Journal of Clinical Nursing最新文献

Background: More than one-third of all diseases in the world are non-communicable diseases (NCDs), and poorer health outcomes are linked to low health literacy (HL), in which nurses have a significant role to play. Various studies have confirmed that there is an association between HL and NCDs. However, less is known about how nurses can intervene in the development of HL in patients with NCDs. This systematic review was carried out to explore, in a comprehensive way, nursing interventions that could promote HL in patients with NCDs.

Methods: A systematic review (PROSPERO registration number: CRD370625) was carried out on five databases (PubMed MEDLINE, Web of Science, Scopus, ScienceDirect and JSTOR). Sequences that provided information for our study topic were retrieved and analysed following PRISMA guidelines for systematic reviews.

Results: In total, 1915 titles and abstracts were screened, 71 articles were assessed in full-text screening and 25 studies were included in the review. Around 23 different nurse-led intervention strategies were identified, but only 11 major ones were explored in detail. The majority of them prioritised communication (teach-back), self-management programs, counselling and education. In the majority of the trials, a significant positive outcome was discovered. Both nurses and patients needed to devote time and attention to the complex nurse-led HL interventions.

Conclusion: Nurses' HL interventions have shown promise in promoting HL and other health outcomes in people with NCDs, but they need to be tailored to fit specific patients. Nursing programs should include more than just patient teaching strategies.

Relevance to clinical practice: Nurses' HL efforts hold potential for enhancing HL in NCD patients, provided they are customised to individual needs.

Aim: To identify barriers and facilitators to implementation of new evidence-based nursing policies among nurse educators.

Background: Evidence-based practice promotes safe patient care through the combination of the best available research, clinical expertise and patient preferences. Policies are utilised by nursing to drive patient care and thus should be evidence-based. Nurse educators are identified as champions of evidence-based practice and policy dissemination. Therefore, understanding nurse educators' perceptions surrounding barriers and facilitators to nursing policy implementation and attitudes regarding evidence-based practice can help drive successful policy implementation and foster evidence-based practice in patient care.

Design: Descriptive, cross-sectional.

Methods: A 7-item survey was electronically distributed to all nurse educators within a large pediatric healthcare system to assess barriers and facilitators to policy implementation as well as attitudes surrounding evidence-based practice and policies.

Findings: The most significant barriers were lack of time and poor understanding of policy development. The most significant facilitators were a standardised policy dissemination process and leadership support of policy implementation efforts. Most nurse educators agreed that evidence-based practice is valuable to patient care. However, nurse educators report that they have a neutral to poor understanding of evidence-based practice.

Conclusion: Findings were consistent with the literature, thus adding to the body of literature that supports the need for further development around policy dissemination and evidence-based practice education for nurse educators.

Implications for the profession and/or patient care: This paper supports the need for professional development for nurse educators, standardisation of policy dissemination and leadership support of policy dissemination and promotion of evidence-based practice.

Patient or public contribution: No patient or public contribution.

Reporting method: This paper adheres to the SQUIRE 2.0 guidelines.

Aim: To evaluate the effects of exergaming on physical frailty in older adults.

Design: Systematic review with meta-analysis.

Methods: Six electronic databases were searched for randomised controlled trials evaluating the effects of exergaming on frailty in older adults. Data were synthesised using narrative synthesis and meta-analysis. The risk of bias and the certainty of the evidence were assessed.

Data sources: CINAHL, Cochrane Library, Embase, PubMed, Web of Science, and China Academic Journal Network Publishing Database were searched from their inception through February 2024.

Results: Five studies (n = 391) were included. Exergaming, which was delivered in 20-36 sessions over 8-12 weeks, resulted in improvements in frailty scores and indices, frailty status, and frailty phenotypes, including exhaustion, low physical activity levels, gait speed, and muscle weakness over time. There was no effect on unintentional weight loss. Meta-analyses showed that the effects of exergaming were not significantly different from those observed in the control groups. The rate of adherence to the intervention of the exergaming group was slightly higher than that of the comparison group (87.3%-87.7% vs. 81.1%-85.4%). The overall risk of bias was high in all studies. The certainty of the evidence was very low.

Conclusion: Exergaming exerts effects on frailty comparable to those of conventional physical exercises. Participants appeared to have better adherence to exergaming. Future studies with robust designs are warranted.

Implications for the profession and/or patient care: With effects comparable to those of conventional physical exercises, exergaming could be considered in clinical settings to address frailty.

Impact: This review addressed the effects of exergaming on frailty instead of physical outcomes. Exergaming was comparable to conventional physical exercises in improving frailty scores and indices, frailty status, and four frailty phenotypes. The findings provide insights to healthcare providers on the design of exergames.

Reporting method: PRISMA guidelines.

