Worldviews on Evidence-Based Nursing最新文献

Background: Patients with chronic kidney disease on hemodialysis experience complex symptom clusters that impact their quality of life. Simplifying symptom management is essential to improve patient care and outcomes. However, there is no comprehensive evaluation of these simplification methods in current literature.

Aim: To evaluate and synthesize strategies for simplifying the symptomatology associated with hemodialysis to improve patient outcomes and management practices.

Methods: We conducted a systematic review. We performed a comprehensive literature search across Pubmed, CINAHL, Embase, Web of Science, Scopus, CNKI, VIP database, and Wanfang in April 2024. Data synthesis was narrative due to the heterogeneity of the methodologies. Studies were selected based on predefined criteria focused on symptom simplification strategies among adult hemodialysis patients. Articles were retrieved and assessed for relevance and quality through April 2024.

Results: We identified 18 eligible studies from an initial pool of 18,324 records, focusing on variable-centered, person-centered approaches and approaches to identifying the main symptoms to symptom simplification. The studies varied significantly in their methodological quality and findings but commonly reported symptom clusters that correlated with poor patient outcomes.

Linking evidence to action: This review underlines critical areas for advancement in hemodialysis patient care through strategic symptom management integration. Our findings emphasize the necessity of implementing simplified symptom assessment protocols in routine clinical practice, thereby enhancing patient engagement and outcomes. Additionally, the results advocate for ongoing research into personalized care approaches, underscoring the potential for these strategies to decrease symptom burden significantly. These insights should inform both policy and educational programs, encouraging the adoption of standardized practices across healthcare systems. Moreover, the study highlights the need for management strategies that align with patient-reported outcomes, fostering a more patient-centered approach in healthcare settings. Ultimately, this evidence should guide educational efforts to better equip healthcare providers with the tools necessary for effective symptom management in hemodialysis care.

Trial registration: PROSPERO: CRD42023473789.

Background: Evidence-based practice (EBP) attributes are associated with improved patient care outcomes. There is a paucity of knowledge on pediatric nurses' attributes based on their clinical sub-specialties.

Aim: To investigate the relationships between pediatric nurses' EBP attributes and background variables, including their academic degree, years of experience, and clinical specialty.

Methods: A convenience sample of 185 nurses participated in this descriptive, cross-sectional study. The electronic surveys included 11 background questions and the short-versions of the EBP Beliefs Scale, Organizational Culture and Readiness Scale, and EBP Implementation Scale.

Results: EBP belief scores were notably higher in pediatric nurses in neonatology, critical care, and among nurse leaders. No statistically significant difference was found in EBP organizational culture among nurse leaders, clinical nurses, and advanced practice nurses. EBP implementation was favorable in neonatology, acute care, and nurse leaders. No significant results were found in EBP attribute scores related to nurses' age, academic nursing degree, or years of experience.

Linking evidence to action: This study confirmed findings from prior studies acknowledging the impact nurse leaders have on creating and sustaining a favorable EBP culture and implementation science. Organizational attributes such as Magnet status, a shared governance structure, support for specialty certification, and EBP mentorship also reinforce nursing EBP attributes. Further research should investigate unit-level strategies and measure the impact on pediatric patient care outcomes.

Background: Previous studies regarding mind-body exercise among people with breast cancer mostly focused on one type of mind-body exercise and provided conflicting results.

Aims: This paper aims to systematically synthesize the evidence hierarchy and examine the credibility of previous meta-analyses of different types of mind-body exercises.

Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, and Epitemonikos from database inception to February 2nd, 2024, for meta-analyses of randomized controlled trials. Included meta-analyses examined the effects of mind-body exercises on at least one outcome of health-related quality of life, cancer-related fatigue, depression, anxiety, and sleep quality in breast cancer patients. The random effects estimates (Hedges'G), 95% prediction interval, small study effect, and excess significance bias were calculated. Furthermore, we categorized meta-analyses based on the evidence credibility criteria and assessed quality using A Measurement Tool to Assess Systematic Reviews 2.

Results: The umbrella review included a re-analysis of 16 meta-analyses of 9 articles including 134 randomized controlled trials involving 9469 breast cancer patients and survivors. We identified 3 articles as "low" quality and 6 articles as "critically low" quality. Convincing evidence supported the effectiveness of Yoga intervention in reducing depression symptoms (G = -0.77, 95% Confidence Interval [-0.93, -0.61]). However, 11 meta-analyses were supported by weak evidence (1 for Qigong alleviated depression, 4 for Qigong, Baduanjin, Tai Chi Chuan, and Yoga improved health-related quality of life, 3 for multiple mind-body exercises, Tai Chi Chuan, and Yoga reduced cancer-related fatigue, 2 of Baduanjin and Yoga reduced anxiety, as well as 1 of Yoga improved sleep quality).

