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Advance care planning for people with dementia is an important process to ensure that patient preferences are respected throughout disease progression. However, the complexity of advance care planning and the challenges in effective communication hinder its implementation. The lack of clear procedural guidance for health care teams and the limited research on practical issues such as building trust and resolving conflicts further complicate this process.
To explore the key components of and processes for advance care planning for people with dementia.
The authors conducted a comprehensive search of databases, including PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, NICE, Open Grey, CNKI, and Wanfang. The inclusion criteria focused on studies reporting advance care planning practices and stakeholder perspectives related to dementia.
The review included 45 studies and identified key components and processes for successfully implementing advance care planning in dementia care. These components include enhancing readiness, capturing patient wishes, and executing those wishes. The implementation processes cover assessing participation capacity, selecting surrogate decision-makers, and identifying healthcare providers who implement advance care planning. As the condition of people with dementia progresses, the role of healthcare providers who implement advance care planning becomes increasingly important in advance care planning practices.
The success of advance care planning depends on the interconnection of multiple components, and the findings offer practical insights for improving the advance care planning process to ensure that the care preferences of people with dementia are respected throughout the progression of the disease.
PRISMA-ScR.
This is a review without patient and public contribution.
Cognitive decline, including subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia, significantly affects social participation, leading to social isolation and reduced quality of life. Enhancing social participation through interventions may mitigate these effects, yet evidence on intervention effectiveness and mechanisms remains inconsistent.
To evaluate the effectiveness of social participation interventions for individuals with cognitive decline and identify effective behavior change techniques (BCTs) supporting social participation.
Our search using the following databases—PubMed, Web of Science, Embase, Cochrane Library, CINAHL, Scopus, CNKI, and Wanfang—was conducted until October 2024. The quality of the included studies was assessed using the Cochrane risk of bias tool for randomized trials. Meta-analyses were conducted using Review Manager 5.4 and Stata18, and the certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach.
Sixteen RCTs involving 2190 participants were included. Music therapy (SMD = 0.62, 95% CI [0.15, 1.10]) and reminiscence therapy (SMD = 0.34, 95% CI [0.02, 0.66]) demonstrated significant positive effects on social participation. Group-based interventions were particularly effective (SMD = 0.23, 95% CI [0.04, 0.43]). Commonly used BCTs included goal setting, behavioral practice/rehearsal, and social support. However, substantial heterogeneity and limited data on SCD and MCI restricted generalizability.
Interventions promoting social participation may enhance engagement for individuals with cognitive decline, particularly through music therapy, reminiscence therapy, and group-based formats. The complexity and dynamic nature of social interaction require individuals to engage and integrate various cognitive functions and skills, which can present significant challenges for older adults with cognitive impairments in their daily social participation. Further research is needed to optimize intervention components and address gaps in targeting early cognitive decline stages.
This study investigated the current status of nutrition literacy and related influencing factors in stroke patients, with a view to providing a reference for the development of targeted interventions.
Cross-sectional study.
A convenience sampling method was used to select 342 stroke patients from June to November 2024 as the study population, and a cross-sectional survey was conducted using the General Information Questionnaire, Nutrition Literacy Scale, Herth Hope Scale, Chronic Disease Self-Efficacy Scale and Social Support Rating Scale. Descriptive analysis, independent samples t-test, one-way ANOVA, Pearson's correlation analysis and multiple linear regression analysis were used for data analysis.
The results showed that the nutrition literacy score of stroke patients was 122.24 ± 16.66, and gender, age, education level, monthly per capita family income, nutrition education, hope level, self-efficacy and social support were the factors affecting the nutrition literacy of stroke patients (all p < 0.05).
According to the study, stroke patients' nutrition literacy has to be raised, and medical practitioners should create focused intervention plans to raise patients' nutrition literacy levels.
Healthcare professionals should assess the level of nutritional literacy in order to provide targeted interventions. The establishment of a multidisciplinary care team and implementation of long-term nutritional management after stroke are essential to reduce stroke recurrence and mortality.
The study adhered to the STROBE checklist.
No patient or public contribution.
To investigate the association between positive coping style and family resilience, considering the mediating factors of burden and individual resilience within caregivers of chronic obstructive pulmonary disease (COPD) patients.
A cross-sectional survey.
