Nayana Maria Gomes de Souza, Viviane Martins da Silva, Marcos Venícios de Oliveira Lopes, Emanuela Aparecida Teixeira Gueiros, Ana Luisa Brandão de Carvalho Lira, Rosely Leyliane Dos Santos
Aim: To test a middle-range theory (MRT) for the nursing diagnosis of ineffective breathing pattern in children with congenital heart disease (CHD) based on analysis of two general propositions.
Methods: This cross-sectional study is guided by STROBE. The propositions represent hypotheses about the relationships between the concepts of this MRT to be tested empirically, and thus, log-linear models were used to verify the structure of the proposition related to the stimuli. Diagnostic accuracy measures, univariate logistic regressions and the Mann-Whitney test were used to analyse the structure of the propositions related to behaviours.
Results: The analysis of the propositions related to the stimuli (eight concepts, four of which were classified as focal stimuli and four as contextual stimuli) suggested a reclassification of the stimulus "deformities in the thoracic wall" which became too focal. In the analysis of the propositions related to behaviours (17 concepts, five of which were classified as acute confirmatory, nine as acute clinical deterioration and three classified as chronic), guided changes in the operationalisation of concepts were suggested after comparing clinical findings; thus, acute confirmatory behaviours now have 10 concepts, while acute clinical deterioration behaviours and chronic behaviours continued with nine and three concepts, respectively, but with reclassifications between them.
Conclusion: Changes in the operationalisation of the classification of the elements of the two propositions occurred after comparing the clinical findings with the theoretical model.
Relevance to clinical practice: By establishing precise causal relationships and describing how IBP manifests itself over time in children with CHD, empirical testing of this MRT helps nurses understand clinical reasoning based on temporal logic and spectral interaction between diagnostic components, which in turn will improve the use and accuracy of nursing diagnoses.
Patient contribution: Children and adolescents with CHD were recruited for this study sharing their clinical history and physical lung examination.
{"title":"Empirical Testing of a Middle-Range Theory for Ineffective Breathing Pattern in Children With Congenital Heart Disease.","authors":"Nayana Maria Gomes de Souza, Viviane Martins da Silva, Marcos Venícios de Oliveira Lopes, Emanuela Aparecida Teixeira Gueiros, Ana Luisa Brandão de Carvalho Lira, Rosely Leyliane Dos Santos","doi":"10.1111/jocn.17533","DOIUrl":"https://doi.org/10.1111/jocn.17533","url":null,"abstract":"<p><strong>Aim: </strong>To test a middle-range theory (MRT) for the nursing diagnosis of ineffective breathing pattern in children with congenital heart disease (CHD) based on analysis of two general propositions.</p><p><strong>Methods: </strong>This cross-sectional study is guided by STROBE. The propositions represent hypotheses about the relationships between the concepts of this MRT to be tested empirically, and thus, log-linear models were used to verify the structure of the proposition related to the stimuli. Diagnostic accuracy measures, univariate logistic regressions and the Mann-Whitney test were used to analyse the structure of the propositions related to behaviours.</p><p><strong>Results: </strong>The analysis of the propositions related to the stimuli (eight concepts, four of which were classified as focal stimuli and four as contextual stimuli) suggested a reclassification of the stimulus \"deformities in the thoracic wall\" which became too focal. In the analysis of the propositions related to behaviours (17 concepts, five of which were classified as acute confirmatory, nine as acute clinical deterioration and three classified as chronic), guided changes in the operationalisation of concepts were suggested after comparing clinical findings; thus, acute confirmatory behaviours now have 10 concepts, while acute clinical deterioration behaviours and chronic behaviours continued with nine and three concepts, respectively, but with reclassifications between them.</p><p><strong>Conclusion: </strong>Changes in the operationalisation of the classification of the elements of the two propositions occurred after comparing the clinical findings with the theoretical model.</p><p><strong>Relevance to clinical practice: </strong>By establishing precise causal relationships and describing how IBP manifests itself over time in children with CHD, empirical testing of this MRT helps nurses understand clinical reasoning based on temporal logic and spectral interaction between diagnostic components, which in turn will improve the use and accuracy of nursing diagnoses.</p><p><strong>Patient contribution: </strong>Children and adolescents with CHD were recruited for this study sharing their clinical history and physical lung examination.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631512","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}