Linking evidence to action: Mind-body exercises, especially yoga, may be beneficial for improving health-related quality of life and mental health for breast cancer patients. Further high-quality interventions investigating diverse mind-body exercise interventions are warranted to ascertain the effectiveness of health-related quality of life and mental health outcomes.

Background: Prior international collaborative studies indicated that job satisfaction, a factor of nursing work wellbeing (WWB), is closely linked to retention, with notable cross-country differences. However, limited regional comparisons, especially between Central and Eastern Europe (CEE), North America, and the Middle East and North Africa (MENA), restrict understanding of nurse wellbeing and retention regional impacts, limiting tailored strategy development.

Aims: This secondary analysis study compared the effects of region on nursing WWB and job satisfaction factors in CEE, MENA, and North America, aiming to identify those CEE region-specific predictors associated with and effects on job satisfaction and, in turn, WWB.

Methods: CEE (n = 1616), MENA (n = 1562), and North America (n = 1386) data were analyzed using descriptive and linear regression analytics (p < 0.001). The CEE sample included nursing staff from Croatian (n = 301), Polish (n = 215), Serbian (n = 489), and Slovenian (n = 611) nurses and nursing assistants. Six job satisfaction factors were examined: coworkers, patient care, participative management, autonomy, professional growth, and organizational rewards.

Results: The CEE region reported statistically significant lower mean scores and negative effects across all six job satisfaction factors compared to MENA and North America. Satisfaction with coworkers had the largest effect within the CEE region when compared to MENA and North America (ϐ = -0.26), while satisfaction with participative management had the smallest regional effect (ϐ = -0.10). Findings informed operational discussions for CEE-targeted retention interventions.

Linking evidence to action: Job satisfaction subscale factors facilitate the identification of empirically- and theoretically-informed operational actions to improve CEE nursing job satisfaction as an important factor of WWB and contribute to nursing retention.

Background: Nationally and in Hawaii, nurses are in crisis with high rates of distress, burnout, and intent to change jobs. Organizations need evidence-based strategies to support nurse well-being.

Purpose: Informed by the National Academy of Medicine Factors Affecting Clinician Well-Being Model, this study aimed to identify individual and external factors associated with nurses' well-being.

Methods: In December 2023, an online survey of hospital-based nurses from two major hospitals, representing various unit types, was conducted in Hawaii. Survey measures included individual (role, personal characteristics, skills/abilities) and external factors (organizational, environmental) that support clinician well-being. The outcome (well-being) was measured using the well-being index (scores ranged from -2 [excellent] to 9 [very poor]). The analysis included general linear modeling with stepwise backward selection.

Results: The final sample included 552 nurses. Years of experience were evenly distributed, and the majority worked ≥ 36 h/week (85.9%), worked in intensive-focused or other specialties units (53.8%), and identified as female (87.3%). The nurses identified their race/ethnicity as 27% Filipino, 23% White, 14% Japanese, 11% Other Asian, 6.1% Hispanic, 5.1% Native Hawaiian/Pacific Islander (NHPI), and 14% mixed or other race. The average well-being score was 2.8 (SD = 2.3). NHPI had the lowest (Mean ± SD = 2.2 ± 2.2), and Filipino and White nurses had the highest well-being scores (3.0 ± 2.2; 3.0 ± 2.0, respectively), although no significant racial/ethnic difference was found. Several internal and external factors were significantly associated with well-being. For example, working ≥ 36 h/week, reports of experienced burnout, having primary caregiving responsibility outside of work, lower self-reported physical health, and the experience of workplace violence all increased average well-being scores (worsened well-being). In contrast, having higher personal resilience, no leadership responsibilities, the belief that their organization is responsive to complaints and concerns, and appropriate ancillary staff to support their work all decreased average well-being scores (improved well-being).

Linking evidence to action: Healthcare organizational leaders and policymakers must urgently correct system issues contributing to burnout, suboptimal mental health, decreased well-being, and attrition among nurses. Healthcare organizations should cultivate wellness cultures and provide infrastructure that offers evidence-based interventions to support nurses' well-being.

Background: Female patients with an acute cardiovascular event face a care disparity due to implicit bias (IB) by clinical providers in the emergency department (ED).

Objective: The objective of this study is to evaluate and compare the effects of IB training on clinical practice change in the cardiac care of men versus women through education on IB, comparing attitudes of clinicians pre- and post-education. The implementation of the evidence-based practice project included 30 days after education. Attitudes and perceptions of the IB training were measured with a 10-item survey and open-ended feedback on the education for future use.

