Pub Date : 2025-02-18DOI: 10.1016/j.ijnurstu.2025.105033
Wing-Fai Yeung , Agnes Yuen-Kwan Lai , Branda Yee-Man Yu , Fiona Yan-Yee Ho , Ka-Fai Chung , Janice Yuen-Shan Ho , Lorna Kwai-Ping Suen , Lai-Ming Ho , Tai-Hing Lam
Background
Whether simple lifestyle-integrated exercise training can improve insomnia remains unclear. In this study, we examined whether zero-time exercise, a simple exercise incorporated into daily routines without extra time, can improve sleep in physically inactive adults with insomnia.
Methods
This was a single-blinded, parallel-group, randomized controlled trial. A total of 140 physically inactive adults (mean [SD] age, 46.7 [14.0] years; 115 [82.1 %] women; mean [SD] insomnia duration, 4.9 [6.7] years) with insomnia disorders were randomly allocated (1:1) to the zero-time exercise intervention group or the sleep hygiene education control group. They received two 2-h zero-time exercise training sessions or sleep hygiene education lessons within 2 weeks and two phone call reminders per week for 8 weeks to follow their respective programs. The outcomes were assessed at 8, 16, and 24 weeks. The primary outcome was the Insomnia Severity Index score at week 24.
Results
The intervention group showed a significantly greater decrease in the Insomnia Severity Index scores than those in the control group at weeks 16 (− 1.59 points, 95 % CI -3.09 to − 0.08; P = 0.039) and 24 (− 2.59 points, 95 % CI -4.17 to − 1.01; P = 0.001); however, the difference at week 8 was not significant (− 1.23 points, 95 % CI -2.54 to 0.07; P = 0.065). No serious adverse events were observed.
Conclusions
Zero-time exercise effectively reduces insomnia severity in physically inactive adults and can be easily incorporated into daily routines to improve insomnia symptoms and daytime impairment.
Trial registration
ClinicalTrials.gov, NCT04227587 (Registration date: January 13, 2020; The first participant was recruited on September 1, 2020). Word count: 240.
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Pub Date : 2025-02-15DOI: 10.1016/j.ijnurstu.2025.105030
Fangshi Xu , Hongxin Ni , Liwei Zhang, Jiancang Ma
{"title":"Comment on Raya-Benítez et al. (2025) ‘Effectiveness of non-instrumental early mobilization to reduce the incidence of deep vein thrombosis in hospitalized patients’","authors":"Fangshi Xu , Hongxin Ni , Liwei Zhang, Jiancang Ma","doi":"10.1016/j.ijnurstu.2025.105030","DOIUrl":"10.1016/j.ijnurstu.2025.105030","url":null,"abstract":"","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"165 ","pages":"Article 105030"},"PeriodicalIF":7.5,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-12DOI: 10.1016/j.ijnurstu.2025.105016
Ruth Harris, Sarah Sims, Mary Leamy
<div><h3>Background</h3><div>Locally driven ward and unit accreditation programmes provide a comprehensive tool to assess the quality of care delivered to patients, bringing together several measures in a single overarching framework. Reported outcomes of locally driven ward accreditation include reduced variation in care delivery, increased assurance of care quality and improved staff motivation. However, there is little empirical research that clarifies the underlying assumptions about what causes outcomes or the theoretical basis to explain how ward accreditation programmes work.</div></div><div><h3>Design</h3><div>A rapid realist review methodology with in-depth stakeholder consultation was adopted to explore the question “What are the key principles and processes of successfully implemented local ward accreditation programmes?”</div></div><div><h3>Setting(s)</h3><div>Six study sites (NHS Trusts) across England participated in this review.</div></div><div><h3>Participants</h3><div>Sixteen senior nurse leaders at six study sites participated in focus groups lasting 90–120 min to elicit detailed reflections on how their accreditation programmes had been designed and implemented, to test out initial programme theories identified in the literature. These theories were then further scrutinised through a consultation group of key stakeholders.</div></div><div><h3>Methods</h3><div>Ten databases were searched, after screening 186 papers for relevance, 43 remained. An additional 11 papers were identified via a Google Scholar search. The 54 papers were then appraised for ‘fitness for purpose’, and thematically analysed for context, mechanisms and outcomes. A rapid realist review approach was adopted to develop and iteratively refine programme theories of locally driven ward accreditation programmes through evidence review, expert focus groups, and in-depth stakeholder consultation.