Worldviews on Evidence-Based Nursing最新文献

Background: Cancer survivors often receive inadequate pain management, leading to impaired quality of life. Despite their importance, evidence on the global prevalence of chronic pain in cancer survivors remains insufficiently clear.

Aims: The systematic review and proportional meta-analysis aimed to estimate the pooled global prevalence of chronic pain among cancer survivors and to explore heterogeneity stratified by geographic region, cancer type, pain duration, and pain assessment tool.

Methods: Five databases (PubMed, Embase, Cochrane Library, CINAHL, and China National Knowledge Infrastructure) were searched up to September 2024 for studies in English or Chinese. The review followed MOOSE and PRISMA guidelines with PROSPERO registration (CRDxx). Studies were included if they reported chronic pain prevalence in cancer survivors using validated instruments or solely reported chronic pain. Two reviewers independently screened studies, extracted data, and assessed quality using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Pooled prevalence and 95% prediction intervals were calculated using a random-effects model with Freeman-Tukey double arcsine transformation. Subgroup analysis was used to explore heterogeneity. Leave-one-out analysis explored robustness. Funnel plot and Egger's test were used to examine publication bias.

Results: In total, 36 studies involving 39,806 participants were included. The pooled prevalence of chronic pain among cancer survivors was 41% (95% CI: 34%-49%) after testing robustness, with significant heterogeneity (I² = 99.32%). Subgroup analysis indicated significant group differences in prevalence rates by geographic region, cancer type, and pain duration (all p < 0.001).

Linking evidence to action: These findings stress the need for more extensive and tailored chronic pain management in current clinical practice. Additional research on chronic pain outcomes among pediatric cancer survivors, cancer populations within Africa and South America, and those with cancer types other than breast cancer is needed.

Trail registration: PROSPERO Registration: CRD42024597090.

Background: Health coaching has emerged as a promising intervention to improve health outcomes in older adults. However, its effectiveness has not been comprehensively synthesized.

Aim: To evaluate the effectiveness of health coaching interventions on anxiety, depression, quality of life, self-management behavior, and self-efficacy among older adults.

Methods: A systematic search of six English databases (PubMed, Scopus, CINAHL, Cochrane Library, APA PsycInfo, and ProQuest Dissertations & Theses Global) was conducted from inception to October 20, 2024. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated using meta-analysis with random or fixed effects. Sensitivity analyses, subgroup analyses, and publication bias tests were also performed.

Results: Thirty-five randomized controlled trials (RCTs) involving 20,200 older adults were included in this review. Meta-analysis results indicated that health coaching interventions could significantly improve anxiety (SMD: -0.09; 95% CI: -0.15, -0.04; I²: 0%), quality of life (SMD: 0.22; 95% CI: 0.05, 0.39; I²: 76%), self-management behaviors (SMD: 1.15; 95% CI: 0.45, 1.86; I²: 95%), and self-efficacy (SMD: 0.18; 95% CI: 0.02, 0.33; I²: 69%) among older adults, but had no significant effects on depression (SMD: -0.26; 95% CI: -0.64, 0.12; I²: 98%).

Linking evidence to action: Health coaching interventions may enhance the well-being of older adults. However, the certainty of the current evidence was generally very low to moderate, and substantial heterogeneity existed across studies. Therefore, these findings should be interpreted with caution. More high-quality RCTs with extended follow-up, as well as analyses of differential effects across demographic information, are needed to provide more robust and generalizable evidence.

Background: The incidence of cancer continues to increase, and cancer patients still suffer from a range of burdens, leading to decreased quality of life. AI has been increasingly studied in the field of cancer care, demonstrating its enormous potential. However, most AI applications in cancer care are still in the developmental stage, and the strength of evidence from randomized controlled trials is not yet sufficient.

Objective: To evaluate the effects of AI-enhanced interventions in randomized controlled trials conducted in clinical settings and the impact of AI-enhanced interventions on the health outcomes of adult cancer patients.

Design: Meta-analysis of randomized controlled trials.

Methods: Nine databases (MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, Web of Science, CNKI, VIP, and Sinomed) were systematically searched, and metadata analysis was performed using R software and R Studio. The quality of the included studies was evaluated using the Cochrane Risk of Bias tool (RoB2) and the GRADE approach. The process was independently completed by two authors. The intervention effect was estimated by calculating the standardized mean difference (SMD) and 95% confidence interval (CI) using a random-effects model.

