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To examine the association between perceived quality of care and the level of coercion experienced by individuals hospitalised in acute mental health units.
National cross-sectional study.
Data were collected from 255 patients admitted to 12 acute mental health units across Spain. Standardised instruments assessed perceived quality of care and levels of coercion, humiliation and fear at discharge. Multiple linear regression analyses were used to explore associations between care quality dimensions and patients' experiences.
Perceived quality of care was significantly associated with lower levels of perceived coercion and humiliation. All dimensions of care quality showed inverse associations, with the “secluded” dimension showing the strongest association. The association between care quality and perceived fear was less consistent. These findings are particularly relevant for mental health nurses, who play a central role in delivering relational care and ensuring patients' emotional safety.
Higher perceived quality of care is associated with lower levels of coercion, humiliation, and fear during hospitalisation in acute mental health settings.
For mental health nursing, these results underscore the critical role of nurses in creating therapeutic environments that reduce coercive experiences. By fostering trust, promoting patient autonomy, and ensuring emotional and physical safety, nurses can significantly influence the quality of care and patient outcomes.
The study addresses the lack of evidence on how perceived quality of care influences experiences of coercion in acute mental health settings. Better perceived care quality is linked to reduced feelings of coercion, humiliation and fear. The research has direct implications for mental health nurses, clinical educators and healthcare managers aiming to improve patient experiences and reduce coercive practices in psychiatric care.
STROBE reporting guideline.
No patient or public contribution.
To explore how a staff and managers experienced a multi-component and multi-level intervention to influence the psychological safety climate within nursing teams.
Qualitative, to explore the experiences of registered nurses, licensed practical nurses, and managers in a Swedish hospital.
Four focus group discussions were conducted in March 2023 with staff and managers (n = 20). A deductive thematic analysis was conducted, guided by a theoretical model of psychological safety, to examine work climate perceptions and antecedent conditions. An inductive approach was used to explore how participants experienced the intervention.
Participants experienced a shift from a blame-oriented to a more psychologically safe work climate. These developments were enabled by enhanced self-awareness, more supportive interpersonal dynamics, and leaders adopting a more accessible and vulnerable role. The intervention created a safe space to reflect on team dynamics.
Sustained efforts that integrate self-awareness, interpersonal dynamics, and managerial support are important to intentionally develop psychological safety. The creation of safe spaces can serve as a first step to confront unaddressed group beliefs.
Interventions aimed at improving psychology safety can have positive effects if they focus on developing individual trust and vulnerability, targeting group dynamics, and including leaders.
Problem addressed: Inadequate psychological safety among nursing teams, hindering effective collaboration. Main findings: By changing work conditions, the intervention led to improved perceived psychological safety. Research impact: Creating conditions for psychological safety can improve how teams function.
COREQ-checklist.
No PPI patient or public contribution.
The onset of delirium in older inpatients is associated with worse outcomes, including longer length of hospital stay, loss of functionality, loss of cognitive function, sleep disorders, increased polypharmacy, higher rates of adverse effects, and mortality. Previous studies have analyzed mortality after delirium, but without discriminating between settings, time, or critical conditions.
To assess the pooled incidence of delirium and risk of mortality at different times after hospital admission in older people and its association with mortality and length of stay in hospitalized people aged 65 years or older.
This systematic review and meta-analysis included studies analyzing the incidence of delirium and mortality. MEDLINE, Scopus, and the Web of Science were searched from inception to December 2023. PRISMA guidelines were followed. Inclusion criteria were original peer-reviewed studies in medical hospital areas using validated screening or diagnostic methods and quantifying mortality at admission or after excluding surgical patients. Exclusion criteria were studies that included only participants with a single condition at baseline, such as cancer, pneumonia, or frailty, or who were admitted to a specific unit such as the intensive care unit, as well as studies that assessed delirium in surgical areas. Study quality was assessed with Joanna Briggs Institute Critical Appraisal tools. The statistical analysis was performed in RevMan v5.4.0 (Cochrane Collaboration, Oxford, UK), using a random-effects model to calculate incidence, mortality, and length of hospital stay along with their 95% confidence intervals (CIs). The PROSPERO registration number for the review was CRD42023491604.
