Journal of Clinical Nursing最新文献

Aims: Identify and describe patient engagement interventions used to improve medication management in older adults during transitions of care.

Design: A mixed-methods systematic review.

Methods: A comprehensive search of all study designs was conducted. Studies were categorised using the ladder of patient and family engagement, a framework that positions engagement from low (passive) to high (active partnership) patient engagement.

Data sources: Six databases were searched from inception to April 2024.

Results: The search yielded 29 reports, with 25 classified as studies. Most interventions (n = 19, 76%) were low-level interventions that comprised informing patients in a passive manner. Interventions that facilitated high-level engagement (n = 6, 24%) where patients were integrated in the decision-making process were associated with consistently improved patient and healthcare long-term outcomes.

Conclusions: While low and high-level engagement interventions were associated with significantly decreased hospital readmission rates, high-level interventions consistently demonstrated positive patient outcomes. Interventions supporting older adults beyond discharge achieved meaningful and lasting patient and healthcare outcomes for older adults.

Implications for the profession and/or patient care: Findings provide clinical reference for designing engagement interventions, highlighting long-term benefits of partnership-based approaches and continuity beyond discharge.

Impact: Engagement in medication management during transitions of care varied significantly. High-level engagement was consistently linked to improved patient and healthcare outcomes but was often resource intensive. This review identifies the need to design balanced interventions that align with the preferences of older adults and real-world contextual healthcare settings.

Reporting method: PRISMA guidelines.

Patient or public contribution: No patient or public contribution.

Protocol registration: PROSPERO (registration number CRD42024557385).

Aim: To scope international evidence on educational interventions to support delegation practices of nursing students and newly graduated nurses.

Design: A scoping review was undertaken following the Joanna Briggs Institute methodology, reported using the preferred reporting items for systematic reviews and meta-analysis scoping reviews extension (PRISMA-ScR) checklist.

Methods: CINAHL, ProQuest, Medline (Ovid), Scopus, EMBASE, Open grey and grey literature, from January 2014 to September 2024 were searched. Studies in English, empirical, evaluative, and available in full text were included.

Results: Eighteen studies were included in this review. Nine papers were evaluative. Fourteen of the papers were American. Educational interventions included role-play, case scenarios and peer learning. Three studies defined delegation, with four aligned to a delegation framework. Three studies were in clinical settings.

Conclusion: This review highlighted heterogeneity in educational interventions to support delegation practices. Gaps in the evidence base were highlighted, limited interventions in the clinical setting, absence of evidence underpinning educational effectiveness and minimal long-term follow up.

Implications for the profession: Students and new graduate nurses were able to demonstrate learning after an intervention, highlighting the benefit of case studies, peer learning and simulation. However, the long-term impact is unknown. Interventions need to support theory to practice transition. Professional standards, roles, responsibilities and scope of practice need to be incorporated, and educational interventions should occur more than once to support meaningful and ongoing learning.

Impact: This scoping review highlighted variation in delegation educational interventions for nursing students and new graduate nurses, with limited interventions in the clinical setting. Knowledge acquisition regarding roles and responsibilities was not always evident within interventions. Given the evolving context of healthcare practice, interventions aligned to professional standards necessitate supporting the acquisition of knowledge regarding roles, responsibilities and scope of practice of healthcare workers registered nurses delegate too.

Patient or public contribution: No Patient or Public Contribution.