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by Shawn Walker, Emma Spillane, Kate Stringer, Lauren Trepte, Siân M. Davies, Jacana Bresson, Jane Sandall, Andrew Shennan, the OptiBreech Collaborative
OptiBreech collaborative care is a multi-disciplinary care pathway for breech presentation at term, with continuity from a breech specialist midwife, including where chosen, for vaginal breech birth (VBB). Pilot randomised trial using unblinded 1:1 parallel group allocation to OptiBreech versus standard care, within a cohort. Participants were women with a breech-presenting fetus > 33 weeks, at four sites in England, January–June 2022. A two-stage consent process was used. Participants consented to undergo random selection to be offered a ‘new care process’, with a choice to accept it, or not. Primary objectives were to identify recruitment, acceptance, and attrition rates. Randomisation procedures and potential primary outcomes for a substantive study were also feasibility-tested. 68 women were randomised between January–June 2022. The consent process was acceptable to participants, but randomisation was unacceptable to women who specifically sought OptiBreech care. Two women withdrew due to concerns about sharing personal information. More women planned a VBB when randomised to OptiBreech Care (23.5% vs 0, p = .002, 95% CI = 9.3%,37.8%). Women randomised to OptiBreech care had: lower rates of cephalic presentation at birth (38.2% vs 54.5%), higher rates of vaginal birth (32.4% vs 24.2%), lower rates of in-labour caesarean birth (20.6% vs 36.4%), lower rates of neonatal intensive care (5.9% vs 9.1%), and lower rates of severe neonatal morbidity (2.9% vs 9.1%). Randomisation was stopped on the advice of the steering committee before the planned sample of 104, as lack of access to VBB within standard care prohibited comparison of outcomes. Demand for VBB is sufficient for a cohort study, but comparison of outcomes by 1:1 randomisation is not feasible. OptiBreech care would be best evaluated using stepped wedge cluster randomisation. Funded by the United Kingdom National Institute for Health and Care Research (NIHR300582). Clinical trial registration: ISRCTN 14521381.
This study aimed to investigate the experiences and transitional care needs of Turkish frail older adults living in the UK and determine how this information can be utilized to improve the provision of culturally sensitive care during the transitional period.
Qualitative descriptive research with semi-structured individual interviews.
“The ‘Silences’ Framework guided the research design, from conceptualizing the research question to structuring the report of final outputs. For this study, semi-structured, in-depth interviews were conducted with sixteen older adults living with frailty and five family caregivers between January and May of 2023 in the United Kingdom.
Major themes that were identified included: (i) information and communication, (ii) care and support, (iii) the role of culture and (iv) trust and satisfaction. Further analysis, through discussion and immersion in the data, revealed that care transition periods were presented alongside three phases of transitional care: pre-transition (during hospitalization), early-transition (the period between discharge and the 7th day after discharge) and late transition (the period between the 8th day and 12th month after discharge).
Our study revealed that the communication and informational needs of frail older individuals change during the transition period. While Turkish older adults and family caregivers expressed satisfaction with healthcare services in the UK, many struggled due to a lack of knowledge on how to access them.
The support of family caregivers is a crucial component in facilitating transitional care for frail older patients, as they help in accessing healthcare services and using technological devices or platforms. It should be noted that family caregivers often hold the same level of authority as their elderly Turkish counterparts.
No patient or public contribution.
To explore clinician-perceived barriers to and facilitators for the provision of actionable processes of care important for patients with persistent or chronic critical illness.
Qualitative descriptive interview study.
Secondary analysis of semi-structured telephone interviews (December 2018 – February 2019) with professionally diverse clinicians working with adults experiencing persistent or chronic critical illness in Canadian intensive care units. We used deductive content analysis informed by the Social-Ecological Model.
We recruited 31 participants from intensive care units across nine Canadian provinces. Reported intrapersonal level barriers to the provision of actionable processes of care included lack of training, negative emotions and challenges prioritizing these patients. Facilitators included establishment of positive relations and trust with patients and family. Interpersonal barriers included communication difficulties, limited access to physicians and conflict. Facilitators included communication support, time spent with the patient/family and conflict management. Institutional barriers comprised inappropriate care processes, inadequate resources and disruptive environmental conditions. Facilitators were regular team rounds, appropriate staffing and employment of a primary care (nurse and/or physician) model. Community-level barriers included inappropriate care location and insufficient transition support. Facilitators were accessed to alternate care sites/teams and to formalized transition support. Public policy-level barriers included inadequacy of formal education programs for the care of these patients; knowledge implementation for patient management was identified as a facilitator.
