Worldviews on Evidence-Based Nursing最新文献

Background: Nurses face heightened risks of developing posttraumatic stress disorder (PTSD) due to occupational stressors, with prevalence rates significantly higher than the general population before and during the COVID-19 pandemic. Although PTSD symptoms are known to impair various domains of functioning, research examining which specific PTSD symptom clusters most strongly impact nurses' functioning remains limited.

Aims: This study examines how individual PTSD symptom clusters relate to overall functioning and distracted practice, a measure of workplace functioning, in nurses with probable PTSD.

Methods: We examined relationships between PTSD symptoms and functioning among 420 U.S. nurses recruited through social media platforms in late 2021. Participants completed validated measures assessing PTSD symptom clusters (PTSD Checklist for DSM-5), anxiety (Generalized Anxiety Disorder Scale), depression (Patient Health Questionnaire), general psychosocial functioning (The Brief Inventory of Psychosocial Functioning), and a proxy measure for workplace functioning (Distracted Practice Scale), with hierarchical regression analyses used to evaluate the unique contributions of PTSD symptom clusters to functional outcomes while controlling for demographic, workplace, and mental health variables.

Results: PTSD symptom clusters accounted for significant additional variance in both general functional impairment (9.5%) and occupational impairment (9.3%), beyond demographic, workplace, and other mental health variables. For general psychosocial impairment, PTSD cluster D, negative alterations in cognition and mood, and cluster E, arousal symptoms, were the most impactful, whereas PTSD cluster B, reexperiencing, and cluster D were most strongly associated with workplace functional impairments. Final models revealed that education level predicted general psychosocial impairment while years of nursing experience predicted impairments in workplace functioning.

Linking evidence to action: Nurses with PTSD during the COVID-19 pandemic faced significant impairments in overall and work functioning. Our findings highlight that PTSD symptoms vary in how they impact functioning. Symptom clusters such as negative mood, arousal, and reexperiencing were linked to worsened functioning. Tailored support programs should address specific PTSD symptoms.

Background: Nurse managers are pivotal to the successful implementation of evidence-based practice (EBP). However, enhancing their skills and competencies remains a critical priority. Assessing the influence of nurse managers' competencies in managing and practicing EBP is essential, as it directly impacts outcomes across all levels of healthcare institutions.

Purpose: This study explored how leadership, organizational support, and knowledge management influence EBP implementation among nurse managers.

Methods: A descriptive correlational study was conducted with a convenience sample of nurse managers in seven Egyptian hospitals. A total of 369 nurse managers completed three validated instruments: EBP Leadership and Organizational Support Scale (EBPLOSS), Knowledge Management Competencies for Nurse Managers (KMQN), and EBP Questionnaire (EBPQ). Descriptive statistics, hierarchical regression, and structural equation modeling (SEM) were applied for data analysis.

Results: Nurse managers reported high levels of perceived EBP leadership (84.7%), organizational support (79.52%), knowledge management (KM) competencies (75.15%), and EBP implementation (74.83%). SEM analysis identified KM competencies as the strongest predictor of EBP implementation, with a direct effect (B = 0.86, p < 0.001) accounting for 86% of the total effect. EBP leadership significantly influenced EBP implementation both directly (β = 0.31, p = 0.02) and indirectly through KM competencies (B = 0.89, p < 0.001). Organizational support showed a minimal direct effect (B = 0.13, p < 0.05) and a slightly negative indirect effect through KM competencies (B = -0.10, p < 0.001).

Linking evidence to action: KM competencies are critical for EBP implementation, mediating the effects of leadership and organizational support. Healthcare organizations should enhance nurse managers' KM skills, foster transformational leadership, and create supportive environments. Future research should address barriers and explore longitudinal relationships in EBP implementation from a managerial perspective.

Background: Nursing well-being is foundational to the specialties workforce and broader healthcare industry worldwide. Despite frequent reports and descriptions of activities that support nurses' well-being, most reports describe singular activities and programs that lack science-based structures contextualized within academic healthcare systems (AHS) with validated impact.

Aims: To evaluate and synthesize the existing national and international literature on nurse well-being initiatives offered in AHS.