Results: A total of ten articles were included. Meta-analysis results showed that AI-enhanced interventions can significantly improve the quality of life (SMD 0.89, 95% CI 0.06-1.73), symptom burden (SMD -0.81, 95% CI -1.44 to -0.18), anxiety (SMD -0.20, 95% CI -0.32 to -0.07), and self-efficacy (SMD 0.55, 95% CI 0.06 to 1.03) of cancer patients. The type of AI application and the duration of the intervention had an impact on the quality of life of cancer patients: the effect of algorithm recommendations (SMD 1.49, 95% CI 0.04-2.93) was better than that of risk alerts (SMD 0.33, 95% CI 0.03-0.63), and the effect of short-term interventions (< 3 months) (SMD 1.49, 95% CI 0.04-2.93) was better than that of long-term interventions (≥ 3 months) (SMD 0.19, 95% CI -0.04 to 0.43). Sensitivity analysis showed that the results of this study were stable and reliable.

Linking evidence to action: AI-enhanced interventions are effective tools for improving patient outcomes. When integrating AI into clinical practice for cancer patients, priority should be given to the type of technology involved, ensuring its acceptability by enhancing perceived usefulness. AI technology should be adopted to relieve clinical nurses from documentation and low-complexity tasks, thereby addressing concerns about the loss of "humanistic care." We recommend the formal integration of AI literacy frameworks, such as N.U.R.S.E.S., into nursing education and practice.

Trial registration: PROSPERO (registration number: CRD420251040938).

Background: Loneliness and social isolation are prevalent and persistent in cancer patients, affecting their psychosocial adjustment. Non-pharmacological interventions have been shown to be effective in previous studies; however, the most effective types of non-pharmacological interventions for this population remain unclear.

Aim: The aim of this systematic review and network meta-analysis (NMA) was to synthesize the existing evidence and compare the effectiveness of different types of non-pharmacological interventions in treating loneliness and social isolation among cancer patients.

Methods: A systematic search was conducted in PubMed, Web of Science, Cochrane Library, Embase, CINAHL, PsycINFO, and MEDLINE databases from their inception to December 2024. Randomized controlled trials (RCTs) evaluating non-pharmacological interventions targeting loneliness and social isolation in cancer patients were included. NMA was performed using Stata 17.0 software under a frequentist framework.

Results: A total of 13 RCTs were included, including 9 non-pharmacological interventions and 1151 cancer patients. In order of probability, group logotherapy (SUCRA: 99.9%, SMD: -1.62, 95% CI: -2.23 to -1.01) was the most effective intervention for alleviating loneliness and social isolation, followed by psychoeducational therapy (SUCRA: 76.9%, SMD: -0.62, 95% CI: -1.16 to -0.07) and supportive expressive group therapy (SUCRA: 65.7%, SMD: -0.40, 95% CI: -0.75 to -0.05).

Linking evidence to action: The NMA suggests that, in terms of short-term efficacy, group logotherapy may be considered the optimal choice for reducing loneliness and social isolation levels in cancer patients. Healthcare professionals could regularly conduct group logotherapy among cancer patients to promote their psychosocial adaptation.

Trial registration: PROSPERO Registration Number: CRD42024616937.

Aim: This study aimed to evaluate and rank the effectiveness of various acupoint stimulation therapies in alleviating cancer-related fatigue (CRF), a pervasive and distressing symptom among cancer patients.

Background: CRF severely compromises patients' quality of life across treatment and survivorship stages. Despite growing interest in nonpharmacological interventions, comparative evidence on the efficacy of acupoint stimulation therapies remains limited.

Methods: A systematic review and network meta-analysis of 28 randomized controlled trials (RCTs) involving 2370 participants was conducted. Databases searched included MEDLINE, CINAHL, Embase, Cochrane, Web of Science, and Airiti Library. Interventions included acupuncture, acupressure, oil acupressure, moxibustion, and transcutaneous electrical acupoint stimulation (TEAS). Standardized mean differences (SMDs) were calculated using a random-effects model. Surface Under the Cumulative Ranking Curve (SUCRA) was used to rank therapies.

Findings: Oil acupressure (SUCRA: 73.6%), relaxing acupressure (73.4%), and acupuncture (72.7%) were the most effective interventions. Both professionally administered and self-administered therapies significantly reduced CRF, with no major differences in efficacy. Subgroup analyses revealed consistent effectiveness across cancer types, particularly breast and lung cancer, and treatment stages.

Conclusions: Acupoint stimulation therapies, especially acupressure and acupuncture, effectively reduce CRF and are suitable for integration into routine cancer care. Self-administered acupressure offers a practical, low-cost alternative, especially in resource-limited settings. Standardization of protocols and long-term studies are warranted to guide clinical implementation.

Trial registration: The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42024556455).

