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Incidence and Associated Factors of Postoperative Delirium in Adults Undergoing Cardiac Surgery With Cardiopulmonary Bypass: A Prospective Cohort Study. 成人心脏手术合并体外循环术后谵妄的发生率及相关因素:一项前瞻性队列研究。
IF 3.2 3区 医学 Q1 NURSING Pub Date : 2024-12-09 DOI: 10.1111/jocn.17596
Yating Guo, Chengyang Li, Yan Mu, Tingting Wu, Xiuxia Lin

Background: Delirium is one of the most common and serious complications after cardiac surgery with cardiopulmonary bypass (CPB). A comprehensive assessment of independent risk factors for postoperative delirium (POD) is essential for early detection and prevention.

Aims and objectives: To investigate the incidence and independent associated factors of POD in adults undergoing cardiac surgery with CPB.

Design: Prospective cohort design.

Methods: A total of 203 patients were enrolled in this study from October 2022 to December 2023 in China. Richmond agitation and sedation scale (RASS) and confusion assessment method-intensive care unit (CAM-ICU) were used for assessing delirium symptom. This study analysed various factors for POD, including demographic, physical, psychological, social, spiritual and environmental aspects. Using logistic regression analysis to identify the independent associated factors.

Results: A totla of 60.1% (n = 122) of patients had POD. Of these cases, 86 (70.5%) were hypoactive delirium, 4 (3.3%) were hyperactive delirium and 32 (26.2%) were mixed delirium. Advanced age (OR = 1.069, 95% confidence interval [CI]: 1.031-1.107; p < 0.001), preoperative depression (OR = 1.847, 95% CI: 1.246-2.736; p = 0.002), postoperative albumin level (OR = 0.921, 95% CI: 0.851-0.997; p = 0.042) and duration of mechanical ventilation (OR > 1.000, 95% CI: 1.000-1.001; p < 0.001) were independent predictors of POD.

Conclusions: The incidence of POD in patients undergoing cardiac surgery with CPB was high. This study identified advanced age, preoperative depression, postoperative albumin level and duration of mechanical ventilation as significant and independent predictors of POD.

Relevance to clinical practice: The study's findings highlight the urgent necessity for improved clinical vigilance and proactive management strategies.

Patient or public contribution: No patient or public contribution.

