Journal of Clinical Nursing最新文献

Aims: To understand the role of simulation in ensuring the development of the competencies expected by newly graduated register nurses (NGRNs) from the work initiation up to 5 months of transition.

Methods: Mixed-method study design. A longitudinal phase employing the Nurse Competence Scale (NCS, from 0 to 100, excellent) to assess the perceived competencies among NGRNs (N = 151) at three time points (first day of work up to fifth month); followed by a qualitative phase involving four focus groups of preceptors (N = 16) to explore the potential role of simulation in the NGRNs' working transition. Integration was performed at findings level, using the building procedures and joint displaying the results.

Results: During the different time periods, variations emerged in the NCS scores from 64.41 out of 100 in the first day of work to 61.82 after 15 days, reaching 69.25 and 73.21 at 3 and 5 months. Nine potentialities have been identified as having simulation supporting NGRNs during their transition to independent practice. Simulation may contribute to develop competencies in some competence domains (diagnostic function, managing situation, therapeutic intervention, quality assurance and working role) while not in others (helping role and teaching-coaching).

Conclusion: Early interventions, through integration of simulation sessions into strategies offered at the unit's level may be useful to ensure an effective working transition.

Impact: Problem the study addresses: Challenges in transition from education to working settings are increasing given the difficulties of the units in providing time and support to NGRNs.

Main findings: Competencies of NGRNs' are fluctuant in the five first months of work, and sub-optimal in certain domains. Simulation may support the full development of most competencies. Impact on research: Healthcare organisations can support NGRNs to ensure smoother transitions by integrating simulations in their strategy.

Reporting method: This study was conducted following the Good Reporting of a Mixed-Methods Study.

Patient or public contribution: Only healthcare professionals were involved.

Background: Extended reality (XR) interventions have the potential to benefit patients undergoing elective cardiac surgical and interventional procedures. However, there are no systematic reviews with meta-analyses to guide clinical care.

Aim: To critically evaluate the evidence on the effectiveness of XR interventions on patient anxiety and pain and other associated outcomes.

Design: Systematic review and meta-analysis following the PRISMA 2020 statement.

Data sources: A systematic search of five databases (CENTRAL, CINAHL, MEDLINE, PsycInfo, Scopus) from inception to July 2023.

Methods: Screening and data extraction was conducted independently by multiple reviewers. Stata (Version 17) was used to conduct meta-analyses for patient anxiety and pain. Secondary patient outcomes were summarised in a synthesis. The Cochrane Risk of Bias (Version 2) tool was applied to trials and the NHLBI Study Quality Assessment tools to all other study designs.

Results: Of the 3372 records identified, 22 were included, 10 of which were eligible for inclusion in the meta-analyses. Fifty-seven percent of randomised trials were rated as high risk of bias. Virtual reality (VR) was the only XR technology evaluated. VR significantly reduced pre-procedural anxiety (standardised mean difference: -1.29; 95% confidence interval - 1.96, -0.62, p < 0.001), and peri-procedural anxiety (standardised mean difference: -0.50; 95% confidence interval - 0.83, -0.18, p < 0.003) but did not reduce pain levels, compared with usual care. VR increased pre-procedural knowledge and postsurgical physical and pulmonary function. VR interventions may also improve emotional wellbeing, care delivery and physiological outcomes, but evidence was inconsistent.

Conclusions: XR potentially benefits cardiac patients undergoing elective invasive procedures and surgery by reducing pre- and peri-procedural anxiety and increasing procedural knowledge and physical function.

Relevance to clinical practice: Cardiac nurses' role can be supported by VR interventions to improve the patient experience and several aspects of patient care.

Patient or public contribution: Not applicable as this is a systematic review.

Objective: To determine nursing costs for intensive care unit (ICU) patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), assess the correlation with diagnosis-related group (DRG) payments and identify cost determinants.

Design: Prospective, descriptive and quantitative study.

Methods: From January to December 2022, we selected ICU patients with AECOPD and used time-driven activity-based costing method to calculate the overall nursing costs. We examined the cost recovery rate, correlations between nursing costs and DRG Relative Weight, and factors influencing nursing costs using nonparametric tests, Spearman's rank correlation and quantile regression.