Significance/background: The cause of medical errors and adverse events in healthcare is multifactorial and includes faulty systems, processes, and conditions that can lead individuals to make mistakes. These mistakes are estimated to cause between 210,000 and 400,000 preventable deaths each year in the United States and are often caused by ineffective communication and teamwork failures among interdisciplinary team members. Effective communication is crucial, especially during critical events as this impacts health care quality and patient safety.

Aims: The project's aim was to implement the identified best practice of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) 3.0 to improve communication and teamwork during critical events on a perinatal unit.

Implementation plan: This was an evidence-based practice project consisting of 2 h of TeamSTEPPS didactic and interactive instruction followed by using the TeamSTEPPS concepts during 2 h of critical event simulation training to assess the perception of communication and teamwork of a multidisciplinary team on a perinatal unit. The multidisciplinary team members included labor and delivery nurses, mother/baby nurses, hospital aides, ward clerks, obstetrical technicians, obstetricians, and midwives.

Outcomes: Using the TeamSTEPPS Teamwork Perception Questionnaire (T-TPQ), the perception of communication and teamwork was compared pre- and post-implementation. Communication and teamwork mean scores from pre to post increased by 61% and 56%, respectively. The mean posttest scores improved for each of the T-TPQ measures, indicating the intervention had an impact on each of the dimensions of the TeamSTEPPS approach, including team function, team leadership, situational monitoring, mutual support, and communication (p < 0.01) and Cohen's d_z, of 0.82-1.32 provided evidence of a large effect.

Linking evidence to action: This evidence-based practice project provided clear and specific guidance for communicating and strengthening teamwork during perinatal critical events. Implementing TeamSTEPPS strategies can provide a safe environment for patients and a positive work environment where teamwork and communication are encouraged.

Background: Evidence-based practice (EBP) has been in existence for more than 30 years and is recognized as the standard to achieve high quality care.

Purpose: To examine EBP beliefs, competence, implementation self-efficacy, organizational culture and readiness, access to mentors and assess relationships between nurse characteristics and EBP variables in a large healthcare system in six U.S. states.

Methods: A cross-sectional descriptive correlational design was used to conduct a web-based anonymous survey of registered nurses in a large multistate healthcare system throughout the western US. Measures included: EBP Competency Self-Assessment Scale, the EBP Mentoring Scale, and the Short forms of the EBP Beliefs Scale, EBP Implementation Scale, the Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice.

Results: A total of 1468 nurses completed the survey from 36 hospitals in six U.S. states. Overall, participants rated themselves competent in only one competency (asks clinical questions). EBP beliefs followed by implementation self-efficacy scores were highest. Total scores for EBP implementation showed the strongest positive correlation with EBP competency followed by beliefs and mentorship with culture and readiness, the least strong relationship. EBP competency, beliefs, and implementation increased with educational attainment. EBP mentorship scores were low across the system.

Linking evidence to action: The study continues to demonstrate nurses' low perceptions of their EBP competency. Compared to previous studies, nurses in this sample reported their EBP competency higher; however, they still rated themselves above competence in only one statement. This underscores an urgent need for comprehensive education and robust support mechanisms. It is imperative that healthcare organizations establish access to experienced mentors and cultivate organizational structures to empower nurses to master EBP, thereby enhancing patient outcomes and advancing overall quality of care.

Background: Palliative care reduces caregiver burden, alleviates patient symptoms, and supports treatment decision-making. However, despite these benefits, there is limited evidence on the effectiveness of palliative care interventions for caregivers of individuals with advanced dementia.

Aims: To integrate and analyze data on the effectiveness of palliative care interventions in improving caregiver outcomes in order to ensure that both patients and caregivers receive the support necessary for optimal care experiences, quality of life management, and advanced care planning.

Methods: A systematic search was conducted of six databases to identify relevant studies published from database inception to 12 December 2024. Randomized controlled trials (RCTs) investigating palliative care interventions for caregivers of people with advanced dementia were included. Version 2 of the Cochrane Risk of Bias tool was used to assess the risk of bias in the methodology of each study. Standardized mean differences (SMDs) between each intervention and control group were calculated. A random-effects DerSimonian and Laird model was applied to generate pooled SMD estimates for each outcome and assess its heterogeneity. A leave-one-out sensitivity analysis was performed to ensure the stability of the pooled effect sizes.

Findings: Eight RCTs were included in the final analysis. Palliative care interventions appeared to reduce conflict in decision-making among caregivers of people with advanced dementia.

Conclusion: Palliative care interventions were successful in reducing conflict in decision-making of caregivers of people with advanced dementia. However, the modality's effects on caregiver satisfaction and caregiver distress need further investigation.

Linking evidence to action: Future palliative care interventions for caregivers of advanced dementia patients should focus on developing the contents of palliative care materials based on evidence-based evaluations and explore strategies to improve engagement between patients, caregivers, and healthcare professionals.