In the 32 included studies, the pooled cumulative incidence of delirium was 28.79% (95% confidence interval [CI] 24.06%, 33.51%). The mortality risk was higher in patients who had delirium during admission (odds ratio [OR] 5.23, 95% CI [3.45, 7.93]). This varied by time point: 1 month, OR 3.80 (95% CI 2.40, 6.00); 6 months, OR 3.48 (95% CI [2.01, 6.01]); 12 months, OR 2.73 (95% CI [2.07, 3.60]); 2 years, OR 2.09 (95% CI [1.57, 2.78]); and 5 years, OR 3.34 (95% CI [2.40, 4.64]). In the pooled analysis, mean length of hospital stay was 2.26 days (95% CI [0.54, 3.99]) longer in patients with delirium.
This study shows the markedly increased risk of mortality in older people with delirium during hospital admission and over the first month, in addition to an increased length of stay. The onset of delirium leads to increased use of healthcare resources. These data help to quantify the impact that delirium has on the health of older people, with implications for health system management. The evidence highlights the need to implement preventive pharmacological treatment or multicomponent strategies that minimize the onset of delirium in the older population.
The PROSPERO registration number for the review was: CRD42023491604, available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=491604
For nurse leaders to excel in leadership roles in the clinical world of informatics, a comprehensive understanding of nursing informatics as translated within the broader scope of health informatics including clinical informatics and business intelligence is necessary. The translation of nursing informatics in the comprehensive scope of health informatics is not consistently taught in graduate nursing leadership curricula. Collaboratively, from an interprofessional education stance, a graduate nurse informatics course was re-visioned using translational pedagogy: the idea of teaching related concepts by translating each and vice versa. Specifically, we translated nursing informatics amid health informatics concepts including business intelligence. Leadership students in the re-visioned course experienced the ability to visualize, conceptualize, and understand how work in information systems impacts broader aspects of clinical and business decision-making. Looking at nursing informatics through the lens of health informatics will develop students' ability to visualize, conceptualize, and understand how work in information systems has an impact on the broader aspects of clinical decision-making and support. Further, this paradigm shift will enhance students' ability to utilize information systems in leadership decision-making as future knowledge workers.
The coexistence of frailty and type 2 diabetes mellitus in the older population heightens the risk of adverse events. However, research on functional and wellness factors associated with frailty in this population is limited.
To investigate the associations of physical performance, functional dependency, physical activity, nutritional status, sleep, self-perceived health and depression with frailty in community-dwelling older adults with coexisting frailty and type 2 diabetes mellitus.
Cross-sectional.
The study included 123 community-dwelling older adults (73.7 ± 6.0 years) with pre-frailty/frailty and type 2 diabetes mellitus. Physical performance (Short Physical Performance Battery), functional dependency (Barthel Index and Lawton & Brody), physical activity and inactivity (GeneActiv wrist-worn accelerometer), malnutrition risk (Mini Nutritional Assessment), sleep (Pittsburgh Sleep Quality Index), self-perceived health (EuroQoL 5-Dimension 3-Level) and depression (Yesavage 15-item-Geriatric-Depression-Scale) were evaluated through personal interviews. Principal component analysis (PCA) was performed to categorize the variables into components, and logistic regressions were used to propose the best-fitted model for each component.
The PCA identified four components: (i) physical performance, with gait speed and leg mean velocity as the main variables associated with frailty; (ii) balance, showing significant associations with monopodal balance; (iii) daily activities, with moderate to vigorous physical activity and the Lawton and Brody score as the main variables associated with frailty within this component; and (iv) wellness factors, with nutritional status, self-perceived health and depression score as the primary variables associated with frailty.
This research underscores the significance of physical function and daily activities as protective factors against frailty in community-dwelling older adults with coexisting frailty and type 2 diabetes mellitus. The health dimension contributes both protective and risk factors, emphasizing the need for comprehensive assessments in managing frailty in this population.
The study adhered to the STROBE checklist.
No patient or public contribution.
Women with disabilities are more exposed to violence. The health sector has a key role in all three levels of prevention of violence against women. The objective of this paper was to review the interventions for preventing gender-based violence and reducing its impact on the mental health of women with any form of disability.
Relevant studies were identified through conducting searches in PubMed, Scopus, CINAHL, PsyInfo, Social Services Abstracts, and PILOTS. Two reviewers analyzed and selected studies. A qualitative synthesis was made.