A total of, 204 caregivers of COPD patients were recruited using convenient sampling from April 2023 to May 2024 to investigate general information, family resilience, individual resilience, caregiver burden and positive coping styles on caregivers of COPD patients. Influencing factors were primarily identified using Mann–whitney U test and Kruskal–Wallis H test. Spearman correlation analysis was used to explore the correlation between family resilience, positive coping, caregiver burden and resilience. Linear regression was used to analyse the influencing factors of family resilience of caregiver. Structural equation modelling was used to detect the mediating effects of caregiver burden and resilience.
The STROBE checklist was followed.
The family resilience of caregivers was positively correlated with positive coping styles and individual resilience, and negatively correlated with caregiver burden. The family resilience of caregivers increased with the improvement positive coping style and individual resilience, and decreased with the increase of caregiver burden. Caregiver burden and resilience played the chain mediating roles between positive coping style and family resilience.
Family caregivers of COPD patient with higher education levels also have higher family resilience. Higher positive coping style may lead to higher family resilience of caregivers of COPD patients by reducing caregiver burden and promoting resilience.
There are individual differences in the level of family resilience of caregivers of COPD patients, and nurses can provide personalised interventions to different family caregivers by understanding their characteristics and needs. Nurses can improve the family resilience of caregivers by guiding them to adopt positive coping styles, reducing burdens and promoting resilience.
This study was conducted with the participation of caregivers of COPD patients who contributed data by completing study questionnaires.
To explore the stability of resilience among frontline nurses and to analyse the predictive role of internal and external factors on the patterns of resilience transformation in China during public health emergencies.
The study used a longitudinal design and surveyed 258 frontline nurses at three different time points: February–March 2020 (T1), May–June 2020 (T2) and May–June 2022 (T3). The survey included the 10-item Connor–Davidson resilience scale, the Emotion Regulation Questionnaire and the Simple Coping Style Questionnaire. Latent profile analysis and latent transition analysis were used to examine the potential classes and changes. Multivariate logistic regression analysis was applied to evaluate the predictors of resilience transitions.
The resilience of frontline nurses was divided into three categories: fragile group, general group and high resilience group. From T1 to T2, the general group exhibited the least stability, with a probability of maintaining its original latent state at 72.9%. Marriage and positive coping styles significantly impacted the transition between resilience categories. From T2 to T3, the fragile group showed the lowest stability, with a 74.9% likelihood of retaining its initial latent state. In this context, supportive hospital management (including psychological counselling, restful environments, and both spiritual and material incentives) and individuals' emotional regulation and sleep quality significantly affected the transition between resilience categories.
These findings emphasise the necessity for early intervention. For frontline nurses, conducting initial assessments of resilience coupled with sustained hospital support is crucial for maintaining mental health and improving the quality of nursing care in public health emergencies.
This study offers a fresh perspective for understanding the resilience of frontline nurses during public health emergencies. At the same time, it reveals the factors that promote or hinder the change in resilience among frontline nurses at both individual and organisational levels. This provides a theoretical basis for future resilience interventions and helps us formulate effective crisis management strategies to respond to future public health emergencies. For frontline nurses with diverse resilience characteristics and relevant transformation factors, a personalised multi-mode resilience improvement plan can be developed to mitigate public health emergencies' potential adverse psychological impact on frontline nurses, especially those in the fragile group.
No patient or public contribution.
Breast cancer patients experience various adverse symptoms during adjuvant chemotherapy. These adverse symptoms often form symptom clusters and have a negative impact on patients.
To summarise common symptom clusters in different dimensions and their longitudinal changes among breast cancer patients receiving adjuvant chemotherapy.
A systematic review.
Ten electronic databases were searched from 2001 to January 2024, and the search was last updated on 16 August 2024.
Two reviewers independently assessed the eligibility of each study and extracted data. The Standard Quality Assessment Criteria for Evaluating Primary Research Papers was used to evaluate the quality of included studies. The findings were synthesised narratively. This systematic review has been registered (CRD42022370210).
Nine studies with a total of 1454 participants were included. The common symptom clusters in breast cancer patients receiving adjuvant chemotherapy were the gastrointestinal symptom cluster (nausea-lack of appetite), the fatigue-pain-sleep disturbance symptom cluster and the psychological symptom cluster (worry-sadness-nervousness-distress-feeling irritable-difficult concentrating). The severity dimension was the most frequently utilised in identifying symptom clusters, with the number and concurrence of symptom clusters showing variation over time.
