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Although the UK is a multicultural society, racially minoritised populations are often under-represented in healthcare research owing to the significant barriers to participation they experience.
Commentary on: Considine J, Casey P, Omonaiye O, et al. (2024). Importance of specific vital signs in nurses' recognition and response to deteriorating patients: A scoping review. Journal of Clinical Nursing, 00, 1–18.
Implications for practice and research There is a need to develop training and protocols that will enhance nurse’s documentation and utilisation of vital signs in clinical decision-making and patient care. To further guide the creation of training curricula and standards, future studies should examine how nurses prioritise and make decisions about vital sign assessments and their use in patient care.
Vital signs are essential markers of a patient’s physiological state, and these include heart rate, temperature, blood pressure, oxygen saturation, respiration rate and level of consciousness. Consequently, accurate assessment, documentation and interpretation of these markers are vital for early detection of patients’ deterioration and timely intervention.
Commentary on: Zhao et al. The impact of education/training on nurses caring for patients with stroke: a scoping review. BMC Nurs 23:90
Implications for practice and research Nurses working in clinical stroke care could benefit from leadership and management strategies that encourage empowerment and time and space to reflect on current evidence, training and practice. Comprehensive evaluation strategies are needed to assess the impact and effectiveness of empowerment-based stroke education and training on patient outcomes.
Stroke nursing is widely recognised for its significant role across the whole multidisciplinary stroke care pathway.
Commentary on: Taylor SP, Kowalkowski MA, Skewes S, Chou SH. Real-world implications of updated surviving sepsis campaign antibiotic timing recommendations. Crit Care Med. 2024 doi: 10.1097/CCM.0000000000006240.
Implications for practice and research Antibiotic delivery in suspected sepsis must be prioritised within the clinical context emphasising the need to individualise antibiotic timing according to patient profiles. In the absence of shock, a more lenient approach to antibiotic timing could support the rational use of antibiotics.
Sepsis is a life-threatening response to infection and remains a critical challenge with high morbidity and mortality rates. The Surviving Sepsis Campaign (SSC) guidelines serve as a cornerstone for sepsis management and are pivotal in standardising care. Taylor et al’s article
Commentary on: Doyle J, Alsan M, Skelley N, et al. Effect of an intensive food-as-medicine programme on health and healthcare use: a randomized clinical trial. JAMA Intern Med. 2024;184(2):154–163. doi:10.1001/jamainternmed.2023.667
Implications for practice and research Food-as-medicine programmes could enhance patient engagement with preventive healthcare. Further adjustments are needed within these programmes to improve glycaemic control significantly. Food-as-medicine programmes interest nurses, as these programmes are sensitive to nursing interventions.
Type 2 diabetes mellitus (T2DM) is a significant public health issue, with diet playing a crucial role in its management.
As discussed in the accompanying editorial Nursing on the front foot,
People living with Long Covid often find the complexity of navigating health services difficult. The nurse’s role is to support patients in this context. This includes ensuring they are sufficiently informed about what Long Covid is. The specialist nurses recommended the British Heart Foundation’s online resource - Long Covid: Symptoms, tests and treatments: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/long-covid%23whatdoesfatiguefeel.
Information about Long Covid is also available via Long Covid Physio:
Every person...
Nursing is a profession that has always worked with diverse people and communities and has taken a social justice approach to care. Nursing has also undertaken research that includes diverse groups and communities. However, nurse researchers working with and undertaking research with diverse groups and communities may encounter problems in executing the research. This may be for reasons such as poor understanding of cultural and racial difference, not having an inclusive research team, for example, LGBTQIA+ researchers to help conduct LGBTQIA+ focused research or using an ableist approach, all of which can lead to exclusion, diminished trust and credibility. In this commentary, we draw on Hollowood’s doctoral journey and Moorley’s research experience, where both work with and research diverse communities’ health. Nurse researchers need to apply methodologies and approaches that are culturally sensitive and inclusive and here we offer essential tips, which have helped us by drawing on culturally specific...
Commentary on: Family caregivers’ burden, patients’ resourcefulness, and health-related quality of life in patients with colorectal cancer.
Practice: Treat the patient, and also treat the family and caregiver; help patients build or activate their resourcefulness, as resourcefulness can be a learnt skill. Research: Additional work should identify targets for improving patient resourcefulness.