</div></div><div><h3>Results</h3><div>Seven initial programme theories were identified from the literature: 1) Performance assessment; 2) Public disclosure and/as incentivisation; 3) Strengthening the Nursing voice; 4) Standardisation, consistency, accountability and shared governance; 5) Cultures of improvement; 6) Leadership development and 7) Teamwork and communication. These were discussed in focus groups with senior nursing teams and through a consultation group of key stakeholders. There was evidence for all seven initial programme theories, although some had more resonance with the senior nursing teams and stakeholders than others. No new theories were identified, demonstrating that the review comprehensively captured the reasons why locally driven ward accreditation programmes are thought to generate actions that lead to the outcomes the programmes are designed to produce.</div></div><div><h3>Conclusions</h3><div>This review provides an important and newly developed conceptual framework to underpin future empirical work and evaluate the effectiveness of locally driven
{"title":"What makes a local accreditation programme successful and how? A rapid realist review and in-depth consultation with senior nursing leaders","authors":"Ruth Harris, Sarah Sims, Mary Leamy","doi":"10.1016/j.ijnurstu.2025.105016","DOIUrl":"10.1016/j.ijnurstu.2025.105016","url":null,"abstract":"<div><h3>Background</h3><div>Locally driven ward and unit accreditation programmes provide a comprehensive tool to assess the quality of care delivered to patients, bringing together several measures in a single overarching framework. Reported outcomes of locally driven ward accreditation include reduced variation in care delivery, increased assurance of care quality and improved staff motivation. However, there is little empirical research that clarifies the underlying assumptions about what causes outcomes or the theoretical basis to explain how ward accreditation programmes work.</div></div><div><h3>Design</h3><div>A rapid realist review methodology with in-depth stakeholder consultation was adopted to explore the question “What are the key principles and processes of successfully implemented local ward accreditation programmes?”</div></div><div><h3>Setting(s)</h3><div>Six study sites (NHS Trusts) across England participated in this review.</div></div><div><h3>Participants</h3><div>Sixteen senior nurse leaders at six study sites participated in focus groups lasting 90–120 min to elicit detailed reflections on how their accreditation programmes had been designed and implemented, to test out initial programme theories identified in the literature. These theories were then further scrutinised through a consultation group of key stakeholders.</div></div><div><h3>Methods</h3><div>Ten databases were searched, after screening 186 papers for relevance, 43 remained. An additional 11 papers were identified via a Google Scholar search. The 54 papers were then appraised for ‘fitness for purpose’, and thematically analysed for context, mechanisms and outcomes. A rapid realist review approach was adopted to develop and iteratively refine programme theories of locally driven ward accreditation programmes through evidence review, expert focus groups, and in-depth stakeholder consultation.</div></div><div><h3>Results</h3><div>Seven initial programme theories were identified from the literature: 1) Performance assessment; 2) Public disclosure and/as incentivisation; 3) Strengthening the Nursing voice; 4) Standardisation, consistency, accountability and shared governance; 5) Cultures of improvement; 6) Leadership development and 7) Teamwork and communication. These were discussed in focus groups with senior nursing teams and through a consultation group of key stakeholders. There was evidence for all seven initial programme theories, although some had more resonance with the senior nursing teams and stakeholders than others. No new theories were identified, demonstrating that the review comprehensively captured the reasons why locally driven ward accreditation programmes are thought to generate actions that lead to the outcomes the programmes are designed to produce.</div></div><div><h3>Conclusions</h3><div>This review provides an important and newly developed conceptual framework to underpin future empirical work and evaluate the effectiveness of locally driven","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"165 ","pages":"Article 105016"},"PeriodicalIF":7.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-09DOI: 10.1016/j.ijnurstu.2025.105018
Joanna Hope , Chiara Dall'Ora , Oliver Redfern , Julie L. Darbyshire , Peter Griffiths
Background
Vital signs monitoring is key to identifying deteriorating hospital patients. However, adherence to monitoring protocols is limited, with observations frequently missed or delayed. Previous studies of interruptions and delays to vital signs observations have been descriptive, with none attempting to conceptualise the types of tasks that are prioritised over vital signs observations.