Protocol registration: PROSPERO number: CRD42023460495.

Patient or public contribution: No Patient or Public Contribution.

Aim: To analyse and synthesise current evidence on the effectiveness of cancer rehabilitation interventions in increasing physical activity, increasing healthy dietary habits, alleviating psychological distress, and increasing health-related quality of life (HRQoL) in women treated for gynaecological cancers (GCs).

Design: A meta-analysis of randomised controlled trials (RCTs).

Data sources: A systematic search was conducted in 12 databases from inception to 31 May 2024.

Review methods: The quantitative results from comparable RCTs were pooled and meta-analysed using Review Manager 5.4 software. The results from non-comparable (i.e., clinically heterogeneous) RCTs were narratively summarised. The methodological quality of all RCTs was assessed using Version 2 of the Cochrane risk of bias tool for randomised trials.

Results: Nine RCTs reported in a total of 12 articles met the inclusion criteria and comprised a total of 418 patients. The interventions had significant effects on total physical activity levels at post-intervention, 6-month follow-up, and 12-month follow-up, and on self-efficacy in physical activity at post-intervention and 3-month follow-up. However, the interventions did not significantly improve overall HRQoL or healthy dietary habits and did not significantly alleviate anxiety and depression. The key intervention components were information provision on health-promoting behaviours; adoption of behavioural change techniques (goal setting, action planning, relapse prevention, problem-solving, self-monitoring, and social support); and stress and emotion management.

Conclusion: Rehabilitation interventions effectively increase physical activity in women treated for GCs, leading to sustainable effects. However, there is limited evidence on the effectiveness of such interventions in improving overall HRQoL, encouraging healthy eating, and alleviating psychological distress in women treated for GCs.

Relevance to clinical practice: This review found that rehabilitation interventions can increase physical activity levels among women treated for GCs. It also identified the key effective components of such interventions.

Reporting method: This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.

Patient or public contribution: None.

Trial registration: International Prospective Register of Systematic Reviews registration number: CRD42023442877.

Background: Depressive symptoms are common among people with dementia (PWD). Exergaming consisting of combined cognitive and physical training in gaming is increasingly used to alleviate their depressive symptoms in research. With its potential synergistic neurobiological and psychosocial effects on reducing depressive symptoms among PWD, this review aimed to understand its effectiveness and contents.

Methods: This is a systematic review of the effectiveness of exergames on depressive symptoms among older adults with dementia. A search was conducted on 7 May 2024 of the online databases CINAHL, Embase, PsycINFO, PubMed and the China Academic Journal Network Publishing Database (CNKI). The methodological quality of randomised controlled trials (RCT) and quasi-experimental studies was assessed with RoB2 and ROBINS-I, respectively. A meta-analysis of the included RCTs was conducted.

Results: Six studies consisting of four RCTs and two quasi-experimental studies involving 235 participants with various stages of dementia were included. The meta-analysis showed a significant overall improvement in depression with a large effect size (SMD = 1.46, 95% CI = -2.50, -0.43; p = 0.006). Despite high heterogeneity (I² = 91%), all studies demonstrated a trend of improvement in depression after the intervention. The exergames adopted in the included trials had the following elements: simultaneous motor-cognitive training, a scoring mechanism and a social play. The dose of exergames ranged from 15 to 60 min per session for at least 8 weeks, with a minimum of two sessions weekly. However, the included studies had a moderate-to-serious risk of bias. The certainty of the evidence was very low.

Conclusion: Exergames could be effective at improving the depressive symptoms of older adults with dementia. Yet, a moderate-to-severe risk of bias shows a rigorous study should be conducted in the future.

Implications for patient care: This study provides evidence for healthcare professionals and informal caregivers to use exergames to address depressive symptoms in PWD.

Review registration: The review was registered on PROSPERO with the reference CRD42022372762.

Aim: To explore the meaning of adaptation after visceral transplantation in terms of patient experiences, symptoms, self-efficacy, transplant-specific and mental well-being.

Design: A convergent parallel mixed-methods study, consisting of interviews and generic as well as transplant-specific questionnaires. Results were integrated using meta-inference.

Methods: The study comprises a population of 17 visceral transplant recipients in Scandinavia, 12 women and 5 men with a mean age of 40.6 years (range 19-63 years) and an average follow-up of 9.4 years (range 0-25 years). Data were collected between May 2023 and January 2024 through open-ended in-depth interviews with 12 participants and analysed in accordance with phenomenological hermeneutics. Questionnaires from all 17 participants were analysed to measure transplant-specific well-being, symptoms, self-efficacy as well as anxiety and depressive symptoms.

