Worldviews on Evidence-Based Nursing最新文献

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.

Background: This 2022-2023 study across nine countries builds on a 2019-2021 ten-country study exploring nurse work well-being (WWB) and its associated outcomes. WWB, as assessed using the Profile of Caring (PoC) survey, is conceptualized as a multifactorial construct encompassing caring for self, caring of manager, clarity of role/system, and job satisfaction.

Aims: To explore relationships between WWB and staff outcomes by evaluating the PoC construct validity within an international nursing population in the post-pandemic context.

Methods: Nursing staff (n = 2546) from 128 facilities participated. Mixed methods, including thematic analysis, descriptive statistics, regression analyses, and path analysis, were employed to develop a WWB outcome model. Reliability was assessed with Cronbach's alpha, and construct validity was assessed through exploratory factor analysis.

Results: The final model had good model fit, explaining 76% of nurse WWB. Feeling rewarded for work well done, total direct effect had a positive relationship with job satisfaction (β = 0.415, p = < 0.001) and a negative effect on intent to leave (β = -0.242, p = 0.003). Job satisfaction total direct effect negatively related to intent to leave (β = -0.584, p = < 0.001). Relationship direction, strength, and significance varied by country. Caring of manager explained one-third of WWB. Job satisfaction subscales explained intent to leave (25.2%). The PoC showed high reliability (Cronbach's alpha ≥ 0.80), and robust construct validity was confirmed through exploratory factor analysis (KMO = 0.950, factor loadings ≥ 0.40).

Linking evidence to action: Conclusions suggest that understanding job satisfaction and intent to leave predictors is complex, requiring complex models to globally and contextually explain nurse WWB outcomes.

Background: Assumption of an informal caregiving role is often circumstantial and unexpected. Older informal caregivers (OICGs), those aged 60 years and above, exhibit impaired coping and considerably poorer psychological and physical health outcomes due to the demanding nature of the caregiving role. Digital caregiving tools were found to be effective in enhancing caregivers' mental health.

Aims: To synthesize randomized controlled trials related to digital caregiving tools and aids available for OICGs and to study their impact on OICG's key outcomes, including burden, depression, and quality of life (QoL).

Methods: Literature from 7 electronic databases from January 1, 2006 to April 1, 2024 was reviewed: Medline, PsycINFO, Embase, Cochrane, Scopus, CINAHL, and Web of Science. The protocol for this review is registered in PROSPERO (CRD42023493282).

Results: Eight randomized controlled trials were included for analysis. None of the included trials purposefully recruited or catered to OICGs. There was low quality evidence suggesting that the use of digital tools may slightly reduce caregiver burden (SMD -0.42, CI [-0.66, -0.18]) and depression (MD -2.5, 4.19 lower to 0.82 lower). For QoL, moderate quality evidence suggests that digital tool use will likely result in a slight improvement in QoL (SMD 0.21, CI [-0.18, 0.6]). Within the retrieved literature, complex digital interventions were associated with higher dropout rates in OICGs. There is also a trend of OICGs caring for dependents with neurodegenerative diseases.

Linking evidence to action: This systematic review highlighted the increased uptake and benefits of digital tool use by the OICG population. Nursing research on technology-enabled caregiving innovations should include an in-depth consideration of their target audience's demography, offering simplified, age-friendly features as necessary.

Background: Dissemination of results following clinical trials and community-based research provides value to participants and communities beyond the intent of the primary study. Organizations participating in multi-site research may see similar benefits if local results are shared; however, it is not standard practice. Evaluation of the impact of results sharing in multi-site research is needed.

Aims: To assess the benefits of organizational participation in a multi-site pediatric pain study when results were shared, identify how sites applied local results, and the outcomes of participation, including subsequent improvement efforts and scholarship.

Methods: Following data collection for a 12-hospital multi-site study, site research teams shared their experiences collecting the data and lessons learned. All sites received a packet with overall results, their local results, and an interpretation guide. 4 years later, the sites were surveyed about initiatives that were undertaken because of the primary study.

