days) and difficulty concentrating, associated with memory impairment (M = 101.1 days). Participants reported extreme pressure at the base of the head, syncope, sharp or sudden chest pain, and “brain pressure” among the most distressing and impacting daily life.
Post-acute sequelae of SARS-CoV-2 infection can be characterised by a wide range of symptoms, many of which cause moderate-to-severe distress and can hinder survivors' overall well-being.
This study advances our understanding of the symptoms of PASC and their health impacts.
To investigate clients' perspectives about outcomes of a telehealth residential unit (RU) program for families experiencing complex early parenting issues, and to explore facilitators and barriers to positive client outcomes.
Qualitative study using semi-structured interviews.
Semi-structured interviews were conducted with mothers (n = 18) admitted to a telehealth RU program. Interview transcripts were analysed using thematic analysis.
Mothers reported short-term improvements in their child's presenting issues (e.g. feeding to sleep, night-time waking, co-sleeping), increased confidence and increased partner involvement. According to participants, program outcomes were facilitated by a positive parent–clinician relationship, the accessibility of clinicians and being able to take part in the program from their own home. Barriers included difficulties with technical equipment and connecting with the clinician overnight, and challenges with implementing strategies in the longer term.
This nurse-led telehealth program was viewed positively by parents and the study identified a number of areas for improvement.
Telehealth early parenting programs provide an important way for parents to receive support with early child sleep, settling and feeding issues. Clinicians working in this area should focus on the development of positive parent–nurse relationships, enhancing communication and availability for parents during overnight periods and supporting parents to develop early parenting skills that will be applicable across the early childhood period.
The study is the first to address client experiences of a telehealth RU program. Facilitators and barriers identified will inform service improvements to the program going forward, and similar telehealth programs for families; to ensure benefits and service outcomes are maximised for parents for such a crucial service.
The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative research were followed.
To discuss professionalism for pre-licensure nursing students and identify recommendations for inclusion in core values, didactic coursework and clinical training.
Professionalism is part of the nursing identity that encompasses integrity and honesty. This concept has been difficult to translate into formal education in nursing programs and clinical practice.
A discursive paper.
A search of national literature without date restrictions in PubMed, CINAHL, Google Scholar and frameworks for nursing education. We explored principles of professionalism in nursing education and practice.
Evidence-based literature supports the integration of core values of altruism, autonomy, human dignity, integrity, honesty and social justice into didactic curricula, and clinical training. Principles of professionalism can be incorporated intentionally in nursing education to maintain patient safety and trust.
The principles of professionalism, related to core values of the nursing profession, are abundantly described in the literature. However, these principles represent core values that have not been formally conceptualized. With the changing landscape of healthcare, there is a need for deliberate, measurable integration of professionalism into pre-licensure education.
There was no patient or public involvement in the design or drafting of this discursive paper.
FreshRSS 