背景:谵妄是体外循环(CPB)心脏手术后最常见和最严重的并发症之一。全面评估术后谵妄(POD)的独立危险因素对于早期发现和预防至关重要。目的:探讨成人CPB心脏手术患者POD的发生率及独立相关因素。设计:前瞻性队列设计。方法:从2022年10月至2023年12月,在中国共有203例患者入组。采用Richmond躁动镇静量表(RASS)和神志不清评定法-重症监护病房(CAM-ICU)评估谵妄症状。本研究分析了影响POD的各种因素,包括人口、生理、心理、社会、精神和环境方面。采用logistic回归分析确定独立相关因素。结果:60.1% (n = 122)的患者有POD。其中低活动性谵妄86例(70.5%),多活动性谵妄4例(3.3%),混合性谵妄32例(26.2%)。高龄(OR = 1.069, 95%可信区间[CI]: 1.031-1.107;p 1.000, 95% CI: 1.000-1.001;结论:心脏手术合并CPB患者POD发生率较高。本研究发现高龄、术前抑郁、术后白蛋白水平和机械通气时间是POD的重要且独立的预测因素。与临床实践的相关性:该研究的结果强调了提高临床警惕性和积极主动的管理策略的迫切必要性。患者或公众捐款:没有患者或公众捐款。
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引用次数: 0
Prevalence of Frailty and Its Impact on Quality of Life in Older Patients With Breast Cancer: A Prospective Cross-Sectional Study. 老年乳腺癌患者的衰弱患病率及其对生活质量的影响:一项前瞻性横断面研究。
IF 3.2 3区 医学 Q1 NURSING Pub Date : 2024-12-09 DOI: 10.1111/jocn.17599
Min Xiao, Xi Chen, Lei Ji, Xiaoyan Qian, Meng Xiu, Zhuoran Li, Heng Cao, Shanshan Chen, Qing Li, Qiao Li, Xiang Wang, Jiani Wang, Yiqun Li, Xiaojuan Zheng, Pin Zhang
<p><strong>Aims: </strong>To evaluate the prevalence of frailty and its impact on quality of life (QoL) in older Chinese breast cancer (BC) patients, which have not been thoroughly reported in this population.</p><p><strong>Design: </strong>A prospective multi-centre cross-sectional registry study.</p><p><strong>Data sources: </strong>Data were collected from Cancer Hospital of the Chinese Academy of Medical Sciences, Peking University Third Hospital and Beijing Chaoyang District San Huan Cancer Hospital between October 2021 and July 2023.</p><p><strong>Methods: </strong>BC patients aged over 65 years were enrolled in this study. They completed three assessment scales including the FRAIL scale, Hospital Anxiety and Depression Scale (HADS) and European Organization for Research and Treatment of Cancer Quality of Life questionnaire Core 30 (EORTC QLQ-C30), to screen for frailty, related factors and QoL. Clinical and pathological data were also collected. Analysis of frailty and prefrailty risk factors was performed via logistic regression. A multivariable linear regression model was used to evaluate the mean differences in scores for each QoL domain between patients with different frailty statuses.</p><p><strong>Results: </strong>A total of 946 patients were enrolled from three hospitals in Beijing between October 2021 and July 2023. Their median age was 69 years and 73.6% of them had early-stage breast cancer. Further, 37.2% of these patients had ≥ 1 comorbidity. The prevalence of frailty was 8.8% and frailty was more common in those with aged ≥ 75 years (22.3%), those with advanced tumours (15.6%), those with anxiety (31.3%) and those with depression (29.3%). More than half (57.2%) of the patients were prefrail. Regression analysis revealed that older age (odds ratio [OR] 1.12 [95% CI 1.07-1.17], p < 0.001), an advanced tumour (OR 2.27 [1.33-3.89], p = 0.003), anxiety (OR 2.74 [1.37-5.48], p = 0.004) and depression (OR 3.84 [1.97-7.49], p < 0.001) were significantly associated with frailty. After adjusting for other factors, different frailty states were shown to be independent influencing factors for QoL in both the functional and the symptom domains (all p < 0.05).</p><p><strong>Conclusions: </strong>Our study provides data on the prevalence of frailty and prefrailty in older Chinese patients with BC. Both conditions are closely related to poor QoL. It is helpful for oncologist and clinical care to making intervention and better treatment decisions.</p><p><strong>Reporting method: </strong>The study adhered to the STROBE checklist.</p><p><strong>Implications for the profession and patient care: </strong>This study provides detailed data on the prevalence of frailty in older Chinese patients with BC and correlative factors. It suggests that clinical care should fully assess patients' frailty before making treatment decisions and provide early intervention for related factors.</p><p><strong>Patient or public contribution: </strong>Patients partic
目的:评估中国老年乳腺癌(BC)患者的虚弱患病率及其对生活质量(QoL)的影响,这在该人群中尚未得到全面报道。设计:前瞻性多中心横断面登记研究。数据来源:数据来自中国医学科学院肿瘤医院、北京大学第三医院和北京市朝阳区三环肿瘤医院,时间为2021年10月- 2023年7月。方法:65岁以上的BC患者入组。他们完成了虚弱量表、医院焦虑抑郁量表(HADS)和欧洲癌症研究与治疗组织生活质量问卷核心30 (EORTC QLQ-C30)三个评估量表,以筛选虚弱、相关因素和生活质量。同时收集临床及病理资料。通过逻辑回归分析脆弱和脆弱的危险因素。采用多变量线性回归模型评价不同虚弱状态患者各生活质量域评分的平均差异。结果:2021年10月至2023年7月,北京三家医院共纳入946例患者。她们的中位年龄为69岁,73.6%的人患有早期乳腺癌。此外,37.2%的患者有≥1个合并症。虚弱的患病率为8.8%,在年龄≥75岁(22.3%)、晚期肿瘤(15.6%)、焦虑(31.3%)和抑郁(29.3%)患者中更为常见。超过一半(57.2%)的患者是虚弱的。回归分析显示年龄较大(优势比[OR] 1.12 [95% CI 1.07-1.17], p)。结论:我们的研究提供了中国老年BC患者虚弱和易患性患病率的数据。这两种情况都与不良的生活质量密切相关。有助于肿瘤学家和临床护理人员做出干预和更好的治疗决策。报告方法:本研究遵循STROBE检查表。对专业和患者护理的启示:本研究提供了中国老年BC患者虚弱患病率及相关因素的详细数据。提示临床护理在做出治疗决策前应充分评估患者的虚弱程度,并对相关因素进行早期干预。患者或公众贡献:患者参与项目实施(包括知情同意和问卷调查过程)。没有其他公众对这项研究的贡献。与临床实践的相关性:本研究提供了中国老年BC患者虚弱患病率及相关因素的数据。提示临床医生在做出治疗决策前应充分评估患者的虚弱程度,并对相关因素进行早期干预。试验注册:ChiCTR2200056070。
{"title":"Prevalence of Frailty and Its Impact on Quality of Life in Older Patients With Breast Cancer: A Prospective Cross-Sectional Study.","authors":"Min Xiao, Xi Chen, Lei Ji, Xiaoyan Qian, Meng Xiu, Zhuoran Li, Heng Cao, Shanshan Chen, Qing Li, Qiao Li, Xiang Wang, Jiani Wang, Yiqun Li, Xiaojuan Zheng, Pin Zhang","doi":"10.1111/jocn.17599","DOIUrl":"https://doi.org/10.1111/jocn.17599","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;To evaluate the prevalence of frailty and its impact on quality of life (QoL) in older Chinese breast cancer (BC) patients, which have not been thoroughly reported in this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A prospective multi-centre cross-sectional registry study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Data were collected from Cancer Hospital of the Chinese Academy of Medical Sciences, Peking University Third Hospital and Beijing Chaoyang District San Huan Cancer Hospital between October 2021 and July 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;BC patients aged over 65 years were enrolled in this study. They completed three assessment scales including the FRAIL scale, Hospital Anxiety and Depression Scale (HADS) and European Organization for Research and Treatment of Cancer Quality of Life questionnaire Core 30 (EORTC QLQ-C30), to screen for frailty, related factors and QoL. Clinical and pathological data were also collected. Analysis of frailty and prefrailty risk factors was performed via logistic regression. A multivariable linear regression model was used to evaluate the mean differences in scores for each QoL domain between patients with different frailty statuses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 946 patients were enrolled from three hospitals in Beijing between October 2021 and July 2023. Their median age was 69 years and 73.6% of them had early-stage breast cancer. Further, 37.2% of these patients had ≥ 1 comorbidity. The prevalence of frailty was 8.8% and frailty was more common in those with aged ≥ 75 years (22.3%), those with advanced tumours (15.6%), those with anxiety (31.3%) and those with depression (29.3%). More than half (57.2%) of the patients were prefrail. Regression analysis revealed that older age (odds ratio [OR] 1.12 [95% CI 1.07-1.17], p &lt; 0.001), an advanced tumour (OR 2.27 [1.33-3.89], p = 0.003), anxiety (OR 2.74 [1.37-5.48], p = 0.004) and depression (OR 3.84 [1.97-7.49], p &lt; 0.001) were significantly associated with frailty. After adjusting for other factors, different frailty states were shown to be independent influencing factors for QoL in both the functional and the symptom domains (all p &lt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our study provides data on the prevalence of frailty and prefrailty in older Chinese patients with BC. Both conditions are closely related to poor QoL. It is helpful for oncologist and clinical care to making intervention and better treatment decisions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Reporting method: &lt;/strong&gt;The study adhered to the STROBE checklist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for the profession and patient care: &lt;/strong&gt;This study provides detailed data on the prevalence of frailty in older Chinese patients with BC and correlative factors. It suggests that clinical care should fully assess patients' frailty before making treatment decisions and provide early intervention for related factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient or public contribution: &lt;/strong&gt;Patients partic","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Nurses' Perspectives on the Use of Prophylactic Dressings to Prevent Pressure Injury: A Qualitative Study. 护士对使用预防性敷料预防压伤的看法:一项定性研究。
IF 3.2 3区 医学 Q1 NURSING Pub Date : 2024-12-09 DOI: 10.1111/jocn.17595
Jake McMahon, Elizabeth McInnes, Ching Shan Wan, Nicola Straiton, Louisa Lam, Jane Rodgers, Paul Fulbrook

