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Implementing a Safety Protocol for Thirst Management to Improve Postoperative Thirst Using the Iowa Model of Evidence‐Based Practice: A Propensity Score–Matched Evaluation

ABSTRACT

Aim

This study aimed to (1) implement a Safety Protocol of Thirst Management (SPTM) as an evidence-based practice for quenching postoperative thirst and (2) evaluate its effectiveness using a comparative pre-and-post induction design.

Design

A quasi-experimental study using propensity scored matching.

Method

Guided by the Iowa Model, the SPTM was implemented at a tertiary medical centre in Taiwan in 2023. Outcomes were compared between adult surgical patients admitted in 2023 (post-induction) and those admitted prior (pre-induction). Data on thirst and pain intensity, body temperature, and PACU length of stay (LOS) were analyzed for 15,168 patients.

Results

A standardized SPTM flow diagram was established. Following SPTM induction, mean thirst scores significantly decreased from 5.76 to 1.30 (p < 0.001). Although pain intensity and PACU LOS (63.63 vs. 62.23 min) showed statistically significant increases, these changes were clinically marginal. Body temperature remained stable with no incidence of perioperative hypothermia.

Conclusions

The Iowa Model effectively guides nursing organizations in translating evidence into practice. The SPTM provides a safe, consistent framework for nurses to alleviate postoperative thirst, significantly enhancing the quality of surgical care.

Impact

This study addresses the lack of standardized thirst management. Results demonstrate that an evidence-based SPTM protocol effectively quenches thirst without increasing adverse clinical risks.

Patient and Public Contribution

The SPTM was triggered by patient reports of thirst-related distress. During the design phase, patient feedback on the acceptability of cold oral stimuli was used to refine the protocol. While patients did not participate in the data analysis, the primary outcome (thirst intensity) was selected based on its significance to patient-cantered care.

Reporting Method

This study was reported according to TIDieR guideline.

Parents' Lived Experiences of Their Child's Undergoing Emergence Delirium During Anaesthesia Recovery: A Descriptive Phenomenological Study

ABSTRACT

Aim

To explore parents' experience when their children underwent emergence delirium during anaesthesia recovery.

Design

A descriptive phenomenological qualitative study.

Methods and Setting

This descriptive phenomenological study was conducted at a medical center in Taiwan. Purposive sampling was employed, and a semi-structured interview guide was used to conduct in-depth interviews. Twelve parents whose children experienced emergence delirium were recruited after data saturation was reached. Data were collected between January and July 2024 and analysed using Colaizzi's seven-step method.

Findings

Parents underwent an unexpected journey characterised by emotional ups and downs when witnessing their child's emergence delirium. Four major themes were generated, including ‘unexpected chaos’, describing the disorienting situation parents experienced when confronted with their child's unfamiliar behaviours; ‘help beyond reach’, reflecting their inability to provide comfort despite being physically present; ‘a day of suffering’, highlighting the emotional overwhelm during the emergence delirium episode; and ‘appreciation after recovery’, illustrating their relief and gratitude once their child returned to baseline. These themes reveal the intense emotional fluctuations parents experience during this critical phase.

Conclusions

This study highlights the complex emotional fluctuations parents experience when facing their child's emergence delirium. The findings emphasise the need for anticipatory guidance and support strategies to better prepare parents and inform family-centred nursing practices.

Impact

This study addresses a gap regarding the emotional challenges experienced by East Asian parents when their child undergoes emergence delirium. The findings reveal complex parental distress shaped by internal worry and external social pressure in shared recovery spaces. These insights inform culturally sensitive care models, emphasising the importance of private environments and communication strategies that reduce parental stress and improve clinical support.

Patient or Public Contribution

Two parents reviewed and provided feedback on the interview content and results, improving cultural relevance and clarity.

Reporting Method

The study followed COREQ guidelines.

Correlation of psychological resilience with social support and coping style in Parkinson's disease: A cross‐sectional study

Abstract

Aims

To analyse the current status of psychological resilience in Parkinson's disease (PD) patients and its correlation with social support and coping style.

Design

A cross-sectional study.

Methods

PD patients hospitalized in a tertiary-level hospital in Shijiazhuang, Hebei Province, from March 2022 to March 2023 were selected for the study using the convenience sampling method. A general information questionnaire, psychological resilience scale, Medical Coping Modes Questionnaire and Perceived Social Support Scale were used to investigate 111 cases of PD. SPSS 25.0 software was used for statistical analysis. The data were analysed using independent samples t-test, one-way ANOVA, multiple linear regression analysis and the Pearson correlation coefficient.