Objective
This paper aims to explore how nursing teams perform vital sign observations on acute hospital wards and conceptualises which types of work delay or interrupt them.
Design
Non-participant observational study.
Setting(s)
Four hospitals in the south of England.
Methods
Eligible adult wards (surgical and medical) within each hospital were randomly sampled for inclusion. Four sets of two-hour daytime observation sessions were undertaken on each ward. Two observers recorded structured and unstructured observations (open comments, field notes) on a tablet with adapted QI Tool software. We collected data over 128 h, including 715 sets of vital signs observations and 1127 interruptions. We undertook a qualitative content analysis of interruptions and delays to planned vital signs observations using both structured and unstructured observations.
Results
We identified eight reasons why vital signs were delayed or interrupted: fixed routines, staff availability, bundled care, proximity-related activities, collaborative care, patient inaccessible or unavailable, requests for or responses to time-critical activities, or limited context available. We propose a new concept of ‘temporal status.’ Flexible care (vital signs observations, ‘bundled care’ and ‘proximity-related care’) has a low temporal status so is delayed in favour of higher temporal status activities (fixed routines and time-critical care).
Conclusions
Our findings could explain why vital signs taken early in the morning and evening are least likely to be postponed, as there may be fewer competing tasks with a higher temporal status at these times. Our work also challenges binary conceptualisations of interruptions as ‘beneficial’ or ‘detrimental’, recognising the complexity of nursing care decisions on a moment-by-moment basis. Our new framework suggests the lower temporal status of vital signs observations (and other flexible care) means they are delayed by higher temporal status tasks during daytime shifts in acute hospitals, regardless of their clinical priority.
Registration
10863045, ISRCTN (6/8/2019).
{"title":"Why vital signs observations are delayed and interrupted on acute hospital wards: A multisite observational study","authors":"Joanna Hope , Chiara Dall'Ora , Oliver Redfern , Julie L. Darbyshire , Peter Griffiths","doi":"10.1016/j.ijnurstu.2025.105018","DOIUrl":"10.1016/j.ijnurstu.2025.105018","url":null,"abstract":"<div><h3>Background</h3><div>Vital signs monitoring is key to identifying deteriorating hospital patients. However, adherence to monitoring protocols is limited, with observations frequently missed or delayed. Previous studies of interruptions and delays to vital signs observations have been descriptive, with none attempting to conceptualise the types of tasks that are prioritised over vital signs observations.</div></div><div><h3>Objective</h3><div>This paper aims to explore how nursing teams perform vital sign observations on acute hospital wards and conceptualises which types of work delay or interrupt them.</div></div><div><h3>Design</h3><div>Non-participant observational study.</div></div><div><h3>Setting(s)</h3><div>Four hospitals in the south of England.</div></div><div><h3>Methods</h3><div>Eligible adult wards (surgical and medical) within each hospital were randomly sampled for inclusion. Four sets of two-hour daytime observation sessions were undertaken on each ward. Two observers recorded structured and unstructured observations (open comments, field notes) on a tablet with adapted QI Tool software. We collected data over 128 h, including 715 sets of vital signs observations and 1127 interruptions. We undertook a qualitative content analysis of interruptions and delays to planned vital signs observations using both structured and unstructured observations.</div></div><div><h3>Results</h3><div>We identified eight reasons why vital signs were delayed or interrupted: fixed routines, staff availability, bundled care, proximity-related activities, collaborative care, patient inaccessible or unavailable, requests for or responses to time-critical activities, or limited context available. We propose a new concept of ‘temporal status.’ Flexible care (vital signs observations, ‘bundled care’ and ‘proximity-related care’) has a low temporal status so is delayed in favour of higher temporal status activities (fixed routines and time-critical care).</div></div><div><h3>Conclusions</h3><div>Our findings could explain why vital signs taken early in the morning and evening are least likely to be postponed, as there may be fewer competing tasks with a higher temporal status at these times. Our work also challenges binary conceptualisations of interruptions as ‘beneficial’ or ‘detrimental’, recognising the complexity of nursing care decisions on a moment-by-moment basis. Our new framework suggests the lower temporal status of vital signs observations (and other flexible care) means they are delayed by higher temporal status tasks during daytime shifts in acute hospitals, regardless of their clinical priority.</div></div><div><h3>Registration</h3><div>10863045, ISRCTN (6/8/2019).</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"164 ","pages":"Article 105018"},"PeriodicalIF":7.5,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-07DOI: 10.1016/j.ijnurstu.2025.105026
Halil Ibrahim Tasdemir , Deniz Tasdemir
Background
Understanding nursing students' perspectives on organ donation is essential to foster positive attitudes and increase donation rates.