<p><strong>Aim: </strong>The study aimed to examine factors associated with the perceived feeling of safety and postoperative recovery in patients who have undergone orthopaedic day surgery under regional anaesthesia.</p><p><strong>Design: </strong>The design was quantitative, descriptive, and cross-sectional. The study participants comprised a consecutive sample (n = 209) of patients who underwent orthopaedic day surgery under regional anaesthesia.</p><p><strong>Methods: </strong>A questionnaire was sent to the home addresses of the study population approximately 3 weeks postoperatively. The questionnaire included the Feeling Safe During Surgery Scale (FSS), the Swedish version of the post-discharge surgical recovery scale (S-PSR), and questions concerning background variables. Multivariate regression models were used to examine the association of different variables with both feeling safe and postoperative recovery.</p><p><strong>Results: </strong>The only factor associated with the feeling of safety was preoperative anxiety; higher levels of preoperative anxiety were associated with lower levels of perceived safety during surgery. The factors associated with postoperative recovery were the recovery process itself and the patient's feeling of safety. Higher levels of postoperative anxiety were associated with a lower level of postoperative recovery. Higher levels of perceived safety during surgery were associated with higher postoperative recovery.</p><p><strong>Conclusion: </strong>The perceived feeling of safety in the perioperative period could not be explained by factors such as age, gender, or level of education. Based on the results of this study, postoperative recovery was associated with the perceived feeling of safety in the perioperative period. Anxiety in the perioperative period was associated with patients' perceived feeling of safety and their postoperative recovery. Thus, this study's results emphasise the importance of ensuring that people undergoing surgery feel safe to promote their recovery. Based on previous research, the nurse-patient relationship seems to be an important part of making patients feel safe, which ultimately affects their recovery.</p><p><strong>Implications for the profession/and or patient care: </strong>This study examines the association between perceived feeling of safety in the perioperative period and patients' postoperative recovery after undergoing orthopaedic day surgery under regional anaesthesia. Previous research has shown that the nurse-patient relationship and patients' possibilities to participate in their care are important for them to feel safe. This study further emphasises the importance of fostering relationships in the perioperative period and making patients an active part in decision-making, as it may positively impact their recovery. Creating a feeling of safety for the patient should be prioritised, as it benefits their perioperative experience and postoperative recovery.</p><p><stro
{"title":"Undergoing Orthopaedic Day Surgery: What Factors Are Associated With patients' Feeling of Safety and Their Recovery?","authors":"Fanny Larsson, Åsa Engström, Ulrica Strömbäck, Silje Rysst","doi":"10.1111/jocn.17552","DOIUrl":"https://doi.org/10.1111/jocn.17552","url":null,"abstract":"<p><strong>Aim: </strong>The study aimed to examine factors associated with the perceived feeling of safety and postoperative recovery in patients who have undergone orthopaedic day surgery under regional anaesthesia.</p><p><strong>Design: </strong>The design was quantitative, descriptive, and cross-sectional. The study participants comprised a consecutive sample (n = 209) of patients who underwent orthopaedic day surgery under regional anaesthesia.</p><p><strong>Methods: </strong>A questionnaire was sent to the home addresses of the study population approximately 3 weeks postoperatively. The questionnaire included the Feeling Safe During Surgery Scale (FSS), the Swedish version of the post-discharge surgical recovery scale (S-PSR), and questions concerning background variables. Multivariate regression models were used to examine the association of different variables with both feeling safe and postoperative recovery.</p><p><strong>Results: </strong>The only factor associated with the feeling of safety was preoperative anxiety; higher levels of preoperative anxiety were associated with lower levels of perceived safety during surgery. The factors associated with postoperative recovery were the recovery process itself and the patient's feeling of safety. Higher levels of postoperative anxiety were associated with a lower level of postoperative recovery. Higher levels of perceived safety during surgery were associated with higher postoperative recovery.</p><p><strong>Conclusion: </strong>The perceived feeling of safety in the perioperative period could not be explained by factors such as age, gender, or level of education. Based on the results of this study, postoperative recovery was associated with the perceived feeling of safety in the perioperative period. Anxiety in the perioperative period was associated with patients' perceived feeling of safety and their postoperative recovery. Thus, this study's results emphasise the importance of ensuring that people undergoing surgery feel safe to promote their recovery. Based on previous research, the nurse-patient relationship seems to be an important part of making patients feel safe, which ultimately affects their recovery.</p><p><strong>Implications for the profession/and or patient care: </strong>This study examines the association between perceived feeling of safety in the perioperative period and patients' postoperative recovery after undergoing orthopaedic day surgery under regional anaesthesia. Previous research has shown that the nurse-patient relationship and patients' possibilities to participate in their care are important for them to feel safe. This study further emphasises the importance of fostering relationships in the perioperative period and making patients an active part in decision-making, as it may positively impact their recovery. Creating a feeling of safety for the patient should be prioritised, as it benefits their perioperative experience and postoperative recovery.</p><p><stro","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631686","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}
{"title":"Comment on 'Effectiveness of Horticultural Therapy in Older Patients With Dementia: A Meta-Analysis Systematic Review'.","authors":"Rachana Mehta, Ashok Kumar Balaraman, Sanjit Sah, Ganesh Bushi","doi":"10.1111/jocn.17554","DOIUrl":"https://doi.org/10.1111/jocn.17554","url":null,"abstract":"","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631485","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}