Our results highlighted multilevel barriers and facilitators to the delivery of actionable processes important for quality care for patient/family experiencing persistent or chronic critical illness.
Using the Social-Ecological Model, the results of this study provide intra and interpersonal, institutional, community and policy-level barriers to address and facilitators to harness to improve the care of patients/family experiencing persistent or chronic critical illness.
Consolidated criteria for reporting qualitative studies.
No patient or public contribution.
To identify strategies that develop clinical nursing leadership competencies among staff nurses, and to explain the contextual elements and mechanisms that underpin the development of clinical nursing leadership competencies.
Realist review according to the Realist and Meta-narrative Evidence Syntheses—Evolving Standards (RAMESES).
PubMed, Embase, CINAHL, Web of Science, Wiley Online Library, PsycInfo and ProQuest were searched from January 2000 until October 2022.
Three iterative phases: (1) development of initial programme theory, (2) structured searches for relevant published and grey literature and (3) data synthesis and interpretation by researchers and theory triangulation, and discussions within the research group.
Multiple context–mechanism–outcome configurations were extracted from 10 reports that explain how, under what circumstances and why strategies can facilitate (or discourage) staff nurses to act as clinical leaders. Reports were both quantitative and qualitative in design, originating from English-speaking countries only.
A logic model was developed and suggests four contexts and five mechanisms underlying the development of clinical nursing leadership. Growth in clinical nursing leadership was mainly experienced through experiential learning, which was enhanced by a supportive relationship with a coach or mentor, the use of reflective practices and modelling from other leaders. Furthermore, a supportive work environment triggers ownership, confidence and motivation, and thereby growth in clinical nursing leadership competencies.
Fostering competencies for clinical leadership among staff nurses requires multifaceted strategies. Strategies are successful if, and only if, they combine learning by doing, by knowing and by observing, and establish a responsive work environment. Hospital policy should ensure that staff nurses have access to reciprocal relationships with role models or a coach. In order to grow as clinical nurse leader, ownership and self-reflection on own leadership behaviour need to be facilitated.
Prospero ID CRD42021292290.
During the Coronavirus (COVID-19) pandemic, healthcare providers have overcome difficult experiences such as workplace violence. Nurses are particularly vulnerable to workplace violence. The objective of this study was to characterize violence and aggression against nurses during the COVID-19 pandemic in Latin America.
An electronic cross-sectional survey was conducted in 19 Latin American countries to characterize the frequency and type of violent actions against front-line healthcare providers.
Of the original 3544 respondents, 16% were nurses (n = 567). The mean age was 39.7 ± 9.0 years and 79.6% (n = 2821) were women. In total, 69.8% (n = 2474) worked in public hospitals and 81.1% (n = 2874) reported working regularly with COVID-19 patients. Overall, about 68.6% (n = 2431) of nurses experienced at least one episode of workplace aggression during the pandemic. Nurses experienced weekly aggressions more frequently than other healthcare providers (45.5% versus 38.1%, p < .007). Nurses showed a trend of lower reporting rates against the acts of aggression suffered (p = .076). In addition, nurses were more likely to experience negative cognitive symptoms after aggressive acts (33.4% versus 27.8%, p = .028). However, nurses reported considering changing their work tasks less frequently compared to other healthcare providers after an assault event (p = .005).
Workplace violence has been a frequent problem for all healthcare providers during COVID-19 pandemic in Latin America. Nurses were a particularly vulnerable subgroup, with higher rates of aggressions and cognitive symptoms and lower rate of complaints than other healthcare providers who suffered from workplace violence. It is imperative to develop strategies to protect this vulnerable group from aggressions during their tasks.
La elevada rotación del personal de enfermería que se produce en todos los centros sanitarios públicos y privados de nuestro país es una realidad muy habitual de nuestros días. La formación inicial de las nuevas compañeras plantea una dificultad añadida a la sobrecarga de trabajo que se da en muchos destinos. Con las nuevas tecnologías, tenemos en las formaciones online una gran oportunidad para diseñar planes de inmersión con un formato virtual.