Results: Being a visceral transplant recipient is a dynamic and life-long adaptation process that comprises two distinct yet interconnected trajectories: coherence and endurance. Coherence involves the person's ability to make sense of their situation and find meaning despite the challenges and adversity of the chronic condition. In contrast, endurance involves a person's capacity to withstand hardship and endure unpleasant or difficult experiences. Both trajectories interact dynamically, influencing and reinforcing each other. Resilience based on coherence enabled acceptance and adjustment. Conversely, uncertainty, resignation and feeling unsupported resulted in a lack of acceptance, manifested as resistance. The challenge involved in adaptation was demonstrated by 47% showing borderline elevated or elevated levels of anxiety and 18% reporting symptoms of depression. Self-efficacy varied considerably.

Conclusion: The meaning of adaptation after visceral transplantation in terms of experiences, symptoms, transplant-specific and mental well-being is balancing between coherence and endurance facilitated by acceptance and hampered by resistance. The uncertainty inherent in being a visceral transplant recipient may lead to heightened self-rated anxiety symptoms and diminished self-efficacy.

Implications for the profession and/or patient care: What problem did the study adress? This study adresses the challenges involved in being a visceral transplant recipient and adapting to life after a visceral transplantation. What were the main findings?

Reporting method: COREQ checklist (consolidated criteria for reporting qualitative research).

Patient or public contribution: No Patient or Public Contribution was organised.

Background: Despite the high acuity of coronary care unit (CCU) patients and their risk of deterioration, little is known about how nurses assess them.

Aim: Increase understanding of the scope of nurses' assessments of deteriorating CCU patients.

Design: Online mixed methods survey.

Methods: The mRAPIDS (modified Rescuing a Patient in Deteriorating Situations) tool was used to measure assessment scope in responses to a patient vignette with a higher mRAPID score signalling broader scope (maximum score 24). Reflections on day-to-day practice were collected concurrently and thematically analysed. Themes were integrated with scores using a joint display table and organised into domains. Comparing 'fit' between data showed expansion (overlap with broader nonoverlapping findings) and disconcordance (contradictory findings).

Results: Thirty-four nurses responded, and scope of assessment was found to be narrow (median mRAPIDS 5). Two domains were identified that helped explain this finding 'the act of assessment' and 'education and experience'. Participants emphasised the importance of education and experience, neither increased assessment scope.

Conclusion: This study showed that participant assessments were generally narrower than widely accepted best practice (ABCDE assessment).

Implications: Participant assessments did not reflect gold standard A-E assessment, which may partly reflect a need for assessment frameworks that are more compatible with real-world practice. Further research is required to understand the role of healthcare assistants in the care of deteriorating CCU patients. Clinical judgement is important, but not yet well understood in rapid response systems.

Impact: This study offers preliminary understanding of nurses' assessments of deteriorating patients in CCUs.

Reporting method: American Psychological Association, Mixed Methods Standards.

Patient or public contribution: Reviewed protocol, aided result interpretation and shared ideas for future research.

Background: Patient self-care is established as improving outcomes, yet acute care in hospitals is provided such that patients tend to be passive recipients of care. Little is known about the extent and type of patient participation in treatment care tasks in acute hospital settings.

Aims: To map and synthesise available literature on self-performance of care tasks in acute hospital settings.

Design: A scoping review was conducted guided by JBI methodology.

Methods: A literature search was conducted in July 2021 and updated in March 2024 across five databases: Scopus, PubMed, CINAHL, Embase and Web of Science. Studies were screened using predefined eligibility criteria. Full-text screening and data extraction were performed independently by two researchers. Data were collected using a template specifically designed for this review. Reporting followed the PRISMA-ScR guideline.

Results: Of the 31,361 articles identified, 35 were included. Most of the articles were experimental (n = 20) and conducted in Europe (n = 13), North America (n = 10) and Australia (n = 3). Studies were classified according to investigation of the performance of care tasks (n = 6) or of the outcomes of the performance of the self-care task (n = 29). Most tasks performed involved self-administration of medication (n = 31), only 4 articles referred to other care tasks. Most articles focused on acute tasks (n = 18), while 15 articles referred to chronic care tasks. Ostomy self-care (n = 2) was a separate category, being an acute task that continued into chronic self-care.

Conclusion: Performance of care tasks by patients in acute care settings are predominantly related to chronic and pain medication administration.

Implications for care: Patient preferences and competency to self-perform care tasks during hospitalisation should be assessed and monitored and supported accordingly. Utilising hospitalisation time to observe and assess self-care practices could provide additional teaching opportunities to patient self-care and improve overall care continuity.

Reporting method: The PRISMA-ScR guideline was followed.

Patient or public contribution: No Patient or Public Contribution.

Trial and protocol registration: This review was registered on Open Science Framework before running the final search: (https://doi.org/10.17605/OSF.IO/D8KS2).