Worldviews on Evidence-Based Nursing最新文献

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.

Background: Coronary artery disease (CAD) is a major health problem of atherosclerotic cardiovascular (CV) disease and early intervention is regarded important. Given the proven effect of a lifestyle intervention with nursing telephone counselling and mHealth use in health care, yet the comparisons of both support are lacking, this study is proposed.

Objectives: This study aimed to compare the effects of a coronary artery disease (CAD) support program using a mobile application versus nurse phone advice on exercise amount and physical and psychological outcomes for clients at risk of CAD.

Methods: A prospective randomized controlled trial was conducted. Ethical approval was obtained. Two-hundred and twenty-six clients were screened, and a total of 168 clients who were at risk of CAD and routinely used smartphones were randomized into the app support group (App group) or the nurse phone advice (NPA) group. Although all participants received the same health talk delivered by a cardiac nurse at the community center, the App group received additional CAD app support, whereas the NPA group received nurse phone advice for 20 min monthly. The app content comprised (1) CAD knowledge in 10 modules, (2) individual exercise records with their own goals and health measures, and (3) a chest pain action list. The intervention lasted for 3 months. Health outcome data were collected at baseline (T0) and after 1 (T1) and 3 (T2) months. The outcomes were the total amount of exercise (primary outcome), self-efficacy in illness management, perceived stress, and CAD risk profile (body weight, body mass index, and lipid concentration). Generalized estimating equation models were used to assess differential changes in all outcomes within 3 months.

Results: The attrition rates at 3 months were 3.49% and 9.30% for the App and NPA groups, respectively. The App support group was superior to the NPA group in significantly increasing total exercise amount and reducing body weight, waist circumference, triglycerides, and increased self-efficacy in illness management.

Linking evidence to action: The result provides further insights of app development to support health promotion programs for community-dwelling adults at risk of CAD.

Background: Previous research has demonstrated the effectiveness of virtual reality (VR) technology in many application areas. However, there is a clear gap in the literature regarding its effects on depression and anxiety in older adults with chronic diseases.

Aims: This review aimed to assess the effectiveness of VR interventions for depression and anxiety in older adults with chronic diseases.

Methods: Seven electronic databases were systematically searched from their inception to April 9, 2024. Two researchers evaluated methodological quality using RoB (version 2.0) and performed meta-analyses using RevMan (version 5.4) and Stata (version 16.0) software.

Results: This review included 19 randomized controlled studies. Meta-analysis revealed that VR significantly improved depression (standard mean difference [SMD] = -0.67, 95% confidence interval [CI] [-0.90, -0.45], p < .00001) and anxiety (SMD = -0.76, 95% CI [-0.95, -0.57], p < .00001) in older adults with chronic diseases, improved their quality of life (SMD = 0.39, 95% CI [0.17, 0.61], p = .0006) and positive emotions (SMD = 5.65, 95% CI [3.61, 7.69], p < .00001), and relieved stress (SMD = -1.08, 95% CI [-1.52, -0.64], p < .00001). However, the difference in self-efficacy was statistically non-significant (SMD = 1.01, 95% CI [-0.48, 2.50], p = .19).

Linking evidence to action: The results of this systematic review provide important evidence for developing interventions to improve the mental health of older adults with chronic diseases.

Background: Ongoing nasogastric tube (NGT) testing guidelines aim to prevent the use of a displaced NGT; however, guidelines vary, and the relative risks and benefits of different testing methods are unknown.

Aim: To observe methods used in two hospitals to confirm ongoing NGT position and any differences in outcomes.

Methods: Data were collected prospectively from the medical records of 256 patients with NGTs across a London National Health Service Trust and a Brisbane hospital. These hospitals use different methods of ongoing NGT position confirmation, predominantly pH tests and external tube length measurement (ETLM), respectively. Statistical models explored outcomes associated with test results, including confirmation of NGT position, number of X-rays, and delivery of enteral nutrition and medication.

Results: Most ongoing NGT position tests in London were pH (83.4%) and in Brisbane were ETLM (98.6%). Overall, eight NGTs were reported as displaced, of which six were identified by oral cavity inspection. One hundred and eighty-five (31.8%) ongoing pH tests failed to confirm that the NGT remained correctly positioned. Failed ongoing NGT position tests were associated with significantly more X-rays, which resulted in disruptions to enteral nutrition and medications in London (n = 64, 47.1%) compared to Brisbane (n = 9, 7.5%) (p < 0.001).

Linking evidence to action: Overall, NGT displacement occurred rarely. Compared to ETLM, pH tests frequently failed to confirm that the tube remained correctly positioned, resulting in X-rays and disruptions to enteral nutrition and medications. Oral cavity inspection alongside ETLM could be a safe alternative method to pH testing but requires more research to examine generalizability.

Background: Existing interventions targeting perceived stress in older adults exhibit a diverse range of types and inconsistent effectiveness. It remains unclear which interventions are most effective for older adults in terms of perceived stress, anxiety, depression, and cortisol levels.