Marie Lund, Annelie J. Sundler, Ewa Carlsson Lalloo
<div> <section> <h3> Aim</h3> <p>To explore the healthcare experiences and needs of older adults living with HIV in Sweden.</p> </section> <section> <h3> Design</h3> <p>A phenomenological study using qualitative thematic analysis.</p> </section> <section> <h3> Methods</h3> <p>Data were gathered through semistructured qualitative interviews and analysed using thematic analysis. A purposive sample of individuals ageing and living with HIV was recruited for this study.</p> </section> <section> <h3> Results</h3> <p>A total of 22 participants aged 65 years and older, with a mean age of 75 years, participated in the study. Living with HIV meant a need to rely on consistent healthcare and treatment over the course of one's lifetime. The experiences of older adults were described under four themes: relying on access to health care, desiring involvement and shared decision-making, the importance of trust and confidentiality and experiences of stigma in healthcare visits.</p> </section> <section> <h3> Conclusion</h3> <p>Living and ageing with HIV involved recurring exposure and vulnerability in healthcare encounters, and experiences of being exposed to HIV-related stigma, especially outside HIV clinics. Continuity and being seen as a person in healthcare encounters were important. Enhancing HIV knowledge alongside fostering supportive attitudes and approaches of healthcare professionals is critical for ensuring high-quality and nondiscriminating health care.</p> </section> <section> <h3> Implications for the Profession and/or Patient Care</h3> <p>Meeting the needs of older adults living with HIV requires a person-centred approach, including active involvement and shared decision-making between patients and healthcare providers.</p> </section> <section> <h3> Impact</h3> <p>This study describes the healthcare experiences and needs of older adults, aged 65 years and older, living with HIV, a population that is not typically investigated in qualitative research. Living and ageing with HIV means a vulnerability where the attitudes of professionals and the active involvement of the patient become significant for quality care. The findings can help with the implementation of policies and practices for the care of older adults living with HIV.</p> </s
{"title":"Healthcare Experiences and Needs of Older Adults Living With HIV: A Qualitative Study","authors":"Marie Lund, Annelie J. Sundler, Ewa Carlsson Lalloo","doi":"10.1111/jocn.17538","DOIUrl":"10.1111/jocn.17538","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore the healthcare experiences and needs of older adults living with HIV in Sweden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A phenomenological study using qualitative thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were gathered through semistructured qualitative interviews and analysed using thematic analysis. A purposive sample of individuals ageing and living with HIV was recruited for this study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 22 participants aged 65 years and older, with a mean age of 75 years, participated in the study. Living with HIV meant a need to rely on consistent healthcare and treatment over the course of one's lifetime. The experiences of older adults were described under four themes: relying on access to health care, desiring involvement and shared decision-making, the importance of trust and confidentiality and experiences of stigma in healthcare visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Living and ageing with HIV involved recurring exposure and vulnerability in healthcare encounters, and experiences of being exposed to HIV-related stigma, especially outside HIV clinics. Continuity and being seen as a person in healthcare encounters were important. Enhancing HIV knowledge alongside fostering supportive attitudes and approaches of healthcare professionals is critical for ensuring high-quality and nondiscriminating health care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Implications for the Profession and/or Patient Care</h3>\u0000 \u0000 <p>Meeting the needs of older adults living with HIV requires a person-centred approach, including active involvement and shared decision-making between patients and healthcare providers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Impact</h3>\u0000 \u0000 <p>This study describes the healthcare experiences and needs of older adults, aged 65 years and older, living with HIV, a population that is not typically investigated in qualitative research. Living and ageing with HIV means a vulnerability where the attitudes of professionals and the active involvement of the patient become significant for quality care. The findings can help with the implementation of policies and practices for the care of older adults living with HIV.</p>\u0000 </s","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":"33 12","pages":"4819-4829"},"PeriodicalIF":3.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter to the Editor 'A Cross-Sectional Study of Risk Factors for Coronary Heart Disease in Secondary Prevention for Patients With the Disease in China'.","authors":"Peng Ha, Jiajuan Guo","doi":"10.1111/jocn.17544","DOIUrl":"https://doi.org/10.1111/jocn.17544","url":null,"abstract":"","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631564","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}
Floriana Pinto, Pasquale Roberto, Lucrezia Ferrario, Laura Marotta, Doriana Montani, Gaetano Auletta, Laura Zoppini, Emanuela Foglia
Aim: To evaluate the impact of using 'Situation-Background-Assessment-Recommendation' method ('SBAR') in a palliative care setting.
