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To systematically compare nurse-led versus traditional rehabilitation in improving clinical outcomes for stroke survivors.
Systematic review and meta-analysis.
Data were extracted from Cochrane, PubMed, Embase, and Web of Science (searched up to July 2024). Analyses with standardized mean differences (SMDs) and risk ratios (RRs) as the estimates were performed in Review Manager 5.4 and Stata 15.0. Randomized controlled trials investigating nurse-led stroke rehabilitation with outcomes such as mental component summary (MCS) and physical component summary (PCS) of quality of life, self-efficacy, National Institutes of Health Stroke Scale (NIHSS), stroke-specific quality of life (SS-QOL), Barthel Index (BI), Geriatric Depression Scale-15 (GDS-15), and pain were included. Sensitivity analyses and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were performed.
A total of 12 articles were included. The quality assessment indicated that most studies did not have a serious risk of bias. Nurse-led rehabilitation showed significant improvements in SS-QOL (SMD: 3.33, 95% CI: 1.26, 5.40; very low-quality evidence), depressive symptoms (GDS-15, SMD: −2.21; 95% CI: −2.80, −1.63; high-quality evidence), pain (SMD: −1.61; 95% CI: −2.14, −1.08; high-quality evidence), and BI (SMD: 0.24, 95% CI: 0.01, 0.48; low-quality evidence). However, there were no significant differences in MCS, PCS, self-efficacy, or NIHSS between the two groups. Sensitivity analysis showed that the results for SS-QOL and BI were unstable and should be interpreted with caution.
Nurse-led rehabilitation is effective in improving psychological outcomes, particularly depression (GDS-15) and pain, although this high-quality evidence is based on a single study. Functional independence (BI) and SS-QOL are also improved, but the evidence for these outcomes is of low quality and highly unstable in sensitivity analyses. No significant benefits are found for other outcomes. The evidence quality varies, and future high-quality studies are needed to confirm these findings.
Incorporating nurse-led rehabilitation into stroke guidelines and implementing standardized depression screening programs and non-pharmacological pain interventions in community rehabilitation could be beneficial for populations with depressive symptoms and chronic pain.
This study adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for transparent reporting of systematic reviews.
This study did not include patient or public involvement in its design, conduct, or reporting.
To synthesise evidence on critical care nurses supporting bereaved families in intensive care units (ICUs).
Noblit and Hare's meta-ethnography approach.
We followed Noblit and Hare's 7-phase procedure, using reciprocal translation for data analysis and line-of-argument synthesis. We included studies on registered nurses in adult ICUs with experience supporting bereaved families, using qualitative or mixed-methods studies in English and published in peer-reviewed sources.
Five databases were searched without date restrictions, concluding in January 2024.
The final sample included 24 studies published between 1995 and 2023. The metaphor “Candlelight guides the way through winter's chill” symbolised the crucial role of critical care nurses in supporting bereaved families in ICUs. The synthesis encapsulated two themes: (1) challenges in providing bereavement support, with subthemes of emotional intricacies in bereavement support, and ICU setting limitations; and (2) optimising families' bereavement experiences, with subthemes support systems and emotional commitment, professional nursing behaviours and care practices, and curating personalised and meaningful farewell experiences.
Bereavement support in ICUs poses significant challenges, highlighting the need for greater support for critical care nurses. Nonetheless, these nurses draw on support systems and emotional dedication to overcome obstacles, striving to optimise families' bereavement experiences.
Our findings highlight the importance of structured training programmes (peer support and emotional management) and systemic improvements (optimised workflows and adequate staffing) to enhance quality bereavement care.
This study interprets critical care nurses' experiences supporting bereaved families in intensive care, highlighting the emotional demands. The findings offer insights into improving end-of-life and bereavement care practices and policies, benefiting nurses and families.
This review followed the ENTREQ guidelines for reporting meta-ethnography.
There was no patient or public contribution, as the data were drawn from previously published studies.
CRD42024506847 [PROSPERO]
FreshRSS 