Worldviews on Evidence-Based Nursing最新文献

Background: Cancer is a global public health concern that causes psychosocial and spiritual challenges in those who suffer from it and their family caregivers. Meaning-centered interventions have a positive impact on improving anxiety and depression in patients with advanced cancer. However, the impact of meaning-centered interventions on existential distress of patients with cancer and family caregivers' mental health is still unclear.

Aims: To examine the efficacy of meaning-centered interventions in alleviating existential distress, enhancing quality of life, and fostering a sense of meaning among cancer survivors and their family caregivers.

Methods: This systematic review and meta-analysis were conducted according to the Preferred Reporting Item for Systematic Reviews and Meta-analysis 2020 statement. A comprehensive search was conducted from inception until September 2023 across nine databases: PubMed, Embase, Web of Science, PsycINFO, The Cochrane Library, CINAHL, Scopus, WANFANG, and CNKI. Heterogeneity testing and meta-analyses were conducted using Review Manger 5.3. We calculated standard mean deviations and 95% confidence intervals and presented forest plots for assessing intervention effects. Two reviewers independently evaluated the risk of bias of all included articles. STATA 17.0 was used for publication bias analysis.

Results: The review included 25 studies with 2399 participants, and 22 were included in the meta-analysis. Meaning-centered interventions enhanced quality of life, alleviated existential distress, and reduced depressive symptoms and cancer-related fatigue. They did not affect spiritual well-being. The subgroup analysis showed that the individual form and long-term intervention (≥3 months) enhanced the quality of life in cancer survivors. Meaning-centered interventions reduce depression in advanced cancer survivors more than in mixed-stage cancer survivors. Meaning-centered interventions significantly enhanced benefit finding for family caregivers.

Linking evidence to action: Meaning-centered interventions may improve mental health for patients with cancer and their family caregivers. Future research must include diverse cultural perspectives to understand the impact of meaning-centered interventions on various groups.

Background: High-stress environments, heavy workloads, and the emotional demands of patient care, which are common challenges faced by nurses, are factors that can lead to burnout. Shift work can make traditional burnout interventions costly and difficult to implement. Artificial intelligence (AI) could offer solutions that are less constrained by time, resources, and labor.

Aim: To investigate the effectiveness of an AI-assisted intervention in reducing nurse burnout.

Methods: A single-blind, three-group, randomized controlled trial of 120 nurses (40 per group) was conducted from June 2023 to July 2023. The AI-assisted tailored intervention included two 2-week programs, delivering one of four programs to the intervention group: mindfulness meditation, acceptance commitment therapy, storytelling and reflective writing, or laughter therapy. The experimental group received tailored programs based on demographic and work-related characteristics, job stress, stress response, coping strategy, and burnout dimensions (client-related, personal, and work-related). Control Group 1 self-selected their programs, while Control Group 2 was provided with online information on burnout reduction. Primary outcomes, client-related, personal, and work-related burnout, were measured at baseline, week 2, and week 4. Secondary outcomes, job stress, stress responses, and coping strategies, were assessed at baseline and week 4. Data were analyzed using ANOVA, repeated measures ANOVA, and the Scheffé test for post hoc analysis.

Results: The experimental group showed significant reductions in client-related burnout (F = 7.725, p = 0.001) and personal burnout (F = 10.967, p < 0.0001) compared to the other groups. Significant effects of time and time × group interactions were observed for client-related and personal burnout, with time effects noted for work-related burnout. Stress response reduction was highest in Control Group 1, followed by the experimental group and Control Group 2 (F = 3.07, p = 0.017).

Linking evidence to action: AI algorithms could provide tailored programs to mitigate nurse burnout, particularly in client-related and personal burnout. Reducing nurse burnout could contribute to the quality of care.

Trial registration: This trial is registered with the Clinical Research Information Service (KCT0008546).

Background: Managing medication interruptions is considered one of the biggest dilemmas for nurses in clinical settings. To improve medication safety, it was imperative to conduct a systematic review to get a deeper understanding of nurses' experiences with medication interruptions.

Aims: A systematic review and qualitative meta-synthesis aimed to explore clinical nurses' experiences of interruption during medication in hospitals.