3149 references were obtained, among which eight articles describing nine interventions from the USA and the UK. Most were intended for women with mental/intellectual disability and assessed intimate partner or sexual violence. Only one study showed high methodological quality. They were found to be particularly effective as regards improvement of the skills acquired by participants, but the results as regards improved mental health are not consistent.
Our review shows very little evidence of effective interventions. Further studies are required with higher internal validity and female sample groups with diverse disabilities.
Gender-based violence is a highly prevalent problem for women with disabilities, and in addition to being a public health challenge is a violation of human rights. Health care systems and policymakers should take a key role in all three levels of prevention of violence against women with disabilities. Interventions with longer follow-up times are required. It is also important for interventions to be designed in consultation with people with disabilities.
To identify and synthesise qualitative studies on barriers and facilitators perceived by dialysis patients in relation to self-care and disease management.
Systematic review of qualitative studies.
Qualitative study articles were extracted from PUBMED, MEDLINE, COCHRANE, WEB OF SCIENCE (WOS), CINAHL PsycINFO and EMBASE and electronic journals of the Spanish Society of Nephrology and Spanish Society of Nephrological Nursing until May 2022. Studies on barriers and/or facilitators affecting self-care and disease management expressed by people undergoing haemodialysis or peritoneal dialysis were included.
The SPICE (Setting, Perspective, Intervention, Comparison and Evaluation) strategy was used to develop issues and subissues through the thematic synthesis of the qualitative findings. GRADE-CERQual was used to evaluate the articles.
From 172 articles, 15 qualitative articles about barriers and facilitators perceived by patients concerning self-care and disease management were finally included. Identified eight facilitators and four barriers.
Patients perceived a significant number of barriers and facilitators. It is possible to identify which aspects facilitate self-management of their disease and to understand that the processes are individualised. This is why therapeutic strategies should be designed to foster the participation and empowerment of the person in the management of the disease.
Identifying the barriers and facilitators concerning the management of chronic kidney disease furnishes us with knowledge for individualised clinical practice and improved care processes.
This review is the first to synthesise barriers and facilitators in haemodialysis patients about the management of their disease and treatment. The results enable the proposal of improvements in the training of healthcare personnel, clinical practice guidelines and action protocols to improve the daily life and management of the disease by patients.
No patient or public contribution due to this is a systematic review.
(I) To identify the opinion and practices of nursing professionals regarding the presence of family members during invasive procedures in hospitalised children; (II) to determine the knowledge of nursing professionals about the patient-and family-centred care model.
Family presence in invasive procedures benefits the patient and their relatives, but varied attitudes exist among healthcare personnel, with some being favourable and others unfavourable toward family presence.
Observational, descriptive, cross-sectional study.
Study population: Nurses from paediatric critical care services, emergency services, hospital wards, day hospitals and outpatient clinics at a Catalan tertiary hospital who participated voluntarily between September 2021 and July 2022. Data collection instrument: A questionnaire prepared by the researchers, based on the literature and reviewed by experts. REDCap link with access to the questionnaire was sent out to potential respondents through the institutional email. Bivariate analysis was performed with the R 4.2 program. The study was approved by the hospital's Clinical Research Committee and participants gave informed consent before responding to the questionnaire.
A total of 172 nurses participated, and 155 valid responses were obtained. All respondents consider the family as a key element in paediatric care and report inviting family members to participate in the care given to their child. However, 12.0% of nurses do not invite the family to be present in invasive procedures. Almost all respondents note the need for training to acquire communication skills and improve the management of emotions.
The results show a favourable opinion towards the presence of family members and highlight the need to train nurses to develop communication skills.
The data provided can favour the design of measures to improve and promote the presence of parents during invasive procedures, reinforcing the patient-and family-centred care model and improving the quality of care provided. One example is the creation of family care protocols where the inclusion of parents and the roles of each individual involved in the care process appears.
To explore the rate of NUPs and associated factors in the PED of the ‘Hospital Universitario y Politécnico La Fe’ in Valencia (Spain) using Andersen's Behavioural Model.
We conducted a descriptive cross-sectional study using Andersen's Behavioural Model in parents visiting the PED with their children at the ‘Hospital Universitario y Politécnico La Fe’ in Valencia (Spain).