Results

Parkinson's disease patients have a moderate level of psychological resilience. The results of the Pearson correlation analyses showed that the level of psychological resilience was positively correlated with social support and confrontation and was negatively correlated with avoidance and acceptance-resignation. The results of multiple linear regression analysis showed that social support and acceptance-resignation were the influencing factors of psychological resilience in PD patients.

Conclusion

The psychological resilience of PD patients is at a moderate level. Social support and acceptance-resignation are the factors influencing the psychological resilience of PD patients.

Impact Statement

This study analysed the level of psychological resilience in PD patients and its correlation with social support and coping style from the perspective of positive psychology to provide some reference for targeted clinical interventions. Our study found that social support and acceptance-resignation are influential factors in psychological resilience in PD patients. Medical staff should encourage patients to face the disease positively and their social support should be increased in order to improve their level of psychological resilience.

Patient or Public Contribution

No patient or public contribution.

The Relationships Among Family Involvement, Diabetes Self‐Management and Glycaemic Control in Patients With Type 2 Diabetes: A Cross‐Sectional Study

ABSTRACT

Aims

To investigate diabetes family involvement, including supportive and nonsupportive family behaviours in China, and explore the relationships among opposite forms of family involvement, diabetes self-management and glycaemic control.

Design

A cross-sectional study.

Methods

Type 2 diabetes patients were recruited from hospitals in Nanjing, Shanghai and Jinan, and communities across China, between April 2023 and August 2023. A total of 1648 patients completed questionnaires regarding diabetes family involvement, diabetes self-management, perceived glycaemic control and patient characteristics. Data analysis was conducted using SPSS 26.0 and PROCESS macro.

Results

The mean scores for supportive and nonsupportive family behaviours were 19.14 out of 40 and 12.47 out of 30, respectively, resulting in an overall family involvement score of 6.67. Overall family involvement, especially supportive family behaviours, was positively related to diabetes self-management and perceived glycaemic control, whereas nonsupportive family behaviours were not. Diabetes self-management partially mediated the relationships between both overall family involvement and supportive family behaviours with perceived glycaemic control.

Conclusion

Diabetes family involvement was suboptimal. Overall family involvement, especially supportive family behaviours, could not only directly improve glycaemic control but also indirectly enhance it through promoting diabetes self-management.

Implications for the Profession and/or Patient Care

The findings highlight the importance of promoting supportive family involvement and patient self-management in diabetes management.

Impact

This study endorses the necessity for healthcare professionals to integrate the family unit into diabetes management and implement interventions at the family unit level, to address the neglect of families in current interventions. It also advocates for promoting supportive family involvement rather than all family involvement in future interventions. Promoting supportive family involvement and patient self-management can better improve patients' glycaemic control and alleviate the burden on medical and social systems.

Reporting Method

This study adheres to the STROBE guideline of reporting.

Patient or Public Contribution

No Patient or Public Contribution.

Predicting Nutritional Risk in Elderly Patients With Community‐Acquired Pressure Injury: A Noninvasive Model Integrating Age, Intake, BMI, and Braden Score

ABSTRACT

The aim of this study was to develop a predictive model of nutritional risk in elderly CAPI patients through retrospective cross-sectional data, to identify core predictors applicable to community/nursing home settings, and to validate the predictive augmentation of the combined Braden Score and Nutritional Blood Indicator in hospitalised patients, to provide a basis for stratified nutritional risk management. A retrospective study was conducted to include 424 elderly CAPI patients. They were divided into two groups according to NRS2002 score. Demographic parameters, physiological function parameters and blood parameters were collected. All above indicators of the patients with CAPI were analysed to explore their correlation with nutritional risk. Among 424 participants, 294 patients (69.34%) were at nutritional risk. Independent risk factors identified were aged ≥ 70 years, reduced intake in the last week, and decrease in BMI, Braden score, ALB (albumin), and PA (prealbumin) levels. The AUCs of the first four parameters mentioned above and all the above parameters were 0.816 and 0.872, respectively. The value of aged ≥ 70 years, reduced intake in the past week, BMI, and Braden score in combination to predict and assess nutritional risk is high, which can be used to predict nutritional risk for elderly patients with CAPI who are at home or in nursing homes. The combination of the above parameters combined with albumin and prealbumin has an even higher predictive value in elderly patients hospitalised with CAPI.

Network Analysis of Psychosocial Adaptation in Intestinal Stoma Patients: A National Cross‐Sectional Study in China

ABSTRACT

Aims

The aim of this study was to investigate factors affecting psychosocial adaptation in intestinal stoma patients and to identify central symptoms that might guide future interventions through network analysis.

Design

A multicenter cross-sectional study.

