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Cultural considerations at end‐of‐life for people of culturally and linguistically diverse backgrounds: A critical interpretative synthesis

Abstract

Purpose/Aim

To establish cultural considerations for people from culturally or linguistically diverse backgrounds at the end-of-life in Australia.

Background

Globally, there is a rapidly increasing proportion of the ageing population, and high levels of migration to Australia, the Australian healthcare community must recognise individualised and cultural needs when approaching death and end-of-life care. Many people from culturally and linguistically diverse backgrounds do not traditionally practice the palliative care approaches that have been developed and practised in Australia.

Design

A Critical Interpretive Synthesis.

Methods

A review protocol was established using PRISMA 2020 guidelines and the literature searched using CINAHL, PubMed, Psych INFO and Medline from January 2011 to 27th February 2021. This search protocol results in 19 peer-reviewed results for inclusion in critical analysis.

Results

Included studies were qualitative (14), quantitative (4) and mixed methods (1). Four themes were identified from the literature: (i) communication and health literacy; (ii) access to end-of-life care services; (iii) cultural norms, traditions and rituals; and (iv) cultural competence of healthcare workers.

Conclusions

Healthcare workers have an essential role in providing care to people with life-limiting illnesses. Cultural considerations during end-of-life care are imperative for the advancement of nursing practice. To achieve effective care for people of culturally and linguistically diverse backgrounds during end-of-life care, healthcare workers need to increase their education and cultural competency. There is inadequate research conducted within specific cultural groups, rural and remote Australian communities and individual cultural competence of healthcare workers.

Implications for Practice

Continuing advancement within nursing practice relies on health professionals adopting a person-centred and culturally appropriate approach to care. To ensure individualised person-centred care is provided in a culturally appropriate way, healthcare workers must learn to reflect on their practice and actively advocate for people with culturally and linguistically diverse backgrounds during end-of-life care.

Tourniquets as a haemorrhage control measure in military and civilian care settings: An integrative review

Abstract

Aims and objectives

The aim of review was to describe and synthesise the evidence on the use of tourniquets to control haemorrhages, summarising both civilian and military use.

Background

Trauma-related haemorrhage constitutes one of the most preventable deaths among injured patients, particularly in multi-casualty incidents and disasters. In this context, safe instruments such as tourniquets are essential to help healthcare professionals to minimise loss of life and maximise patient recovery.

Design and methods

An integrative review was conducted in Medline, Nursing & Allied Health Premium, and Health & Medical Collection, using published data until March 2021 and following the PRISMA guidelines.

Results

A total of 25 articles were included. Evidence has been synthesised to understand the use of different types of tourniquets, environment of application, indication for their placement and potential complications associated with tourniquet placement.

Conclusions

Commercial tourniquets such as Combat Application Tourniquet or Emergency Tourniquet models are a valuable and safe instrument for haemorrhage control in both military and civilian out-of-hospital care settings. Nurses, as part of emergency teams, and other professionals should be aware that there is a possibility of adverse complications, but they are directly proportional to the time of tourniquet placement and generally temporary. In addition, national and international guidelines ensure the need for all civilian emergency services to be equipped with these devices, as well as for the training of healthcare professionals and first responders in their use.

Relevance to clinical practice

Despite the lack of complications in the use of tourniquets in these cases, their use has been a matter of debate for decades. In this sense, this review yields up-to-date guidelines in the use of tourniquets, their recommendations and their significance among professionals to manage complicated situations.

Examining the role of micronutrients on improving long COVID sleep‐related symptoms

Abstract

Aims and Objectives

Long COVID is defined as the continuation of symptoms for four or more weeks after initial contraction of the virus. This review article examines the role of four select micronutrients (zinc, vitamins C, D and polyphenols) for their anti-inflammatory and therapeutic potential to improve sleep-related symptoms in persons with long COVID.

Background

Evidence suggests a link between long COVID and increased inflammation. There are currently no therapeutic interventions for common sleep-related symptoms associated with long COVID. Micronutrients, due to their antioxidant and anti-inflammatory properties, may have a role in the treatment of sleep-related symptoms in the context of long COVID.

Design

A narrative literature review was conducted and guided by the PRISMA checklist.

Methods

All articles were screened from PubMed, ScienceDirect, NCBI or Google Scholar and were limited to human studies. The following keywords were used: ‘COVID-19’, ‘sleep symptoms’, ‘zinc’, ‘vitamin C’, ‘vitamin D’, ‘polyphenols’ and ‘micronutrients’.

Results

There are currently no studies that examine the usage of micronutrients and its impacts on long-term, sleep-related symptoms post-COVID-19 infection. We focussed our review on prior studies that examined micronutrients in the context of sleep symptoms and inflammation, while exploring the potential for micronutrients to help improve sleep-related symptoms associated with long COVID.

