Journal of evaluation in clinical practice最新文献

Aims: To investigate the relationship between medical narrative ability and humanistic care ability among Chinese clinical nurses, examining the potential mediating role of empathy.

Background: In the context of the bio-psychosocial medical model and humanistic nursing care, understanding the core competencies of medical narrative ability, empathy and humanistic care in nursing is crucial. This study explored the mediating role of empathy between medical narrative ability and humanistic care ability.

Design: A cross-sectional study.

Methods: The study employed a descriptive, cross-sectional survey design, involving 741 nurses from Wuxi People's Hospital. It assessed nurses' demographic characteristics, medical narrative ability, empathy, and humanistic care ability using an online questionnaire from December 2022 to February 2023. Pearson correlation analysis evaluated variable correlations, and PROCESS v3.3 model 4 was utilised for mediation analysis. The STROBE statement was chosen as the EQUATOR checklist.

Results: A positive correlation was found between nurses' medical narrative ability, humanistic care ability and empathy. Empathy partially mediated the relationship between medical narrative ability and humanistic care ability.

Conclusion: Nurses' medical narrative ability directly and indirectly (via empathy) influences their humanistic care ability. Enhancing nurses' narrative and empathic skills can improve humanistic care, nursing quality and nurse-patient relationships.

Relevance to clinical practice: Managers should prioritise programmes to improve nurses' storytelling and empathy skills to enhance humanistic care, improving nursing quality and patient relationships.

Public contribution: This study involves clinical nurses as participants and does not involve patients. This study collected data from clinical nurses using an online questionnaire platform in China. The questionnaire consisted of four sections, including demographic information and scales such as Narrative Competence Scale, Caring Ability Inventory and the Jefferson Scale of Empathy-Health Professional. Clear instructions were given to participants on how to complete each scale, and measures were taken to prevent missing or duplicate responses.

Rationale: The Joint Commission emphasizes the importance of cultural competence and effective communication in quality medical care, particularly during end-of-life (EOL), when decisions are influenced by diverse cultural and religious backgrounds. For Orthodox Jewish patients, the philosophical framework used for EOL decision-making may conflict with that used in traditional Western medical ethics. In this paper, we explore the complexities of EOL decision-making for devout Jewish patients and highlight how approaches may differ from a Western ethical framework.

Aims and objectives: This paper aims to familiarize clinicians with EOL preferences of Orthodox Jewish patients, organized into an ethical framework called 'casuistic deontology'. Leading with an open-minded approach emphasizing cultural humility, we explore ways in which integrating this perspective can allow for culturally appropriate and compassionate EOL care.

Method: Using a case study methodology, we focus on a 79-year-old Orthodox Jewish male hospitalized with severe injuries. The patient's medical course is analyzed, highlighting how the decisions made by his family in consultation with their Rabbi may differ from the decisions made with a philosophy of a Western ethical framework.

Results and conclusion: This case illustrates the ethical tensions that may arise when Western medical practices intersect with Orthodox Jewish beliefs, particularly regarding brain death, resuscitation, and artificial nutrition. We underscore the need for cultural sensitivity when approaching EOL decision-making, allowing for compassionate and comprehensive care that respects religious perspectives. This paper helps provide a structure for clinicians to navigate the complex EOL care needs for the devout Jewish patient in a manner consistent with their cultural and religious identity.

Rationale, aims and objectives: Diabetes mellitus is a global serious health problem that has a clear negative impact on economy. The high prevalence of diabetes worldwide urges for prevention and educational programs. Engagement of community pharmacists in offering various diabetes care services enables delivery of quality of care for patients and could play key role in diabetes management. The current study was designed to assess the knowledge towards diabetes among community pharmacists and to investigate their role in diabetes management through identifying different diabetes care services they provide in Asir region, Saudi Arabia. In addition, possible barriers for providing these services were evaluated.

Method: A cross-sectional study was performed using an online self-administered anonymous survey that consisted of 4 domains: demographics, knowledge, practice and barriers related to diabetes management.

Results: A total of 258 pharmacists completed the survey, and one-third of respondents (34.5%) demonstrated good knowledge while 42.2% showed moderate knowledge towards diabetes. Respondents of the age group (30-39) years, males, those with bachelor's degree and those with 5 years or less of experience had higher mean knowledge. Nearly half of the participants had positive practice. The most prominent (75%) services offered by the community pharmacists were counselling on the appropriate administration, handling and storage of insulin and the appropriate time to administer oral antidiabetic drugs. Pharmacists who received training had higher mean practice scores. Lack of time, lack of diabetic patients visiting the pharmacy and low patient expectations regarding pharmacists' role in diabetes care were identified as the most important barriers they encountered.

