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.