Aim: To understand, from a nursing perspective, factors affecting the use of prophylactic dressings to prevent pressure injuries in acute hospitalised adults.

Background: Pressure injury causes harm to patients and incurs significant costs to health services. Significant emphasis is placed on their prevention. Relatively recently, prophylactic dressings have been promoted to reduce pressure injury development. However, in the acute care setting, information about the clinical use of these dressing is lacking.

Design: Qualitative, descriptive.

Methods: Nineteen medical and surgical nurses participated. Semi-structured interviews were conducted and transcribed verbatim. Thematic analysis was performed using an inductive approach using NVivo software.

Results: Three themes were identified, reflecting factors that influenced and perpetuated indiscriminate use of prophylactic dressings: False sense of security; Convenience and task prioritisation; and Navigating challenges in evidence-based pressure injury prevention.

Conclusions: The findings indicate inconsistent prevention practices, with prophylactic dressings often applied without justification or referral to research-based evidence to guide clinical decision-making. There was a prevailing attitude of 'job done' when a prophylactic dressing was applied.

Impact: This study has identified several factors that perpetuate the inappropriate use of prophylactic dressings for pressure injury prevention that may be amenable to organisational change. The findings indicate that nurses often rely on these dressings as a shortcut due to time constraints, which led to missed skin assessments and low-value care. The research can be used to inform the development of clear guidelines on dressings within hospital settings which encourage assessment-based selection for their use, and process-based guidance for their application, skin surveillance, dressing inspection and removal.

Reporting method: The Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guideline was followed.

Patient or public contribution: Neither patients nor the public were directly involved in this study.

