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To gain an understanding of palliative care need and provision in adult medical and surgical inpatients.
An observational point prevalence study was conducted across four study sites in Western Australia.
All data were collected directly from patient medical records by Registered Nurses. Potential palliative care need was assessed using disease-specific indicators for the 12 conditions outlined in the Gold Standards Framework Proactive Indicator Guidance.
A total of 865 medical and surgical inpatients met study inclusion criteria. Across the four study sites, 38% (n = 331) of adult inpatients reviewed could have potentially benefitted from palliative care. Of the n = 331 patients assessed as having indicators for palliative care, there was evidence that 27% (n = 90) were currently receiving some form of palliative care, while 3% (n = 9) had been referred for specialist palliative care. For the majority of patients (70%, n = 232) there was no evidence of them receiving any form of palliative care or awaiting specialist palliative care.
This study identified high levels of potential palliative care need among adult medical and surgical inpatients. The majority of the patients identified as having indicators for palliative care were not receiving any form of palliative care.
The high prevalence of palliative care need found in this study highlights that recognising and addressing palliative care is essential for high-quality care for medical and surgical inpatients. To address the high level of need identified all nurses require basic palliative care training to provide optimal patient care.
Knowledge about the level of palliative care need and provision of palliative care in public hospitals was limited. This study identified a high prevalence of potential palliative care need in medical and surgical inpatients. The majority of patients with indicators for palliative care were not receiving any form of palliative care. This research demonstrates that palliative care needs should be considered by all registered nurses and other health professionals caring for medical and surgical inpatients.
The study is reported using the STROBE guidelines.
No patient or public contribution.
The aim of this umbrella review was to summarise the existing evidence on the effectiveness of nursing interventions targeted at adult patients in hospitals.
Existing systematic reviews were synthesised.
The literature search was conducted in PubMed, CINAHL Complete, and the Cochrane Library by two of the authors until June 6th 2024 without a time limit.
A total of 2652 records were identified. After screening the titles and abstracts, 2421 records were excluded. Then two records were excluded as they were not retrieved, and 125 records were excluded during full-text review as they did not meet the inclusion criteria. Finally, 11 reviews (141 original studies) were included in the quality assessment and were analysed narratively.
The most commonly used interventions were educational, followed by preventive, observative, or combinations of various interventions. All interventions were targeted at the care of somatic patients. The interventions lacked detailed descriptions of their content and duration. Nursing interventions were found to reduce anxiety, depression, disorder symptoms, pain intensity, length of hospital stay, serious adverse effects, mortality, infections and pressure ulcer prevalence.
There is limited high-quality evidence on the effectiveness of nursing interventions used by nurses at hospital settings. While nursing interventions can improve hospital patient outcomes, more high-quality systematic reviews and meta-analyses are needed. Only preventive interventions (such as pressure ulcer prevention and use of early warning scores) consistently showed positive effects and are relatively easy to implement in hospital nursing practice. Other interventions are not yet widely integrated into standard care in hospitals. It is necessary to study the cost-effectiveness of nursing interventions.
This umbrella review did not include any patient or public involvement.
This umbrella review of systematic reviews adheres to the PRISMA statement.
To cross-culturally adapt and psychometrically test the Italian version of the EPICC Spiritual Care Competency Self-Assessment Tool for clinical nurses (EPICC Tool-It).
Multicentre, cross-sectional validation study.
The 28-item EPICC Tool was translated into Italian and culturally adapted following a rigorous methodology. A nationwide survey was conducted. Psychometric evaluation included content validity, structural validity (exploratory and confirmatory factor analyses), construct validity (known group analysis) and reliability using Cronbach's alpha, McDonald's omega and factor score determinacy.
The sample included 725 clinical nurses (76% female, 80% hospital-based), on average 38.7 years old (SD 11.33), with 14.6 years (SD 11.03) of experience. Confirmatory factor analysis supported a four-factor model (Knowledge of spirituality, Attitudes towards spirituality and spiritual care, Knowledge of spiritual care and Skills in spiritual care), with a second-order factor for the EPICC Tool-It. Construct validity was supported through known group analysis, showing score variation based on nurses' experience, education and religiosity. Internal consistency was excellent across all factors and the overall scale.