Patients with colorectal cancer face treatments that can bring significant financial burden, physical strain and relationship changes which can affect quality of life. These stressors may be mitigated by coping ability, particularly resourcefulness, which reflects the ability of the patient to independently perform daily tasks and seek help when needed. The patient experience and need for care can affect caregivers as well, leading to caregiver burden: an accumulation of the negative responses to the caregiver that result from providing care, including disrupted schedules, financial and...
Commentary on: Alanazi N, Gu F, Li CS, et al.Lorenz RA, Hong CC. Sleep Quality and Associated Factors Among Survivors of Breast Cancer: From Diagnosis to One Year Postdiagnosis. Oncol Nurs Forum. 2024 Feb 19;51(2):163-–174. doi: 10.1188/24.ONF.163-–174. PMID: 38442284.
Implications for practice and research Sleeping disorders are common in breast cancer patients and increase in the first year after diagnosis. Nurses should be aware of the high frequency of these disturbances, which persist after the conclusion of most therapies. The determinants of worsening sleeping quality in breast cancer survivors need to be understood, including the role of treatments, the type of surgery and psycho-social or contextual factors.
Breast cancer is the most common cancer in women worldwide. While research in recent decades has focused on minimising treatment, the disease still impacts women’s lives in many ways. Because increased sleep disturbances affect approximately...
Commentary on: Turk F, Sweetman J, Chew-Graham CA, et al. Accessing care for long covid from the perspectives of patients and healthcare practitioners: a qualitative study. Health Expect 2024;27:e14008. doi.org/10.1111/hex.14008
Training to enhance healthcare providers’ knowledge about Long Covid and tailored, equitable and timely access to integrated healthcare suitable for diverse and complex needs is required in the management of Long Covid. Future research is needed to address misinformation and the provision and effectiveness of reliable online resources for Long Covid patients along with an understanding of the effectiveness of integrated models of Long Covid care across diverse clinical settings.
Long Covid is an emerging long-term condition resulting from SARS-CoV-2 infection, characterised by a wide array of persistent symptoms, it is heterogenous in nature with fluctuations and experiences of relapse.
Commentary on: Douglas C, Alexeev S, Middleton S, Gardner G, Kelly P, McInnes E, et al. Transforming nursing assessment in acute hospitals: A cluster randomised controlled trial of an evidence-based nursing core assessment (the ENCORE trial). International Journal of Nursing Studies. 2024. 2024;151:104690.
Implications for practice and research Introducing training to enhance manual nursing assessment and surveillance has the potential to improve outcomes for hospitalised patients with multimorbidity. Further research is needed to establish which aspects of nursing assessment and surveillance are essential to improving recognition and response to clinical deterioration.
Failure to identify and respond to deteriorating patients is a significant and complex clinical safety issue. There is a growing body of international research evidence which has identified the importance of system and human factors in ‘failure to rescue’ events.
Commentary on: Hua Y, Lu H, Dai J, et al. Self-management challenges and support needs among patients with primary glaucoma: a qualitative study. BMC nursing. 2023 Nov 14;22(1):426.
Healthcare professionals should provide personalised and comprehensive support, addressing the medical, emotional and social challenges faced by patients with primary glaucoma. Further research is needed to explore the effectiveness of tailored self-management support programmes in improving the quality of life and treatment outcomes for patients with glaucoma.
Glaucoma is a chronic disease characterised by progressive visual field defects. It is the most common cause of irreversible blindness and is associated with a decrease in quality of life.
Understandings of sexuality and gender diversity are ever-developing, and the visibility of their lives and the needs of communities of Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA) people are more in focus than ever before.
While terminology evolves, what is most important is for nurses to acknowledge that there is a diversity of identities and experiences beyond heterosexual and cisgender and that these can have an impact on health outcomes and healthcare experiences. Rather than list out the various terms associated with sexual and gender minority identities, it might be useful for the reader to review a glossary such as that produced by UK LGBTQ+ charity Stonewall.
Embracing and respecting sexuality and gender diversity is a fundamental process in ensuring that the care given by nurses is both person-centred and respectful of the innate human dignity acknowledged in the codes of numerous international and national...
Commentary on: Ali MR, Lam CSP, Strömberg A, et al. Symptoms and signs in patients with heart failure: association with 3-month hospitalisation and mortality. Heart. 2023 Dec 1. doi: 10.1136/heartjnl-2023-323295.
Implications for practice and research In primary care consultations, symptoms reported by patients with heart failure (HF) could be valuable in identifying patients at risk of hospitalisation or death. Further research needs to investigate how best can support patients to monitor and report symptoms and test new patient-centred prognostic models including HF signs and symptoms.