This study summarised common symptom clusters in breast cancer patients receiving adjuvant chemotherapy and revealed their changes from symptom dimensions and the chemotherapy process. These findings support further exploration of symptom cluster changes and underlying mechanisms, facilitating the design of targeted management strategies, including appropriate interventions and measurement dimensions in clinical nursing, to ultimately reduce patients' symptom burden.
Common symptom clusters have been identified in breast cancer patients receiving adjuvant chemotherapy. Clinical nursing in oncology can prioritise these symptom clusters and provide patients with targeted management strategies.
PRISMA guidelines and SWiM guidelines.
No patient or public contribution.
The aim of this study was to investigate self-care behaviours of patients with chronic obstructive pulmonary disease (COPD), understand their complex interconnections and identify key behaviours influencing self-care and self-efficacy.
An observational, cross-sectional study design.
The outpatient department of two tertiary hospital.
A convenience sample of patients with a diagnosis of COPD were included (n = 222). Self-care behaviours were assessed using the Chinese version of self-care of chronic obstructive pulmonary disease inventory based on the Middle-Range Theory of Self-Care of Chronic Illness. Patient self-care efficacy was evaluated using Chinese version of Self-Care Self-Efficacy Scale in Chronic Obstructive Pulmonary Disease. Employing network analysis, associations between behaviours (nodes) and their interrelationships (edges) were deciphered. The study was reported following the STROBE checklist.
Among the spectrum of self-care behaviours, patients exhibited the most pronounced deficiencies in behaviours directed to enhancing breathing, monitoring extra-respiratory symptoms and problem-solving. Within the network, the most central emerging behaviour was the modification of prescribed therapy at the worsening of symptoms, as suggested by healthcare providers, which drives all self-care behaviours. The confidence in being able to do something to relieve symptoms, despite difficulties, was a bridging activator of self-care. The network structure underscored the prominence of self-care self-efficacy in driving self-care maintenance, monitoring, and management behaviours.
Education programs for COPD should prioritise enhancing breathing, symptom monitoring and problem-solving skills. The crucial self-care behaviour in COPD involves adjusting treatments in response to symptom changes. Patient confidence in symptom alleviation acts as a catalyst for self-care engagement. Targeted assessments addressing these aspects could enhance educational interventions, ultimately improving COPD patient outcomes.
This study has been registered in the Chinese Clinical Trials Registry (registration number: ChiCTR2200059764; registration date: 11 May 2022).
This study aims to investigate the current situation of needlestick injuries (NSIs) of clinical nurses and identify associated factors by using the theoretical framework of the human factors analysis and classification system (HFACS).
A nationwide cross-sectional survey was conducted.
Multi-stage sampling was used to investigate 3336 nurses in 14 Chinese hospitals. Descriptive statistics and univariate and multivariate logistic regression were employed to reveal the rate of NSIs and their associated factors.
A total of 970 nurses (29.1%) reported having experienced at least one NSI in the past year. The multivariate logistic regression analysis showed that good hospital safety climate and clinical nurses in intensive care unit (ICU) and emergency department had protective effects against NSIs compared with nurses in internal medicine department. The nurse, senior nurse, and nurse in charge have significantly increased the risk for NSIs compared with the associate chief nurse or above. Patients with poor vision but wearing glasses and poor vision but not wearing glasses were more prone to have NSIs. Working in the operating room compared with internal medicine, average weekly working time of >45 h compared with ≤40 h and poor general health led to increased risk of NSIs.
The rate of NSIs in clinical nurses was high in China. Individual factors including professional title, department, visual acuity and general mental health and organisational factors including weekly working hours and hospital safety atmosphere were significantly correlated with the occurrence of NSIs.
Nursing managers should focused on physical and psychological conditions of clinical nurses, and organisational support is required to enhance the hospital safety atmosphere.
Contributions from patients or the public are irrelevant because this study aims to explore current situation and factors associated with NSIs in clinical nurses.
To summarize existing studies that focused on improving hospitalized patient safety through patient and family engagement interventions to identify priorities and gaps.