Objetivo principal: Evidenciar la seguridad del inicio de vasopresores mediante un catéter venoso periférico corto en pacientes adultos con diagnóstico de choque séptico, a través de la metodología Enfermería Basada en Evidencia. Metodología: Revisión sistemática. La búsqueda de evidencia se realizó en dos periodos, del 15 al 23 de septiembre del 2022 y del 3 al 20 de octubre del 2022, se utilizaron fuentes de búsqueda e información: base de datos PubMed y el buscador Google académico. Resultados principales: Se evaluaron 19679 pacientes, el tiempo de administración de la infusión fue de 101.05 horas, con una duración media de 22.63 horas, el evento adverso con más incidencia fue la extravasación con duración media de 7.5 horas, el vasopresor más utilizado fue la norepinefrina. Conclusión principal: Administrar vasopresores por vía periférica es seguro, considerando factores que reducirían significativamente el riesgo de complicaciones.
Nurses have long received recommendations to employ self-care behaviors to ensure their ability to remain in the profession; however, nurses are rarely asked what self-care behaviors are beneficial. This literature review aimed to map studies on nurses' self-care strategies to provide an understanding of how these strategies are addressed in the literature and to identify gaps in need of additional exploration.
Searches were conducted in accordance with published mapping review methodologies across MEDLINE, Embase, CINAHL, Scopus, PsycINFO, Web of Science, and identified influential nursing journals. Included studies were from the United States, peer-reviewed, and described self-care strategies related to nurses or the nursing profession.
Thirty-five articles were identified for inclusion and were evaluated based on agreed-upon criteria to define how the concept of self-care was studied and applied to nurses. Three main categories were identified in this review: self-care and stress; self-care and burnout; and self-care and leadership, workplace factors, and physical activity.
This mapping review revealed an abundance of literature related to self-care recommendations for nurses; however, there remains a dearth of studies investigating how nurses utilize self-care behaviors independently to improve their own professional well-being. Recommendations for next steps in research in this area are included.
Sr. Director: El Reglamento Sanitario Internacional (2005) exponía que las amenazas para la salud pública internacional en el siglo XXI se centraban en 7 campos: enfermedades epidemiógenas, enfermedades transmitidas por los alimentos, brotes accidentales, brotes intencionados, accidentes por sustancias químicas tóxicas, accidentes radio nucleares y desastres ambientales [Fragmento de texto].
To learn about the attitudes of nurses working in the Andalusian Public Health System regarding euthanasia and its legalisation.
Euthanasia often finds itself in the crosshairs of ethical and political debate on an international scale. Currently, the Spanish Organic Law 3/2021 of 24 March, 2021, recognises euthanasia as a fundamental right in Spain. It is of particular interest to know about the views, attitudes and stances that Andalusian nurses have of euthanasia as they are key players within the framework of euthanasia and administration of life-ending drugs. They play a central role in guiding patients through the euthanasia application process.
Observational descriptive study.
A study of Andalusian Public Health System nurses was carried out using non-probability convenience sampling. 518 nurses with an average age of 44.75 years answered in a questionnaire that was distributed on an online platform. Socio-demographic and occupational variables were assessed, together with the Death Anxiety Scale and the Euthanasia Attitude Scale. A bivariate analysis and a multivariate linear regression model were performed. The STROBE checklist was used.
The mean score obtained on the Euthanasia Attitude Scale was 75.95 (SD = 16.53). The mean score obtained on the Death Anxiety Scale was 7.56 (SD = 3.05). The variables age and work experience were negatively correlated with the total scores of the Euthanasia Attitude Scale and the categories ‘Ethical considerations’, ‘Practical considerations’ and ‘Treasuring life’. On the other hand, there was a significant positive correlation between age and work experience and ‘Spiritual beliefs’ category.
The current situation shows a worrying paradox. There is a stark difference between positive professional attitudes towards euthanasia and the desire to participate in its application.
It is vital that educational and healthcare institutions make the necessary efforts to ensure that nurses develop sound moral judgement, displaying the moral conscience and ethical commitment required of this established profession.
No patient or public contribution.