A valid, multidimensional instrument is provided to assess spiritual care competencies in Italian-speaking nurses. The EPICC Tool-It is suitable for research and practice, facilitating evaluation of self-perceived competencies and educational effectiveness.
The use of the EPICC Tool-It by nursing managers, educators and clinicians is recommended in both clinical and research settings to support education on spiritual care competencies.
The EPICC Tool-It sets reliable measurement standards for spiritual care competencies, enhancing holistic care and comprehensive understanding of competencies globally.
This study adheres to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines.
Patients, service users, caregivers, or the public were not involved in the study. However, nurses as target users of the tool participated in the cultural adaptation and validation process.
To validate a practical method for estimating total Glasgow Coma Scale (etGCS) scores in intubated traumatic brain injury (TBI) patients and evaluate its reliability when integrated into established ICU severity scoring systems.
TBI is a global health issue, often leading to high mortality and disability. The Glasgow Coma Scale (GCS), essential for assessing TBI severity, is less reliable in intubated patients due to the inability to assess verbal responses.
Retrospective cohort study.
Data were extracted from the MIMIC-IV database. The reliability of the etGCS was evaluated through its association with in-hospital mortality and its performance when integrated into established ICU severity scoring systems. Multiple statistical approaches were used to validate the findings.
Among 886 intubated TBI patients, the etGCS showed consistent reliability in predicting in-hospital mortality (AUC: 68.22%, 95% CI: 64.29%–72.14%). When combined with pupillary assessment (etGCS-P), the predictive performance remained stable (AUC: 71.99%, 95% CI: 67.89%–76.08%). Furthermore, the estimation method demonstrated reliable performance when integrated into established severity scoring systems. The removal of etGCS from these systems resulted in decreased predictive performance, confirming its valuable contribution to mortality prediction.
This study validated a practical and reliable method for estimating total GCS scores in intubated TBI patients. The estimated scores showed consistent predictive value and enhanced existing severity scoring systems, supporting its clinical utility in ICU settings.
This validation of a practical GCS estimation method supports nurses in delivering accurate patient assessments, facilitating clinical communication and making informed care decisions for intubated TBI patients.
This retrospective study involved no patient or public participation in the design or conduct.
Stroke represents the second leading cause of death worldwide after cardiovascular disease and the first cause of disability in adults. Only 25% of stroke survivors fully recover, 75% survive with some form of disability, and half of them lose self-sufficiency, negatively impacting their quality of life. This study aims to understand the experiences of stroke survivors and caregivers of training needs and support during the transitional care phase from hospital to home; it also investigates the experience of health care professionals (HCPs) of providing support and training to the dyad during this phase.
Meta-synthesis was conducted following a critical-interpretative approach. The SPIDER method was used for sample selection, and the PRISMA research question was adopted for article selection. The search for studies on CINAHL, Pubmed, Scopus, ERIC, PsycInfo and OVID was conducted until August 2024.
Of the 1123 articles found, 32 met the inclusion criteria and were included in the meta-synthesis. Text analysis revealed two main thematic areas: (1) the training need is a new awareness in the transition of care from hospital to home and (2) moulding oneself to new life. The first theme had six subthemes: need for information and training, uncertainty, involvement, evaluation of training needs, individual discharge planning and physical-psychological problems. The second theme included three subthemes: different role perception, support after discharge and adaptation to change.
Knowing the training and support needs in the stroke survivor caregiver dyad guides HCPs to structure tailored discharge plans. Multi-method and multidisciplinary training and support interventions such as health coaching, weekend passes and early supported discharge are satisfactory outcomes for the triad involved in the transition of care, as continuous feedback on the needs of the new reality at home fortifies the relationship between the dyad and HCPs. A transitional care pathway based on the dynamic needs of the triad can improve the quality of care in the community.
Standardised triage systems have been in place for decades with minor modifications, while nurses' skills and knowledge have significantly advanced.
To determine whether nurses' clinical expertise outperforms triage systems in simulated clinical cases.