A scoping review.
Eight databases and citations of important reviews were searched on 30 September 2022. Two researchers independently screened the records. Then, two researchers extracted the data and cross-checked. The results were synthesized narratively, and a comparison was performed for studies from China and those from other countries.
Ninety-eight studies were included. The results indicated that patient and family engagement interventions were applied to decrease the incidence of patient safety incidents, and to improve the healthcare providers' and patients' knowledge, attitude or practice of patient safety. Most studies only engaged patients and families at the direct care level, and the engagement strategies at the organization and health system levels were insufficient. For stakeholders, many studies failed to consider patients' perspectives in intervention design and report taking staff training as a supportive strategy. Healthcare providers, especially nurses, were the main implementers of current interventions. Certain differences were observed between studies from China and those from other countries in the above aspects.
International interest in engaging patient and family for patient safety is growing. Future studies should enhance the patient and family engagement as a partner in various patient safety at the direct care level, and further explore the engagement at the organization and health system levels.
Nurses, as the main formal caregivers for patients, should promote patient and family engagement in patient safety, especially at direct care level. Nurse should also incorporate the perspectives of patients in the design and implementation of interventions.
PRISMA-ScR Checklist.
A systematic review and meta-analysis was performed to identify the factors related to cancer death anxiety based on available evidence.
This systematic review and meta-analysis followed the PRISMA 2020 guidelines.
Seven databases were searched to identify studies on the relationships of cancer death anxiety with demographic characteristics, disease factors and psychosocial factors from inception to May 2023. The Agency for Medical Research and Quality (AHRQ) scale was used to evaluate the quality of the included studies. After two researchers independently completed the literature search, data extraction and quality evaluation, meta-analysis was conducted by using RevMan5.3 and Stata 17.0 software.
In total, 52 studies were included in this review. The results revealed that there were positive correlations of death anxiety with female sex, the symptom burden, anxiety levels, depression levels, fear of recurrence, attachment avoidance, psychological distress, resignation and confrontation coping. Death anxiety was negatively correlated with age, education level, ability to perform daily activities, self-esteem, spiritual well-being, sense of meaning in life, resilience, quality of life, social support and religious beliefs.
Our results can inform the design of interventions to address death anxiety and improve the overall quality of life of cancer patients. Healthcare professionals should promptly identify and focus on death anxiety in high-risk populations of cancer patients.
Cancer patients commonly experience death anxiety, and this anxiety has a nonnegligible impact on patients' mental health and overall quality of life. This study can inform the development of interventions by clinical healthcare professionals.
This was a meta-analysis based on data from previous studies.
The effect of diabetes mellitus (DM) on the incidence of postoperative wound complications in patients with coronary artery bypass grafting (CABG) is still unclear. Thus, we performed a meta-analysis of CABG in DM patients to evaluate existing data from both prospective and historical cohorts. The objective of this trial was to assess the relevance and extent of the effect of diabetes on the outcome of previous CABG procedures. Data sources like Embase and Pubmed were found throughout the research, and the language was limited to English through manual search. The searches were performed up to August 2023. The data were extracted from the study of the inclusion/exclusion criteria, the features of the population, the statistical approach and the clinical results. A qualitative evaluation of the qualifying studies has been carried out. Out of the 1874 studies identified, 21 cohort studies were chosen for analysis. Meta-analyses were performed in 258 454 patients (71 351 diabetic and 187 103 non-diabetic). Twenty-one studies on deep sternal wound infections in CABG patients showed a lower rate of deep sternal wound infections in non-diabetes group compared with those with diabetes (OR, 2.13; 95% CI: 1.97, 2.31, p < 0.00001). And 16 studies of superficial wound infections in patients undergoing CABG were found to be associated with a lower rate of superficial injury (OR, 1.93; 95% CI: 1.53, 2.43, p < 0.00001) compared with those with diabetes; In five trials, perfusion time during CABG (MD, 2.31; 95% CI: −0.16, 4.79, p = 0.07) was observed, and there were no significant differences between diabetes and non-diabetes. Currently, there is a higher risk for CABG in diabetes than in non-diabetes patients with sternal infections and superficial injuries. Future randomized trials will concentrate on the treatment of such perioperatively related complications, which will lower the risk of postoperative wound infection in diabetes.
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