Conclusion: Community pharmacists of Asir region exhibited moderate knowledge and practices regarding diabetes management. Our results support the need for national advanced diabetes training programs targeting community pharmacists for providing quality of care services for diabetic patients Moreover, strategies to overcome the reported barriers are indispensable.

Rationale: Chronic non-cancer pain (CNCP) is a leading driver of disability. Primary care clinicians treat most patients with CNCP. Yet, they are often unable to identify appropriate pain treatments, mainly due to concerns about the safety and effectiveness of available medications. Clinical practice guidelines (CPGs) can be useful tools to guide primary care clinicians in selecting pain treatments based on the best available evidence.

Objectives: To undertake a systematic review of CPGs that address the management of adults with CNCP, regardless of underlying condition type, in primary care.

Method: We systematically reviewed and synthesised current CPGs for managing adults with CNCP in primary care (2013-2023). We followed a stepwise systematic process to synthesise key CPG recommendations: extracted and analysed each recommendation, synthesised by compiling similar recommendations using a thematic analysis approach, and assessed the strength of CPG recommendations to create a final, unified set of recommendations. We focused on identifying CPGs containing recommendations on the following topics: (a) opioid pain management, (b) non-opioid pharmacological pain management, (c) non-pharmacological pain management, and (d) patient-centred communication around pain management, prevention, and organisation of care.

Results: We included 13 CPGs, 8 of which focused solely on use of opioids, emphasising the lack of long-term effectiveness and safety concerns, being mainly based on the expert consensus. As an exception, high-quality evidence recommended referring patients with suspected opioid use disorder to specialist addiction services for medication-assisted treatment. Recommendations for non-opioid pain management were often contradictory and based on the expert consensus. Patient-centred pain management combined with exercise-based interventions and psychological therapies are appropriate strategies for managing patients with CNCP.

Conclusion: Most CPGs focused on opioid management, with contradictory recommendations for non-opioid management based on low-quality evidence. Additional research is needed to strengthen the evidence for using non-opioid and non-pharmacological interventions to manage patients with CNCP.

Aim: In the context of adjusting to life with a permanent colostomy, this study explored how perceived social support from family, friends and others influences patients' self-efficacy in managing their stoma and engaging with their social lives.

Methods: The study employed a descriptive, correlational design to investigate the relationship between social support and self-efficacy in 94 colostomy patients between April 2021 and August 2022. Participants completed the Descriptive Characteristics Form, Multidimensional Scale of Perceived Social Support (MSPSS), and stoma self-efficacy scale (SSES). Descriptive statistics were used to summarise the data, and one-way ANOVA with Tukey HSD post-hoc test examined group differences. Pearson correlation assessed the relationship between age, social support and self-efficacy, while multiple linear regression identified factors independently associated with self-efficacy level.

Results: The participants had a mean age of 56.9 ± 14.34 years, and 37.2% had been suffering from stoma complications for a duration ranging from 13 months to 5 years. The mean total score on the MSPSS was 64.3 ± 13.5, whereas the mean total score on the SSES stood at 71.22 ± 20.21. A moderate positive correlation (r = 0.419, p < 0.001) was observed between the total scores from the MSPSS and SSES. The increase in the total score on the MSPSS was a significant predictor (β = 0.293, p = 0.001) of the level of stoma self-efficacy, explaining 48.9% of the variance.

Conclusion: Stronger perceived social support was linked to higher stoma self-efficacy in permanent colostomy patients.

Objective: This study aimed to investigate the influential factors of adherence to inhalation drug therapy (IDT) in patients with stable chronic obstructive pulmonary disease (COPD).

Methods: A total of 243 patients with stable COPD who visited the chronic disease clinic of the respiratory department of our hospital between April 2022 and October 2022 were selected as participants using the convenience sampling method. Relevant information about all participants was collected by questionnaire for investigation, including basic information, clinical characteristics, inhaled drug names, situational awareness, dose and frequency.

Results: Univariate analysis revealed positive correlations between the following factors: (1) the total score of drug adherence and the total scores of the COPD knowledge questionnaire (COPD-Q), social support, subjective support, objective support and support utilisation, (2) the total score of dosage adherence and the total scores of COPD-Q, objective support and support utilisation and (3) the total score of technical standardisation and the total scores of social support, subjective support and objective support (p < 0.05). Multifactorial analysis showed that COPD health literacy, number of acute exacerbations in the past year and social support factors collectively accounted for 37.4% of the variable of patient adherence to IDT, as did COPD health literacy, modified Medical Research Council (mMRC) grading, duration of COPD, utilisation of support and marital status collectively account for 47.4% of the variable of patient dosage adherence. The goodness-of-fit of age, mMRC grading, social support, mode of residence, number of acute exacerbations in the past year and literacy to the patients' inhalation technical standardisation in the model was 47.4%.