Methods: Over 18 months, an 8-member interprofessional team conducted a scoping review adhering to PRISMA-ScR reporting guidelines. Five databases were searched, and results were screened in a multistep process by researcher pairs. Discrepancies were resolved by a third team member's review. Citations were reviewed uniquely three times to ensure methodological rigor. A final set of 54 articles was extracted for key data elements pertinent to the research question describing setting, population, study design, intervention, and other subsidiary fields. Reviewers additionally analyzed publication quality indicators and trends for additional implications for research and practice.

Results: Among the 54 eligible articles, 72% were research and 28% were evidence-based practice, quality improvement, or doctoral dissertations. The concepts studied were psychosocial (e.g., resiliency) and physical (e.g., sleep). The number of instruments used per study ranged from 1 to 11. Thirty percent of studies utilized a framework from various disciplines that included nursing, social and behavioral sciences, and safety science principles. Nurses were included as authors 67% of the time, and 35% received funding from either the public or private sector.

Background: The mental health and well-being of nurses are critical issues in health care, particularly following the increased stressors introduced by the COVID-19 pandemic. Nurses frequently experience burnout, stress, and emotional exhaustion due to systemic issues such as staffing shortages, heavy workloads, and limited access to mental health resources. These challenges not only affect nurses' well-being but also impact the quality of patient care. Organizational support plays a pivotal role in mitigating these issues, yet the lived experiences of nurses regarding such support remain underexplored.

Aim: This Study Aimed to Explore Nurses' Lived Experiences of Organizational Support and Its Impact on Their Mental Health Recovery, With a Focus on Identifying Actionable Strategies for Improvement.

Methods: A qualitative phenomenological approach was employed, using Interpretative Phenomenological Analysis (IPA) to gain deep insights into nurses' experiences. Twenty nurses from various healthcare facilities in the Asir region, Saudi Arabia, were recruited through purposive sampling. Data were collected through face-to-face semi-structured interviews and analyzed using thematic analysis to identify recurring patterns and themes.

Results: Three main themes emerged: (1) Supportive Leadership, highlighting the critical role of empathetic and communicative leadership in fostering well-being; (2) Systemic Barriers, including staffing shortages, heavy workloads, and limited access to mental health resources; and (3) Workplace Wellness Culture, reflecting the influence of stigma, peer support, and the practicality of wellness programs on mental health recovery. These themes underscore the interconnected nature of leadership, systemic issues, and workplace culture in supporting nurses' mental health.

Linking evidence to action: The findings suggest several actionable strategies, including leadership training programs to foster empathy and communication, policies to address systemic barriers, tailored and accessible wellness programs, and initiatives to reduce mental health stigma. These interventions are essential for creating supportive environments that prioritize nurses' well-being and enhance their ability to deliver high-quality care.

Background: A skilled and diverse healthcare workforce is essential in nursing homes, yet recruitment and retention remain a major challenge. Gaining insight into the well-being of different care worker groups and how they perceive their work environment can highlight areas of concern and opportunities for improvement.

Aims: To compare the perceived work environment and well-being among different care worker groups in nursing homes.

Methods: This descriptive study used cross-sectional survey data from the Flanders Nursing Home (FLANH) project, collected from February-July 2023. A total of 1521 care workers from 25 Flemish nursing homes participated (64.4% response rate), including care assistants (43.7%), registered nurses (20.5%), support staff (15.4%), allied health professionals (14.8%), and team leaders (5.7%). Chi-squared tests were used to compare the percentages of the care worker groups reporting the work environment items and well-being outcomes (job satisfaction, intention to leave, burnout). Post hoc analyses were conducted to identify which groups contributed to the significant differences observed.

Results: Significant differences among care worker groups were found for almost all work environment items and well-being outcomes. Staffing adequacy was perceived least among care assistants and registered nurses. More registered nurses and team leaders perceived high workload and emotional burden compared to the other groups. Work-life interference and involvement were perceived most among team leaders. A person-centered vision, work autonomy, and salary satisfaction were reported most among allied health professionals and team leaders. Skill use and training opportunities were reported least among support staff. Work-related well-being appeared to be experienced most among allied health professionals and least among care assistants.

Linking evidence to action: These findings highlight key differences in work environment perceptions and well-being among care worker groups, offering valuable insights for tailored initiatives to foster a supportive workplace that benefits the well-being of all types of care workers in nursing homes.