Results: The median nursing charge was US$1001.88, the median nursing cost was US$678.51, and the average cost recovery rate was 68.39%. Nursing costs correlated with the DRG Relative Weight but not with payments. Length of stay, oxygen therapy mode and noninvasive ventilator use days impacted costs.

Conclusions: Nursing costs exceeded charges, with a moderate cost recovery rate. DRG payments do not fully reflect nursing cost variations.

Relevance to clinical practice: Our findings indicate the need to enhance the reimbursement system for nursing costs and to manage ICU nursing expenses by addressing the determinants of these costs.

Reporting method: The authors adhered to the EQUATOR network guidelines STROBE to report observational cross-sectional studies.

Aims: To investigate types of symptom clusters in patients with hepatocellular carcinoma after partial hepatectomy and explore symptom cluster trajectories over time.

Design: A longitudinal observational study was conducted.

Methods: Symptoms of patients with hepatocellular carcinoma were assessed on the second day, seventh day, third week, fourth week and twelfth week post-operation using the MD Anderson Symptom Assessment Inventory and the Symptom Module for Primary Liver Cancer. Symptom clusters were extracted using exploratory factor analysis, and symptom cluster trajectories were analysed using a latent class growth model.

Results: Two hundred and thirty patients with hepatocellular carcinoma completed the five-point investigation after partial hepatectomy. Three symptom clusters were identified: general somatic, psychological and liver impairment. Each symptom cluster was further categorised into three groups: severe, moderate and low. The severity of the three symptom clusters and subgroups decreased over time.

Conclusion: Three symptom clusters were identified in patients who underwent partial hepatectomy for hepatocellular carcinoma, and symptom cluster trajectories decreased over time during the 12-week postoperative period. These findings will assist healthcare professionals in providing prompt symptom management and improve patient quality of life.

Implications for the profession and/or patient care: Healthcare professionals should evaluate symptom clusters and their trajectories in patients with hepatocellular carcinoma after partial hepatectomy.

Reporting method: This report was prepared in accordance with the Guidelines for Reporting Cohort Research.

Patient or public contribution: Hepatobiliary surgery nurses worked closely with the research team to ensure the questionnaires were fully assessed before being sent to patients. The active participation of patients provided valuable information for the study.

Trial registration: Chinese Clinical Trial Registry (ChiCTR2400084232).

Aims: This study aims to assess the correlation between antipsychotic drug use, psychological distress and cardiovascular risk factors among patients with schizophrenia.

Methods: A cross-sectional correlational design was used to obtain data from 143 patients with schizophrenia who were conveniently selected. Data were collected by assessing selected cardiovascular risk indicators blood pressure (BP), random blood sugar (RBS), body mass index (BMI), waist-to-height ratio (WtHR) and waist circumference (WC). A self-administered questionnaire was used to collect sociodemographic data, clinical history and the 18-item Psychological Stress Index for patients with schizophrenia.

Results: The use of antipsychotics was associated with increased cardiovascular risk factors including BP, BMI and WtHR. Atypical antipsychotic medications were associated with weight gain and obesity which increase the risk of diabetes and cardiovascular diseases. Age was significantly correlated with systolic BP (r = 0.31), diastolic BP (r = 0.30) and RBS (r = 0.26). Furthermore, significant correlations were found between the duration of diagnosis with systolic (r = 0.26) and diastolic (r = 0.21) BP. None of the correlations between stress and the other study variables were significant.

Conclusion: Screening of antipsychotic side effects is needed in the early phases, and attention must be paid to the cardiovascular risk in patients with schizophrenia, particularly BP, glucose level and BMI. In addition, clinicians should be informed of this evidence to set guidelines for regular monitoring of metabolic parameters.

Reporting method: STROBE guidelines were followed in this study.

Patient or public contribution: Actively involving patients in data collection, this study ensured that their voices were heard and their experiences were central to informing the research findings. In addition, involving patients in the study would enhance the relevance and applicability of the study's conclusions to real-world contexts, promoting patient-centered care and improved health outcomes for patients with schizophrenia.

Aims: To develop and validate a screening tool to identify patients with cardiovascular disease at risk of poor oral health and requiring referrals.

Design: This study was part of a larger pilot study involving a cross-sectional survey and an oral health assessment conducted with patients with cardiovascular disease.

