Worldviews on Evidence-Based Nursing最新文献

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: 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.

Background: The global prevalence of chronic kidney disease (CKD) has continued to rise over time. Pharmacological therapy is the mainstay of conventional CKD treatment; however, many CKD patients find it difficult to adhere to their medication regimen.

Objective: To systematically evaluate and compare the effects of various self-management support strategies for patients with CKD.

Methods: We searched PubMed, Embase, The Cochrane Library, Web of Science, and Scopus to identify quasi-randomized and RCTs comparing the effectiveness of different self-management support strategies in CKD patients, The search spanned from database inception to June 24, 2025. Two reviewers independently screened the literature, extracted information, assessed the quality of studies, and we performed analysis using RevMan 5.0 and STATA 14.0 software.

Results: Eighty-one studies were included, examining 10 strategies. Compared to conventional interventions, face-to-face combined tele-guidance, group visits, tele-guidance, and multi-component structured interventions significantly improved patients' self-efficacy. Surface under the cumulative ranking curve (SUCRA) of different self-management support strategies influencing self-efficacy ranked in the top three were face-to-face combined tele-guidance, group visits and tele-guidance. Empowerment interventions, cognitive behavioral therapy (CBT) and tele-guidance enhanced quality of life compared to conventional interventions. The SUCRA for quality of life ranked highest for empowerment, CBT and face-to-face combined tele-guidance. Additionally, we found that these strategies were beneficial in improving patients' blood pressure, IDWG, renal disease knowledge, and self-management.

Linking evidence to action: The study offers evidence on effective self-management support strategies for CKD patients, highlighting face-to-face combined tele-guidance might be the most effective intervention for increasing self-efficacy, while empowerment might be the most effective intervention for increasing quality of life in CKD patients. These findings can help healthcare providers design better programs to improve patient outcomes. However, more high-quality RCTs are needed to confirm findings.

Trial registration: PROSPERO: CRD42024596581.

Background: Although some research supports the maintenance of positive outcomes from cardiac rehabilitation Phase II (CR II) up to 12 months, the barriers to maintaining physical activity and risk factor management during CR maintenance (CR III) are well known.

Aim: To investigate participants' ability to sustain clinical, quality-of-life (QOL), and behavioral outcomes and share their experiences 6 months after CR II completion.

Methods: Longitudinal explanatory sequential pre-CR/post-CR study in a community hospital within a large health system. A convenience sample of 155 participants completed a reassessment of health outcomes. Participants also completed an online survey about barriers and facilitators during and after CR II. Analysis methods included MANOVA and summative content analysis.

Results: The sample was mostly male, white, non-Hispanic, and college educated, with a mean age of 67.9 years. CR II participants sustained most behavioral outcomes, but not all clinical outcomes. Outcomes that improved/maintained were physical activity, tobacco status, diet, and QOL. Outcomes that worsened/returned to pre-CR II were weight, blood pressure, and depression. Participants described their motivation for staying healthy, top concerns, goals, barriers, and strengths/resources. Common responses included exercise, weight, diet, quality of life, family, and friends.

Linking evidence to action: Our findings suggest the need for the implementation of innovative strategies during CR II that may extend past discharge into CR III. These include the introduction of digital technology and eHealth to provide value-added service to patients and a solid foundation for future maintenance and a structured, behavioral weight loss intervention. Establishing these tools, in addition to developing a support system will help patients to initiate maintenance care before program completion.

Background: The role of the interprofessional evidence-based practice (EBP) mentor is critical to integrate best practices into healthcare and academic environments to improve outcomes and reduce costs for patients, families, providers, students, and faculty. This study aimed to validate the knowledge, skills, and attitudes/beliefs (KSAs) needed for the EBP mentor. This role delineation study (RDS) assessed knowledge about the EBP mentor role and tasks as related to the steps and competencies of EBP.

Methods: Interprofessional EBP experts participated in an advisory panel. Focus groups were conducted with the advisory panel members to identify the KSAs needed for expert EBP mentors. The steps of EBP were broken into 11 domains to align with the processes and strategies needed for EBP methodology. The focus group data were analyzed to identify the KSAs for each domain. A role delineation survey was developed. Interprofessional experts were invited to complete the survey to validate the KSAs needed for the EBP mentor role. The online survey included demographic information and 11 sections that aligned with the steps of EBP and the 107 KSA items needing to be validated.

Results: A total of 251 interprofessional EBP experts completed the survey (232 nurses, 19 interprofessionals). Healthcare providers comprised 82.5% of the sample, academic/researchers 15.5%, and "worked in both settings" 2%. The results reported strong inter-rater reliability (ranging from 0.836 to 0.955) and strong validity for each of the 11 domains and KSAs.