Hospitalisation in patients with HF is associated with impaired quality of life, increased mortality and excessive medical costs.
Nursing as a profession is deeply rooted in caring and advocating for the well-being of others, linking it to social justice praxis.
Embedding diversity, equity and inclusion (DEI) in evidence-informed nursing practice is crucial to ensuring that healthcare is accessible, culturally competent, socially just and addresses the unique needs of all individuals and communities. We hold the view that diversity is not and should not be a one-off showcase...
Commentary on: Wu J-R, Moser DK, Lin C-Y, et al. Depressive symptoms and sleep quality mediate the relationship between race and quality of life among patients with heart failure: a serial multiple mediator model.J Cardiovasc Nurs 2024; doi: 10.1097/JCN.0000000000001079.
Providers should screen for depression symptoms and quality of life in patients with heart failure. More research is needed on depression symptoms, sleep quality and quality of life across racial and ethnic groups.
Heart failure is the chronic stage of any disease that leads to cardiac functional impairment, affecting between 1% and 7% of the world’s population.
Commentary on: Boxall C, Fenlon D, May C, Nuttall J, Hunter MS. Implementing a nurse-delivered cognitive behavioural therapy intervention to reduce the impact of hot flushes/night sweats in women with breast cancer: a qualitative process evaluation of the MENOS4 trial. BMC Nurs. 2023 Sep 15;22(1):317. doi: 10.1186/s12912-023-01441-3.
Implications for practice and research Collaboration between nurses, primary care and healthcare managers, healthcare partners in breast care will facilitate the role of the breast care nurse in patient care. More research is needed on breast cancer survivors with diverse population at multiple sites, thereby improving the quality of research on cognitive–behavioural therapy.
There is a growing body of evidence that 85% of women experience hot flashes and night sweats after breast cancer treatment
Commentary on: Feo R, Young JA, Urry K, Lawless M, Hunter SC, Kitson A, Conroy T. ‘I wasn’t made to feel like a nut case after all’: A qualitative story completion study exploring healthcare recipient and carer perceptions of good professional caregiving relationships. Health Expect. 2023 Oct 19;27(1):e13871. doi: 10.1111/hex.13871. Epub ahead of print.
Healthcare providers can foster effective patient–provider relationships by addressing concerns early on and adopting key behaviours, such as showing interest in understanding the patient’s issues, validating their concerns and respecting their choices. Future research should focus on identifying strategies to help healthcare providers develop effective patient–provider relationships. This requires a thorough understanding of these relationships from the perspectives of all involved parties, including healthcare providers, patients and their informal caregivers.
The patient–provider relationship is at the core of effective disease management.
Commentary on: Ley C, Heath F, Hastie T, et al. Defining Usual Oral Temperature Ranges in Outpatients Using an Unsupervised Learning Algorithm. JAMA Intern Med. 2023 Oct 1;183(10):1128-1135. doi: 10.1001/jamainternmed.2023.4291.
This study suggests that clinicians should consider age, sex, height, weight and time of day when assessing a patient’s oral temperature. Consider moving away from a one-size-fits-all approach to fever diagnosis.
Future research should focus on how these individualised temperature norms can be integrated into clinical decision-making processes. Develop new diagnostic criteria for fever.
Traditionally, the ‘normal’ oral temperature of 37°C has been a long-standing benchmark in health assessments. However, this standard fails to consider individual variability influenced by age, sex and metabolism. Ley et al
Commentary on: Wu CY, Iskander C, Wang C, et al. Association of sulfonylureas with the risk of dementia: A population-based cohort study. J Am Geriatr Soc. 2023; 71:3059–70.
Unless contraindicated, dipeptidyl peptidase 4 inhibitors (DPP-4i) should be used as first-line choice in older adults with type 2 diabetes in preference to sulfonylurea due to increased risk of dementia. Prospective studies are needed to ascertain if the use of sulfonylurea by older adult patients causes higher risk of developing dementia.
Diabetes is already known as a risk factor for developing dementia. Multiple factors contribute to this association: presence of microvascular and macrovascular complications, chronic inflammation, hyperglycaemia, hypoglycaemia and hyperinsulinemia.
Older adult patients often present with multimorbidities, polypharmacy, malnutrition, sarcopenia, longer duration of diabetes and renal and hepatic dysfunction. Furthermore, low education level, high blood pressure, dyslipidemia, obstructive...
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