Methods: Systematic searches were conducted in PubMed, CINAHL, Ovid Medline, Embase, Web of Science, and The Cochrane Library from inception to January 2024. The search strategy included four groups of keywords: (1) qualitative research, (2) nurses, (3) medication interruption, and (4) experience. Critical Appraisal Skills Programme was used to assess the quality of the studies. Meta-ethnography was utilized to synthesize the findings of the included studies.

Results: Nine articles published between 2012 and 2023 were included; the number of participants varied from 5 to 40, aged 20-68 years, and the majority were female. Four synthesized findings were identified as follows: (1) an inevitable part of the routine, (2) a decision-making process, (3) working in a minefield, and (4) coping with interruption.

Linking evidence to action: Nurses embraced interruptions as an inherent component of clinical care. Previous experience and nursing culture, encompassing personal and professional aspects, significantly influence nurses' attitudes toward medication interruptions. It is crucial to incorporate the distinctive work experiences of nurses into techniques aimed at efficiently handling interruptions in future research. The registration number in PROSPERO is CRD42023470276.

Background: Consistent diabetes control is crucial for patients with type 1 diabetes (T1D) to prevent diabetic complications. Analyzing the long-term effects of non-pharmacological interventions can improve diabetes management.

Aim: To examine the long-term effects of non-pharmacological interventions in adolescents and young adults with T1D through a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: The searches, without any year limitations, were conducted in seven databases. Two reviewers independently performed data extraction and risk of bias assessments. The meta-analysis was conducted using the RevMan 5.4 program and R Studio. The study was registered with PROSPERO (CRD42024503185).

Results: A total of 40 studies were included in the systematic review, of which 28 were included in the meta-analysis. Notably, non-pharmacological interventions were effective in improving glycated hemoglobin (HbA1c) at 6 months and self-care at >12 months of follow-up. Subgroup analyses revealed that combined interventions encompassing self-care behavior management, education, and psychological interventions could enhance self-care. Additionally, a combination of face-to-face and telephonic communication was effective in improving HbA1c.

Linking evidence to action: Non-pharmacological interventions are effective in improving HbA1c levels and self-care in adolescents and young adults undergoing long-term treatment. However, few studies have analyzed their effects on cardiovascular disease risk factors. Future studies should investigate the long-term effects of non-pharmacological interventions.

Background: Mind-body medicine (MBM) is an evidence-based intervention associated with trauma and stressful events. The MBM intervention alleviates symptoms of work-related stress and builds resilience by utilizing self-care techniques facilitated in small group settings. Healthcare leaders who experienced traumatic stress through the COVID-19 pandemic may benefit from interventions aimed at their needs.

Aim: We evaluated the effects of a peer support MBM intervention on perceived stress, resilience, well-being, and empathy for nurse leaders and compassionate care leaders.

Methods: A pre-post intervention was conducted via 7 virtual and 2 on-site groups, recruiting from a large multihospital health system in the United States. Participants engaged in an 8-week program facilitated by a certified faculty group leader from The Center for Mind-Body Medicine and engaged in resilience skills building activities along with facilitated sharing. Validated instruments were used to measure outcomes at pre, post, 1 month, and 6 month follow-up intervals. Surveys included open-ended questions for qualitative feedback related to facilitators, barriers, and group experiences.

Results: Seventy-three leaders completed the MBM program, and 22 completed the four research surveys; all qualitative responses were included for feedback. Perceived stress decreased after the intervention (p < .008) and was maintained for 6 months post intervention (p < .005). Resilience increased after the intervention (p < .034) and for 1 month (p < .049) but decreased after 6 months. Qualitative responses showed that time and workload factors were the most significant barrier to participation, while the benefits included protected time with peers, learning well-being skills, and having a safe place to process emotions.

Linking evidence to action: Healthcare leaders face unique challenges, including workplace trauma and crises. Interventions that support their stress response, resilience, and overall well-being should take into consideration the nature of their work, the balance of time demands, and the need for peer support to overcome barriers to sustainable interventions.

Background: Individuals of reproductive age with cancer may experience reproductive concerns (RCs) due to impaired fertility and disrupted family planning, which can negatively impact their quality of life and psychological well-being. There is limited research on interventions that mitigate the negative effects of RCs among individuals with cancer.

