Worldviews on Evidence-Based Nursing最新文献

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.

Background: Nurse-led education programs in childcare settings are critical for improving early childhood health outcomes and caregiver practices. Despite their potential, a systematic synthesis of their effectiveness is lacking.

Aim: To summarize the characteristics and evaluate the effectiveness of existing nurse-led education programs in childcare settings through a systematic review of experimental studies.

Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search was conducted in five databases from inception to December 9, 2024. Two reviewers independently screened articles, extracted data, and assessed study quality. Due to methodological heterogeneity, a narrative synthesis was performed. The review was registered with PROSPERO (CRD42024618983).

Results: Twelve studies met the inclusion criteria, involving 900 childcare workers and 920 families. The programs targeted two main areas: prevention of child health issues and management of child health issues. Lectures and group discussions were the most frequently used strategies. Nurses assumed diverse roles, including educators, consultants, and facilitators. The findings revealed several benefits, including reduced rates of upper respiratory illness, improved family health practices-such as appropriate medication use-and enhanced childcare worker competencies in first aid knowledge.

Linking evidence to action: Nurses play a critical role in implementing education programs in childcare settings. Their contributions should be fully integrated into program planning and delivery. Future research should adopt rigorous methodologies to strengthen evidence-based practices and improve child health outcomes and caregiver competencies.

Background: The incidence of psychological distress in patients with malignant tumors is high, which seriously affects the treatment compliance and quality of life of patients and even reduces the survival time. Non-pharmacological interventions are acceptable to patients because of their minor side effects. However, among the numerous interventions, which non-pharmacological intervention has demonstrated the most significant effect is still unclear.

Aims: This study aimed to compare the efficacy of different non-pharmacological interventions on psychological distress in patients with malignant tumors.

Methods: The databases, including Wanfang databases, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, SinoMed, PubMed, Embase, Web of Science, Cochrane Library, and PsycINFO, were searched systematically for randomized controlled trials on non-pharmacological interventions for psychological distress in patients with malignant tumors that were published up to July 5, 2025. Revman 5.3 and Stata 18.0 were used for paired and network meta-analysis, respectively.

Results: A total of 43 randomized controlled trials were included. The area under the cumulative sorting curve was ranked as Naikan Morita therapy (99.6%) > acceptance and commitment therapy (79.0%) > music therapy (78.3%) > logotherapy (77.8%) > behavioral activation (67.5%) > solution-focused nursing (66.1%) > dignity therapy (51.2%) > mindfulness-based stress reduction (50.6%) > mindfulness-based cognitive therapy (46.7%) > Mika app (39.8%) > psychological education (38.5%) > multi-dimensional collaborative nursing (29.0%) > life review therapy (26.0%) > exercise therapy (14.7%) > usual care (5.0%).

Linking evidence action: Non-pharmacological interventions had overall benefits in reducing the psychological distress of patients with malignant tumors, especially Naikan Morita therapy, acceptance and commitment therapy, music therapy and logotherapy. However, more high-quality randomized controlled trials are still needed to obtain more reliable conclusions.

Background: Chronic heart failure (CHF) is a progressive life-limiting condition that necessitates early implementation of advance care planning (ACP). However, patients and caregivers encounter emotional, informational, and cultural barriers to effective ACP engagement. This meta-synthesis consolidates qualitative evidence to deepen our understanding of ACP practices in CHF care.

Aims: This study aimed to explore experiences of CHF patients and their caregivers in ACP, which is defined as a proactive decision-making process to establish future treatment plans based on patients' values. The study also aimed to identify barriers and facilitators influencing ACP decisions and assess the impact of flexible, personalized ACP approaches on care quality.

Methods: Using qualitative meta-synthesis, we analyzed 10 qualitative studies on CHF patients' and caregivers' ACP experiences. Data were thematically synthesized to identify emotional, relational, and practical factors that influence engagement in ACP.

Results: Three themes emerged: (1) heart failure patients and caregivers face difficulties in ACP (difficulties from patients, difficulties from the family, and difficulties from the society), (2) multidimensional drivers and impacts of ACP (advance care planning drivers, acceptance and implementation of ACP, emotions and effects of ACP), (3) flexible, personalized ACP delivers tangible benefits (timing and effectiveness of ACP discussions, patients and caregivers have personalized needs for ACP, and patients and caregivers affirm ACP benefits).

Linking evidence to action: ACP plays a critical role in improving end-of-life care quality and reducing emotional and decision-making burdens on caregivers. Flexible and personalized ACP strategies supported by trained healthcare professionals more effectively meet the unique needs of patients and families. To overcome persistent barriers and promote broader ACP adoption, healthcare systems should prioritize provider communication training, ACP education, and support systems tailored to diverse cultural contexts.