Objetivo principal: Determinar qué autocuidados son recomendables, en los procesos de duelo, para las enfermeras. Metodología: Lectura crítica del artículo seleccionado, evaluado con la parrilla de preguntas CASPe, con los criterios propuestos por Arnau y Sala para revisiones narrativas y con The Literature Review Checklist de Leite et al. Resultados principales: Según el sistema GRADE, hablamos, en general, de Moderada Calidad de la Evidencia. Conclusión principal: Tras la lectura crítica y junto a la literatura revisada, vemos a cualquiera de las intervenciones de autocuidado propuestas por McAdam como recomendable. Aun así se hacen precisos más estudios que aporten mayor grado de evidencia en intervenciones concretas.
Widespread and sustained adoption of telemedicine in long-term residential care is emerging. Nursing home (NH) nurses play a key role in collaborating with remote physicians to manage residents' medical conditions through videoconferencing. Therefore, understanding of interprofessional collaboration and effective communication between nurses and physicians is critical to ensure quality of care and safety during teleconsultations.
To explore NH nurses' and physicians' experiences of interprofessional collaboration and communication during teleconsultations.
A qualitative descriptive design was adopted. Purposive sampling was conducted to recruit 22 physicians and nurses involved in NH teleconsultations. Semi-structured online interviews were conducted, and data were thematically analyzed.
Three themes were identified: (1) Manner of communication in telemedicine, (2) sociocultural influences in collaborative practice, and (3) role expectations in telemedicine. Both nurses and physicians recognized the importance of building and maintaining trust as physicians heavily depended on nurses for provision of objective information for clinical decision-making. However, practice differences were observed between nurses and physicians during teleconsultations. Sociocultural influences such as power relations and language barriers also affected the nurse–physician relationship and interpersonal communication. Additionally, different performance expectations were identified between nurses and physicians.
Interprofessional collaboration in teleconsultations is challenging because of lack of in-person assessment and dependence on nurses for clinical information. In addition, expectations and communication styles differ among healthcare professionals. This study called for interprofessional telemedicine training with incorporation of shared mental models to improve role clarity and communication. Given the international-dominated healthcare workforce in long-term care, the development of cultural competency could also be considered in telemedicine training to enhance nurse–physician collaborative practice.
Telemedicine is increasingly adopted in long-term care settings, where multidisciplinary healthcare professionals from different health institutions are involved in resident care. Interprofessional collaboration should be incorporated into telehealth education for enhanced clinical practice in this care delivery model.
Objetivo: Identificar la evidencia científica relacionada con los factores de riesgo y los estilos de vida en adolescentes asociados a la ocurrencia de cáncer pulmonar, cervicouterino, gastrointestinal, de piel y de mama en la adultez. Metodología: Revisión de alcance basada en la metodología del Joanna Briggs Institute (JBI), se exploraron cuatro bases de datos, a los artículos seleccionados se les realizó análisis, extracción y síntesis de datos. Resultados: Se incluyeron 33 artículos, los factores de riesgo identificados fueron antecedentes familiares, sexo, tabaco, alcohol, sobrepeso, bajo peso, exposición al sol, infección por virus del papiloma humano (VPH), desconocimiento sobre medidas de autocuidado, bajo consumo de frutas y verduras, consumo de carnes rojas y de grasas, bajo nivel socioeconómico, bajo nivel de escolaridad y sedentarismo; y, como estilos de vida: actividad física, uso del condón, seguimiento y detección de su situación de salud, vacuna contra el virus del papiloma humano (VPH), alimentación saludable y protección solar. Conclusión: Los factores de riesgos encontrados en la revisión de alcance son numerosos, según cada tipo de cáncer, existen factores modificables que desde la adolescencia se pueden poner en práctica como estilos de vida en sentido individual, familiar y escolar.
Objetivo principal: Explorar el impacto de las lesiones por presión (LPP) en las personas después de un ingreso en la UCI por Covid-19. Metodología: Estudio de caso bajo enfoque cualitativo. Se realizó una entrevista semiestructurada para explorar el fenómeno “padecer LPP en el contexto de la enfermedad por Covid-19” y un análisis temático mediante la teoría fundamentada. Resultados principales: El análisis resultó en las siguientes categorías: signos y síntomas, funcionamiento físico, bienestar psicológico, funcionamiento social, vivencia del proceso, ámbito de los cuidados, espiritualidad, tratamientos, elementos de cura experta, comunicación de la información, satisfacción de cuidados, proceso de alta, integración y déficits de conocimientos. Conclusión principal: El estudio destaca el gran impacto que las lesiones por presión causan en todas las dimensiones calidad de vida, además de en las esferas espiritual, económica y la necesidad de información.