Linking evidence to action: Findings from this study support the EBP mentor role and will guide interprofessional EBP education and EBP mentor positions in healthcare systems. The study showed that the tasks of the EBP mentor were consistent across settings, educational degrees, and professional roles. Validity for the tasks/role for an interprofessional Evidence-based Practice Certification was clear and outlined expectations for the EBP mentor role.

Introduction: Evidence-based practice (EBP) is essential for improving the quality of care and health outcomes in healthcare organizations. This study aimed to analyze the association between the nursing work environment and EBP elements, including attitude, training, implementation and quality of care.

Methods: A multicenter, cross-sectional study was conducted with 1022 registered nurses from 57 primary care centers and four public hospitals in northern Spain. The Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to assess the nursing work environment. Data collection also included the Health Sciences Evidence-Based Practice (HS-EBP) questionnaire to evaluate attitudes toward EBP, and self-reported measures of EBP training, EBP implementation, and overall quality of care. Odds ratios (OR) and 95% confidence intervals for the association between the nursing work environment and EBP elements were calculated using logistic regression adjusted for sociodemographic and occupational characteristics.

Results: Compared to nurses who reported working in unfavorable environments (n = 220; 21.5%), those working in favorable environments (n = 437; 42.8%) exhibited a positive attitude toward EBP (OR = 2.89; 95% CI [2.00, 4.18]), EBP implementation (OR = 2.30; 95% CI [1.52, 3.39]) and higher quality of care (OR = 2.35; 95% CI [1.61, 3.44]). Using a composite measure that considered all EBP elements, favorable environments were associated with overall EBP engagement (OR = 3.47; 95% CI [2.38, 5.07]). The most influential environmental dimensions were adequate staffing and strong nursing foundations.

Linking evidence to action: A favorable nursing work environment was strongly associated with a positive attitude toward EBP, the implementation of EBP, and a commitment to providing high-quality care. Key strategies to promote EBP should involve healthcare and academic institutions working together to establish a healthy work environment with appropriate staffing and care foundations rooted in nursing theory.

Background: Psychosocial interventions are recognized as effective nonpharmacological treatments that can enhance the mental well-being of women dealing with perinatal loss. However, as these interventions vary widely, there is currently no review that systematically evaluates and ranks their effects on the mental health of women affected by perinatal loss.

Objective: The aim of this study is to integrate the existing evidence, assess and compare the effects of psychosocial interventions on negative emotions among women experiencing perinatal loss, rank the effect sizes of various interventions, and identify the most effective intervention on the basis of different outcome measures.

Methods: Seven English-language databases were systematically searched for randomized controlled trials (RCTs) focusing on women experiencing perinatal loss, with publications up to August 20, 2024. Traditional pairwise meta-analyses were performed using Review Manager 5.4.1, while Stata 18.0 was employed for network meta-analysis and evidence synthesis. The surface under the cumulative ranking curve (SUCRA) was used to assess the efficacy of the interventions. The protocol was registered with PROSPERO under number CRD42024530312.

Results: A total of 30 RCTs encompassing 6181 participants were included in the analysis. On the basis of the SUCRA rankings, problem-solving therapy was identified as an effective treatment for alleviating depression and anxiety among women experiencing perinatal loss (depression: SUCRA = 82.55%, SMD = -1.34, 95% CI [-2.41, -0.27]; anxiety: SUCRA = 97.7%, SMD = -2.83, 95% CI [-4.26, -1.40]). Additionally, bereavement intervention emerged as the most effective approach for improving grief symptoms (SUCRA = 81.60%, SMD = -1.11, 95% CI [-2.14, -0.09]).

Linking evidence to action: Compared with traditional treatment, psychosocial intervention can improve the psychological state of women with perinatal loss, and the differences in the effects of face-to-face and technology-assisted interventions should be further explored. Moreover, problem-solving therapy has proven to be effective and appears to be the most effective method for alleviating depressive and anxiety symptoms among women experiencing perinatal loss, while bereavement support is the most effective method for grief due to perinatal loss. Nursing and health policymakers can develop various intervention strategies according to the varied psychological states of women experiencing perinatal loss.

Background: Hemodialysis can lead to complications that negatively impact patients' quality of life. Managing hemodialysis effectively requires patient adherence to complex regimens.

Aim: This randomized controlled experimental study aimed to assess the impact of nurse-led telephone-based patient education and counseling on disease management, quality of life, and self-care behaviors in hemodialysis patients.

Methods: Conducted between September 2022 and June 2023 at State Hospital's Hemodialysis Unit, the study included an intervention and a control group. Data were collected using tools such as the Scale for Dietary Knowledge in Hemodialysis Patients (SDKHP), Attitude Scale for the Dietary Therapy of Hemodialysis Patients (ASDTHP), Dialysis Symptom Index (DSI), Fluid Control in Hemodialysis Patients Scale (FCHPS), the Scale for the Assessment of Self-Care Behaviors with Arteriovenous Fistula (AVF), and the Kidney Disease Quality of Life-36 (KDQOL-36).

