Journal of Clinical Nursing最新文献

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.

Aim: To identify patterns of dyadic engagement in type 2 diabetes care, describe their characteristics, and explore their association with glycated haemoglobin.

Background: In chronic conditions, patient self-care and caregiver contribution should be considered a dyadic phenomenon. However, patterns of dyadic engagement in type 2 diabetes care have not yet been identified.

Design: Multicentre observational cross-sectional study.

Methods: Patient self-care and caregiver contribution were assessed using the Self-Care of Diabetes Inventory and the Caregiver Contribution to Self-Care of Diabetes Inventory. Patterns of dyadic engagement in type 2 diabetes care were identified by latent class analysis. Associations between patient-caregiver characteristics and class membership were estimated using multinomial regression. The association between classes and glycated haemoglobin levels was assessed using linear regression.

Results: 251 dyads of patients with type 2 diabetes and their primary informal caregivers were enrolled. Patients were mostly male (55%, median age 72) and caregivers mostly female (71%, median age 64). Three patterns of dyadic engagement were identified: 'equally engaged-low care' (14%), 'mostly patient engaged-middling care' (25%), and 'equally engaged-high care' (61%). Patient characteristics (sex, education, self-efficacy) and caregiver characteristics (burden, chronic diseases) were associated with pattern membership. Membership in the 'mostly patient engaged-middling care' and 'equally engaged-high care' patterns was associated with decreased glycated haemoglobin compared to 'equally engaged-low care'.

Conclusion: The three identified patterns of dyadic engagement in type 2 diabetes showed differences in patient and caregiver characteristics and were associated with glycated haemoglobin.

Impact: The study identified and described patterns of dyadic engagement in type 2 diabetes care. The three identified patterns showed differences in characteristics and in patient glycemic control. Healthcare professionals should consider these patterns for tailoring interventions focused on both dyad members.

Reporting method: STROBE checklist was followed.

Patient contribution: Patients and their informal caregivers were recruited to participate in the study.

Objectives: To summarise the incidence rate and identify the risk factors for oral endotracheal tube-related mucous membrane pressure injury (OETMMPI) in critically ill patients.

Methods: This systematic review and meta-analysis followed the PRISMA 2020 requirements. We searched the databases PubMed, Embase, Web of Science, the Cochrane Library, WanFang, China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI) and China Biomedical Literature Database (SinoMed) from conception to July 3, 2025. Two independent researchers read the publications, assessed them and extracted data. Stata 18.0 software was used to conduct the analyses.

Result: This meta-analysis comprised 16 observational studies. Two studies recorded the number of days of tracheal intubation rather than the number of patients who required it, which totaled 274 days. The remaining 14 trials included a total of 6768 adult patients. The incidence rate of OETMMPI was 28.9% (95% CI = 0.177-0.417). Risk factors include tracheal catheter indwelling time (OR = 1.13), APACHE II score (OR = 1.39), use of hard bite blocks (OR = 1.88), prone ventilation (OR = 3.95), diabetes history (OR = 4.86), vasoconstrictor medication use (OR = 2.11) and albumin level (OR = 0.50).

Conclusions: The incidence rate of OETMMPI is relatively high in critically ill patients, and there are many influencing factors. Nursing staff should enhance their awareness of OETMMPI, accurately identify high-risk groups and risk factors, and formulate early, full-course, meticulous and personalised intervention measures for critically ill patients to prevent OETMMPI.

Implications for clinical practice: OETMMPI in critically ill patients brings pain to the patients, increases the risk of infection and affects the prognosis of the disease. Therefore, medical staff should regularly assess and address it. This study also identified specific related factors, and these results provided valuable insights for the ICU medical team to identify high-risk patients and offer personalised intervention measures to reduce their occurrence.