A multicenter simulated observational study.
The study was conducted from January 1, 2024 to March 31, 2024, in four Italian emergency departments, enrolling triage-performing nurses. Thirty clinical cases, based on real patients representing daily emergency department influx, were reconstructed. The primary outcome was the agreement between the triage code assigned by the Manchester Triage System and the code assigned based on clinical expertise. The secondary outcome compared the predictive ability of the codes assigned by nurses regarding clinical outcomes, such as death within 72 h, the need for hospitalisation, and the need for life-saving intervention. The study was reported in accordance with the STROBE statement.
Seventy-seven triage nurses completed the 30 vignettes. The agreement between the MTS-assigned code and the clinical expertise triage reported a Cohen's kappa of 0.576 (95% CI: 0.564–0.598). For death within 72 h, the clinical expertise code reported better results than the Manchester Triage System. For life-saving interventions, the Manchester Triage System reported a lower performance than clinical expertise. The variability in triage code assignment was higher for clinical expertise compared to the Manchester Triage System.
Triage codes assigned by nurses based on clinical expertise perform better in terms of clinical outcomes, suggesting a need to update triage systems to incorporate nurses' knowledge and skills. However, standardised triage systems should be maintained to reduce variability and ensure consistent patient classification.
The study was conducted and reported according to the STROBE statement.
No patient or public contribution.
To test a middle-range theory (MRT) for the nursing diagnosis of ineffective breathing pattern in children with congenital heart disease (CHD) based on analysis of two general propositions.
This cross-sectional study is guided by STROBE. The propositions represent hypotheses about the relationships between the concepts of this MRT to be tested empirically, and thus, log-linear models were used to verify the structure of the proposition related to the stimuli. Diagnostic accuracy measures, univariate logistic regressions and the Mann–Whitney test were used to analyse the structure of the propositions related to behaviours.
The analysis of the propositions related to the stimuli (eight concepts, four of which were classified as focal stimuli and four as contextual stimuli) suggested a reclassification of the stimulus “deformities in the thoracic wall” which became too focal. In the analysis of the propositions related to behaviours (17 concepts, five of which were classified as acute confirmatory, nine as acute clinical deterioration and three classified as chronic), guided changes in the operationalisation of concepts were suggested after comparing clinical findings; thus, acute confirmatory behaviours now have 10 concepts, while acute clinical deterioration behaviours and chronic behaviours continued with nine and three concepts, respectively, but with reclassifications between them.
Changes in the operationalisation of the classification of the elements of the two propositions occurred after comparing the clinical findings with the theoretical model.
By establishing precise causal relationships and describing how IBP manifests itself over time in children with CHD, empirical testing of this MRT helps nurses understand clinical reasoning based on temporal logic and spectral interaction between diagnostic components, which in turn will improve the use and accuracy of nursing diagnoses.
Children and adolescents with CHD were recruited for this study sharing their clinical history and physical lung examination.
To synthesise the evidence on and to compare the diagnostic accuracy of the Nu-DESC and CAM in detecting postoperative delirium among hospitalised patients.
Systematic review and diagnostic meta-analysis.
The PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, ProQuest Dissertations and Theses A&I, and PsycINFO databases were systematically searched from their inception to February 10, 2023.
In total, 10 (n = 1950) and seven (n = 830) reports were included for the Nu-DESC and CAM, respectively. For Nu-DESC and CAM, the pooled sensitivities were 0.69 and 0.65, respectively, while the summary specificities were 0.99 for Nu-DESC and 0.92 for CAM. The pooled specificity differed significantly between the two tools (p < 0.001), despite comparable pooled sensitivities. The duration of stay in the intensive care unit significantly moderated the summary specificity of Nu-DESC (B = −0.0003, p = 0.009). Regarding CAM, the percentage of female participants showed a positive correlation with its pooled sensitivity (B = 0.005, p = 0.02). Furthermore, studies where clinical specialists served as assessors demonstrated a higher summary sensitivity than those assessed by nurses (0.87 vs. 0.25, p = 0.01).