目的:从护理角度了解影响急性住院成人使用预防性敷料预防压伤的因素。背景:压力性损伤对患者造成伤害,并给卫生服务带来巨大成本。重点放在预防这些疾病上。最近,预防性敷料已被推广,以减少压力损伤的发展。然而,在急性护理环境中,缺乏关于这些敷料的临床使用的信息。设计:定性的,描述性的。方法:19名内科和外科护士参与。进行了半结构化访谈,并逐字记录。使用NVivo软件采用归纳方法进行主题分析。结果:确定了三个主题,反映了影响和长期滥用预防性敷料的因素:虚假的安全感;便利性和任务优先级;以及应对基于证据的压力性损伤预防的挑战。结论:研究结果表明,预防措施不一致,预防性敷料的应用往往没有理由或参考基于研究的证据来指导临床决策。当使用预防性敷料时,普遍的态度是“工作完成”。影响:本研究已经确定了几个因素,这些因素可能会导致不适当地使用预防性敷料来预防压力损伤,这些因素可能是组织变革的结果。研究结果表明,由于时间限制,护士经常依赖这些敷料作为捷径,从而导致错过皮肤评估和低价值护理。该研究可用于为制定医院环境内敷料的明确指导方针提供信息,这些指导方针鼓励基于评估的敷料选择,并为其应用、皮肤监测、敷料检查和去除提供基于过程的指导。报告方法:遵循定性研究报告综合标准(COREQ)报告指南。患者或公众贡献:患者和公众均未直接参与本研究。
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引用次数: 0
Letter to the Editor "Exploration of Decision Aids to Support Advance Care Planning: A Scoping Review". 致编辑的信“探索支持预先护理计划的决策辅助:范围审查”。
IF 3.2 3区 医学 Q1 NURSING Pub Date : 2024-12-09 DOI: 10.1111/jocn.17589
Tiantian Liu, Jiao Wang, Lujun Wei
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引用次数: 0
Letter to the Editor Regarding 'Effect of Inhaled Aromatherapy on Sleep Quality in Critically Ill Patients: A Systematic Review and Network Meta-Analysis'. 关于“吸入芳香疗法对危重患者睡眠质量的影响:系统回顾和网络荟萃分析”的致编辑信。
IF 3.2 3区 医学 Q1 NURSING Pub Date : 2024-12-09 DOI: 10.1111/jocn.17531
He Sui, Dan Wang, Zhi-Qi Zhang, Yi-Xuan Guo, Hai-Yan Zhang
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引用次数: 0
Comparing Safety and Accuracy of Standardised Versus Subjective Triage Code Assignment by Nurses: A Multicenter Observational Simulated Study. 比较标准化与主观分类代码分配护士的安全性和准确性:一项多中心观察模拟研究。
IF 3.2 3区 医学 Q1 NURSING Pub Date : 2024-12-08 DOI: 10.1111/jocn.17615
Arian Zaboli, Francesco Brigo, Gloria Brigiari, Magdalena Massar, Gabriele Magnarelli, Norbert Pfeifer, Tiziano Garbin, Patrick Clauser, Serena Sibilio, Gianni Turcato

Background: Standardised triage systems have been in place for decades with minor modifications, while nurses' skills and knowledge have significantly advanced.

Aim: To determine whether nurses' clinical expertise outperforms triage systems in simulated clinical cases.

Design: A multicenter simulated observational study.

Methods: The study was conducted from January 1, 2024 to March 31, 2024, in four Italian emergency departments, enrolling triage-performing nurses. Thirty clinical cases, based on real patients representing daily emergency department influx, were reconstructed. The primary outcome was the agreement between the triage code assigned by the Manchester Triage System and the code assigned based on clinical expertise. The secondary outcome compared the predictive ability of the codes assigned by nurses regarding clinical outcomes, such as death within 72 h, the need for hospitalisation, and the need for life-saving intervention. The study was reported in accordance with the STROBE statement.

Results: Seventy-seven triage nurses completed the 30 vignettes. The agreement between the MTS-assigned code and the clinical expertise triage reported a Cohen's kappa of 0.576 (95% CI: 0.564-0.598). For death within 72 h, the clinical expertise code reported better results than the Manchester Triage System. For life-saving interventions, the Manchester Triage System reported a lower performance than clinical expertise. The variability in triage code assignment was higher for clinical expertise compared to the Manchester Triage System.

Conclusions: Triage codes assigned by nurses based on clinical expertise perform better in terms of clinical outcomes, suggesting a need to update triage systems to incorporate nurses' knowledge and skills. However, standardised triage systems should be maintained to reduce variability and ensure consistent patient classification.

Reporting method: The study was conducted and reported according to the STROBE statement.

Patient or public contribution: No patient or public contribution.

