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Digital mindfulness- and acceptance-based stress reduction intervention for individuals looking online for help: protocol for the CRISP randomised controlled trial

Por: af Ekenstam · L. · Nyman · P. · Änghagen · O. · Ahden · U. · Bendtsen · M. · Lundgren · O.
Introduction

Psychosocial stress is a major public health concern, contributing to significant suffering and costs to society. There is a lack of effective interventions that could be offered at an early stage to people who need to reduce their stress in life. Recent advances in psychology have provided evidence-based exercises suitable for testing in an entirely digital intervention. This study aims to estimate the effectiveness of a 12-week digital course in mindfulness- and acceptance-based stress reduction.

Methods and analysis

The effectiveness of the 12-week digital course will be estimated in a parallel-groups randomised controlled trial, in which the control group will receive referrals to self-studies on mental health information found online. The study population will be individuals 15 or older, seeking help online for stress and who have access to a mobile phone. Employing a Bayesian sequential design, the primary outcome will be monitored monthly, after the 6-month follow-up, to calculate target criteria for when to stop recruiting. Perceived stress (Cohen’s 10-item version) will be the primary outcome, with estimands of interest being differences between groups at 3 (immediate), 6 (prolonged) and 12 months (maintained). Mediation analysis will reveal if differences between groups are mediated by acquired equanimity. Effectiveness will be analysed with Bayesian regression models, and mediation will be analysed by using a causal inference framework.

Ethics and dissemination

The research was approved by the Swedish Ethical Review Authority on 2024-05-07 (2024-01974-01). The study will reach out to a vulnerable population, and participation may displace efforts to seek professional help. We have built-in automatic advice to seek additional help for participants scoring high on the depression scale at baseline, before allocation to study groups. The findings from this study will be submitted to peer-reviewed journals and presented at relevant national and international meetings.

Trial registration number

ISRCTN39222610.

The Evolving Role of Nurses in Hospital Settings—A Scoping Review

ABSTRACT

Aim

To explore existing research regarding how nurses' unclear responsibilities influence their professional role development in hospital settings.

Design

A scoping review was conducted according to Arksey and O'Malley.

Methods

The Population Exposure Outcome framework was used to identify eligible inclusion and exclusion criteria and search terms. The included articles have been thematically analysed in guidance by Braun and Clarke.

Data Sources

Twenty-six studies conducted between 2016 and 2024 were identified in CINAHL, PubMed and Scopus.

Results

The roles of nurses were highly adaptable within hospital settings and healthcare teams, requiring nurses to assess both organisational shortcomings and colleagues' needs. These assessments depended on the nurses' competence and motivation for professional growth.

Conclusion

There was a clear need to strengthen organisational structures and frameworks to support the evolving role of nurses. Basic nursing education must be better at preparing nurses for their upcoming leadership role.

Impact

Increasing complexity and unclear responsibilities contribute to role ambiguity among nurses. The review highlights the importance of recognising nurses as visible and accountable leaders. There is also a need to support nurses' adaptability through improved basic education, which may have implications for both clinical practice and education.

Reporting Method

The PRISMA Scoping Review checklist was used during the review process. The PRISMA flowchart was used to report the database searches.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.

First‐line managers' experience of guideline implementation during the COVID‐19 pandemic

Abstract

Aim(s)

To explore first-line managers' experience of guideline implementation in orthopaedic care during the COVID-19 pandemic.

Design

A descriptive, qualitative study.

Methods

Semi-structured interviews with 30 first-line nursing and rehabilitation managers in orthopaedic healthcare at university, regional and local hospitals. The interviews were analysed by thematic analysis.

Results

First-line managers described the implementation of guidelines related to the pandemic as different from everyday knowledge translation, with a swifter uptake and time freed from routine meetings in order to support staff in adoption and adherence. The urgent need to address the crisis facilitated guideline implementation, even though there were specific pandemic-related barriers such as staffing and communication issues. An overarching theme, Hanging on to guidelines for dear life, is substantiated by three themes: Adapting to facilitate change, Anchoring safety through guidelines and Embracing COVID guidelines.

Conclusion

A health crisis such as the COVID-19 pandemic can generate enabling elements for guideline implementation in healthcare, despite prevailing or new hindering components. The experience of guideline implementation during the COVID-19 pandemic can improve understanding of context aspects that can benefit organizations in everyday translation of evidence into practice.

Implications for the Profession and/or Patient Care

Recognizing what enabled guideline implementation in a health crisis can help first-line managers to identify local enabling context elements and processes. This can facilitate future guideline implementation.

Impact

During the COVID-19 pandemic, the healthcare context and staff's motivation for guideline recognition and adoption changed. Resources and ways to bridge barriers in guideline implementation emerged, although specific challenges arose. Nursing managers can draw on experiences from the COVID-19 pandemic to support implementation of new evidence-based practices in the future.

Reporting Method

This study adheres to the EQUATOR guidelines by using Standards for Reporting Qualitative Research (SRQR).

No Patient or Public Contribution.

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