Journal of Clinical Nursing最新文献

Background: In response to global outcries of poor healthcare, organisational interventions have been implemented with the aim of promoting compassionate care. An overall synthesis of qualitative data, including the perspectives of healthcare staff who have attended interventions, can establish 'what works' and inform future interventions.

Aims: To synthesise existing research exploring how healthcare staff experience organisational interventions for compassionate care.

Design: Qualitative evidence synthesis.

Methods and data sources: A qualitative evidence synthesis was conducted in August 2023. Five databases were searched: MEDLINE, Academic Search Premier, CINAHL, APA PsycInfo and APA PsycArticles. Articles met the following criteria: (a) reported on the experiences of healthcare staff who had participated in organisational interventions for compassionate care, (b) taken place in a healthcare setting, (c) use of a qualitative or mixed-methods methodology, (d) published in English and (e) published since 2010. A thematic synthesis was conducted using NVivo software to synthesise findings. Data from the complete 'findings/results' sections were included in the synthesis. The final search protocol and search strategy were registered on PROSPERO (ID: CRD42023472404) and are reported using the PRISMA guidelines.

Results: Eighteen qualitative or mixed-methods studies were included in the review, encapsulating the experiences of healthcare staff across eight countries. Four themes were identified: (1) holding back, (2) humanising healthcare, (3) values are instilled and (4) sustainability is important.

Conclusion: Organisational interventions for compassionate health care are valued and appreciated by healthcare staff and foster reflection and connection. Interventions facilitate clinical creativity, improve staff well-being and strengthen communication between staff.

Implications: The implementation of organisational interventions for compassionate care should be encouraged in healthcare settings. Interventions that consider organisational cultures are driven by organisational values and are embedded with sustainability in mind can improve staff well-being and positively impact the provision of patient care.

Reporting method: PRISMA guidelines were followed in the reporting of this review.

Aims: To describe diagnostic categories and comorbidities associated with increased risk of readmission within 28 days among older adults.

Methods: Retrospective observational study of all hospital admissions following ED attendance by patients aged ≥ 60 years between July 2020 and June 2023. Index and subsequent 28-day readmission were identified using ED data and hospital discharge records. ED diagnosis, Australian Refined Diagnosis-Related Group (AR-DRG) discharge codes, and ICD-10-AM comorbidities were extracted. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations with 28-day readmission. The study and findings have been reported against the STROBE-RECORD guideline.

Results: Of the 28,730 initial patient visits, 7.9% re-presented within 28 days. The most common ED diagnoses at initial and readmission were chest pain (5.4% vs. 4.6%), falls (5.2% vs. 4.1%), dyspnoea (3.5% vs. 3.1%), abdominal pain (3.1% vs. 3.3%) and cerebrovascular accident (1.7% vs. 1.7%). The most frequent AR-DRGs were respiratory infections/inflammations, kidney and urinary signs/symptoms, and other digestive system disorders. Key ICD-10-AM codes associated with a higher likelihood of readmission within 28 days were obstructive/reflux uropathy (OR 2.66, 95% CI 1.78-3.96), urinary retention (OR 1.84, 95% CI 1.38-2.46), chronic ischaemic heart disease (OR 1.57, 95% CI 1.10-2.25), delirium (OR 1.35, 95% CI 1.07-1.71) and disorders of fluid, electrolyte, and acid-base balance (OR 1.29, 95% CI 1.09-1.54).

Conclusion: Nearly 8% of older adults are readmitted within 28 days. Our described approach offers a potential framework to identify at-risk groups and intervene to reduce avoidable representations and/or admissions.

Relevance to clinical practice: The results reported here create the opportunity for clinicians to identify areas for improvement in clinical practice, care coordination, and service delivery. Our approach and methodology can be replicated in other health services.

Patient or public contribution: No patient or public contribution.

Aim and objective: To explore how public health nurses at child and family health clinics work to prevent maltreatment and the experiences of public health nurses in the maltreatment prevention efforts.

Background: Child maltreatment is a serious societal issue with major consequences. Preventive efforts are increasing and have broad political support. A key objective of the child and family health clinic services is to prevent, identify, and stop maltreatment, abuse, and neglect. National clinical guidelines outline, in general terms, how such work should be conducted. However, limited research exists on how public health nurses prevent maltreatment and the effectiveness of their methods.

Design and method: A qualitative and explorative design was used, based on semi-structured interviews with 14 public health nurses conducted as part of the project 'Public Health Nurses in Child and Family Clinics' Role in Preventing and Detecting Child Maltreatment' at Oslo Metropolitan University. The interviews were carried out between August and November 2021. We used qualitative content analysis with an inductive approach to analyse the data.