背景:标准化的分诊系统已经存在了几十年,只有轻微的修改,而护士的技能和知识也有了显著的进步。目的:确定护士的临床专业知识是否优于分诊系统在模拟临床病例。设计:多中心模拟观察研究。方法:研究于2024年1月1日至2024年3月31日在意大利4个急诊科进行,招募分诊护士。本文以真实病例为基础,对30例临床病例进行了重建。主要结果是曼彻斯特分诊系统分配的分诊代码与基于临床专业知识分配的分诊代码之间的一致性。次要结果比较了护士分配的代码对临床结果的预测能力,如72小时内死亡、住院治疗的需要和挽救生命的干预的需要。这项研究是根据STROBE声明进行报道的。结果:77名分诊护士完成了30个小问卷。mts分配代码与临床专家分类之间的一致性报告Cohen kappa为0.576 (95% CI: 0.564-0.598)。对于72小时内的死亡,临床专家代码报告的结果优于曼彻斯特分诊系统。对于挽救生命的干预措施,曼彻斯特分诊系统报告的表现低于临床专家。与曼彻斯特分诊系统相比,临床专家的分诊代码分配的可变性更高。结论:由护士根据临床专业知识分配的分诊代码在临床结果方面表现更好,这表明需要更新分诊系统,以纳入护士的知识和技能。然而,应该保持标准化的分诊系统,以减少可变性并确保一致的患者分类。报告方法:本研究按照STROBE声明进行并报告。患者或公众捐款:没有患者或公众捐款。
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引用次数: 0
Key Factors in the Implementation of Value-Based Healthcare Performance Evaluation in General Hospitals Healthcare Groups: A Mixed Methodology Study 综合医院医疗集团实施基于价值的医疗绩效评估的关键因素:一项混合方法研究。
IF 3.2 3区 医学 Q1 NURSING Pub Date : 2024-12-04 DOI: 10.1111/jocn.17597
Wenbo He, Wei Feng, Liang Du, Wei Zhang
<div> <section> <h3> Objective</h3> <p>To identify the principal factors influencing the implementation of high-value healthcare performance evaluation and to examine the interrelationships among these factors.</p> </section> <section> <h3> Background</h3> <p>Value-based health care (VBHC) is gaining momentum as a model that focuses on improving patient outcomes. However, there is still a lack of understanding of the multifaceted factors that contribute to its successful implementation.</p> </section> <section> <h3> Design</h3> <p>Theoretical modelling and mixed research methods.</p> </section> <section> <h3> Methods</h3> <p>First, this study constructed a framework of influencing factors on the implementation of VBHC performance evaluation based on the Technology-Organization-Environment model. Second, a representative set of influencing factors for healthcare performance evaluation was identified. The implementation of performance evaluation was identified based on a literature analysis and a case study in China. Finally, experts were invited to assess the relevance of the aforementioned influencing factors, and the collected data were analysed using Interpretative Structural Model. The PRISMA-ScR checklist guided the reporting of this study.</p> </section> <section> <h3> Results</h3> <p>We initially constructed the theory framework with the objective of categorising and summarising the influential factors and potential problems revealed in the implementation of patient VBHC performance evaluation in general hospitals. Subsequently, 15 key factors were identified through interviews with 10 experts. Then, a six-level hierarchy was developed to construct a visual structure diagram, the purpose of which was to clarify the hierarchy of roles of each influencing factor. Finally, we categorise the influencing factors into four clusters based on their driving power and dependency within the system.</p> </section> <section> <h3> Conclusion</h3> <p>The insights from this research will assist hospital managers in identifying and prioritising the key factors that influence high-value healthcare performance.</p> </section> <section> <h3> Relevance to Clinical Practice</h3> <p>This study provides a reliable pathway reference for clinical and nursing performance value enhancement and provides important insights into resource allocation and decision-making for clinical practitioners.</p> </sec
目的:确定影响高价值医疗绩效评价实施的主要因素,并探讨这些因素之间的相互关系。背景:以价值为基础的卫生保健(VBHC)作为一种注重改善患者预后的模式正在获得动力。然而,人们仍然缺乏对促成其成功执行的多方面因素的了解。设计:理论建模和混合研究方法。方法:首先,本研究基于技术-组织-环境模型构建了VBHC绩效评估实施的影响因素框架。其次,确定了具有代表性的医疗保健绩效评估影响因素。通过文献分析和案例研究,确定了绩效评估在中国的实施情况。最后,邀请专家评估上述影响因素的相关性,并使用解释结构模型对收集的数据进行分析。PRISMA-ScR检查表指导了本研究的报告。结果:初步构建了理论框架,目的是对综合医院实施患者VBHC绩效评价中发现的影响因素和潜在问题进行分类和总结。随后,通过对10位专家的访谈,确定了15个关键因素。然后,建立了一个六层层次结构,构建了一个可视化的结构图,目的是明确每个影响因素的作用层次。最后,根据影响因素在系统内的驱动力和依赖程度,将影响因素分为四类。结论:本研究的见解将有助于医院管理者识别和优先考虑影响高价值医疗保健绩效的关键因素。与临床实践的相关性:本研究为临床和护理绩效价值提升提供了可靠的路径参考,为临床从业者的资源配置和决策提供了重要见解。患者或公众捐款:没有患者或公众捐款。
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引用次数: 0
Deconstruction and Remodelling: A Grounded Theory Exploration of the Family Resilience of Disabled Elderly People in China. 解构与重塑:中国残疾老年人家庭弹性的扎根理论探索。
IF 3.2 3区 医学 Q1 NURSING Pub Date : 2024-12-04 DOI: 10.1111/jocn.17553
Kai Zhang, Dan Li

Aims and objectives: This study aims to understand the family experiences of disabled elderly people facing adversity from the perspective of family resilience and to develop a theoretical model to explain the constitution of family resilience.

Background: Family resilience is the ability of families to cope with, adapt to, and recover from significant stressors and challenges. Although some studies have focused on disabled elderly people, the components of their family resilience have received little attention.

Design: A grounded theory.

Methods: A total of 30 participants were selected by theoretical sampling, and all participants were from families with disabled elderly people in Chengdu, China. Data were obtained via semi-structured interviews. The COREQ checklist for qualitative research was followed.