Results: Following data collection, 10 of 12 sites described unanticipated benefits of participation, including identifying gaps and strengths of documentation, generation of new practice questions, and identification of new opportunities for improvement. Seven sites answered the follow-up survey 4 years later. Most sites (n = 6, 85.7%) used their data to inform multiple practice changes (M = 2.8, SD 0.75), including changes in pain documentation (n = 5, 83.3%), assessment (n = 4, 66.7%), policy (n = 4, 66.7%), and treatments (n = 4, 66.7%). Five sites reported an average of 2.4 (SD 1.14) additional activities stimulated by participation, but not directly due to data. Three sites used results for American Nurses Credentialing Center Magnet Recognition applications.

Linking evidence to action: When multi-site investigators provide local data, organizations see long-term benefits, including new collaborations, quality improvement efforts, and research. Additional exploration of collaborative strategies between investigators and practice settings in multi-site research is needed for pediatric pain management and beyond.

Background: Mechanical ventilation (MV) is a critical intervention for critically ill patients in intensive care units (ICUs). However, extended durations of MV are associated with adverse outcomes such as prolonged ICU stays, elevated mortality rates, and increased health-care costs. To address these challenges, nurse-led weaning protocols have been identified to be a promising strategy for enhancing the weaning process. This approach leverages the advantages of nurses' closer patient monitoring and more stringent adherence to protocols relative to physicians.

Aim: This systematic review and meta-analysis evaluated the safety and efficacy of nurse-led weaning protocols compared with physician-directed weaning, specifically in terms of reducing MV duration and improving patient outcomes in ICU settings.

Methods: A comprehensive search of databases was conducted to identify randomized controlled trials (RCTs) that compared nurse-led weaning protocols with physician-directed weaning. A total of 6 RCTs met the inclusion criteria, encompassing 1278 patients across various countries. Data on MV duration, failed weaning rates, in-hospital mortality, and ICU length of stay were extracted and analyzed using meta-analytic techniques.

Results: The meta-analysis revealed that nurse-led weaning protocols significantly reduced MV duration by 8% to 45% across the included studies. However, no significant differences were observed in the rates of failed weaning (risk ratio [RR]: 0.96; 95% confidence interval [CI] [0.63, 1.47]; p = 0.86) or in-hospital mortality (RR: 1.06; 95% CI [0.85, 1.33]; p = 0.58). Additionally, patients in the nurse-led group experienced a shorter ICU length of stay, with a standardized mean difference of 0.62 (p < 0.01).

Linking evidence to action: Nurse-led weaning protocols are a safe and effective strategy for reducing MV duration without compromising patient safety. The implementation of these protocols has the potential to enhance ICU operational efficiency and reduce health-care costs, thereby reinforcing the critical role of nurses in leading interventions in critical care environments.

Background: The COVID-19 pandemic has exacerbated the global nursing shortage, leading to increased turnover intentions among nurses due to heightened workplace stress, burnout, and job dissatisfaction. This study investigates the mediating effects of burnout and job satisfaction on the relationship between professional identity, occupational stress, and nurses' turnover intentions. Additionally, it explores the impact of socio-demographic factors on these relationships in the post-pandemic era.

Methods: A cross-sectional study of 338 nurses across 4 hospitals in Israel was conducted between June 2023 and January 2024. Self-reported questionnaires were utilized to measure turnover intention using the Turnover Intention Scale, with professional identity and occupational stress as predictors and burnout and job satisfaction as mediators. A fixed effect path analysis approach was employed to assess the hypothesized mediation model, controlling for hospital-level variance and socio-demographic variables.

Results: The findings revealed that professional identity was negatively associated with burnout (β = -0.26, p < 0.001) and positively associated with job satisfaction (β = 0.25, p < 0.001). Occupational stress was positively associated with burnout (β = 0.57, p < 0.001) and negatively associated with job satisfaction (β = -0.42, p < 0.001). Burnout (β = 0.35, p < 0.001) and job satisfaction (β = -0.10, p = 0.025) were both significantly associated with turnover intentions. Mediation analysis indicated that job satisfaction and burnout fully mediated the relationship between professional identity and turnover intentions, and partially mediated the relationship between occupational stress and turnover intentions.

