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Given that stroke is a leading cause of disability and mortality worldwide, there is an urgent need for a coordinated healthcare approach to mitigate its effects. The objectives of this study were to perform a systematic review and meta-analysis of stroke integrated care models and develop recommendations for a representative model.
A systematic review and meta-analysis.
The literature search identified randomized controlled trials comparing integrated care models with standard care for stroke patients. The included studies followed PICOs inclusion criteria. The qualitative analysis included creating a flowchart for the literature screening process, and tables detailing the basic characteristics of the included studies, the adherence to the ten principles and the results of the quality assessments. Subsequently, quantitative meta-analytical procedures were conducted to statistically pool the data and quantify the effects of the integrated care models on stroke patients' health-related quality of life, activities of daily living, and depression. The China National Knowledge Infrastructure (CNKI), Wanfang Data, Chongqing VIP Chinese Science and Technology Periodical Database (VIP), China Biology Medicine Disc (CBMDISC), Cochrane Library, Cumulated Index to Nursing and Allied Health Literature (CINAHL), PubMed, Web of Science, Embase, Google Scholar, and Clinical Trials were searched from inception to March 13, 2024.
Of the 2547 obtained articles, 19 were systematically reviewed and 15 were included in the meta-analysis. The integrated care models enhanced stroke patients' health-related quality of life, ability to perform activities of daily living, and reduced depression. Adherence to the 10 principles varied: comprehensive services, patient focus, and standardized care delivery had strong implementation, while gaps were noted in geographic coverage, information systems, governance structures, and financial management.
Integrated care models improve outcomes for stroke patients and adherence to the 10 principles is vital for their implementation success. This study's findings call for a more standardized approach to implementing integrated care models, emphasizing the need for integrated services, patient-centred care, and interdisciplinary collaboration, while also addressing the identified gaps in terms of integration efforts.
This study provides evidence-based recommendations on the most effective integrated care approaches for stroke patients, potentially leading to better patient outcomes, reduced healthcare costs, and improved quality of life.
To summarize the best evidence-based strategies for the management of cognitive dysfunction in patients with brain injury and to provide a reference for clinical nursing practice.
Review.
The review was presented using PRISMA guidelines. A systematic search of evidence on the management of cognitive dysfunction in patients with brain injury was conducted in computerized decision systems, guideline websites, professional association websites and comprehensive databases from the date of creation to 21 June 2023. The types of evidence included were clinical decision making, guidelines, evidence summaries, best practices, recommended practices, expert consensus, systematic reviews and meta-analyses. Two researchers trained in evidence-based methodological systems independently evaluated the quality of the literature and extracted, integrated and graded the evidence for inclusion.
A total of 20 articles were selected, including nine guidelines, three expert consensus articles, one clinical practice article and seven systematic reviews, and the overall quality of the literature was high. Thirty pieces of evidence were summarized in seven areas: assessment, multidisciplinary team, rehabilitation program, cognitive intervention, exercise intervention, music intervention and medication management.
This study summarizes the latest evidence on the management of cognitive dysfunction in the care of adults with brain injury and provides a reference for clinical nursing practice. The best evidence should be selected for localized and individualized application in clinical work, and the best evidence should be continuously updated to standardize nursing practice.
Patients with cognitive impairment after brain injury often suffer from memory loss, attention deficit and disorientation and are unable to have a normal life and experience much enjoyment, which seriously affects their physical and mental health and creates a great burden of care for their families and society. Best evidence-based strategies for the nursing management of cognitive impairment in brain injury are essential for standardizing clinical nursing practice and providing timely, professional, systematic and comprehensive nursing interventions for patients.
This review is reported following the PRISMA 2020 statement guidelines, as applicable, to enhance transparency in reporting the evidence synthesis.
This study has been registered with the Fudan University Centre for Evidence-based Nursing, a JBI Centre of Excellence under registration number ES20232566, http://ebn.nursing.fudan.edu.cn/myRegisterList.
No patient or public contribution.
To identify latent profiles of competence and perceptions of spiritual care among clinical nurses and explore the possible influencing factors.
Understanding nurses' level of spiritual care competence and their perceptions and acceptance of such care is important, which could help devise nurse training programmes to address such competence in clinical nurses. However, research addressing interindividual variability in competence and perceptions among Chinese nurses is lacking.
Multicentre cross-sectional study.
Nurses working in departments with critically ill patients from 12 community, 5 secondary and 10 tertiary hospitals in Shanghai completed a demographic information questionnaire and the Chinese versions of the Spiritual Care Competence Scale, Spiritual Care-Giving Scale and Spiritual Perspectives Scale. The data were analysed using IBM SPSS v26.0 and Mplus version 8.3. Latent profile analysis identified subgroups with different levels of spiritual care competence.
In total, 1277 Chinese nurses were recruited. Four profiles of competence and perceptions of spiritual care were revealed: Low ability (23.8%), High ability (6.4%), High acceptance (34.9%) and Moderate (34.9%). The level of job position, spiritual care-related education, hospital grade and nurses' perceptions and perspectives of spiritual care predicted the probability of profile memberships in their competence.
There was heterogeneity in the characteristics of spiritual care competence. Nursing managers can implement individualised interventions, including relevant training, according to the influencing factors of different competence profiles to improve the level of such competence among nurses.
The results provide a new and expanded view of improving nurses' spiritual care competence. Interprofessional collaboration with clinicians, administrators, educators and spiritual leaders can contribute to the development of related education and training.
EQUATOR guidelines, STROBE checklist: cross-sectional studies.
All participants were clinical nurses. Participants were informed they could withdraw from the study at any time.
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