Objective
This study aimed to uncover the metaphors used by nursing students to describe organ donation, revealing their underlying perceptions and beliefs.
Design
A qualitative metaphor analysis study.
Methods
This study was conducted at Burdur Mehmet Akif Ersoy University, Bucak Health College with 318 nursing students in Turkey. Data were collected through written responses and analyzed using metaphor analysis. The surveys, composed of open-ended questions to elicit nursing students' metaphors of organ donation, were distributed to the participants. The collected data were named, classified, and categorized.
Results
In this study, students produced 311 valid metaphors related to organ donation. The metaphors revealing the students' perceptions of the concept of organ donation were grouped under 10 categories. Nursing students in this study expressed both positive metaphorical concepts, such as ‘gift box,’ ‘rainbow bridge,’ ‘Candle in the dark,’ and ‘new beginning,’ as well as negative metaphorical concepts, such as ‘soldier on the battlefield,’ ‘heavy load,’ and ‘disfigurement’ associated with organ donation.
Conclusion
The findings reveal a wide spectrum of metaphorical perceptions among nursing students, ranging from highly positive to very negative. This variability underscores the need for targeted educational strategies to address divergent attitudes and misconceptions, fostering more consistent and informed perspectives on organ donation in nursing education.
{"title":"From gift to mutilation: Exploring nursing Students' metaphorical conceptions of organ donation: A qualitative study","authors":"Halil Ibrahim Tasdemir , Deniz Tasdemir","doi":"10.1016/j.ijnurstu.2025.105026","DOIUrl":"10.1016/j.ijnurstu.2025.105026","url":null,"abstract":"<div><h3>Background</h3><div>Understanding nursing students' perspectives on organ donation is essential to foster positive attitudes and increase donation rates.</div></div><div><h3>Objective</h3><div>This study aimed to uncover the metaphors used by nursing students to describe organ donation, revealing their underlying perceptions and beliefs.</div></div><div><h3>Design</h3><div>A qualitative metaphor analysis study.</div></div><div><h3>Methods</h3><div>This study was conducted at Burdur Mehmet Akif Ersoy University, Bucak Health College with 318 nursing students in Turkey. Data were collected through written responses and analyzed using metaphor analysis. The surveys, composed of open-ended questions to elicit nursing students' metaphors of organ donation, were distributed to the participants. The collected data were named, classified, and categorized.</div></div><div><h3>Results</h3><div>In this study, students produced 311 valid metaphors related to organ donation. The metaphors revealing the students' perceptions of the concept of organ donation were grouped under 10 categories. Nursing students in this study expressed both positive metaphorical concepts, such as ‘gift box,’ ‘rainbow bridge,’ ‘Candle in the dark,’ and ‘new beginning,’ as well as negative metaphorical concepts, such as ‘soldier on the battlefield,’ ‘heavy load,’ and ‘disfigurement’ associated with organ donation.</div></div><div><h3>Conclusion</h3><div>The findings reveal a wide spectrum of metaphorical perceptions among nursing students, ranging from highly positive to very negative. This variability underscores the need for targeted educational strategies to address divergent attitudes and misconceptions, fostering more consistent and informed perspectives on organ donation in nursing education.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"164 ","pages":"Article 105026"},"PeriodicalIF":7.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143378972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijnurstu.2024.104985
Jessica Rheindorf, Christian Schlereth, Christian Hagist
{"title":"Authors' response to “Comment on Rheindorf et al. (2024) ‘Getting midwives back to hospitals: A discrete choice experiment’”","authors":"Jessica Rheindorf, Christian Schlereth, Christian Hagist","doi":"10.1016/j.ijnurstu.2024.104985","DOIUrl":"10.1016/j.ijnurstu.2024.104985","url":null,"abstract":"","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"162 ","pages":"Article 104985"},"PeriodicalIF":7.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Contemporary healthcare environments are becoming increasingly reliant on digital health technologies, presenting new opportunities and challenges for the nursing profession and nurses across practice settings and roles. Little is known about newly qualified Canadian nurses' experiences as they transition from academic settings to digitally enabled healthcare workplaces.