Methods

All intestinal stoma patients were evaluated for psychosocial adaptation using the Ostomy Adjustment Inventory-20 (OAI-20). Univariate and multivariate linear regression were used to analyse the potential relationship between the level of psychological adjustment of intestinal stoma patients and individual factors. By network analysis, we calculated the centrality indicators for each node in the ostomy psychosocial adaptation network at different levels of low, medium and high, respectively.

Results

This study ultimately enrolled a total of 19,909 intestinal stoma patients from 202 Chinese hospitals, out of which 6408 reported low psychosocial adaptation. It was found that there is a negative association between being female, partially self-care, completely dependent on others for care and having no medical insurance with psychosocial adaptation scores. In the low-level psychosocial adaptation network, no. OAI-14:limited activity, no. OAI-9: worried about ostomy, and no. OAI-11:always like a patient were identified as central indicators.

Conclusions

Being female, partially self-care, completely dependent on others for care, and having no health insurance can be considered characteristics of patients with lower psychosocial adaptation. Network analysis results provide intervention targets to improve adaptation.

Impact

Individualised and precise interventions can be carried out in terms of both the influencing factors and the most influential nodes of psychosocial adaptation in order to improve the level of psychosocial adaptation in intestinal stoma patients.

Patient or Public Contribution

No patient or public contribution.

Nurses' Perceptions and Experiences of Paediatric Emergence Delirium in the Post‐Anaesthesia Care Unit: An Interpretative Qualitative Study

ABSTRACT

Aim

To explore post-anaesthesia care unit nurses' perceptions and experiences in managing paediatric emergence delirium, and to understand their experiences in implementing the Cornell Assessment of Paediatric Delirium—Traditional Chinese version tool in clinical practice following delirium-focused education.

Methods

This interpretive qualitative study involved 20 nurses in the post-anaesthesia care unit from a medical centre hospital in Taiwan who participated in small group interviews after completing delirium-focused education. Data were collected through semi-structured interviews between October and December 2024 and analysed using a thematic analysis approach.

Findings

Five main themes were identified: (1) First impressions and reflexive actions during emergence delirium, (2) Clinical interpretation through observation and elimination, (3) The dual role of parents in emergence delirium management, (4) Negotiating trust and learning with the delirium screening tool and (5) System-level needs and recommendations. Nurses described the chaotic and emotionally charged nature of emergence delirium episodes, the intuitive yet uncertain interpretive work they performed, the complex influence of parental presence, evolving trust in structured assessment tools and systemic barriers that hindered timely emergence delirium recognition.

Conclusion

Nurses face complex clinical, emotional and relational challenges in managing paediatric emergence delirium. Embedding delirium awareness into practice requires sustained training, screening integration and proactive parental engagement.

Implications for Profession and Patient Care

Findings highlight the need for integrating delirium screening into post-anaesthesia care routines, the need for ongoing education and preparing parents for emergence delirium scenarios to enhance care delivery and safety.

Reporting

The COREQ checklist was used for reporting.

Patient or Public Contribution

No patient or public involvement.

Profiles of Compassion Competence Among Nurses of China: A Latent Profile Analysis

ABSTRACT

Aims

To understand the current situation of nurses' compassion competence and analyse the characteristics and influencing factors of different categories of nurses' compassion competence based on latent profile analysis, to provide a theoretical basis for formulating targeted compassion training programmes.

Design

A cross-sectional study.

Methods

From June to October 2023, 550 nurses from tertiary grade A hospitals in Shandong province were selected by convenience sampling and investigated by utilising a demographic characteristics questionnaire, the Compassion Competence Scale for the Nurses, the Mindful Attention Awareness Scale and the Maslach Burnout Inventory-Human Service Survey. Latent profile analysis was performed to explore the potential categories of nurses' compassion competence, and single-factor analysis and logistic regression analysis were used to explore the related influencing factors.

Results

A total of 513 nurses were included. The compassion competence of nurses could be divided into four categories: the compassion competence deficient group (7.56%), the compassion competence low-imbalanced group (15.35%), the compassion competence high-balanced group (50.38%) and the compassion competence excellent group (26.70%). Department, years of working, humanistic care training experience, whether work is supported by colleagues and leaders, mindfulness and job burnout were the influencing factors of different potential categories (all p < 0.05).

Conclusion

There are four categories into which nurses' compassion competency can be categorised. Nursing managers and medical institutions can formulate precise training methods that enhance nurses' compassion competency based on the traits of various nurse categories in order to improve the quality of nursing service.

Impact

The results of this study help to understand the categories and heterogeneity of nurses' compassion competence and provide a basis for nursing managers and medical institutions to improve the compassion competence of different categories of nurses.

Patient or Public Contribution

All participants were nurses who completed an electronic questionnaire related to this study.

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