Trans youth experience significantly higher rates of societal violence and ill-health compared to their cisgender peers. Although recent clinical guidelines for trans young people in health have paved the way for revolutionizing care, many trans young people still experience adversity in clinical settings. This discursive literature review provides a novel approach in exploring why trans young people experience violence in health care despite the availability of evidence-based resources and guidelines.
Databases (CINAHL and Scopus) were systematically searched to identify qualitative literature on the experiences of trans young people (<18 years) in health care settings.
Rather than synthesizing and presenting the literature, Fairclough's (2001) CDA methodology was used to critically analyze the literature as texts in a data corpus. The authors engaged with the data from a critical social theory perspective.
Fifteen qualitative articles and one report (n = 16) on the experiences of trans young people (3–24 years) in health care settings were included. Two key discourses were identified in the literature. First, discourses that constituted the trans young person were identified in the definitions of ‘trans’ as a pathological incongruence and as alternate, self-determined ways of being. Further discourses were identified in the constitution of trans young people as victims, extra-pathological, and alternatively problematised as socially dysphoric. Second, discourses in health provider responses were identified in dismissive, gatekeeping, regulatory, and respectful practices.
The discursive constitution of the trans young person as incongruent, vulnerable, and pathological is constituted and generated by dismissive, gatekeeping, and regulatory practices of health care providers. The analysis reveals how trans young people are considered pathological and deemed treatable (at the site of the body), in the interest of ‘protecting’ them from a perceived abject future of trans adulthood. The logic and violence of cisgenderism is uncovered as the foundation of these dominant discourses, whereby growing up cisgender is often presented as the only option in health care settings. The dominant discourses that constitute the trans young person in health care as incongruent, pathological, and vulnerable, alongside the reifying health care responses of dismissal, gatekeeping, and regulation contribute to the erasure of the young trans person.
This paper identified key discourses in the literature in how trans young people are constituted and regulated in health care. This review highlights an urgent need for further critical scholarship in trans health by trans researchers, from critical perspectives. Furthermore, it provides a starting point for critical reflection of health care provider and researcher practices and the re-imagination of trans-futurity for all young people in health care.
Nurses are situated at the forefront of health care delivery and play a crucial role in the advocacy and provision of culturally safe care. With this ideal proximity to clients, nurses can powerfully affect change through better understanding and reflecting on how regulatory practices constitute and position trans young people in health care. Nursing knowledge, such as cultural safety, can offer novel approaches in working towards safer ways of meeting the needs of trans young people.
Objetivo principal: Interpretar el significado que se le asigna a las estrategias de enseñanza-aprendizaje en el área de salud destinada a personas mayores. Método: Estudio cualitativo de carácter exploratorio. Participaron personas mayores de 60 años y profesionales del área gerontológica con experiencia en la planificación y ejecución de educación en salud. La información fue recolectada a través de entrevista semiestructurada, y los datos fueron analizados a través de análisis de contenido. Resultados principales: Las personas mayores reconocen el realizar talleres y la educación individual como las mejores estrategias para recibir educación. Al triangular la información, los profesionales gerontológicos coinciden con la apreciación positiva de los talleres, pero acompañados de un adecuado diagnóstico participativo y desde la experiencia del participante. Conclusión principal: Los talleres se reconocen como la mejor estrategia de enseñanza-aprendizaje para personas mayores. Esta debe aplicarse considerando un diagnóstico participativo, con la experiencia de la persona mayor y ser mantenido en el tiempo.