Objective
To explore (1) perceptions of nurse managers, clinical preceptors and educators regarding newly qualified nurses' practice with digital health, and (2) identify strategies to enhance new nurses' practice with digital health technologies as they transition to the workplace.
Methods
A descriptive qualitative design was used. Fifteen participants representing nurse managers, clinical preceptors, and educators from two Canadian provinces participated in semi-structured interviews. Thematic analysis was applied to analyze the data.
Results
Three themes were identified: 1) Onboarding upon joining the workplace, 2) Factors influencing new hires' practice with technology, and 3) Improving the transition experience to the workplace. Newly qualified nurses have strong digital skills and access to technology training; however, they also face challenges that affect their overall transition and practice. Having a broader understanding of digital health during formal education and in the workplace, mentorship and support from mentors and colleagues, user-friendly technologies, and stable nursing practice environments are key for safe practice and can facilitate the transitional experience and professional growth of new nurses.
Conclusion
Clearly, digital health is here to stay and will further advance in the years to come. Considering global nursing shortages and the demand for a digitally capable workforce, it is imperative to address gaps and challenges that newly qualified nurses and all nurses face when providing care in digitally enabled healthcare environments.
{"title":"Mentors' and supervisors' perspectives regarding newly qualified nurses' practice in digitally enabled workplaces: A qualitative study","authors":"Manal Kleib , Antonia Arnaert , Rebecca Sugars , Lynn M. Nagle","doi":"10.1016/j.ijnurstu.2024.104968","DOIUrl":"10.1016/j.ijnurstu.2024.104968","url":null,"abstract":"<div><h3>Background</h3><div>Contemporary healthcare environments are becoming increasingly reliant on digital health technologies, presenting new opportunities and challenges for the nursing profession and nurses across practice settings and roles. Little is known about newly qualified Canadian nurses' experiences as they transition from academic settings to digitally enabled healthcare workplaces.</div></div><div><h3>Objective</h3><div>To explore (1) perceptions of nurse managers, clinical preceptors and educators regarding newly qualified nurses' practice with digital health, and (2) identify strategies to enhance new nurses' practice with digital health technologies as they transition to the workplace.</div></div><div><h3>Methods</h3><div>A descriptive qualitative design was used. Fifteen participants representing nurse managers, clinical preceptors, and educators from two Canadian provinces participated in semi-structured interviews. Thematic analysis was applied to analyze the data.</div></div><div><h3>Results</h3><div>Three themes were identified: 1) Onboarding upon joining the workplace, 2) Factors influencing new hires' practice with technology, and 3) Improving the transition experience to the workplace. Newly qualified nurses have strong digital skills and access to technology training; however, they also face challenges that affect their overall transition and practice. Having a broader understanding of digital health during formal education and in the workplace, mentorship and support from mentors and colleagues, user-friendly technologies, and stable nursing practice environments are key for safe practice and can facilitate the transitional experience and professional growth of new nurses.</div></div><div><h3>Conclusion</h3><div>Clearly, digital health is here to stay and will further advance in the years to come. Considering global nursing shortages and the demand for a digitally capable workforce, it is imperative to address gaps and challenges that newly qualified nurses and all nurses face when providing care in digitally enabled healthcare environments.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"162 ","pages":"Article 104968"},"PeriodicalIF":7.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijnurstu.2024.104976
Döndü Kurnaz, Gamze Fışkın Siyahtaş, Meltem Demirgöz Bal
Introduction
Interventions aimed at perineal healing and pain relief can have a positive impact on postpartum experiences in women who experience perineal trauma during childbirth.