Linking evidence to action: The study highlights that professional identity mitigates nurse turnover by increasing job satisfaction and reducing burnout, while occupational stress drives turnover intentions by increasing burnout and decreasing job satisfaction. Tailored interventions aimed at enhancing professional identity and addressing occupational stress, particularly in light of pandemic-related challenges, are essential for improving nurse retention and well-being in the post-pandemic era.

Background: Staff shortages as well as poor nurse and clinician well-being are currently an epidemic within the health workforce and pose a substantial risk to healthcare quality and safety. Creating a strong wellness culture is one strategy to address the issue, but there is a paucity of research that investigates how other types of organizational cultures are related to nurses' mental health and well-being.

Aims: To describe the relationships among innovation culture, wellness culture, evidence-based practice (EBP) culture, and clinician well-being (healthy lifestyle behaviors, burnout, depression, stress, anxiety, and job satisfaction).

Methods: A cross-sectional descriptive correlational study design was used with a convenience sample of nurses, physicians, and allied health professionals from a Magnet-recognized health system in the United States. An online wellness survey collected data with the variables of interest using valid and reliable scales. Pearson's r correlations assessed the relationship among innovation culture, wellness culture, and EBP culture. A series of regressions examined if each type of culture was associated with clinician well-being.

Results: The analytic sample included 199 respondents. Innovation culture had a strong and significant correlation (p ≤ 0.0001, r > 0.7) with both clinician well-being and EBP cultures. Wellness and EBP cultures also were correlated (p ≤ 0.0001, r = 0.592). Higher ratings of each type of culture were significantly associated with higher job satisfaction as well as higher ratings of both mental and physical health. Further, higher ratings on each culture scale were significantly associated with reduced stress, anxiety, depression, burnout, and job satisfaction.

Linking evidence to action: This is the first study to establish correlations among innovation culture, EBP culture, and wellness culture as well as to find that these three types of cultures are associated with clinician well-being outcomes and job satisfaction. Since culture strongly impacts the healthcare workforce's mental health and job satisfaction, leaders need to focus on an organizational-wide strategic approach that builds a sustained culture that supports clinician well-being, innovation, and EBP.

Background: The Evidence-Based Practice Mentoring Program (EBPMP) is a 12-month initiative offered at a large acute care facility in Hawai'i. The EBPMP provided two layers of mentoring, with experienced evidence-based practice (EBP) faculty supporting EBP mentors who, in turn, guide mentees or novice EBP team members.

Aim: The primary aim of this pilot initiative was to promote the Value, Implementation, and Knowledge of EBP.

Methods: A literature search, appraisal, and synthesis were conducted, and the results informed the development of the EBPMP. The pilot was initiated from July 2022 to June 2023 and consisted of a nurse-led interdisciplinary team. Outcome measurements involved the Quick-EBP-VIK survey, a faculty-developed Self-Confidence in EBP Mentoring Skills Inventory, feasibility measures, and the program cost.

Results: Pre- and post-EBPMP outcome measures demonstrated that the mentors' and mentees' scores increased in the domains of EBP Value (11.14%), Implementation (80.87%), and Knowledge (99.46%). Mentors' self-confidence increased over time (Baseline: 0.06, 6-months: 2.33, 12-months: 3.03). Feasibility measures showed that the majority (80%) of the mentees were able to complete > 75% of assigned modules by the due date, most (80%) spent 1-2 h to complete the didactic modules, and the monthly mentee meeting attendance rate was 88.1%. The program cost was 1.2 FTE per month.

Linking evidence to action: EBP mentoring was an effective strategy for supporting staff's EBP development. Continued leadership support is crucial to the EBPMP's success and sustainability. The EBPMP may be an effective strategy to contribute to the development of an organization's culture of EBP.