Background: Effective handover communication is crucial for patient safety. Standardised communication tools, such as the SBAR method, are recommended to reduce errors and improve care coordination, but their use in palliative care is not investigated.
Design: Mixed method study design, adhering to the GRAMMS guideline.
Methods: From January to October 2021, a SBAR guide tailored for palliative care was developed using the Delphi method and implemented in a Hospice setting. Data on 150 nurse handovers were collected before and after implementation to assess changes in nursing outcomes, including medication errors, adverse events and the identification of psychological and spiritual needs. Nurses' perceptions on the handover process were gathered through a qualitative survey.
Results: The SBAR guide significantly improved the handovers quality, reducing medication errors and eliminating adverse events postimplementation. The identification of psychological and spiritual needs increased during postimplementation period. Nurses also reported improved clarity, accuracy and completeness of information during handover.
Conclusion: This is the first study to evaluate the impact of SBAR for handover in palliative nursing care. Findings show the added value of using communication tools.
{"title":"Using 'Situation-Background-Assessment-Recommendation' Method in Palliative Care to Enhance Handover Quality and Nursing Practice: A Mix Method Study.","authors":"Floriana Pinto, Pasquale Roberto, Lucrezia Ferrario, Laura Marotta, Doriana Montani, Gaetano Auletta, Laura Zoppini, Emanuela Foglia","doi":"10.1111/jocn.17537","DOIUrl":"https://doi.org/10.1111/jocn.17537","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the impact of using 'Situation-Background-Assessment-Recommendation' method ('SBAR') in a palliative care setting.</p><p><strong>Background: </strong>Effective handover communication is crucial for patient safety. Standardised communication tools, such as the SBAR method, are recommended to reduce errors and improve care coordination, but their use in palliative care is not investigated.</p><p><strong>Design: </strong>Mixed method study design, adhering to the GRAMMS guideline.</p><p><strong>Methods: </strong>From January to October 2021, a SBAR guide tailored for palliative care was developed using the Delphi method and implemented in a Hospice setting. Data on 150 nurse handovers were collected before and after implementation to assess changes in nursing outcomes, including medication errors, adverse events and the identification of psychological and spiritual needs. Nurses' perceptions on the handover process were gathered through a qualitative survey.</p><p><strong>Results: </strong>The SBAR guide significantly improved the handovers quality, reducing medication errors and eliminating adverse events postimplementation. The identification of psychological and spiritual needs increased during postimplementation period. Nurses also reported improved clarity, accuracy and completeness of information during handover.</p><p><strong>Conclusion: </strong>This is the first study to evaluate the impact of SBAR for handover in palliative nursing care. Findings show the added value of using communication tools.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631696","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}
Background: Hospice care for patients with advanced cancer mainly takes the family members and healthcare professionals as the main body and the patients as the object. There is a lack of relevant research on reflexive hospice care that considers patients as subjects.
Aim: To explore the experience of reflexive hospice care for patients with advanced cancer.
Design: An empirical phenomenological approach to research was conducted.
Methods: Data were collected using face-to-face semi-structured interviews between April 3, 2024 and May 27, 2024 in the oncology wards of two comprehensive hospitals. Purposive sampling was used to recruit 18 patients with advanced cancer receiving hospice care. Colaizzi's phenomenological analysis method was used to analyse the data. We followed the consolidated criteria for reporting qualitative research (COREQ).
Results: Four themes were identified as being relevant to the experience of reflexive hospice care for patients with advanced cancer: the absence of prior awareness, reconciling with self and others, care and concern for others, and pursuing the meaning of life.