Background: The translation of evidence-based practice (EBP) into routine nursing practice remains a persistent challenge.

Aim: To evaluate the impact of a structured EBP Mentor Nurse Training Program, developed using the Johns Hopkins EBP model as a process guide and conceptually grounded in the ARCC (Advancing Research and Clinical Practice through Close Collaboration) model, which emphasizes the development of EBP mentors to enhance implementation and competency.

Method: This quasi-experiment used a pretest-posttest design with equivalent control and intervention groups (n = 52; intervention group = 26, control group = 26). The intervention consisted of a blended training program (16 h face-to-face, 3 h online) covering EBP, mentoring, and communication skills. The control group received no intervention. Data were collected using the Nurse Information Form, the Evidence-Based Practice Evaluation Competency Scale, and the Mentoring Scale. The TREND statement guided reporting.

Results: Post-test results indicated significant improvements in the intervention group's EBP knowledge sub-dimension and total competency scores. Statistically significant gains were also observed in the coaching, role modeling, counseling, acceptance and approval, and friendship sub-dimensions of the Mentoring Scale. Effect sizes ranged from d = 0.5 (coaching) to d = 0.8 (EBP knowledge), indicating moderate to large practical significance.

Linking evidence to action: Structured EBP mentorship programs effectively enhance nurses' knowledge, EBP competencies, and mentoring abilities. These outcomes align with the ARCC model, supporting the cultivation of EBP mentors as a sustainable strategy for EBP integration. Incorporating blended learning and active mentorship in nursing education can foster a culture of collaboration, improve clinical decision-making, and promote better patient outcomes.

Background: Cognitive decline, including subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia, significantly affects social participation, leading to social isolation and reduced quality of life. Enhancing social participation through interventions may mitigate these effects, yet evidence on intervention effectiveness and mechanisms remains inconsistent.

Aims: To evaluate the effectiveness of social participation interventions for individuals with cognitive decline and identify effective behavior change techniques (BCTs) supporting social participation.

Methods: Our search using the following databases-PubMed, Web of Science, Embase, Cochrane Library, CINAHL, Scopus, CNKI, and Wanfang-was conducted until October 2024. The quality of the included studies was assessed using the Cochrane risk of bias tool for randomized trials. Meta-analyses were conducted using Review Manager 5.4 and Stata18, and the certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results: Sixteen RCTs involving 2190 participants were included. Music therapy (SMD = 0.62, 95% CI [0.15, 1.10]) and reminiscence therapy (SMD = 0.34, 95% CI [0.02, 0.66]) demonstrated significant positive effects on social participation. Group-based interventions were particularly effective (SMD = 0.23, 95% CI [0.04, 0.43]). Commonly used BCTs included goal setting, behavioral practice/rehearsal, and social support. However, substantial heterogeneity and limited data on SCD and MCI restricted generalizability.

Linking evidence to action: Interventions promoting social participation may enhance engagement for individuals with cognitive decline, particularly through music therapy, reminiscence therapy, and group-based formats. The complexity and dynamic nature of social interaction require individuals to engage and integrate various cognitive functions and skills, which can present significant challenges for older adults with cognitive impairments in their daily social participation. Further research is needed to optimize intervention components and address gaps in targeting early cognitive decline stages.

Background: Medication errors, particularly during administration, are a major threat to patient safety, with interruptions being a key contributor. Nurses are the most affected by these disruptions, and various interventions have been proposed to reduce interruptions.

Aims: This review evaluates the effectiveness of preventive and responsive interventions aimed at reducing interruptions during medication administration.

Methods: A systematic search of multiple databases identified 14 eligible studies on interventions targeting nurse interruptions. The review includes randomized controlled trials and quasi-experimental studies, focusing on interruption and medication error rates. Significant heterogeneity prevented meta-analysis.

Results: Preventive strategies, like no-interruption vests and awareness campaigns, may reduce interruptions from external sources, but nurse-to-nurse interruptions remained common. Responsive strategies showed limited success in reducing interruptions but improved nurses' ability to manage them. The impact on medication errors was inconclusive.

Linking evidence to action: Preventive strategies help reduce interruptions, but more targeted interventions are needed for nurse-to-nurse disruptions. A combined approach of preventive and responsive strategies can enhance medication safety.

Background: Physiological, psychological, and social changes may make older adults more vulnerable to stressors and lead to adverse health outcomes. It remains unclear whether interventions targeting coping strategies in older adults are effective.

Aims: This study aimed to systematically review and summarize existing interventions aimed at improving coping strategies in older adults and analyze intervention effectiveness.

Methods: A systematic search was conducted using PubMed, EMBASE, Web of Science, Cochrane, CINAHL, PsycINFO, CNKI, SinoMed, VIP, and WanFang databases for randomized controlled trials (RCTs) and quasi-experimental studies. Two researchers independently performed literature screening, quality assessment, and data extraction.