Objetivo principal: Analizar la influencia del contacto piel con piel (CPP) en el éxito de la lactancia materna exclusiva (LME) hasta los 6 meses de vida. Metodología: Estudio analítico descriptivo y prospectivo, realizado mediante entrevista directa con 500 puérperas seleccionadas por muestreo de casos consecutivos. Resultados principales: Cuando se realizó el CPP de manera ininterrumpida la LME a los 6 meses de vida fue del 17,40% y la de lactancia artificial del 12,60%. En los casos en que no se realizó, eran mayores las tasas de lactancia artificial (10,80%) frente a las de LME (4,40%). Las variables con mayor influencia en el éxito de la lactancia materna exclusiva a los 6 meses de vida, el tipo de alimentación en hijos anteriores y el tipo de alimentación al alta hospitalaria. Conclusión principal: Se deben evitar rutinas hospitalarias que interrumpan el CPP así como procurar que al alta hospitalaria la LME esté correctamente establecida.
Today's nursing workforce is expected to know how to identify and understand research methods and procedures and apply the most current evidence into daily practice. However, teaching evidence-based practice (EBP) in an undergraduate nursing curriculum poses unique challenges in overcoming students' perception of content relevancy to their educational experience, but also offers opportunities for innovation to facilitate critical thinking and clinical application.
The aim of this article is to report on how teaching and learning innovation was infused into a research and evidence-based practice course and the effect on students' perceptions of course values and effectiveness.
We used a Plan-Do-Study-Act approach to introduce innovation in an undergraduate course within a university setting. Final student course evaluations were used to measure outcomes on a 5-point Likert scale (1 = low and 5 = high) on the following dimensions: (1) value of overall educational experience, (2) relevancy of course content, (3) improvement in critical thinking, and (4) level of student-instructor interaction.
Overall course evaluation scores improved greatly from 2.69 to 3.90 between Spring 2020 and Fall 2021. This finding remained relatively consistent across subsequent semesters (3.79 [Spring 2022], 3.84 [Fall 2022]). Students also reported appreciation and increased engagement and interest with the material after transitioning from examinations to a project-based assignment that allowed them to walk through the steps of EBP in class.
We identified and implemented several innovative strategies to improve student outcomes and increase the relevance of the course content. These innovations can be easily incorporated at other universities to enhance delivery and student engagement in this content that is essential to advancing quality care in nursing and developing future nurse scientists and practice leaders who care, lead, and inspire.
Introducción. Las heridas crónicas suponen un grave problema de salud con gran impacto socioeconómico debido a su morbimortalidad y a la afectación de la calidad de vida. Desde hace tiempo se conocen las propiedades de los lípidos en el sistema inmunitario. Un sistema inmunológico débil podría conducir a una infección o cronificación de las heridas. El colesterol es un lípido con importancia cuantitativa en las membranas de las células donde contribuye al mantenimiento de la fluidez de membrana. Unos niveles bajos de colesterol se relacionan con mayor riesgo de padecer infecciones. El objetivo del estudio fue analizar los niveles de lípidos en pacientes con úlceras por presión infectadas. Metodología. Se estudiaron 77 pacientes del Departamento de Salud de Elche Hospital General con úlceras por presión infectadas en un periodo de un año. Resultados. Se ponen de manifiesto diferencias estadísticamente significativas entre pacientes con niveles de C-LDL por debajo de 70mg/dL y pacientes con niveles por encima de 70mg/dL que presentan un CT por debajo de 140mg/dL. Discusión. La investigación futura sobre estos aspectos ayudará a aclarar los mecanismos de transporte del colesterol hacia los tejidos para así protegerlos de las agresiones de los microorganismos.
ABSTRACT
Introduction. Chronic wounds are a serious health problem with great socioeconomic impact due to their morbidity and mortality and the affectation of quality of life. The properties of lipids in the immune system have been known for a long time. A weak immune system could lead to infection or chronic wounds. Cholesterol is a quantitatively important lipid in cell membranes where it contributes to maintaining membrane fluidity. Low levels of cholesterol are associated with an increased risk of infections. The objective of the study was to analyze the levels of lipids in patients with pressure ulcers infected. Methodology. 77 patients with infections in pressure ulcers from the Health Department of Elche-General Hospital were studied for one year. Results. Statistically significant differences are revealed between patients with LDL-C levels below 70mg/dL and patients with levels above 70mg/dL. Levels of TC were below 140mg/dL in both groups. Discussion. Future research on these aspects will help clarify the mechanisms of cholesterol transport to the tissues and therefore protect them from microorganism aggressions.
FreshRSS 