Objective
The aim of this systematic review and meta-analysis was to compare various methods applied for healing and pain relief from perineal trauma based on primary studies.
Methods
The study protocol was developed following PRISMA guidelines, and Meta-Analyses guidelines. Searches were conducted between March and April 2024. Registration was completed using PROSPERO. Searches were performed using PubMed, the Cochrane Library, EBSCO, Embase, Web of Science, PsycINFO, Scopus, National Thesis Center, TR Dizin, Türkiye Klinikleri, and DergiPark Academic search engines. The methodological quality of the studies was assessed using the RoB-1 and RoB-2. Data were aggregated through meta-analysis, and a GRADE evidence profile was created.
Results
Nineteen studies involving 1899 participants were included in the meta-analysis. The results showed that interventions performed within the first 24 h after episiotomy did not reduce pain. However, the effects of the interventions were observed on the second day, with cold application identified as the most effective method. Additionally, interventions did not affect healing during the first three days, but a more pronounced improvement was noted in the intervention group by the fifth day. Healing began around the 7th–10th days even without intervention. The REEDA (redness, edema, ecchymosis, discharge, and approximation) score decreased most significantly in the group that received perineal education (diet, Kegel exercise, infection symptoms, and perineal hygiene).
Conclusion
Cold application is recommended on the second day to reduce pain following perineal trauma. Interventions were found to accelerate the healing process by initiating healing at least two days earlier, with perineal education being the most effective method. However, further research on topical herbal treatments and perineal hygiene education is needed to strengthen this evidence.
针对会阴愈合和疼痛缓解的干预措施可对分娩时经历会阴创伤的妇女的产后体验产生积极影响。
{"title":"The effect of postpartum interventions on healing and pain in women with perineal trauma: A systematic review and meta-analysis","authors":"Döndü Kurnaz, Gamze Fışkın Siyahtaş, Meltem Demirgöz Bal","doi":"10.1016/j.ijnurstu.2024.104976","DOIUrl":"10.1016/j.ijnurstu.2024.104976","url":null,"abstract":"<div><h3>Introduction</h3><div>Interventions aimed at perineal healing and pain relief can have a positive impact on postpartum experiences in women who experience perineal trauma during childbirth.</div></div><div><h3>Objective</h3><div>The aim of this systematic review and meta-analysis was to compare various methods applied for healing and pain relief from perineal trauma based on primary studies.</div></div><div><h3>Methods</h3><div>The study protocol was developed following PRISMA guidelines, and Meta-Analyses guidelines. Searches were conducted between March and April 2024. Registration was completed using PROSPERO. Searches were performed using PubMed, the Cochrane Library, EBSCO, Embase, Web of Science, PsycINFO, Scopus, National Thesis Center, TR Dizin, Türkiye Klinikleri, and DergiPark Academic search engines. The methodological quality of the studies was assessed using the RoB-1 and RoB-2. Data were aggregated through meta-analysis, and a GRADE evidence profile was created.</div></div><div><h3>Results</h3><div>Nineteen studies involving 1899 participants were included in the meta-analysis. The results showed that interventions performed within the first 24 h after episiotomy did not reduce pain. However, the effects of the interventions were observed on the second day, with cold application identified as the most effective method. Additionally, interventions did not affect healing during the first three days, but a more pronounced improvement was noted in the intervention group by the fifth day. Healing began around the 7th–10th days even without intervention. The REEDA (redness, edema, ecchymosis, discharge, and approximation) score decreased most significantly in the group that received perineal education (diet, Kegel exercise, infection symptoms, and perineal hygiene).