Outcomes: The Wilcoxon signed-rank test demonstrated significant increases in staff knowledge post-education. Pearson chi-square tests used to evaluate educational effects for before and after education showed that younger female patients (under 50 years of age) had evidence of pre/post differences in frequency of electrocardiogram tests and desired changes in troponin lab assessments. Before the education, evidence of gender difference disparities, except for EKG testing and troponin labs for older patients, existed. Post-education, evidence of gender differences in medications used for younger patients was also revealed.

Implications for practice: Education on IB creates awareness potentially altering cardiovascular care positively.

Background: Unsupervised exercise is beneficial for pregnant women, and ongoing exercise may affect the course of pregnancy. Therefore, promoting continued exercise among women is critical.

Aims: To implement a home-based exercise program, guided by the COM-B model theory, and assess its effects on depression, sleep quality, and sense of control among pregnant women.

Methods: Pregnant women (N = 100) were selected and randomly assigned in a 1:1 ratio to either the intervention or the control group. Both groups received exercise instruction. The intervention group received an additional intervention based on the COM-B model theory. Depression and sleep quality were evaluated at 28 and 35 weeks of gestation, while women's sense of control was assessed at 35 weeks of gestation.

Results: In total, 91 participants completed the study, with 100 included in the intention-to-treat analysis. The intervention group showed improvement in depression at 28 and 35 weeks of gestation and in sleep quality at 35 weeks. Although there was no significant difference in the sense of control between the groups, the intervention group demonstrated better emotional control.

Linking evidence to action: A theory-guided exercise intervention shows benefits in improving third-trimester depression, sleep quality, and emotional control. Therefore, exercise programs during pregnancy should consider to encompass capacities, opportunities, and motivations to encourage exercise behavior.

Background: Unlike other medical practitioners, nurses working in pediatric intensive care units face uniquely challenging workplace conditions because they care for preterm newborns and critically ill patients. These workplace challenges led to increased compassion fatigue (i.e., burnout and secondary traumatic stress) and decreased compassion satisfaction. Compassion fatigue and compassion satisfaction strongly influence the quality of care and patient outcomes, and these need to be addressed through effective interventions such as mindfulness-based interventions.

Aim: This study aimed to examine the impact of a brief mindfulness-based intervention on compassion fatigue and compassion satisfaction among pediatric intensive care nurses.

Methods: A quasi experimental study with a pretest posttest design was used to recruit 204 nurses: 102 in the intervention group and 102 in the control group with randomization by hospital (n = 4). The brief mindfulness-based intervention was delivered over 6 weeks. Data were collected using a demographics questionnaire and the Professional Quality of Life Scale, Version 5.

Results: The intervention group's mean scores of burnout and secondary traumatic stress were significantly lower postinterventions compared with the control group. Similarly, the mean compassion satisfaction score for the intervention group indicated a significant improvement post-intervention compared with the control group. Additional evidence for the effectiveness of the intervention was the disappearance of low compassion satisfaction, high burnout, and high secondary traumatic stress categorizations postintervention in the intervention group, contrary to the control group.

Linking evidence to action: Implementing brief mindfulness-based interventions can improve pediatric intensive care nurses' well-being by reducing burnout and secondary traumatic stress while enhancing compassion satisfaction. By using the study's findings, nurse managers can make these practices essential for high-quality care and effective workforce management.

Trial registration: ClinicalTrials.gov identifier: ACTRN12622000389707.

Background: Healthy aging has become increasingly important owing to the rapidly growing population of older adults globally, and results from the complex interplay of multiple characteristics such as depression and quality of life. Several countries have included peer-led interventions in their health policies to promote healthy aging. Given the growing evidence for these interventions, determining their comparative effectiveness is vital and warranted.

Aim: The aim of this study was to examine the relative effectiveness of peer-led interventions on the depression and quality of life of community-dwelling older adults.

Methods: A systematic review and network meta-analyses were performed. The meta-analysis was performed using random-effects models. Additionally, subgroup, meta-regression, and frequentist network meta-analyses were conducted. The protocol was registered with PROSPERO (CRD 42023492659).

Results: Twelve studies with depression outcomes and 11 studies with quality-of-life outcomes were included. The effect sizes for depression and quality of life were moderate and small, respectively. For depression, face-to-face interactions and intervention duration were moderating factors. For quality of life, intervention provider was a moderating factor. The combined peer-nurse intervention was shown to have a large effect on quality of life, whereas interventions provided by professionals other than nurses or provided only by peers had a small effect. A ranking analysis found that the most effective intervention for increasing quality of life was the simultaneous involvement of both healthcare professionals and peers. The provision of education and exercise interventions showed a higher ranking than goal setting in the leading group.

Linking evidence to action: The peer-led interventions were sufficient for depression. The effectiveness for improving quality of life may increase when involving both peers and healthcare professionals, particularly nurses. Nursing and health policymakers could establish distinct strategies depending on whether the goal of peer-led interventions is to improve quality of life or alleviate depression for older adults.