Conclusion: This study provides new insights into hospice care for patients with advanced cancer. It emphasises the importance of patients' participation as subjects in hospice care. In reflexive hospice care, patients can actively participate and express their care for others and their understanding of life, thus gaining more respect and care in the end-of-life stage. Therefore, placing patients as the subjects of hospice care and fully respecting and listening to their wishes and needs is one of the most important ways to promote the development of hospice care quality.
Patient or public contribution: No patient or public contribution.
{"title":"The Experience of Reflexive Hospice Care for Patients With Advanced Cancer: A Qualitative Study.","authors":"Xi Zhang, Tieying Zeng, Ye Chen","doi":"10.1111/jocn.17541","DOIUrl":"https://doi.org/10.1111/jocn.17541","url":null,"abstract":"<p><strong>Background: </strong>Hospice care for patients with advanced cancer mainly takes the family members and healthcare professionals as the main body and the patients as the object. There is a lack of relevant research on reflexive hospice care that considers patients as subjects.</p><p><strong>Aim: </strong>To explore the experience of reflexive hospice care for patients with advanced cancer.</p><p><strong>Design: </strong>An empirical phenomenological approach to research was conducted.</p><p><strong>Methods: </strong>Data were collected using face-to-face semi-structured interviews between April 3, 2024 and May 27, 2024 in the oncology wards of two comprehensive hospitals. Purposive sampling was used to recruit 18 patients with advanced cancer receiving hospice care. Colaizzi's phenomenological analysis method was used to analyse the data. We followed the consolidated criteria for reporting qualitative research (COREQ).</p><p><strong>Results: </strong>Four themes were identified as being relevant to the experience of reflexive hospice care for patients with advanced cancer: the absence of prior awareness, reconciling with self and others, care and concern for others, and pursuing the meaning of life.</p><p><strong>Conclusion: </strong>This study provides new insights into hospice care for patients with advanced cancer. It emphasises the importance of patients' participation as subjects in hospice care. In reflexive hospice care, patients can actively participate and express their care for others and their understanding of life, thus gaining more respect and care in the end-of-life stage. Therefore, placing patients as the subjects of hospice care and fully respecting and listening to their wishes and needs is one of the most important ways to promote the development of hospice care quality.</p><p><strong>Patient or public contribution: </strong>No patient or public contribution.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631599","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}
<p><strong>Aims and objectives: </strong>This study aims to compare the effectiveness of the case management model and the primary nursing care model by focusing on hospital stay length, readmission, follow-up resource utilisation and survival.</p><p><strong>Background: </strong>To improve patient continuity of care, a discharge planning team has been established at the hospital to implement the service concept of long-term medical care. The team works with a multidisciplinary medical team to provide case management, which ensures high-quality patient care.</p><p><strong>Design: </strong>Retrospective case-control study.</p><p><strong>Methods: </strong>This study collected data from the medical record information system database and the Ministry of Health and Welfare's care service management information system to explore medical and follow-up care utilisation of patients discharged between 2017 and 2018. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, with the checklist used to ensure transparent and complete reporting of the methodology and results.</p><p><strong>Patient or public contribution: </strong>To ensure comparability between the case management model group and the primary nursing model group, propensity score matching was used. After matching, 660 individuals from the case management model group and 2876 individuals from the primary nursing model group were selected for further analysis. In this study, patients were primarily involved in the research as participants, providing data through their medical records for analysis. However, no direct involvement from the public or patients was used in the planning or design stages of the research.</p><p><strong>Results: </strong>The study found that factors such as activities of daily living (ADL) score ≤ 60 points, catheterisation, poor chronic disease control and inadequate primary caregiver capacity can lead to longer hospitalisations. Males and patients with catheters have a higher risk of readmission within 30 days, and men, those aged ≥ 75 years, those with ADL score ≤ 60, catheterisation, pressure sores or unclean wounds, financial problems, insufficient primary caregiver capacity and those readmitted within 14 days after discharge had significantly increased mortality after discharge. Although the case management model group had higher hospitalisation days, they had lower readmission rates and higher survival rates than the primary nursing model group.</p><p><strong>Conclusions: </strong>Early consultation with the case manager for discharge planning can help patients to continue to receive care and utilise relevant resources after returning home.</p><p><strong>Relevance to clinical practice: </strong>Identifying and addressing patient-specific factors can significantly improve patient outcomes by reducing hospitalizations and readmissions, and lowering mortality rates. The case management model is more effective than