Background: Evidence-based practice (EBP) should be implemented in clinical settings and practiced by registered nurses as it improves healthcare quality, safety, costs, and patient outcomes. For this to occur, nurses need to be skilled and acculturated. An EBP culture needs to be developed and sustained, both in initial academic programs and in clinical settings. Implementation models already exist and are being used, but outcomes are not consistently measured.

Aims: The aim of this scoping review was to gather and map the use of EBP implementation models as well as their implementation strategies and outcomes.

Method: The methodology for the JBI Scoping Reviews was applied. The databases queried were PubMed, CINAHL, EMBASE, EMCARE, AMED, BNI, HMIC, PsycInfo. Inclusion criteria were as follows: Any primary study that describes the implementation of EBP in nursing, clinical, or academic settings. Studies using the following EBP implementation models were included: the ARCC Model, ARCC-E Model, IOWA Model, Stetler Model, Johns Hopkins Nursing EBP Model, ACE Star Model as well as PARIHS and i-PARIHS. They must have used Proctor's taxonomy for implementation outcomes as well as described implementation strategies according to the ERIC classification. Data extraction was performed by four independent reviewers in February 2024. There was no language or date limitation. Three independent reviewers performed an initial selection on titles and abstracts. Reading of the full texts was carried out by two independent reviewers using the JBI SUMARI.

Results: A total of 2244 articles were retrieved. After removing duplicates and applying the inclusion criteria, 26 articles were reviewed, and data extracted. The most used implementation model was the PARiHS or i-PARiHS model followed by the IOWA model, the ARCC model combined with the JHNEBP model and the Stetler model. Nearly all studies used the implementation strategy domain "Use evaluative and iterative strategies" of ERIC classification. Overall, the selected studies used between 1 and 2 outcomes from Proctor's eight available.

Linking evidence to action: The underuse of existing taxonomies (Proctor, ERIC) prevents an exhaustive mapping of the use of implementation models. The vocabulary used is too vague, and the implementation strategies are sometimes poorly described. An effort needs to be made to report on all work done to transfer the results to other settings and thus improve health care practices.

Background: Work wellbeing, also known as workplace wellbeing, is a global concern for nurses, particularly because excessive stress and exhaustion contribute to burnout.

Objective: The Caring Science International Collaborative (CSIC), an international research network, empirically investigates nurse work wellbeing using the Profile of Caring, a psychometrically validated and reliable instrument.

Framework: The CSIC framework defines wellbeing intrinsically-as caring and clarity-and extrinsically-as the social and technical resources needed to work efficiently and effectively. The Profile of Caring explains 80% of work wellbeing in nursing without bias across 10 countries.

Study design: This research protocol describes an international multicenter observational study that measures nurse work wellbeing using the Profile of Caring and other concepts and outcomes measures.

Background: The increasing prevalence of burnout, compassion fatigue, and reduced compassion satisfaction among healthcare professionals has highlighted the need for effective interventions. Mobile applications offer a promising solution due to their accessibility and low cost.

Methods: This systematic review and meta-analysis evaluates the effectiveness of mobile interventions in addressing burnout, compassion fatigue, and compassion satisfaction among healthcare professionals, while analyzing subcomponents of burnout to account for the frequently overlapping definitions and symptoms shared by these conditions. We included randomized controlled trials (RCTs) and quasi-experimental studies published between 2010 and 2024. Data were synthesized using a random effects model, with effect sizes estimated in Hedge's g.

Results: Fourteen studies met the inclusion criteria, comprising 11 RCTs and 3 quasi-experimental studies, with participant numbers ranging from 20 to 2182. Most intervention content focused on mindfulness and meditation (n = 7) and resilience-based programs (n = 3). The systematic review indicated mixed results for mindfulness and resilience apps, while most studies that used meditation showed improvements in burnout. Although interventions directly targeting compassion fatigue and compassion satisfaction showed no significant effects, the meta-analysis revealed improvements in burnout domains, including a significant effect on personal accomplishment (Hedge's g = 0.51) and mixed findings for emotional exhaustion. While these interventions do not directly reduce compassion fatigue or raise compassion satisfaction, they may contribute to job satisfaction and a sense of professional efficacy. A sensitivity analysis improved homogeneity, leading to significant effects on emotional exhaustion and the generalizability of our findings.