Objective: This systematic review aimed to identify and evaluate the effectiveness of interventions developed to mitigate RCs among individuals with cancer.

Methods: This systematic review was conducted following the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of nine English and Chinese electronic databases including PubMed, Cochrane Library, CINAHL Plus, Embase, PsycINFO, Web of Science, Wan Fang Data, Chinese National Knowledge Infrastructure (CNKI), and SinoMed, was conducted for relevant studies from inception to November 2023. Intervention studies designed to mitigate RCs among individuals with cancer were included. Two reviewers independently performed study selection, data extraction, and quality appraisal where JBI Critical appraisal tools were used. Narrative syntheses were conducted to summarize the characteristics and effectiveness of interventions due to high heterogeneity across studies.

Results: Nine studies were included. Interventions were categorized into psychoeducational interventions (n = 6), couple-based interventions facilitating open communication and intimate relationships (n = 2), and mindfulness-based interventions (n = 1). A statistically significant reduction in RCs was observed in five psychoeducational interventions, two couple-based interventions, and one mindfulness-based stress reduction intervention. The effect sizes (Cohen's d) of the interventions on RCs varied substantially from 0.08 to 5.66.

Linking evidence to action: Psychoeducation, couple-based, and mindfulness-based interventions demonstrated promising findings in mitigating RCs among individuals with cancer. However, more randomized controlled trials with larger sample sizes and rigorous designs are warranted to strengthen the current evidence.

Background: Cancer-related fatigue (CRF) emerges as a common symptom in pediatric cancer patients during treatment. Exercise interventions are increasingly being used as CRF interventions to improve CRF in children with cancer.

Aim: The objective of this meta-analysis was to synthesize the best available evidence concerning the effectiveness of exercise interventions for cancer-related fatigue in children with cancer.

Methods: Six databases were extensively searched from inception to December 2023 to identify relevant randomized controlled trials. The risk of bias and methodological quality were assessed using the Cochrane appraisal tool. Pooled effects were calculated using a random-effects model. Heterogeneity was assessed using the I ² test.

Results: Eight trials (n = 465) were finally included. Exercise was statistically more effective than conventional care in improving CRF in children with cancer (SMD = -0.62, 95% CI [-1.21, -0.03]) with high statistical heterogeneity (p = .004; I ²  = 86%). The results of the subgroup analysis showed that intervention duration <12 weeks (p < .05), exercise frequency ≥ 3 times/week (p < .05), and exercise duration <45 min/time (p < .05) were more effective in improving CRF in children with cancer.

Linking evidence to action: Our results suggest that exercise interventions are effective in reducing CRF in children with cancer. We recommend exercise frequency ≥ 3 times/week, exercise duration <45 min/time, and intervention duration <12 weeks.

Background: Evidence-based practices (EBPs) are instrumental in improving patient outcomes and ensuring high-quality nursing care, yet their implementation often encounters substantial barriers. The Iowa Implementation for Sustainability Framework and the Precision Implementation Approach© offer systematic strategies for overcoming barriers and enhancing EBP implementation and sustainability in health care settings.

Aim: This project aimed to use the Iowa Implementation for Sustainability Framework and the Precision Implementation Approach© to support the use of an evidence-based maternal depression intervention within Iowa's Title V Maternal Health Program that serves mothers of young children living in poverty.

Methods: This practice-based implementation was accomplished in three steps: (1) hold intervention-focused staff meetings, (2) identify barriers to using the intervention, and (3) identify and deliver implementation strategies. Collected data included barriers identified, selected implementation strategies, and evaluation of meeting attendance and impact on confidence.

Results: Four of the monthly virtual staff meetings focused on Listening Visits (LV) use. The 7 strategies comprising our approach to supporting LV use addressed three categories of identified barriers: lack of confidence, logistical issues, and not understanding intervention procedures. In the LV-focused meetings, representation of the 14 maternal health clinics was high, although attendance by individual staff was inconsistent. Post-meeting polls indicated that 40% to 65% of attendees felt more confident using intervention skills.

Linking evidence to action: This practical nursing-implementation framework facilitated EBP adoption, and our well-structured targeted strategies effectively increased staff confidence. Nursing managers and educators should consider using this framework to enhance their organizations' capacity to implement EBPs sustainably.