{"title":"Evaluate the Differential Effectiveness of the Case Management and Primary Nursing Models in the Implementation of Discharge Planning.","authors":"Hui-Wen Po, Ying-Chien Chu, Hui-Chen Tsai, Chung-Yu Chen, Yi-Wen Chiu","doi":"10.1111/jocn.17550","DOIUrl":"https://doi.org/10.1111/jocn.17550","url":null,"abstract":"<p><strong>Aims and objectives: </strong>This study aims to compare the effectiveness of the case management model and the primary nursing care model by focusing on hospital stay length, readmission, follow-up resource utilisation and survival.</p><p><strong>Background: </strong>To improve patient continuity of care, a discharge planning team has been established at the hospital to implement the service concept of long-term medical care. The team works with a multidisciplinary medical team to provide case management, which ensures high-quality patient care.</p><p><strong>Design: </strong>Retrospective case-control study.</p><p><strong>Methods: </strong>This study collected data from the medical record information system database and the Ministry of Health and Welfare's care service management information system to explore medical and follow-up care utilisation of patients discharged between 2017 and 2018. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, with the checklist used to ensure transparent and complete reporting of the methodology and results.</p><p><strong>Patient or public contribution: </strong>To ensure comparability between the case management model group and the primary nursing model group, propensity score matching was used. After matching, 660 individuals from the case management model group and 2876 individuals from the primary nursing model group were selected for further analysis. In this study, patients were primarily involved in the research as participants, providing data through their medical records for analysis. However, no direct involvement from the public or patients was used in the planning or design stages of the research.</p><p><strong>Results: </strong>The study found that factors such as activities of daily living (ADL) score ≤ 60 points, catheterisation, poor chronic disease control and inadequate primary caregiver capacity can lead to longer hospitalisations. Males and patients with catheters have a higher risk of readmission within 30 days, and men, those aged ≥ 75 years, those with ADL score ≤ 60, catheterisation, pressure sores or unclean wounds, financial problems, insufficient primary caregiver capacity and those readmitted within 14 days after discharge had significantly increased mortality after discharge. Although the case management model group had higher hospitalisation days, they had lower readmission rates and higher survival rates than the primary nursing model group.</p><p><strong>Conclusions: </strong>Early consultation with the case manager for discharge planning can help patients to continue to receive care and utilise relevant resources after returning home.</p><p><strong>Relevance to clinical practice: </strong>Identifying and addressing patient-specific factors can significantly improve patient outcomes by reducing hospitalizations and readmissions, and lowering mortality rates. The case management model is more effective than ","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631526","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}
Aims: To systematically analyse expert perspectives on paediatric-friendly care in the emergency department and establish specific indicators.
Background: With an increasing number of children seeking emergency care, nurses must understand the specific needs of paediatric patients and their families.
Design: A two-round modified Delphi method was used in this study.
Methods: In this study, experts from clinical practice and academia assessed 56 paediatric-friendly care criteria in the emergency department. Data were collected to establish a consensus and ensure content validity.
Results: Thirty experts completed two survey rounds with response rates of 100% and 93.3%, respectively. In the initial survey, no consensus was reached for eight items. After the items were consolidated, 37 paediatric emergency-friendly care needs were identified. For each need, the item-level content validity index exceeded 0.79 for importance and feasibility. The average scale-level content validity index values were 0.95 and 0.92 for importance and feasibility. These needs were categorised into six dimensions: timely comfort (3 items), emotional care (5 items), frontline safety (11 items), emergency response (10 items), human resources support (5 items) and treatment efficiency (3 items).
Conclusion: Paediatric emergency nurses play a vital role in caring for children, improving soft skills through compassion and training and ensuring a well-equipped, safe environment in the emergency department.
Relevance of clinical practice: This study offers valuable insights for emergency department nurses on the needs of children and their families, emphasising the importance of patient and family education, environmental considerations and the role of certified child life specialists in supporting the emergency healthcare team and ensuring appropriate paediatric care.
Patient/public contribution: No direct patient, service user, caregiver or public involvement existed in this study.