Result: Three main categories were developed: 1. Structure and system: weaving prevention into daily practice; 2. To dare and endure: a negotiation of courage and understanding, and 3. To empower and uphold: the goal of strengthening and supporting parents. The results show the importance of early intervention, barriers to discussing maltreatment with parents, and the importance of building trust and empowering parents.

Conclusion: Preventing maltreatment is a key part of public health nurses' clinical work, focusing on early risk identification and parental guidance. While building trust with families is prioritised, structural, resource, and guideline-related challenges persist.

Implications for practice: This study provides knowledge about Norwegian public health nurses clinical work with child maltreatment at the child and family health clinics, which can serve as a valuable foundation for further research as well as for collaborating services.

Reporting method: EQUATOR guidelines were followed, using the COREQ checklist.

Patient or public contribution: No patient or public contribution.

Aim: To develop and psychometrically test a comprehensive Cancer Nurse Self-Assessment Tool (CaN-SAT).

Design: Modified Delphi to assess content validity and cross-sectional survey to assess reliability and validity.

Methods: Phase 1: An expert group developed the tool structure and item content. Phase 2: Through a modified Delphi, cancer nursing experts rated the importance of each element of practice and assessed the relevance and clarity of each item. Content Validation Indexes (CVI) were calculated, and a CVI of ≥ 0.78 was required for items to be included. Phase 3: Cancer nurses participated in a survey to test internal consistency (using Cronbach's alpha coefficients) and known-group validity (through Mann-Whitney U tests). This study was reported using the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) checklist.

Results: The CaN-SAT underwent two rounds of Delphi with 24 then 15 cancer nursing experts. All elements of practice were rated as important. Only three items achieved a CVI < 0.78 after round one; however, based on open-ended comments, 26 items were revised and one new item added. After round two, all items received a CVI above 0.78. The final tool consisted of 93 items across 15 elements of practice. Cronbach's alpha coefficients were between 0.92 and 0.98 indicating good reliability. Mann-Whitney U tests demonstrated significant differences between clinical nurses and advanced practice nurses across 13 out of 15 elements of practice.

Conclusion: The CaN-SAT is a comprehensive, valid and reliable tool that can be used for cancer nurses to self-assess current skill levels, identify their learning needs and inform decisions about educational opportunities to optimise cancer care provision.

Patient or public contribution: The research team included three patient advocates from Cancer Voices NSW, who were actively involved in all aspects of the study and are listed as authors.

Background: Cancer is a major social, public health and economic problem worldwide, causing physical and psychological distress to patients. The emerging telemedicine model in healthcare delivery has garnered significant interest because of its potential effectiveness.

Objective: To assess the effects of telemedicine on distress, physical function, and self-efficacy in cancer patients.

Design: This meta-analysis was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 checklist.

Methods: Six databases were searched for relevant studies published from inception to October 2024. The literature search and data collection were conducted by two separate researchers. The quality of the methodologies in the studies included was evaluated using the Cochrane Risk of Bias Tool. Data analysis was conducted using Review Manager (version 5.4).

Result: Compared with the control group, patients who received telemedicine experienced significant reductions in distress (SMD = -0.44, 95% CI: -0.62 to -0.25, p < 0.00001, I² = 46%) and significant increases in physical function (SMD = 0.11, 95% CI: 0.01-0.22, p = 0.04, I² = 0%) and self-efficacy (SMD = 0.46, 95% CI: 0.23-0.69, p < 0.0001, I² = 0%).

Conclusion: Telemedicine can effectively enhance the psychological health and physiological function of cancer patients, as well as their self-efficacy, suggesting a sustainable approach to the clinical care of cancer patients. Future studies are needed to further investigate the effectiveness of telemedicine interventions in different types of cancer patients and in different cultural contexts and to conduct long-term follow-up studies to evaluate their long-term effectiveness and cost-effectiveness.

Clinical relevance: This systematic review and meta-analysis provides evidence to offer effective and sustainable telemedicine care among cancer patients.

Patient and public contribution: No patient or public contribution.

Trial registration: This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (Registration number: CRD42024604929) under the title 'The effectiveness of death education on death anxiety, depression and quality of life in patients with advanced cancer: A meta-analysis of randomised controlled trials'. The full study protocol could be obtained at https://www.crd.york.ac.uk/PROSPERO/view/CRD42024604929.