The sensitivities of the Nu-DESC and CAM for detecting postoperative delirium did not achieve optimal levels. Therefore, developing more accurate tools to detect postoperative delirium by integrating features from related risk factors or incorporating technology-based algorithms to enhance the screening capability is warranted.
The study has adhered to PRISMA-DTA guideline.
No patient or public contribution.
The study protocol has been registered on PROSPERO (CRD42023398961)
To identify the reasons and/or risk factors for hospital admission and/or emergency department attendance for older (≥60 years) residents of long-term care facilities.
Older adults' use of acute services is associated with significant financial and social costs. A global understanding of the reasons for the use of acute services may allow for early identification and intervention, avoid clinical deterioration, reduce the demand for health services and improve quality of life.
Systematic review registered in PROSPERO (CRD42022326964) and reported following PRISMA guidelines.
The search strategy was developed in consultation with an academic librarian. The strategy used MeSH terms and relevant keywords. Articles published since 2017 in English were eligible for inclusion. CINAHL, MEDLINE, Scopus and Web of Science Core Collection were searched (11/08/22). Title, abstract, and full texts were screened against the inclusion/exclusion criteria; data extraction was performed two blinded reviewers. Quality of evidence was assessed using the NewCastle Ottawa Scale (NOS).
Thirty-nine articles were eligible and included in this review; included research was assessed as high-quality with a low risk of bias. Hospital admission was reported as most likely to occur during the first year of residence in long-term care. Respiratory and cardiovascular diagnoses were frequently associated with acute services use. Frailty, hypotensive medications, falls and inadequate nutrition were associated with unplanned service use.
Modifiable risks have been identified that may act as a trigger for assessment and be amenable to early intervention. Coordinated intervention may have significant individual, social and economic benefits.
This review has identified several modifiable reasons for acute service use by older adults. Early and coordinated intervention may reduce the risk of hospital admission and/or emergency department.
This systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology.
No patient or public contribution.
To design, develop and validate a new tool, called NEUMOBACT, to evaluate critical care nurses' knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention through simulation scenarios involving central venous catheter (CVC), endotracheal suctioning (ETS) and mechanically ventilated patient care (PC) stations.
Simulation-based training is an excellent way for nurses to learn prevention measures in VAP and CRB.
Descriptive metric study to develop NEUMOBACT and analyse its content and face validity that followed the COSMIN Study Design checklist for patient-reported outcome measurement instruments.
The first version was developed with the content of training modules in use at the time (NEUMOBACT-1). Delphi rounds were used to assess item relevance with experts in VAP and CRB prevention measures, resulting in NEUMOBACT-2. Experts in simulation methods then assessed feasibility, resulting in NEUMOBACT-3. Finally, a pilot test was conducted among 30 intensive care unit (ICU) nurses to assess the applicability of the evaluation tool in clinical practice.
Seven national experts in VAP and CRB prevention and seven national simulation experts participated in the analysis to assess the relevance and feasibility of each item, respectively. After two Delphi rounds with infection experts, four Delphi rounds with simulation experts, and pilot testing with 30 ICU nurses, the NEUMOBACT-FINAL tool consisted of 17, 26 and 21 items, respectively, for CVC, ETS and PC.
NEUMOBACT-FINAL is useful and valid for assessing ICU nurses' knowledge and skills in VAP and CRB prevention, acquired through simulation.
Our validated and clinically tested tool could facilitate the transfer of ICU nurses' knowledge and skills learning in VAP and CRB prevention to critically ill patients, decreasing infection rates and, therefore, improving patient safety.
Experts participated in the Delphi rounds and nurses in the pilot test.
This paper aims to: (a) determine the personal, sociodemographic, clinical, behavioural, and social characteristics of older Brazilians with clinical evidence of long COVID; (b) evaluate perceived quality of life and determine its association with personal, sociodemographic, behavioural, clinical and social variables; and (c) assess significant predictors of high perceived QoL.
Given the inherent vulnerabilities of the ageing process, the older people are an at-risk group for both contagion of SARS-CoV-2 and the perpetuation of residual symptoms after infection, the so-called long COVID or post-COVID syndrome.