{"title":"Identifying the Needs of Paediatric-Friendly Care in Emergency Department: A Delphi Study.","authors":"Yen-Ju Chen, Wei-Chieh Tseng, Jao-Shwann Liang, Tzu-Hui Tung, Su-Fen Cheng, Chi-Wen Chen","doi":"10.1111/jocn.17505","DOIUrl":"https://doi.org/10.1111/jocn.17505","url":null,"abstract":"<p><strong>Aims: </strong>To systematically analyse expert perspectives on paediatric-friendly care in the emergency department and establish specific indicators.</p><p><strong>Background: </strong>With an increasing number of children seeking emergency care, nurses must understand the specific needs of paediatric patients and their families.</p><p><strong>Design: </strong>A two-round modified Delphi method was used in this study.</p><p><strong>Methods: </strong>In this study, experts from clinical practice and academia assessed 56 paediatric-friendly care criteria in the emergency department. Data were collected to establish a consensus and ensure content validity.</p><p><strong>Results: </strong>Thirty experts completed two survey rounds with response rates of 100% and 93.3%, respectively. In the initial survey, no consensus was reached for eight items. After the items were consolidated, 37 paediatric emergency-friendly care needs were identified. For each need, the item-level content validity index exceeded 0.79 for importance and feasibility. The average scale-level content validity index values were 0.95 and 0.92 for importance and feasibility. These needs were categorised into six dimensions: timely comfort (3 items), emotional care (5 items), frontline safety (11 items), emergency response (10 items), human resources support (5 items) and treatment efficiency (3 items).</p><p><strong>Conclusion: </strong>Paediatric emergency nurses play a vital role in caring for children, improving soft skills through compassion and training and ensuring a well-equipped, safe environment in the emergency department.</p><p><strong>Relevance of clinical practice: </strong>This study offers valuable insights for emergency department nurses on the needs of children and their families, emphasising the importance of patient and family education, environmental considerations and the role of certified child life specialists in supporting the emergency healthcare team and ensuring appropriate paediatric care.</p><p><strong>Patient/public contribution: </strong>No direct patient, service user, caregiver or public involvement existed in this study.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631554","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}
Hongxia Tao, Hongyan Zhang, Xinmian Kang, Yahan Wang, Yuxia Ma, Juhong Pei, Lin Han
<div> <section> <h3> Background</h3> <p>Pressure injuries (PIs) impose a significant burden on patients in the intensive care unit (ICU) and the healthcare system. Assessing the risk of developing PIs is crucial for prevention. However, it is unclear whether all subscales of the Waterlow scale can be used to assess PIs risk in ICU.</p> </section> <section> <h3> Objectives</h3> <p>To assess whether all subscales of the Waterlow scale can predict PIs risk in ICU.</p> </section> <section> <h3> Design</h3> <p>Multicentre prospective study.</p> </section> <section> <h3> Methods</h3> <p>A total of 18,503 patients from ICUs in 40 tertiary-level hospitals in Gansu province of China were enrolled from April 2021 to August 2023. The incidence and characteristics of PIs were recorded. Univariate Cox regression analyses were performed for each subscale as a predictor of PIs development, followed by multivariate Cox regression with covariates for each subscale separately.</p> </section> <section> <h3> Results</h3> <p>Out of 17,720 patients included, the incidence of PIs was 1.1%. Multivariate analysis revealed skin type (HR: 1.468, 95% CI: 1.229, 1.758), sex (HR: 0.655, 95% CI: 0.472, 0.908), advanced age (HR: 1.263, 95% CI: 1.106, 1.442), continence (HR: 1.245, 95% CI: 1.052, 1.473), tissue malnutrition (HR: 1.070, 95% CI: 1.007, 1.136) and neurological deficit (HR: 1.153, 95% CI: 1.062, 1.251) were independently predictive of PIs development for all participants. Skin type (HR: 2.326, 95% CI: 1.153, 3.010) (HR: 2.217, 95% CI: 1.804, 2.573) independently predicted PIs occurrence for high-risk and very high-risk group, respectively, while sex (HR: 0.634, 95% CI: 0.431, 0.931) and age (HR: 1.269, 95% CI: 1.083, 1.487) predicted PIs development for very high-risk group.</p> </section> <section> <h3> Conclusions</h3> <p>This study found that not all subscales of the Waterlow scale are associated with the PIs development in patients in ICU, highlighting the importance of the skin type subscale in predicting PI risk across all patient groups.</p> </section> <section> <h3> Implications for Clinical Practice</h3> <p>Nurses need to focus on patient's skin and related (moisture, pain and pressure) conditions and take measures to promote skin health and avoid the occurrence of PI.</p> </section> <section> <h3> Patient or Public Contribution</h3>