Results: A total of 9 studies were included, comprising 7 RCTs and 2 quasi-experimental studies. Meta-analysis revealed that the interventions significantly enhanced the use of problem-focused coping strategies among older adults (SMD = 0.37, 95% CI: 0.12 ~ 0.63, p = 0.005, I² = 39%). However, there was no significant effect on emotion-focused coping strategies (SMD = -0.07, 95% CI [-0.62, 0.48], p = 0.80, I² = 76%). Moreover, no significant statistical differences were observed between the intervention group and the control group in terms of positive (SMD = 1.49, 95% CI [-0.23, 3.21], p = 0.09, I² = 98%) or negative coping strategies (SMD = -0.76, 95% CI [-1.79, 0.28], p = 0.15, I² = 96%).

Linking evidence to action: Interventions targeting coping strategies can significantly improve the problem-focused coping strategies of older adults. It is crucial to help older adults accurately recognize daily stressors, acquire emotional regulation strategies, and enhance coping skills. More large-scale RCTs are needed to draw more robust conclusions.

Background: Instant messaging-based applications are increasingly used to deliver interventions designed to promote health behavior change. However, the effectiveness of these interventions has not been evaluated.

Aims: This systematic review and meta-analysis aimed to evaluate the effectiveness of instant messaging-based interventions on health behavior change, addressing a gap in the literature regarding the impact of instant messaging on various health behaviors.

Methods: We conducted comprehensive searches of six electronic databases (PubMed, EMBASE, Cochrane Library, PsycINFO, CINAHL Plus, and Web of Science) from their inception until July 2024, utilizing terms related to health behavior and instant messaging. Two authors independently screened studies and extracted data. Randomized controlled trials published in English that investigated the effects of instant messaging-based interventions on health behavior change, including physical activity, sedentary behavior, sleep, diet/nutrition, cancer screening, smoking cessation, and alcohol consumption were included. We used the revised Cochrane Risk-of-Bias Tool to assess the quality of the studies.

Results: Fifty-seven randomized controlled trials published between 2014 and 2024 were included. The results showed that compared with the control groups, instant messaging-based interventions had statistically significant differences in physical activity (SMD = 0.52, 95% CI [0.21, 0.83], p < 0.001) and sleep (SMD = -0.93, 95% CI [-1.44, -0.42], p < 0.001). It also significantly impacted smoking cessation (OR = 1.88, 95% CI [1.28, 2.7], p < 0.001). However, it did not influence sedentary behavior (SMD = 0.25, 95% CI [-0.24, 0.74], p = 0.01) or diet/nutrition (SMD = 0.01, 95% CI [-0.31, 0.34], p < 0.001).

Linking evidence to action: Instant messaging-based interventions are promising in enhancing health behavior change, including physical activity, sleep, and smoking cessation. Leveraging real-time communication and multimedia content can improve patient engagement and intervention effectiveness.

Background: "Opiophobia" lacks a clear definition and measurement, but it is commonly used by researchers and healthcare professionals in pain management to describe the underutilization of opioids by patients, caregivers, prescribers, and other healthcare professionals. This inconsistency complicates research and clinical interventions.

Objective: This systematic review aimed to comprehensively evaluate the conceptualization and operationalization of opiophobia across quantitative studies involving adult populations.

Methods: Peer-reviewed articles published before July 2024 were retrieved from four bibliographic databases (CINAHL, Embase, MEDLINE, and Scopus) and systematically reviewed. Included studies defined and/or measured opiophobia or opioid stigma among adult patients, family caregivers, and healthcare professionals. The review was conducted in two phases: the first phase provided a comprehensive understanding of study characteristics, while the second phase evaluated the conceptualization and measurement of opiophobia.

Results: Thirty-six articles met inclusion criteria. Studies focused on healthcare professionals (n = 23, 64%); adult patients (n = 13, 33%), including 7 studies involving patients with cancer (19%); healthcare professionals and patients (n = 2, 5%); and family caregivers (n = 1, 3%). Among the studies that defined opiophobia (n = 20, 67%), common definitions included fear, prejudice, reluctance, addiction, exaggeration, underutilization, and inappropriate attitudes/beliefs, respectively. Limitations included the predominance of observational designs (n = 32, 89%) and the use of investigator-developed instruments (n = 27, 73%).

Linking evidence to action: Instruments measuring opiophobia focused on opioid-related fears and behaviors. Instrument items that measured opiophobia primarily focused on fears and behaviors resulting from these fears. It remains unclear whether opiophobia is solely fear-based or also includes poor adherence to prescribed opioids. The wide variations in definitions and the use of mostly investigator-developed measures led to inconsistencies among studies. Further research is needed to design specific interventions and determine delivery times.