Journal of Clinical Nursing最新文献

Background: Diabetes is a global problem. Diabetes nurses, in particular, take great responsibility in reducing and controlling the fears of individuals using insulin and increasing their capacity to tolerate discomfort.

Aim: This study was conducted to examine the effects of the capacity to tolerate discomfort on the fear of self-injection and the status of testing blood glucose levels in patients with type 1 and type 2 diabetes using insulin.

Methods: This cross-sectional study was conducted between December 2022 and February 2023 with 320 adult patients with type 1 and type 2 diabetes using insulin who were followed up in the Endocrinology and Internal Medicine Clinics of a university hospital in Turkey. The data analysis process included analyses of the frequency, independent-samples t-tests, one-way ANOVA, the Kruskal-Wallis H test, and Pearson's correlation analysis. Data were analysed using the IBM SPSS v27.0 software, considering alpha as 0.05.

Results: The mean total Discomfort Intolerance Scale score of the patients was 22.78 ± 6.74, and the mean Fear of Self-Injecting and self-testing was 21.1 ± 6.7. A negative significant correlation was found between the discomfort intolerance levels of the patients and their levels of fear of self-injection and self-testing (p < 0.05).

Conclusion: Individuals with a higher capacity to tolerate discomfort have lower levels of fear of self-testing and self-injection. Therefore, the fear of self-testing and self-injection in patients using insulin injections may affect diabetes self-management.

Relevance to clinical practice: Individuals with low tolerance for discomfort should be identified, interventions to increase tolerance in individuals at risk should be planned, and diabetes self-management should be better supported.

Reporting method: The reporting of the results of the study adhered to the STROBE guidelines.

Aim: To synthesise stakeholders' experiences and perceptions of animal-assisted intervention (AAI) for people with dementia in community care settings.

Design: Qualitative evidence synthesis.

Methods: We systematically searched Medline, CINAHL, Embase, Scopus, Web of Science, PsycINFO and AgeLine for potentially eligible studies. Thematic synthesis was used to analyse the data from included studies. We assessed the methodological limitations of included studies using an adaptation of the Critical Appraisal Skills Programme checklist and used Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) tool to assess confidence in review findings. This review is reported using the ENTREQ checklist.

Results: We included 14 reports from 11 studies and developed three analytical themes incorporating a gardening analogy: planting-connecting with animals, growing-engaging in AAI and nurturing-making AAI work; and six subthemes: willingness to connect, building relationships, a rich experience, the benefits of AAI, individualised and holistic approach and training and support, with 15 key findings.

Conclusion: This review describes people's experiences and perceptions of AAI for people with dementia, and provides recommendations on the development and implementation of AAI, with moderate to high confidence. Nurses need to consider the factors that influence the implementation of AAI identified in this review, to facilitate engagement and long-term impacts while adopting AAI in community care settings.

Implications for the profession and patient care: This review may enhance healthcare professionals' understanding of AAI for people with dementia in community care settings. AAI is a complex intervention that can be delivered in varied manner. A multicomponent, flexible and individualised AAI is important. Additional training and education for staff are needed.

Patient or public contribution: A man with dementia and his wife who share a love of dogs, advised at each step of the review, providing insights and perspectives and contributing as co-authors.

Background: Sleep is a fundamental prerequisite for physical and mental health. Poor quality of sleep is common among post-cardiac surgery patients and leads to serious health conditions.

Objective: To conduct a systematic review that investigates the effectiveness of eye masks, earplugs and deep-breathing exercise on sleep quality among post-cardiac surgery patients.

Design: A systematic review of interventional studies was established to meet the PRISMA guidelines.

Methods: PRISMA guidelines were used to assess the findings of 11 selected studies that met the inclusion criteria, published between 2007 and 2023 across four databases: CINAHL, JDNR, MEDLINE and PubMed. The search was conducted on 23 November 2023.

Results: The 11 most eligible studies were analysed. All of them were interventional, encompassing a total of 787 participants. Randomised controlled trials were the most common design. Interventions included eye masks, earplugs and deep-breathing exercises. The Richards-Campbell Sleep Questionnaire was the most used assessment scale. Most of the reviewed studies found that the use of non-pharmacological interventions (eye masks, earplugs and deep-breathing exercise) significantly improves the quality of sleep. These interventions were also found to have potentially positive effects on reducing pain and delirium experienced by patients after undergoing cardiac surgery.

Conclusions: Non-pharmacological interventions (eye masks, earplugs and deep-breathing exercise) were found to be cost-effective interventions that could be easily applied in the clinical setting and are effective in improving the quality of sleep among patients after cardiac surgery.