Background: Smoking cessation is a pressing public health concern. Behavioral therapy has been widely promoted as a means to aid smoking cessation. Acceptance and commitment therapy (ACT), based on the principles of cognitive behavioral therapy, can help participants accept, rather than suppress, the physical and emotional experiences and thoughts associated with not smoking, identify experiential avoidance behaviors, strengthen the determination to quit, and ultimately commit to adaptive behavioral changes guided by smoking-cessation-related values, thereby achieving the goal of quitting smoking.

Aims: To assess the effects of ACT compared with other smoking cessation interventions by examining three key outcomes: cessation rates, smoking behaviors, and psychological outcomes.

Methods: We searched 8 databases and 2 registration platforms, covering the period from inception to March 26, 2025. We included only randomized controlled trials that recruited adult smokers and implemented ACT for smoking cessation, with the comparison group receiving either active treatment, no treatment, or any other intervention.

Results: A total of 23 studies involving 8951 participants were included. The findings indicated that, compared with all types of control interventions, ACT significantly increased smoking cessation rates both immediately postintervention (RR = 1.48, 95% CI [1.03, 2.14], p = 0.04, I² = 81%) and at short-term follow-up (RR = 1.63, 95% CI = 1.31 to 2.01, p < 0.01, I² = 0%). Subgroup analyses showed that ACT significantly improved short-term cessation rates compared with behavioral support (RR = 1.60, 95% CI [1.27, 2.02], p < 0.01, I² = 0%), while, compared with the blank control, ACT significantly increased smoking cessation rates across three different time points (postintervention: RR = 3.11, 95% CI [2.13, 4.54], p < 0.01, I² = 0%; medium-term follow-up: RR = 2.55, 95% CI [1.32, 4.93], p < 0.01; long-term follow-up: RR = 3.33, 95% CI [1.66, 6.68], p < 0.01). Narrative synthesis suggested that compared with behavioral therapy, ACT may confer benefits in improving psychological outcomes, while compared with the blank control, it may also reduce daily cigarette consumption and nicotine dependence, and enhance psychological outcomes.

Linking evidence to action: Acceptance and commitment therapy may be a beneficial approach for improving cessation rates, enhancing smoking cessation behaviors, and promoting psychological well-being among adult smokers. However, the quality of the included evidence was limited, thereby weakening the strength of these findings. Future rigorously designed trials with larger sample sizes, particularly those comparing ACT against other smoking cessation interventions, are warranted to further confirm its effects.

Background: Nurse-led telephone-based follow-up interventions play a role in patient follow-up, but at present, no meta-analysis has been found to assess the effectiveness of nurse-led, telephone follow-up interventions for patients with acute coronary syndrome.

Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of nurse-led telephone-based follow-up interventions on health outcomes in people with acute coronary syndromes.

Design: Systematic review and meta-analysis of randomized controlled trials.

Methods: A comprehensive search of six databases: PubMed, Web of Science, Embase, Cochrane Library, CINAHL and Scopus was conducted from the inception of the databases to 30 September 2023. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the included randomized controlled studies. Review Manager 5.4 and Stata 16.0 were used to conduct statistical analysis.

Results: A total of 12 studies were included. Nurse-led telephone-based follow-up interventions may reduce systolic and diastolic blood pressure (MD = -2.55, 95% CI [-4.16, -0.94]) (MD = -2.15, 95% CI [-3.18, -1.12]) and low-density lipoprotein (MD = -9.06, 95% CI [-14.33, -3.79]) in patients with acute coronary syndrome. However, its effectiveness in controlling high-density lipoprotein (MD = 1.65, 95% CI [-4.30, 7.61]) and reducing total cholesterol (MD = -2.72, 95% CI [-7.57, 2.13]) was uncertain. In addition, the results showed that the nurse-led follow-up intervention did not play a role in improving anxiety (SMD = -0.20, 95% CI [-0.44, 0.04]) and depression (SMD = -0.07, 95% CI [-0.21, 0.06]) in patients with acute coronary syndrome, but it probably improved drug adherence (RR = 1.30, 95% CI [1.05, 1.60]) and smoking cessation (RR = 1.31, 95% CI [1.08, 1.60]).

Linking evidence to action: The findings of this review suggest that nurse-led telephone-based follow-up interventions had a potentially positive effect on controlling blood pressure and low-density lipoprotein levels, as well as improving medication adherence and smoking cessation among patients with acute coronary syndrome, compared to usual care. However, the intervention did not appear to significantly impact high-density lipoprotein, total cholesterol, anxiety, and depression, indicating that further research in these areas will be necessary in the future.

Trial registration: PROSPERO (International Prospective Register of Systematic Reviews): CRD42023465894.