Methods: A four-item screening tool was developed by an expert panel and validated through a cross-sectional survey of patients with cardiovascular disease. The survey contained the tool and the oral health impact profile (OHIP-14) (first gold standard). Additionally, all survey participants were provided a clinical oral health assessment (second gold standard). Sensitivity and specificity analysis was undertaken comparing the tool to the two gold standards to assess patients with cardiovascular disease at risk of poor oral health.

Results: Three hundred and twenty-one participants completed the cross-sectional survey and eighty nine undertook the oral health assessment. Results from both approaches showed that the tool had high sensitivities (OHIP-14 = 89%, Oral assessment = 88%) and low specificities (OHIP-14 = 33% and Oral assessment = 24%).

Conclusion: The four-item screening tool is a simple and valid tool to identify patients with cardiovascular disease at risk of poor oral health and requiring a dental referral. The tool could be incorporated into routine practice of nurses across various cardiac settings.

Aims and objectives: To explore the relationship between the Geriatric Nutritional Risk Index (GNRI) and the occurrence of Pressure injury (PI) in elderly Intensive Care Unit (ICU) patients.

Background: PI represent a significant health concern within ICU, where the occurrence of such injuries is notably high among critically ill patients. However, few studies have explored the relationship between GNRI and PI.

Design: A longitudinal, single-centre, retrospective study.

Methods: The study utilised GNRI calculation to identify PI occurrences. A comprehensive set of covariates was analysed, including demographic information, severity of illness scores, comorbidities, therapeutic interventions, vital signs and laboratory values. Statistical analysis involved descriptive statistics, logistic regression and receiver operating characteristic curves, supplemented by a doubly robust estimation method and propensity score modelling. This study follows the STROBE-nut checklist.

Results: Among 5327 critically ill patients enrolled in the study, with a median age of 76 years, of which 2339 were females, representing 43.91% of the total study population. Binary logistic regression analysis revealed that with each unit increase in the GNRI, the likelihood of PI occurrence decreased by 3.7% in the fully adjusted model. Furthermore, there was a significant decrease in PI occurrence among patients deemed to have no risk compared to those identified as at-risk.

Conclusions: GNRI emerges as a significant, independent predictor of PI risk in elderly ICU patients, underscoring the importance of nutritional assessment and management in this population.

Relevance to clinical practice: This study highlights the critical importance of nutritional assessment, specifically through GNRI, in early identification and prevention of pressure injuries among elderly ICU patients, underscoring the need for integrated nutritional strategies in clinical settings.

No patient or public contribution: This is a retrospective cohort study, and no patients or the public were involved in the design and conduct of the study.

Aim: Synthesise evidence on advanced practice nurses' impact on health services utilisation, healthcare costs, access and quality of care globally.

Design: Scoping review.

Methods: A scoping review guided by the Joanna Briggs Institute Manual for Evidence Synthesis and the PRISMA-ScR checklist.

Data sources: PubMed, CINHAL and Embase for articles between 2016 and 2023.

Results: Eighteen studies were included (14 from the United States, two from the Netherlands and one from Australia and New Zealand each). Outcomes included health services utilisation, healthcare costs, access, and quality of care. Most studies reported advanced practice nursing patients had fewer emergency department (9 of 11 studies), fewer hospital (re-)admissions (9 of 10 studies) and primary care visits (3 of 3 studies). Seven (of eight) studies found advanced practice nursing care was associated with significantly lower healthcare costs. For access and quality of care, advanced practice nursing care was associated with lower consultation rates, similar mean number of patients seen, higher protocol adherence, more rural patient care and lower-to-similar quality delivery of chronic disease management.

Conclusion: Majority of the studies reported that advanced practice nursing care was associated with lower emergency department visits, hospital readmissions and costs. Access to care outcomes varied under advanced practice nursing care.

Implications for the profession and/or patient care: Advanced practice nursing care can improve patient outcomes, reduce costs and impact access and quality of care. Practices need supportive work environments for advanced practice nurses to deliver high-quality, effective care.

Impact: Addressing the need for a synthesis of up-to-date evidence, this review highlights the importance of advanced practice nurses in primary care. Findings can inform global workforce development strategies to address health inequalities through effective advanced practice nursing integration.

Patient or public contribution: No patient or public contribution is required for this study.