Conclusion: Dose adherence was predominantly influenced by COPD health literacy, mMRC grading, duration of COPD, utilisation of support and marital status. Inhalation technical standardisation was substantially limited by age, mMRC grading, social support, mode of residence, number of acute exacerbations in the past year and literacy.

Aim: The aim of this research is to determine the relationship between nurses' burnout status and their intention to leave the job during the COVID-19 pandemic.

Materials and methods: The population of the descriptive study, which seeks a relationship, consists of nurses working in State Hospital, the sample consists of 213 nurses who agreed to participate in the research between April 2021 and August 2021. Data were collected using the 'Personal Data Collection Form', 'Burnout Scale' and 'Intention to Leave Scale'. Ethics committee approval was obtained for the study.

Results: Of the participants, 75.6% were women, 91.1% cared for patients with a diagnosis of COVID-19. The participants' Burnout Scale mean score was 4.34 ± 1.10, and the Intention to Leave Scale mean score was 2.94 ± 1.04. The relationship between burnout and age, gender, marital status, income status, unit of work, professional experience, choosing the profession voluntarily, being happy to do the job and caring for a patient with COVID-19 was found to be statistically significant (p < 0.05). It has been concluded that age, income status, unit of work, professional experience, choosing the profession willingly and being happy to do the job affect the intention to leave the job. A positive and significant relationship was found between the mean scores of the Burnout Scale and the mean scores of the Intention to Leave Scale.

Conclusion: This study determined that as nurses' burnout level increased, their intention to quit their jobs increased.

Since its inception, the Journal of Evaluation in Clinical Practice has been all about providing a forum for serious, critical interdisciplinary debate regarding matters of practical importance in healthcare.¹ Through early editions focussing on issues in health management, quality and audit,^2-4 and the numerous thematic editions focussing on evidence-based healthcare^5-9 we have given authors the opportunity to challenge dominant ideas and to raise pertinent questions that they feel are not being discussed elsewhere.

This forum has proved to be an important resource, with the dialogue generated playing a significant role in advancing our understanding of issues absolutely fundamental to good practice across the globe. The lengthy (and still on-going) critical discussion of evidence-based practice is a fine illustration of this process. As argued in a previous special edition of this journal, the ‘great debate’ about research, practical reasoning, evidence and clinical decision-making has very much ‘moved forward’.¹⁰ The edition brought together contributors previously classed as either ‘critics’ or ‘protagonists’ of evidence-based medicine, demonstrating the shared understandings and common ground that have developed between what were once two ‘camps’, due to open and frank debate over several years. Mutual understanding really can be achieved by open dialogue, when contributors from different starting points are willing to engage, and it is our hope that further progress can be made via future editions, to resolve outstanding differences and clarify remaining areas of uncertainty.

One of the essential features of this process is a willingness to identify and analyse assumptions of an underlying nature. Practitioners, researchers, managers, patients and carers from diverse intellectual and cultural backgrounds will often bring with them different understandings of such key ideas as evidence and value. The question ‘what do we mean by evidence?’ is by no means a trivial or merely ‘academic’ question. Only by asking it, and critically interrogating the answers given in a range of contexts, can we uncover, discuss and evaluate our different understandings and the conceptual frameworks that shape our thinking and practice.

For this reason, in 2010, the journal published its first thematic edition dedicated specifically to exploring health philosophy. The stated goal of the edition was ‘to bring depth and clarity to the discussion of topics too often addressed superficially’ by promoting philosophy as the activity of critical thinking and dialogue, applied to pressing problems confronting health professionals, service users and policymakers.¹¹ Authors from an impressive range of academic and professional disciplines examined assumptions about the nature of scientific and causal reasoning, explaining

Background: Routine clinical biochemistry tests are crucial for clinical diagnostics and play a key role in enhancing outpatient turnover efficiency and patient satisfaction. This study aimed to implement Lean Six Sigma in the biochemistry laboratory of a hospital in China to improve efficiency and quality by reducing turnaround time.

Methods: The study was conducted from January to December 2023, using the DMAIC (Define, Measure, Analyze, Improve, Control) framework, and employed tools such as the voice of the customer, Value Stream Mapping, '5 whys' technique, Nominal Group Technique, and Pareto chart.

Results: The turnaround time for outpatient routine clinical biochemistry tests was reduced from 139 min to 58 min (p < 0.05), effectively increasing both patient and physician satisfaction.

Conclusions: Lean Six Sigma aimed to reduce the turnaround time for biochemical tests have significant advantages. This study confirms the effectiveness of Lean Six Sigma in a Chinese clinical laboratory setting and provides guidance for optimizing efficiency in global clinical laboratories with limited implementation experience, constrained technical and equipment resources, and high demand for medical diagnostics.