Results: A theoretical model of family resilience for disabled elderly people was established based on three categories: family organisation, family beliefs, and family relationships. Family organisations include the organisation model and resources; family beliefs include coping styles and adversity remodelling; and family relationships include communication and atmosphere.

Conclusions: These categories suggest that there are several similar components of family resilience for disabled elderly people, which can be used to understand how families cope with this challenging experience by adjusting their roles, resources, and perspectives. Our findings are believed to offer significant theoretical and practical implications for improving the resilience and well-being of families with disabled elderly members, improving the effectiveness of caregiving services, and guiding strategies for disabled elderly individuals, their families, caregivers, and researchers.

Relevance to clinical practice: Healthcare professionals must recognise that disability impacts not only the individual but also the entire family system. The process of disability is slowed by early intervention, and psychological counselling services are provided to relieve stress and anxiety. Training in practical skills can be provided to build social support networks to help them cope with challenges.

目的与目的:本研究旨在从家庭弹性的角度了解残疾老年人面对逆境的家庭经历,并建立一个理论模型来解释家庭弹性的构成。背景:家庭弹性是家庭应对、适应和从重大压力源和挑战中恢复的能力。虽然一些研究集中在残疾老年人身上,但他们家庭弹性的组成部分却很少受到关注。设计:有根据的理论。方法:采用理论抽样的方法,选取30名来自成都市残疾老年人家庭的研究对象。数据通过半结构化访谈获得。遵循COREQ定性研究检查表。结果:基于家庭组织、家庭信念和家庭关系三个维度,建立了残疾老年人家庭弹性的理论模型。家族组织包括组织模式和资源;家庭信念包括应对方式和逆境重塑;家庭关系包括沟通和氛围。结论:这些类别表明残疾老年人家庭弹性有几个相似的组成部分,可以用来了解家庭如何通过调整他们的角色、资源和观点来应对这一具有挑战性的经历。我们的研究结果对于提高残疾老年人家庭的弹性和幸福感,提高护理服务的有效性,以及为残疾老年人个人、其家庭、照顾者和研究人员提供指导策略具有重要的理论和实践意义。与临床实践相关:医疗保健专业人员必须认识到残疾不仅影响个人,而且影响整个家庭系统。通过早期干预减缓残疾的进程,并提供心理咨询服务,以减轻压力和焦虑。可以提供实用技能培训,以建立社会支持网络,帮助他们应对挑战。
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引用次数: 0
Non-Pharmacological Sleep Interventions after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. 心脏手术后的非药物睡眠干预:随机对照试验的系统回顾和荟萃分析。
IF 3.2 3区 医学 Q1 NURSING Pub Date : 2024-12-04 DOI: 10.1111/jocn.17583
Sueyeon Lee, Pei Chen, Chang Park, Bingqian Zhu, Bilgay I Balserak

Aim: To synthesise up-to-date research evidence for non-pharmacological interventions to improve various sleep outcomes (e.g., sleep quality, duration) in postsurgical cardiac patients.

Background: Sleep disturbances are common amongst postsurgical cardiac patients, yet the effectiveness of non-pharmacological interventions in improving various sleep outcomes has not been comprehensively reviewed.

Design: A systematic review and meta-analysis guided by the PRISMA protocol.

Methods: CINAHL, PubMed, PsycINFO, Embase, Web of Science, and Cochrane Library were searched for relevant research in May 2023. Included studies used a randomised controlled trial design that applied a non-pharmacological intervention for postsurgical cardiac patients and reported sleep as an outcome. For the meta-analysis, mean effect sizes were separately calculated for studies with regular and reverse-scored scales.

Results: Of 37 studies included, the most common cardiac surgery was coronary artery bypass graft. Most interventions were performed within the first postoperative week and assessed sleep quality outcomes using the Pittsburgh Sleep Quality Index. The interventions are categorised into five types. Human resource-based strategies emerged as the most effective. The meta-analysis of 27 eligible studies showed a mean effect size of 0.76 for studies with regular scoring scales and - 1.04 for those with reverse-scored scales, indicating medium to large effect sizes.

Conclusion: Our findings provide strong evidence that non-pharmacological interventions, particularly human resource-based strategies, significantly improve sleep quality in postsurgical cardiac patients. The medium to large effect sizes underscore the clinical significance of these findings.

Implications: Healthcare professionals should consider incorporating non-pharmacological interventions, especially human resource-based strategies, in care plans for postsurgical cardiac patients to improve sleep outcomes and promote recovery. These interventions should be tailored to individual physical and cultural differences for maximum effectiveness. Future research should evaluate the long-term effects of these interventions on various sleep outcomes, using both objective and subjective measures to provide a comprehensive assessment of their efficacy.

Reporting method: This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.

No patient or public contribution: Patient and public contributions were not required for this review.