Results: Pre- and posttest comparisons showed significant improvements in the intervention group's mean scores for SDKHP, ASDTHP, and FCHPS, with the control group experiencing declines. DSI scores indicated reduced symptoms in the intervention group and an increase in the control group. The AVF Self-Care Scale results demonstrated increased self-care behaviors in the intervention group, while a decrease was observed in the control group. KDQOL-36 subscales, including physical and mental functioning, disease burden, and symptom management, also improved in the intervention group, while scores declined in the control group. These findings confirm the effectiveness of telephone-based patient education and counseling on multiple outcome measures.

Linking evidence to action: Nurse-led, telephone-based patient education and counseling improved dietary adherence and disease management. Telephone-based patient interventions enhanced patients' self-care skills regarding AVF maintenance. Quality of life improved across multiple dimensions in the intervention group. Telephone counseling ensured continued monitoring and individual support, even after discharge. Nurses should integrate telephone-based counseling into routine care, especially for chronic disease management.

Background: The comparative efficacy of brief behavioral therapy for insomnia (BBTI) remains unclear.

Aims: This systematic review and network meta-analysis examined the effectiveness of different BBTI approaches and compared BBTI with other nonpharmacological interventions, such as cognitive behavioral therapy for insomnia (CBT-I).

Methods: Three databases were searched from inception to December 27, 2024. Primary outcomes were insomnia severity and sleep quality. Secondary outcomes included total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, and daytime sleepiness. A frequentist network meta-analysis with random-effects modeling was conducted. Heterogeneity was assessed using the I² statistic.

Results: Eighteen randomized controlled trials involving 1104 participants (mean age: 52.6 years) were included. Compared with usual care, BBTI significantly reduced insomnia severity (mean difference [MD] = -4.79; 95% confidence interval [CI = -6.05, -3.53]; I² = 0%) and improved sleep quality (MD = -3.45; 95% CI [-4.97, -1.94]; I² = 0%). BBTI also shortened sleep onset latency (MD = -19.81 min; 95% CI = -30.64, -8.98; I² = 17%) and wake after sleep onset (MD = -15.51 min; 95% CI [-22.75, -8.27]; I² = 47%) and increased sleep efficiency (MD = 10.78%; 95% CI [7.67%, 13.89%]; I² = 8%). No significant differences were found in total sleep time or daytime sleepiness. Face-to-face BBTI and CBT-I demonstrated similar outcomes. Face-to-face BBTI ranked as the most effective approach based on the surface under the cumulative ranking curve.

Linking evidence to action: Face-to-face BBTI is an optimal nonpharmacological option for improving sleep quality and efficiency and reducing insomnia severity, sleep onset latency, and wake after sleep onset.

Trial registration: PROSPERO number: CRD42021242589.

Background: Shift work-especially during night hours-adversely affects nurses' cognitive and motor performance, potentially compromising patient safety. Variations in shift duration and rotation patterns contribute to these effects. Implementing evidence-based strategies such as optimized scheduling, structured rest breaks, and supportive work environments may mitigate performance declines. These findings highlight the importance of organizational policies aimed at protecting both healthcare workers and patient outcomes.

Methods: A comprehensive search across PubMed, Cochrane Library, and Web of Science identified 22 studies with 224 comparison data points for inclusion. Study quality was assessed using the ROBINS-I tool across seven bias domains. Analyses were performed using Python, applying random-effects models to account for heterogeneity (Cochran's Q, I²), with Egger's test used for publication bias assessment.

Results: Day shifts led to a small performance decline (Hedges' g = 0.238, 95% CI [0.155, 0.321]), while night shifts caused a more substantial decline (Hedges' g = 0.386, 95% CI: 0.320 to 0.451). Motor performance across all shift types showed a moderate effect size (Hedges' g = 0.326, 95% CI [0.210, 0.442]). Comparing day shifts to nonstandard shifts, a small effect size (Hedges' g = 0.220, 95% CI [0.171, 0.269]) highlighted reduced performance under irregular shift conditions. High heterogeneity in night shifts (I² = 86.8%) suggested variability in study designs and methodologies.

Linking evidence to action: Shift work, particularly night shifts, negatively impacts cognitive and motor performance, posing risks to clinical safety. The variability in shift durations (6-17 h) and different shift rotation strategies contributed to heterogeneity. Targeted interventions, including optimized scheduling, adequate rest breaks, and supportive workplace practices, are needed to mitigate negative effects. This meta-analysis provides evidence-based insights into the detrimental effects of shift work on nurses' performance, supporting the development of policies and strategies to promote safer clinical environments and enhance healthcare quality.

Trial registration: PROSPERO.