Aims: Aging populations require adapting healthcare systems for older adult's specific needs. Numerous initiatives to improve older-patient care have emerged, but the field lacks a unified framework. The current study aims to provide a systematic concept analysis of 'age-friendly healthcare', examining its characteristics, components and structure.

Design: Rodger's evolutionary concept analysis.

Data sources: Searches were conducted in ProQuest, CINAHL, PubMed and Scopus databases between November 2022 and October 2023, utilising the PRISMA 2020 reporting checklist.

Methods: A literature search using specific terms relevant to age-friendly healthcare retrieved 1407 articles. After screening for duplicates and relevance, 140 articles were examined for eligibility based on inclusion criteria for age-friendly care, language and full-text availability. Following full-text screening, 65 articles were included for data extraction by multiple researchers to synthesise theoretical, methodological and design elements.

Results: Our findings highlight key attributes of age-friendly healthcare: Respect for older adults' autonomy and needs; leadership and organisational knowledge and support; Proactive policies and processes of care; holistic care environments; and communication and follow-up with awareness of challenges and barriers as well as prioritisation of continuity-of-care.

Conclusion: The concept of age-friendly healthcare is still developing, with much research focused on development and implementation rather than evaluation of real-world patient and health-system outcomes. Our analysis of the concept may help unify the field and clarify future research directions through identification of areas requiring further study and enable development of improved practices and policies for implementing age-friendly healthcare in a variety of settings.

No patient or public contribution: This concept analysis did not include any patient or public involvement.

Reporting method: This study utilised the PRISMA reporting checklist.

Aim: To identify best practices to prevent violence against healthcare workers by patients at risk for aggression in the adult inpatient setting.

Design: An integrative review.

Methods: Conducted using the Johns Hopkins Evidence-based Practice for Nurses and Healthcare Professionals Model. Title and abstract screening on 4186 articles resulted in 156 for full text review. Full text screening yielded 14 articles that met inclusion criteria.

Data sources: A search of the databases PubMed, CINAHL, Embase, and JBI from January 2019 to February 2023.

Results: The review revealed behavioural intervention teams, environmental changes, and coordinated communication plans were the most used strategies, however none demonstrated significant decreases in violence.

Conclusions: Health systems can implement strategies shown to decrease the incidence of violence in healthcare settings globally. Lack of consistency in the evidence suggests the need for further research to assess mitigating strategies for violence against healthcare workers in inpatient hospital settings.

Implications for the profession and/or patient care: Patient safety is a cornerstone of nursing practice; however, healthcare workers need to feel safe in their work environment. Violent events are chronically underreported, ill defined, and when reported, do not address change in the practice setting. Identifying strategies to address escalating behaviour before it results in violence is crucial for everyone's safety.

Impact: This integrative review exposes the scarcity of evidence available to address rising concerns about patients on healthcare provider violence (Type II) in the workplace. Although several assessment tools for identifying violent patients exist, evidence regarding prevention is woefully absent. The review highlights potential interventions for further study to equip healthcare workers to manage patients safely and effectively before an escalation occurs.

Reporting method: PRISMA checklist for integrative reviews.

Patient or public contribution: No patient or public contribution was part of this review.

Aims: To analyse and synthesise knowledge on workplace violence perpetrated by patients and caregivers against nurses, its consequences and strategies to prevent this phenomenon.

Design: A systematic review of the literature was conducted following the method of the Center for Reviews and Determination and reported in accordance with the PRISMA checklist. A pre-defined protocol was designed (PROSPERO ID: CRD42023432271).

Methods: Three researchers screened eligible studies independently. The Joanna Briggs Institute Critical Appraisal for Analytical Cross-Sectional Studies was used to assess the risk of bias within the studies included.

Data sources: Quantitative primary studies published between January 2012 and June 2023 were included through specific research strings used in the CINHAL, Scopus, PubMed and PsychInfo databases.

Results: A total of 15 studies were selected, the majority of which were cross-sectional and observational. The consequences related to events of verbal and physical violence were highlighted, ranging from the psychological to the physical effects on nurses' mental health, for example, gastrointestinal symptoms, headache and sleep problems. Four studies analysed the strategies used to cope with such violence.

Conclusion: The results showed that aggression on the part of patients affects nurses' health adversely on both a personal and a work level, and makes it necessary to pay more attention to the phenomenon and to find strategies to reduce the incidents, such as developing policies to safeguard the professionals' physical and mental health.

Implications for the profession and/or patient care: Nurses and nursing managers should be aware of violence and its consequences on the victims' health. Therefore, it is essential for nursing managers to develop effective policies to reduce violence and its consequences.