</div></div><div><h3>Conclusion</h3><div>Cold application is recommended on the second day to reduce pain following perineal trauma. Interventions were found to accelerate the healing process by initiating healing at least two days earlier, with perineal education being the most effective method. However, further research on topical herbal treatments and perineal hygiene education is needed to strengthen this evidence.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"162 ","pages":"Article 104976"},"PeriodicalIF":7.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijnurstu.2024.104979
Jiamin Wang , Ying Wu , Yongjun Huang , Fangyu Yang
Background
Early recognition of delirium is essential for effective management, but it often goes unrecognized, resulting in adverse outcomes. Clinical decision support systems can enhance adherence to guidelines and improve patient outcomes. We developed a mobile-based clinical decision assessment tool (3D-DST) based on the 3-minute diagnostic interview for confusion assessment method-defined delirium (3D-CAM). Implementing the 3D-DST may enhance delirium recognition and adherence to interventions among healthcare professionals, potentially improving outcomes in older adults.
Objective
To test whether improved recognition of delirium could lead to better clinical outcomes in older adults.
Design
A cluster randomized controlled trial with pair-matching.
Setting
A tertiary geriatric hospital.
Participants
Patients aged ≥ 65 years.
Methods
Four general wards were paired and randomly assigned to the intervention group (two wards) or the control group (two wards). The intervention included routine delirium assessments by nurses using either the 3D-DST or the 3D-CAM, along with delirium prevention and intervention measures carried out by a multidisciplinary team. Outcomes measured included delirium incidence, duration, severity, length of stay, and adherence to the delirium assessment, prevention, and treatment protocol. A trained nursing researcher collected data on demographics, clinical characteristics, and primary and secondary outcomes.
Results
211 eligible patients participated (106 in the intervention group and 105 in the control group), with 21 identified as delirium-positive using the 3D-DST. The median Charlson comorbidity index score among older adults in the intervention group was 1 (1–2), compared to 2 (1–3) in the control group (P = 0.032). Nurses' adherence to delirium assessment was significantly higher in the intervention group than in the control group (73 % vs. 31 %). The recognition rate of delirium among nurses was 89 % in the intervention group and 42 % in the control group. There were no statistically significant differences in delirium duration (6 [3–9] vs. 7 [2–14], P = 0.967), incidence (8.5 % vs. 11.4 %, P = 0.500), severity (2 [1–3] vs. 2 [1–4], P = 0.891) or length of hospital stay (15 [14–18] vs. 18 [13–22], P = 0.568) between the intervention and control groups.
Conclusions
The 3D-DST enhanced adherence to routine delirium recognition by nurses. However, effective strategies are urgently needed to strengthen multidisciplinary collaboration and enhance adherence to delirium management among healthcare professionals.
Registration
Chinese Clinical Trial Registry, Identifier: ChiCTR1900028402.