Linking evidence to action: Interventions focused on mindfulness, resilience training, and other strategies via mobile applications enhance personal accomplishment among healthcare professionals and show promising results in reducing emotional exhaustion. Their effectiveness in reducing compassion fatigue, depersonalization, and increasing compassion satisfaction remains inconsistent. Current research predominantly focuses on healthcare professionals, despite evidence suggesting that a broader range of healthcare professionals also suffer from compassion fatigue and burnout. The limited data on compassion fatigue and satisfaction highlights a gap in the current literature, showing the need for further high-quality studies in the form of RCTs.

Background: Evidence-based practice (EBP) is an approach that integrates the best evidence from research. It combines four concepts: patient preferences and values, clinical expertise, available resources, and the best evidence. Models exist and allow for its implementation, and the mentor appears as a facilitator.

Objectives: To explore the mentor's role and its impact on nursing staff.

Methods: Inclusion criteria included sources that report clinical setting, EBP context, nurse, mentor, and related terms. We searched for published and unpublished studies and reports without any language and date limit. The search was conducted on January 25, 2024. Databases searched included MEDLINE, CINAHL, COCHRANE Library, Embase, Emcare, Google Scholar, Web of science, JBI EBP Database, and ProQuest Dissertations and Theses. The search strategy identified a total of 3195 studies and reports. The relevant data were extracted by two reviewers as recommended by the JBI Manual for Evidence Synthesis.

Results: Seventy studies and reports were included in this scoping review. The mentors are mostly advanced practice nurses (APNs) who have completed EBP training. Mentorship programs aim to instill a spirit of inquiry and improve EBP skills of future mentors. As interprofessionality appears as a facilitator, a lack of time and resources is the main barrier. Mentors help teams improve their research skills in different ways to develop a research culture in a sustainable way and significantly improve beliefs and implementation.

Linking evidence to action: This study demonstrated the interest of the mentor l working in interprofessionality while establishing a close link between the clinical environment and the university to combine the skills and resources of the two fields. The implementation of a mentoring program appears to be a necessity to train nurses in EBP daily. An investment in mentoring makes it possible to improve the quality of care, but also the quality of the work environment. APNs and managers must take on this leadership role to drive this culture of research and practice improvement. Managers must free up time for mentors in order to be able to support and carry out EBP projects. As mentors, they are expected to communicate about ongoing research projects, whether through conferences, congresses, informal, or formal meetings.

Background: Managing cancer and living meaningfully (CALM) therapy is a psychosocial intervention designed to enhance the well-being of cancer patients; however, its impact on health-related outcomes in cancer patients remains unclear.

Aims: This study aimed to systematically synthesize current evidence to assess the impact of CALM therapy on health-related health outcomes and identify key features for optimizing the intervention.

Methods: An exhaustive search was conducted across seven databases from inception to July 5, 2024. Two reviewers separately evaluated the eligibility of studies, performed data extraction, and examined the methodological quality using the Cochrane's risk of bias tool. The certainty of evidence was evaluated using GRADE, and data analysis was conducted with Review Manager 5.4. The study protocol was registered with PROSPERO (CRD42024568561).

Results: Eleven studies (n = 1284) were included. CALM therapy showed significant improvements in psychological distress (MD = -2.43, 95% CI [-3.99, -0.86], p = 0.002), anxiety (SMD = -1.06, 95% CI [-1.78, -0.34], p = 0.004), depression (SMD = -0.65, 95% CI [-1.13, -0.17], p = 0.008), quality of life (SMD = 1.44, 95% CI [0.47, 2.40], p = 0.003), cancer-related fatigue (SMD = -3.54, 95% CI [-5.84, -1.23], p = 0.003), and sleep disturbance (SMD = -1.00, 95% CI [-1.86, -0.14], p = 0.02). However, its effects on alleviating the fear of cancer recurrence were not statistically significant.

Linking evidence to action: CALM therapy has demonstrated positive effects on psychological distress, anxiety, depression, cancer-related fatigue, sleep disturbance, and quality of life. However, evidence regarding its effects on the fear of cancer recurrence remains limited. While we explored potential sources of heterogeneity, no primary cause was identified. Our findings remained largely consistent after this exploration, but due to the observed heterogeneity, these results should still be interpreted with caution. Further high-quality randomized controlled trials with larger sample sizes are needed to confirm these findings and assess the long-term implications of CALM therapy.