Aims: This study aimed to assess the effectiveness of interventions targeting perceived stress in older adults for perceived stress, depression, anxiety, and cortisol levels.

Methods: A systematic search was conducted using PubMed, EMBASE, Web of Science, Cochrane, CINAHL, PsycINFO, CNKI, SinoMed, VIP, and WanFang databases on January 9, 2024 for randomized controlled trials (RCTs). Pairwise meta-analysis and network meta-analysis (NMA) were conducted using Review Manager v.5.4 and Stata v.16.0.

Results: A total of 23 RCTs were included. The reminiscence therapy had the highest probability (98.6%) of being the most promising intervention to reduce perceived stress, followed by exercise (68.1%) and yoga (56.1%). The included interventions had benefits on cortisol levels (SMD = -0.30; 95% CI [-0.54, -0.06]; p = 0.01). Moreover, exercise showed positive effects on reducing depression (SMD = -1.84; 95% CI [-3.69, 0.01]; p = 0.05), and it was ranked as the most promising method for depression or anxiety. Health education also reduced anxiety symptoms compared to control group (SMD = -0.77; 95% CI [-1.27, -0.26]; p = 0.03).

Linking evidence to action: Interventions targeting perceived stress had overall benefits in reducing perceived stress in older adults, especially reminiscence therapy and exercise. Exercise and health education each had potential benefits for alleviating depression and anxiety, respectively. More high-quality RCTs are needed to obtain more robust conclusions.

Background: Since 2019, invasive cancer diagnoses in people younger than 50 years old have increased by 12.8%, which impacts people of childbearing age. Currently, family interventions for parents with cancer primarily focus on the impacted parent communicating the initial cancer diagnosis or at end-of-life messages with their dependents through in-person interventions. Limited web-based interventions have been developed to increase communication across all family members (e.g., parents with cancer with co-parents or children with their parents) about communicating the impact of cancer on the individual's and family's well-being across the cancer trajectory, a key gap to improved outcomes in this population.

Aim: This scoping review aimed to comprehensively summarize family communication interventions designed for a parent with cancer who has dependents and to identify and analyze any knowledge gaps regarding family communication interventions in this population.

Methods: A comprehensive informationist-assisted search was completed in seven databases. Two reviewers independently performed title/abstract reviews and full-text reviews within the Rayyan software system. Two reviewers performed data extraction.

Results: Thirty-five articles were included, and 24 different interventions were investigated. Most articles were published by European teams (45%). Fourteen articles (40%) evaluated interventions that included the entire family, seven (20%) reported family theories, and three (9%) used a web-based delivery. Most articles focused on the outcomes of the parent with cancer and the outcomes of their dependents (31%). Most interventions aimed to increase parent communication with dependents at end-of-life (43%) or at early diagnosis (32%) in the breast cancer population.

Linking evidence to action: In-person communication interventions have been developed to communicate with dependents about an early or terminal cancer diagnosis. The impact of the intervention on parents with cancer and their children's outcomes were also investigated. No web-based interventions have been published that focus on the entire family, include family-level outcomes, or completed dyadic analysis across the family on the family-level outcomes to determine relationships. Web-based interventions are needed to address communication challenges for all family members affected by a cancer diagnosis, and equitable access to such interventions should be supported.

Background: Peripherally inserted central catheters (PICCs) are commonly used for extended intravenous therapy but are associated with a significant risk of bloodstream infections (BSIs), which increase morbidity and healthcare costs.

Aim: The aim of this study was to identify patients at high risk of developing PICC-related bloodstream infections (PICC-RBSIs) to establish new and more specific targets for precise prevention and intervention.

Methods: A search was conducted from the earliest available record to May 2024 among the following databases: Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Scopus, and Chinese National Knowledge Infrastructure (CNKI). Hand searching for gray literature and reference lists of included papers was also performed. We assessed the quality of the studies using the Newcastle-Ottawa Scale (NOS) checklist. Two reviewers screened all the retrieved articles, extracted the data, and critically appraised the studies. Data analysis was performed using RevMan statistical software.

Results: A total of 20 cohort studies involving 51,907 individuals were included in the analysis. The statistically significant risk factors identified were hospital length of stay, line type (tunneled), history of PICC placement, multiple lumens, previous infections, chemotherapy, total parenteral nutrition, hematological cancers, delays in catheter care, local signs of infection (e.g., localized rashes), previous BSIs, and diabetes mellitus. Due to high heterogeneity among studies regarding previous BSIs, this factor was excluded from the final predictive model, while all other risk factors were included.

Conclusions: The present meta-analysis identified risk factors for PICC-RBSIs and developed a predictive model based on these findings, incorporating 10 risk factors that integrate both patient-specific and procedural factors.

Linking evidence to action: Integrating the risk prediction model for PICC-RBSI into clinical guidelines and training is essential. Healthcare providers should be trained to use this model to identify high-risk patients and implement preventive measures proactively. This integration could enhance personalized care, reduce infection incidence, and improve patient outcomes. Future research should update the model with new risk factors and validate its effectiveness in diverse clinical settings.