Aim: This study aimed to review studies exploring the experiences and perceptions of healthcare students and providers regarding their personal choices for elective female fertility preservation and their recommendations of the same to patients.

Design/methods: Employing Pluye and Hong's convergent qualitative synthesis approach, a mixed-studies review was conducted. The appraisal of studies was performed using the Mixed Methods Appraisal Tool and data analysis utilised Thomas and Harden's thematic synthesis approach.

Data sources: Six electronic databases (PubMed, Embase, CINAHL, PsycINFO, Scopus and Web of Science) were searched from their inception till November 2023.

Results: About 24 studies were reviewed, uncovering four major themes: varied personal perspectives, knowledge gaps and role ambiguities, perceived temporal and financial constraints and apprehensions related to fear and stigma.

Conclusion/implication: This review underscored the challenges faced by healthcare professionals and students in their personal pursuit of elective fertility preservation. Addressing these challenges demands the implementation of fertility navigators, culturally and religiously sensitive public health campaigns and staff training. Moreover, standardised guidelines, transparent cost and process reporting, evidence-based education, counselling on risks and success rates and governmental support in the form of subsidies can mitigate barriers, enhance cost-effectiveness and promote equitable access to care. Collaboration among stakeholders is imperative to ensure equitable access and maintain quality care in elective female fertility preservation.

Reporting method: This mixed studies review followed the reporting guidelines in the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement.

Patient or public contribution: No Patient or Public Contribution.

Trial registration: This review has been registered on the Prospective Register of Systematic Reviews (PROSPERO) database (CRD42023395406).

Aims: To identify the barriers and enablers of effective transitions of care between the emergency department and primary care providers.

Background: Successful patient care transitions from the emergency department to primary care providers are important because this process has implications for the quality, patient safety, and cost of patient care. Failure in follow-up consultations with primary care can result in representations to the emergency department, which can impact negative emergency department operational issues throughout the entire hospital.

Design and methods: An integrative systematic review was reported according to PRISMA guidelines. The reviewers followed a systematic review protocol registered with PROSPERO (CRD42022316165). A search strategy was applied to extract articles from included databases: CINAHL, MEDLINE, PsycINFO, Scopus, ProQuest Nursing and Allied Health databases. Articles were assessed using a predetermined eligibility criterion. Quality assessment and a narrative synthesis were conducted.

Results: Of the 1200 articles screened, 25 studies were included. Four additional articles were identified from reference lists. The range of study designs included: four qualitative, three mixed methods and 22 quantitative studies. A total of 291,012 patients were represented. Successful care transition was enhanced by access to insurance, ease of payment methods, effective communication, prior booked primary care provider appointments and access to transportation. Many patients experienced financial toxicity, and the shortfall between fees charged and rebates provided was found to influence primary care provider follow-up compliance.

Conclusion: Future recommendations to provide safe and effective transitions of care would be to optimise supported self-management for patients and deliver timely and clear communication with standardised discharge documentation to be shared between the emergency department and primary care providers.

Relevance for clinical practice: There is no one-size-fits-all approach to delivering safe care transitions between emergency department and primary care providers, and future research should target high-risk groups.

Trial registration: Prospero: CRD42022316165.

Aims: To explore (a) the associations between individual social responsibility and the public intention to use violence against nurses; and (b) the relationship between individual social responsibility, personal variables and the public's intention to employ violence against nurses.

Background: Workplace violence against nurses is a significant widespread occupational health issue. To date, no reference has been found to the association between personality traits such as individual social responsibility and the public's intention to use violence against nurses.

Design and methods: A cross-sectional survey design with a convenience sample of 667 Israeli participants from among the public. A structured self-report questionnaire was distributed, including socioeconomic variables, individual social responsibility and responses to four vignettes describing incidents of violence directed at nurses. Multiple linear regressions were calculated for intention to employ violence, with demographic variables and individual social responsibility as independent variables. The STROBE checklist for cross-sectional studies was used for reporting.

Results: Negative correlations were found between individual social responsibility and the intention to employ violence against nurses. Gender, having witnessed physical violence and individual social responsibility explained 19% of the variance in the intention to employ violence against nurses. Demographic variables and having witnessed verbal or physical violence were found to moderate the association between individual social responsibility and the intention to employ violence against nurses.

Conclusions: Witnessing a violent incident in a healthcare setting is a risk factor for the intention to employ violence against nurses. Our findings point to the role of individual social responsibility as one of the strategies to help reduce violent events.

Implications for the profession and/or patient care: Educating and promoting values of social responsibility among the public can reduce incidents of violence in healthcare settings, thus contributing to the safety and quality of care provided.

Patient or public contribution: The public contributed via study participation.