背景：压迫性损伤（PIs）给重症监护病房（ICU）的患者和医疗系统带来了沉重的负担。评估发生压伤的风险对于预防压伤至关重要。然而，目前尚不清楚 Waterlow 量表的所有分量表是否都能用于评估重症监护室的压伤风险：评估 Waterlow 量表的所有分量表是否都能预测 ICU 中的 PIs 风险：多中心前瞻性研究：方法：2021年4月至2023年8月，甘肃省40家三级甲等医院ICU的18503名患者入组。记录了 PI 的发生率和特征。对预测 PIs 发生的各分量表进行单变量 Cox 回归分析，然后对各分量表分别进行带协变量的多变量 Cox 回归分析：在纳入的 17720 名患者中，PIs 的发生率为 1.1%。多变量分析显示皮肤类型（HR：1.468，95% CI：1.229，1.758）、性别（HR：0.655，95% CI：0.472，0.908）、高龄（HR：1.263，95% CI：1.106，1.442）、尿失禁（HR：1.245，95% CI：1.在所有参与者中，组织营养不良（HR：1.070，95% CI：1.007，1.136）和神经功能缺损（HR：1.153，95% CI：1.062，1.251）可独立预测 PIs 的发生。皮肤类型（HR：2.326，95% CI：1.153，3.010）（HR：2.217，95% CI：1.804，2.573）分别独立预测高危组和极高危组 PIs 的发生，而性别（HR：0.634，95% CI：0.431，0.931）和年龄（HR：1.269，95% CI：1.083，1.487）预测极高危组 PIs 的发生：本研究发现，并非 Waterlow 量表的所有分量表都与 ICU 患者的 PIs 发展相关，这突出了皮肤类型分量表在预测所有患者组 PI 风险方面的重要性：对临床实践的启示：护士需要关注患者的皮肤及相关情况（湿度、疼痛和压力），并采取措施促进皮肤健康，避免PI的发生：患者或公众贡献：无。
{"title":"Pressure Injuries and the Waterlow Subscales in the Intensive Care Unit: A Multicentre Study","authors":"Hongxia Tao, Hongyan Zhang, Xinmian Kang, Yahan Wang, Yuxia Ma, Juhong Pei, Lin Han","doi":"10.1111/jocn.17526","DOIUrl":"10.1111/jocn.17526","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pressure injuries (PIs) impose a significant burden on patients in the intensive care unit (ICU) and the healthcare system. Assessing the risk of developing PIs is crucial for prevention. However, it is unclear whether all subscales of the Waterlow scale can be used to assess PIs risk in ICU.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess whether all subscales of the Waterlow scale can predict PIs risk in ICU.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Multicentre prospective study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 18,503 patients from ICUs in 40 tertiary-level hospitals in Gansu province of China were enrolled from April 2021 to August 2023. The incidence and characteristics of PIs were recorded. Univariate Cox regression analyses were performed for each subscale as a predictor of PIs development, followed by multivariate Cox regression with covariates for each subscale separately.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 17,720 patients included, the incidence of PIs was 1.1%. Multivariate analysis revealed skin type (HR: 1.468, 95% CI: 1.229, 1.758), sex (HR: 0.655, 95% CI: 0.472, 0.908), advanced age (HR: 1.263, 95% CI: 1.106, 1.442), continence (HR: 1.245, 95% CI: 1.052, 1.473), tissue malnutrition (HR: 1.070, 95% CI: 1.007, 1.136) and neurological deficit (HR: 1.153, 95% CI: 1.062, 1.251) were independently predictive of PIs development for all participants. Skin type (HR: 2.326, 95% CI: 1.153, 3.010) (HR: 2.217, 95% CI: 1.804, 2.573) independently predicted PIs occurrence for high-risk and very high-risk group, respectively, while sex (HR: 0.634, 95% CI: 0.431, 0.931) and age (HR: 1.269, 95% CI: 1.083, 1.487) predicted PIs development for very high-risk group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study found that not all subscales of the Waterlow scale are associated with the PIs development in patients in ICU, highlighting the importance of the skin type subscale in predicting PI risk across all patient groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Implications for Clinical Practice</h3>\u0000 \u0000 <p>Nurses need to focus on patient's skin and related (moisture, pain and pressure) conditions and take measures to promote skin health and avoid the occurrence of PI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient or Public Contribution</h3>\u0000 \u0000 ","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":"33 12","pages":"4809-4818"},"PeriodicalIF":3.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631571","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}
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