目的:综合非药物干预改善心脏术后患者各种睡眠结果(如睡眠质量、持续时间)的最新研究证据。背景:睡眠障碍在心脏术后患者中很常见,但非药物干预在改善各种睡眠结果方面的有效性尚未得到全面的评价。设计:在PRISMA方案指导下进行系统评价和荟萃分析。方法:检索CINAHL、PubMed、PsycINFO、Embase、Web of Science、Cochrane Library于2023年5月的相关研究。纳入的研究采用随机对照试验设计,对心脏病术后患者采用非药物干预,并报告睡眠作为结果。在荟萃分析中,分别计算了正量表和反量表的平均效应量。结果:纳入的37项研究中,最常见的心脏手术是冠状动脉搭桥术。大多数干预措施在术后第一周内进行,并使用匹兹堡睡眠质量指数评估睡眠质量结果。干预措施分为五种类型。以人力资源为基础的战略是最有效的。27项符合条件的研究的荟萃分析显示,使用常规评分量表的研究的平均效应量为0.76,使用反评分量表的研究的平均效应量为- 1.04,表明中等到较大的效应量。结论:我们的研究结果提供了强有力的证据,证明非药物干预,特别是基于人力资源的策略,可以显著改善心脏病术后患者的睡眠质量。中等到较大的效应量强调了这些发现的临床意义。意义:医疗保健专业人员应考虑在心脏术后患者的护理计划中纳入非药物干预措施,特别是基于人力资源的策略,以改善睡眠结果并促进康复。这些干预措施应根据个人的身体和文化差异进行调整,以达到最大效果。未来的研究应该评估这些干预措施对各种睡眠结果的长期影响,使用客观和主观的方法来全面评估其疗效。报告方法:本研究遵循系统评价和荟萃分析首选报告项目(PRISMA)协议。无患者或公众贡献:本综述不需要患者和公众的贡献。
{"title":"Non-Pharmacological Sleep Interventions after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.","authors":"Sueyeon Lee, Pei Chen, Chang Park, Bingqian Zhu, Bilgay I Balserak","doi":"10.1111/jocn.17583","DOIUrl":"https://doi.org/10.1111/jocn.17583","url":null,"abstract":"<p><strong>Aim: </strong>To synthesise up-to-date research evidence for non-pharmacological interventions to improve various sleep outcomes (e.g., sleep quality, duration) in postsurgical cardiac patients.</p><p><strong>Background: </strong>Sleep disturbances are common amongst postsurgical cardiac patients, yet the effectiveness of non-pharmacological interventions in improving various sleep outcomes has not been comprehensively reviewed.</p><p><strong>Design: </strong>A systematic review and meta-analysis guided by the PRISMA protocol.</p><p><strong>Methods: </strong>CINAHL, PubMed, PsycINFO, Embase, Web of Science, and Cochrane Library were searched for relevant research in May 2023. Included studies used a randomised controlled trial design that applied a non-pharmacological intervention for postsurgical cardiac patients and reported sleep as an outcome. For the meta-analysis, mean effect sizes were separately calculated for studies with regular and reverse-scored scales.</p><p><strong>Results: </strong>Of 37 studies included, the most common cardiac surgery was coronary artery bypass graft. Most interventions were performed within the first postoperative week and assessed sleep quality outcomes using the Pittsburgh Sleep Quality Index. The interventions are categorised into five types. Human resource-based strategies emerged as the most effective. The meta-analysis of 27 eligible studies showed a mean effect size of 0.76 for studies with regular scoring scales and - 1.04 for those with reverse-scored scales, indicating medium to large effect sizes.</p><p><strong>Conclusion: </strong>Our findings provide strong evidence that non-pharmacological interventions, particularly human resource-based strategies, significantly improve sleep quality in postsurgical cardiac patients. The medium to large effect sizes underscore the clinical significance of these findings.</p><p><strong>Implications: </strong>Healthcare professionals should consider incorporating non-pharmacological interventions, especially human resource-based strategies, in care plans for postsurgical cardiac patients to improve sleep outcomes and promote recovery. These interventions should be tailored to individual physical and cultural differences for maximum effectiveness. Future research should evaluate the long-term effects of these interventions on various sleep outcomes, using both objective and subjective measures to provide a comprehensive assessment of their efficacy.</p><p><strong>Reporting method: </strong>This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.</p><p><strong>No patient or public contribution: </strong>Patient and public contributions were not required for this review.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Information Needs Among Thai Women Breast Cancer Patients During the Initial Treatment Phase: A Cross-Sectional Study. 泰国女性乳腺癌患者在初始治疗阶段的信息需求:一项横断面研究。
IF 3.2 3区 医学 Q1 NURSING Pub Date : 2024-12-04 DOI: 10.1111/jocn.17598
Kanittha Rattanakanlaya, Boonchoo Anusasananun, Patcharin Chaisurin, Imjai Chitapanarux, Wimrak Onchan, Suchada Sajjaprakasit, Penchan Sanguansak, Srisuda Iamruksa

Aims: To examine the information needs of breast cancer patients during the initial phase of treatment and to analyse the factors that influenced these needs.

Background: Providing comprehensive and timely information during early breast cancer treatment is crucial for informed decision-making and effective coping. Healthcare providers must address these needs to enhance patient support and improve outcomes.

Design: A cross-sectional study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Methods: A total of 123 post-mastectomy patients were selected through purposive sampling and completed the Thai version of the Sri Lankan Information Needs Assessment Questionnaire-BC (SINAQ-BC). Direct associations between demographic data and information needs were analysed descriptively, while bivariate analysis and linear regression were used to identify significant predictors of information needs.