Conclusions

There is evidence to suggest that sleep-related symptoms associated with long COVID, such as fatigue and poor sleep quality, are associated with inflammation. Zinc, vitamins C, D and polyphenols all have the potential to improve both inflammation and sleep quality to alleviate symptoms. Future research should further examine these micronutrients in the context of long COVID to improve sleep and quality of life.

Relevance to Clinical Practice

This article provides implications for clinicians to be at the forefront of research on the usage of micronutrients to improve sleep-related symptoms in persons with long COVID.

Psychological trauma among nurses during the COVID‐19 pandemic with strategies for healing and resilience: An integrative review

Abstract

Aims and Objectives

The aim of this study was to identify nurses' responses to psychological trauma and strategies to support nurses' healing and resilience during COVID-19 and generate creative integrated understandings of nurses' responses to psychological trauma and strategies supporting nurses' healing and resilience during COVID-19.

Background

COVID-19 exacerbated trauma already experienced by some nurses. Nursing leadership called for action to improve nurses' mental health and resilience. However, policy changes have been rudimentary and insufficiently funded. Negative impacts manifesting as mental health disorders may significantly disrupt care quality, deepen nursing shortages and de-stabilize healthcare systems. Building nurses' capacity to respond with resilience is widely indicated for countering harmful effects of psychological trauma and enabling professional longevity.

Design

Integrative review design was used to support discovery of emergent knowledge, as phenomena of interest lacked a traditional empirical evidence base.

Methods

Cumulative Index to Nursing and Allied Health, ProQuest Nursing & Allied Health, and PubMed databases were searched for nursing publications, January–October 2020. Search words included nurs*, COVID-19, Coronavirus, pandemic, post-traumatic stress disorder, trauma, mental health, resilience. PRISMA Checklist standards guided reporting. Joanna Briggs Institute tools facilitated quality measurement. Inclusion criteria were English language and nursing focus on trauma, healing or resilience strategies. Thirty-five articles met inclusion criteria. Elo and Kyngäs' qualitative content analysis method guided thematic analysis.

Results

Findings suggest dysfunctional responses for some nurses to COVID-19 trauma, or living fearful, uncertain and unstable. Findings also reveal numerous potential regenerative healing and resilience strategies for nurses, or living whole, optimistic and supported. Individual actions of self-care, adjustment, social connection and finding meaning, coupled with workplace changes, hold potential to improve nurses' future.

Conclusions

Risks to nurses' mental health from COVID-19's extraordinary intensity and duration of trauma warrant timely research.

Relevance to Clinical Practice

Nurses' responses to COVID-19 trauma are complex, but strategies for professional resilience are abundant.

Implications for long COVID: A systematic review and meta‐aggregation of experience of patients diagnosed with COVID‐19

Abstract

Aims and Objectives

This review aims to synthesize the available evidence of what patients experience when infected with COVID-19, both in hospital and post-discharge settings.

Design

This review was conducted using the Joanna Briggs Institute (JBI) methodology for qualitative systematic reviews and evidence synthesis. Reporting of results was presented according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist.

Background

Coronavirus disease 2019 (COVID-19) continues to be a public health crisis worldwide. Many patients diagnosed with COVID-19 have varied levels of persisting mental disorders. Previous studies have reported the degree, prevalence and outcome of psychological problems. Minimal research explored the experience of patients with long COVID. The real-life experience of patients with COVID-19 from diagnosis to post-discharge can deepen the understanding of nurses, physicians and policymakers.

Methods

All studies describing the experience of patients were included. Two authors independently appraised the methodological quality of the included studies using the JBI Critical Appraisal Checklist for Qualitative Research 2020.

Results

This systematic review aggregated patients’ experience of being diagnosed with COVID-19 in both hospitalized and post-discharge settings. Finally, 17 studies met inclusion criteria and quality appraisal guidelines. The selected studies in the meta-synthesis resulted in 12 categories, and further were concluded as five synthesized findings: physical symptoms caused by the virus, positive and negative emotional responses to the virus, positive coping strategies as facilitators of epidemic prevention and control, negative coping strategies as obstacles of epidemic prevention and control, and unmet needs for medical resource.

Conclusions

The psychological burden of patients diagnosed with COVID-19 is heavy and persistent. Social support is essential in the control and prevention of the epidemic. Nurses and other staff should pay more attention to the mental health of the infected patients both in and after hospitalization.

Relevance to clinical practice

Nurses should care about the persistent mental trauma of COVID-19 survivors and provide appropriate psychological interventions to mitigate the negative psychological consequences of them. Besides, nurses, as healthcare professionals who may have the most touch with patients, should evaluate the level of social support and deploy it for them. It is also needed for nurses to listen to patient's needs and treat them with carefulness and adequate patience in order to decrease the unmet needs of patients.

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