Journal of Clinical Nursing最新文献

Aim: To analyse the comfort needs of patients following renal transplantation, guided by Kolcaba's Theory of Comfort.

Design: A qualitative design was employed.

Methods: This study was conducted at a Brazilian university hospital's renal transplant outpatient clinic. Forty-six post-transplant patients were purposively sampled by age, transplant time and clinic attendance. Face-to-face interviews were audio-recorded, transcribed and conducted using a semi-structured script. Data were analysed through thematic content analysis, guided by Kolcaba's Comfort Theory and relevant literature.

Results: Participant narratives were categorised according to the contexts outlined by Kolcaba's Theory of Comfort: Physical, Environmental, Sociocultural and Psychospiritual. In the physical context, pain was identified as a major factor diminishing comfort after renal transplantation. In the environmental context, elements such as light, odour, sound, temperature and uncomfortable furnishings contributed to discomfort. In the sociocultural context, family support was highlighted as essential. In the psychospiritual context, religiosity played a key role in enhancing the comfort of transplant recipients.

Conclusion: Spirituality, strengthened social support networks and non-pharmacological comfort measures are essential for promoting comfort among patients following renal transplantation. These findings underscore the importance of integrated care approaches that address physical, emotional and social aspects to improve quality of life for this population.

Implications for the profession and/or patient care: Conceptual models in nursing provide a critical perspective for care and support the delivery of effective, evidence-based interventions. By identifying the multidimensional comfort needs of post-renal transplant patients, this study informs the development of targeted, holistic strategies for nursing and multidisciplinary practice in outpatient settings.

Impact: This study examined the multidimensional comfort needs of post-renal transplant patients and found that comfort is shaped by physical, environmental, sociocultural and psychospiritual factors. The results may guide global nursing and multidisciplinary outpatient care by informing integrated approaches that enhance the quality of life of transplant recipients.

Reporting method: This study was reported according to the COREQ framework.

Patient or public contribution: No patient or public contribution.

Background: Nurse-led interventions have demonstrated effectiveness in managing emergence delirium (ED), but there is a lack of evidence in pediatric studies.

Aim: To systematically synthesize the evidence on the effectiveness of the nurse-led interventions on ED in pediatric patients.

Study design: A comprehensive literature search was conducted in PubMed, CINAHL, EMBASE, MEDLINE, Web of Science, Cochrane Library, and APA PsycINFO from the inception to January 13, 2025. Risk of bias was assessed by using the revised Cochrane risk-of bias tool (ROB2) and the Cochrane risk of bias in non-randomized studies-of interventions (ROBINS-I). The meta-analysis was performed using Stata16.0. The forest plots showed the overall effect of the included study.

Results: A total of 20 studies were included, involving 2369 children, comprising 17 RCTs, 1 quasi-experimental study and 2 cohort studies. Compared with usual care, nurse-led interventions significantly reduced the incidence of ED (risk ratio [RR]: 0.50, 95% confidence interval [CI]: 0.33 to 0.77, p = 0.002, I² = 77.2%), m-YPAS scores (weighted mean difference [WMD]: -7.67, 95% CI: -10.96 to -4.39, p = 0.000, I² = 91.7%), PAED scores (WMD: -1.47, 95% CI: -2.35 to -0.60, p = 0.000, I² = 91.3%), and FLACC scores (WMD: -0.97, 95% CI: -1.59 to -0.35, p = 0.000, I² = 92.9%). However, no significant effect was observed on the length of PACU stay or the anesthesia induction compliance.

Conclusions: Nurse-led interventions can reduce the incidence and severity of ED in children, as well as in alleviating preoperative anxiety and postoperative pain. However, more research is needed on influencing PACU length of stay and induction compliance.

Relevance to clinical practice: Nurse-led interventions can be integrated into the perioperative management of children to reduce the incidence of ED. However, in clinical practice, these interventions should be flexibly adapted based on the individual differences of pediatric patients.

Trial registration: This study protocol was registered on PROSPERO with the registration number CRD42024601191.

Background: Older adults often experience unplanned hospital admissions at the end of life, which may conflict with their wish to remain at home. Advance care planning (ACP) can help align care with patient preferences, but timely discussions and documentation are often lacking. Effective communication across healthcare settings is therefore essential.

Aim: To explore how ACP is delivered for community-dwelling older adults, focusing on intervention components, communication during care transitions and related barriers and facilitators.

Design: A scoping review conducted according to Joanna Briggs Institute methodology and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

Methods: We systematically searched six databases (PubMed, Embase, CINAHL, PsycINFO, Scopus and Web of Science) on 7 April 2025 for peer-reviewed primary studies on ACP interventions for community-dwelling older adults during healthcare transitions. Data were extracted using a structured table.

Results: Sixteen studies from seven countries (2016-2024) were included, with most conducted in the United States. ACP interventions typically involved healthcare professional education, structured documentation and coordination across settings. Communication strategies included written records, discharge summaries, telephone calls, face-to-face meetings and electronic systems. Key facilitators were timely patient identification, GP involvement, clear role distribution and use of existing clinical structures. Barriers included time constraints, unclear responsibilities, fragmented communication, insufficient training and emotional reluctance. ACP was often deprioritised due to acute care episodes.

Conclusion: ACP for community-dwelling older adults is a complex intervention challenged by structural, organisational and relational barriers. Future research should explore sustainable, context-sensitive ACP models that emphasise long-term integration, patient experiences and diverse care settings.

Patient or public contribution: No patient or public contribution.