Results: The findings revealed that patients exhibited high overall information needs (224.7/260.0), with the greatest demand focused on physical care, treatment and diagnosis. In contrast, needs related to disease specifics and psychosocial care were less prominent. A total of 94 respondents (76.4%) expressed a particularly high demand for information regarding physical care. Education level was identified as an influencing factor, accounting for 7.7% of the variance in information needs among women with breast cancer.

Conclusions: Patients with higher education levels had significantly greater information needs. Nursing staff should provide customised information packages that are tailored to the participants' education levels. Further testing of the Thai version of the SLINQ-BC would also be warranted.

Implications for patient care: Patients are increasingly expected to manage their own care even as medical treatment grows more complex and technical. Nursing staff can contribute to the care of patients by being ready to evaluate, monitor and address breast cancer patient's individual information needs in the early stage of treatment based on factors such as educational level.

Patient or public contribution: No patient or public contribution because the nature of the study's design, data analysis and writing did not require patient or public contribution.

目的:探讨乳腺癌患者在治疗初期的信息需求,并分析影响这些需求的因素。背景:在乳腺癌早期治疗中提供全面及时的信息对于知情决策和有效应对至关重要。医疗保健提供者必须满足这些需求,以加强对患者的支持并改善结果。设计:根据加强流行病学观察性研究报告(STROBE)指南,报告了一项横断面研究。方法:采用目的抽样的方法,选取123例乳房切除术后患者,填写泰文版斯里兰卡信息需求评估问卷- bc (SINAQ-BC)。对人口统计数据和信息需求之间的直接关联进行了描述性分析,同时使用双变量分析和线性回归来确定信息需求的重要预测因子。结果:患者总体信息需求较高(224.7/260.0),其中对身体护理、治疗和诊断的需求最大。相比之下,与疾病特点和心理社会护理有关的需求不太突出。共有94名受访者(76.4%)表达了对身体护理信息的特别高需求。教育水平被确定为一个影响因素,占乳腺癌妇女信息需求差异的7.7%。结论:受教育程度越高的患者对信息的需求越高。护理人员应根据参与者的教育水平提供定制的信息包。泰国版SLINQ-BC的进一步测试也将得到保证。对患者护理的影响:即使医疗变得越来越复杂和技术,患者也越来越期望管理自己的护理。护理人员可以根据教育水平等因素,在治疗早期评估、监测和处理乳腺癌患者的个人信息需求,从而为患者的护理做出贡献。患者或公众贡献:没有患者或公众贡献,因为研究的设计、数据分析和写作的性质不需要患者或公众贡献。
{"title":"Information Needs Among Thai Women Breast Cancer Patients During the Initial Treatment Phase: A Cross-Sectional Study.","authors":"Kanittha Rattanakanlaya, Boonchoo Anusasananun, Patcharin Chaisurin, Imjai Chitapanarux, Wimrak Onchan, Suchada Sajjaprakasit, Penchan Sanguansak, Srisuda Iamruksa","doi":"10.1111/jocn.17598","DOIUrl":"https://doi.org/10.1111/jocn.17598","url":null,"abstract":"<p><strong>Aims: </strong>To examine the information needs of breast cancer patients during the initial phase of treatment and to analyse the factors that influenced these needs.</p><p><strong>Background: </strong>Providing comprehensive and timely information during early breast cancer treatment is crucial for informed decision-making and effective coping. Healthcare providers must address these needs to enhance patient support and improve outcomes.</p><p><strong>Design: </strong>A cross-sectional study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.</p><p><strong>Methods: </strong>A total of 123 post-mastectomy patients were selected through purposive sampling and completed the Thai version of the Sri Lankan Information Needs Assessment Questionnaire-BC (SINAQ-BC). Direct associations between demographic data and information needs were analysed descriptively, while bivariate analysis and linear regression were used to identify significant predictors of information needs.</p><p><strong>Results: </strong>The findings revealed that patients exhibited high overall information needs (224.7/260.0), with the greatest demand focused on physical care, treatment and diagnosis. In contrast, needs related to disease specifics and psychosocial care were less prominent. A total of 94 respondents (76.4%) expressed a particularly high demand for information regarding physical care. Education level was identified as an influencing factor, accounting for 7.7% of the variance in information needs among women with breast cancer.</p><p><strong>Conclusions: </strong>Patients with higher education levels had significantly greater information needs. Nursing staff should provide customised information packages that are tailored to the participants' education levels. Further testing of the Thai version of the SLINQ-BC would also be warranted.</p><p><strong>Implications for patient care: </strong>Patients are increasingly expected to manage their own care even as medical treatment grows more complex and technical. Nursing staff can contribute to the care of patients by being ready to evaluate, monitor and address breast cancer patient's individual information needs in the early stage of treatment based on factors such as educational level.</p><p><strong>Patient or public contribution: </strong>No patient or public contribution because the nature of the study's design, data analysis and writing did not require patient or public contribution.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Clinical Nursing
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