A cross-sectional survey design using the STROBE checklist.
Brazilian older people with long COVID syndrome (n = 403) completed a phone survey measuring personal, sociodemographic, behavioural, clinical, and social characteristics, and perceived Quality of Life (QoL). Data were collected from June 2021–March 2022. A multiple linear regression model was performed to identify salient variables associated with high perceived QoL.
The mean age of participants was 67.7 ± 6.6 years old. The results of the multivariate regression model showed that race, home ownership, daily screen time, musculoskeletal and anxiety symptoms, and work situation were the significant predictors of QoL among COVID-19 survivors.
Knowledge about the persistence of physical, emotional, and social symptoms of COVID-19 can help nurses and other healthcare providers to improve the management of survivors, bringing benefits to the whole society.
Given the novelty of long-COVID and its heterogeneous trajectory, interventions focusing on the repercussions and requirements unique to more vulnerable older persons should be developed and these aspects should be included in public health recommendations and policymakers' concerns.
No patient or public contribution was required to design, to outcome measures or undertake this research. Patients/members of the public contributed only to the data collection.
Malnutrition, sedentary lifestyle, cognitive dysfunction and poor psychological well-being are often reported in patients on haemodialysis (HD).
We aimed to explore needs, barriers and facilitators—as perceived by patients, their carers, and healthcare professionals (HCPs) for increasing the adherence to the diet, to physical activity and cognition and psychological well-being.
This is an observational cross-sectional study following the STROBE statement. This study is part of an ERASMUS+ project, GoodRENal—aiming to develop digital tools as an educational approach to patients on HD. For that, the GoodRENal comprises HD centers located in four Belgium, Greece, Spain and Sweden. Exploratory questionnaires were developed regarding the perceived needs, barriers and facilitators regarding the diet, physical activity, cognition and psychological well-being from the perspective of patients, their carers and HCPs.
In total, 38 patients, 34 carers and 38 HCPs were included. Nutrition: For patients and carers, the main needs to adhere to the diet included learning more about nutrients and minerals. For patients, the main barrier was not being able to eat what they like. Physical activity: As needs it was reported information about type of appropriate physical activity, while fatigue was listed as the main barrier. For Cognitive and emotional state, it was perceived as positive for patients and carers perception but not for HCPs. The HCPs identified as needs working as a team, having access to specialised HCP and being able to talk to patients in private.
Patients and their carers listed as needs guidance regarding nutrition and physical activity but were positive with their cognitive and emotional state. The HCPs corroborated these needs and emphasised the importance of teamwork and expert support.
To examine the predictors and outcomes of patient safety culture (PSC) among oncology nurses working in public Saudi hospitals according to participant characteristics and evaluate the relationship between PSC domains.
PSC is crucial in healthcare systems, particularly in oncology and chemotherapy units, and its assessment can enhance the standard service provided and cancer care quality. There is currently limited research on the status, predictors and outcomes of PSC in cancer care settings in developing countries, including Saudi Arabia.
A cross-sectional correlational study.
A convenience sample of 101 oncology nurses working in two large Saudi tertiary care hospitals participated in this study. The Hospital Survey on Patient Safety Culture validated instrument and demographic and work surveys were completed by the participants. The study methods were compliant with the STROBE checklist. Descriptive statistics and multiple linear regressions were used to analyse the data.
The areas of PSC strength were related to organizational learning–constant improvement, feedback and communication about errors, and transitions and handoffs. Manager/supervisor actions and expectations, hospital management support, communication openness, experience in the current unit and oncology unit/area were the predictors of PSC. In terms of PSC outcomes, the oncology nurses reported either no or one to two adverse events and a substantially good patient safety rating.
The level of PSC was lower than expected. Communication openness, experience in the current unit and oncology unit/area were the strongest predictors of PSC. Investing in oncology nursing practice that addresses these concerns and prioritizes patient safety is critical in Saudi cancer care settings to increase patient safety.
The findings contribute to a better understanding of the predictors and outcomes of PSC, which should be considered when establishing effective nursing interventions or strategies for PSC in cancer care settings.
No patient or public contribution.
FreshRSS 