The study involved a total of 530 participants, of whom 419 (79%) had made an NUP. The predisposing factors identified were: (I) paediatric patients brought in by their fathers (OR = 0.460; p = 0.005), (II) lower educational attainment (OR = 3.841; p = 0.000), (III) first-time parenthood (OR = 2.335; p = 0.000) and (IV) higher parental stress (OR = 1.974; p = 0.023). The enabling factors included: (I) responsibility for a significant part of the childcare shared with others (OR = 0.348; p = 0.041) and (II) the perception that PEDs provide better care than primary care (PC) services (OR = 1.628; p = 0.005). The need factors were: (I) existing chronic illness in the child seeking care (OR = 0.343; p = 0.000) and (II) the perceived severity of the urgency (OR = 0.440; p = 0.031).
The NUP rates found in this study are similar to those found internationally. In accordance with Andersen's Behavioural Model, we identify predisposing, enabling and need factors to explain the multifactorial nature of NUPs in PEDs.
Identifying the factors associated with NUPs enables interventions to be targeted at those groups most likely to engage in NUPs, thereby optimising the functioning of the PED and improving the well-being of children and families. These interventions should focus on improving parental health literacy, providing education on making appropriate decisions about accessing health services and recognising severe symptoms in children, as well as improving access to high-quality PC services. Providing support to parents during the transition to parenthood would also be beneficial.
This paper adheres to the STROBE initiative guidelines.
Participants, who voluntarily agreed to take part, contributed to the study by completing a paper-based questionnaire containing all the study variables as prepared by the research team.
To evaluate changes in compassion fatigue (CF), burnout (BO), compassion satisfaction (CS) and fear of COVID-19 among Spanish nurses by comparing two assessment points: before and after the COVID-19 vaccination campaign.
The COVID-19 pandemic has produced a great impact in healthcare worker's professional quality of life, especially among nurses. CF, BO and fear of COVID-19 decisively affect the care provided by nurses and put them at risk for mental health problems, so longitudinal studies are essential.
A repeated cross-sectional design was carried out with a time-lapse of 12 months.
A total of 439 registered nurses in December 2020 and 410 in December 2021 participated in this study through an online survey. Data were collected using the Professional Quality of Life Questionnaire and the Fear of COVID-19 Scale. Occupational and sociodemographic variables were also analysed. This article adheres to the STROBE guidelines for the reporting of observational studies.
The fear of COVID-19 has not been reduced among nurses. The levels of BO remain stable and continue to be high in half of the professionals. CF has been reduced with a small effect size (d = 0.30), while CS has also decreased (d = 0.30). Positive correlations were found in both assessment points between fear of COVID-19 and BO (r = .44, p ≤ .001; r = .41, p ≤ .001) and also between fear of COVID and CF (r = .57, p ≤ .001; r = .50, p ≤ .001). Negative correlations between fear and CS were also found (r = − .16, p = .001; r = − .22, p ≤ .001).
Programmes to reduce fear of COVID-19, BO and CF are needed to improve mental health and to prevent psychological distress among nurses, as well as to increase CS and preserve the productivity and quality of nursing care.
The nurses collaborated by participating in the present study anonymously and disinterestedly.
To identify scales that assess parental stress in the paediatric clinical population and to analyse their psychometric properties.
Four electronic databases (PubMed, Web of Science, PsycINFO, and Scopus) and metasearch engines (Google Scholar and Open Grey) were searched with no time period limitations. Methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach modified by COSMIN. Finally, recommendations were made for the instruments with the highest quality of evidence.
A total of 38 studies reporting on 11 different instruments for assessing parental stress in the paediatric clinical setting were included. Six instruments were ‘A’ rated (recommended) in the final phase in line with COSMIN guidelines. The Paediatric Inventory for Parents was the instrument that evaluated the highest number of psychometric properties and obtained the highest methodological quality, global assessment, and quality of evidence for the different psychometric properties.
This systematic review provides an overview of the measurement properties of the parental stress instruments used in the paediatric clinical setting. The Paediatric Inventory for Parents stands out as being one of the most robust instruments for measuring stress in parents with a hospitalised or sick child. Evidence needs to be generated for all the parental stress scales used in the clinical setting.
Given that the psychometric properties of the existing parental stress scales used in paediatric health care settings have not been systematically assessed, the present review utilised comprehensive methods according to COSMIN.
PRISMA statement and COSMIN reporting guidelines for studies on measurement properties of patient-reported outcome measures.
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