{"title":"Comparative effectiveness of delirium recognition with and without a clinical decision assessment system on outcomes of hospitalized older adults: Cluster randomized controlled trial","authors":"Jiamin Wang , Ying Wu , Yongjun Huang , Fangyu Yang","doi":"10.1016/j.ijnurstu.2024.104979","DOIUrl":"10.1016/j.ijnurstu.2024.104979","url":null,"abstract":"<div><h3>Background</h3><div>Early recognition of delirium is essential for effective management, but it often goes unrecognized, resulting in adverse outcomes. Clinical decision support systems can enhance adherence to guidelines and improve patient outcomes. We developed a mobile-based clinical decision assessment tool (3D-DST) based on the 3-minute diagnostic interview for confusion assessment method-defined delirium (3D-CAM). Implementing the 3D-DST may enhance delirium recognition and adherence to interventions among healthcare professionals, potentially improving outcomes in older adults.</div></div><div><h3>Objective</h3><div>To test whether improved recognition of delirium could lead to better clinical outcomes in older adults.</div></div><div><h3>Design</h3><div>A cluster randomized controlled trial with pair-matching.</div></div><div><h3>Setting</h3><div>A tertiary geriatric hospital.</div></div><div><h3>Participants</h3><div>Patients aged ≥<!--> <!-->65 years.</div></div><div><h3>Methods</h3><div>Four general wards were paired and randomly assigned to the intervention group (two wards) or the control group (two wards). The intervention included routine delirium assessments by nurses using either the 3D-DST or the 3D-CAM, along with delirium prevention and intervention measures carried out by a multidisciplinary team. Outcomes measured included delirium incidence, duration, severity, length of stay, and adherence to the delirium assessment, prevention, and treatment protocol. A trained nursing researcher collected data on demographics, clinical characteristics, and primary and secondary outcomes.</div></div><div><h3>Results</h3><div>211 eligible patients participated (106 in the intervention group and 105 in the control group), with 21 identified as delirium-positive using the 3D-DST. The median Charlson comorbidity index score among older adults in the intervention group was 1 (1–2), compared to 2 (1–3) in the control group (<em>P</em> = 0.032). Nurses' adherence to delirium assessment was significantly higher in the intervention group than in the control group (73 % vs. 31 %). The recognition rate of delirium among nurses was 89 % in the intervention group and 42 % in the control group. There were no statistically significant differences in delirium duration (6 [3–9] vs. 7 [2–14], <em>P</em> = 0.967), incidence (8.5 % vs. 11.4 %, <em>P</em> = 0.500), severity (2 [1–3] vs. 2 [1–4], <em>P</em> = 0.891) or length of hospital stay (15 [14–18] vs. 18 [13–22], <em>P</em> = 0.568) between the intervention and control groups.</div></div><div><h3>Conclusions</h3><div>The 3D-DST enhanced adherence to routine delirium recognition by nurses. However, effective strategies are urgently needed to strengthen multidisciplinary collaboration and enhance adherence to delirium management among healthcare professionals.</div></div><div><h3>Registration</h3><div>Chinese Clinical Trial Registry, Identifier: ChiCTR1900028402.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"162 ","pages":"Article 104979"},"PeriodicalIF":7.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijnurstu.2024.104981
Sandra Martínez-Rodríguez , Julián Rodríguez-Almagro , Alberto Bermejo-Cantarero , Estíbaliz Laderas-Díaz , Noelia Sanchez-Millan , Antonio Hernández-Martínez
Background
Postpartum haemorrhage is a preventable cause of maternal mortality that commonly occurs during the third stage of labour. Skin-to-skin contact is an intervention that can support the physiological processes of labour by increasing oxytocin levels, which can accelerate placental expulsion and enhance uterine contractions, thereby contributing to the prevention of postpartum haemorrhage.
Objective
This systematic review aims to evaluate the impact of skin-to-skin contact on key maternal variables during the third stage of labour, including the duration of this stage, placental integrity, the need for manual placental extraction, the administration of therapeutic uterotonics, and the position of the uterine fundus.
Methods
A systematic review with meta-analysis of randomised controlled trials and prospective quasi-experimental studies was conducted. Studies were searched in PubMed, Scopus, Cochrane, CINAHL, Google Scholar, and Web of Science. Statistical analysis was performed using STATA version 18. The results of the meta-analysis were reported using relative risk (RR) for dichotomous data and mean difference (MD) for continuous data, both with 95 % confidence intervals (CI). A random-effects model was employed due to the anticipated heterogeneity among the included studies. Sensitivity analyses were performed to assess the robustness of the findings, and a subgroup analysis was conducted based on the type of birth, study design, and country economic level.
Results
Twenty-five trials were included. Skin-to-skin contact significantly reduced the duration of the third stage of labour (MD: − 4.26; 95 %; CI: − 5.70, − 2.81), increased the likelihood of complete placental integrity (RR: 1.09; 95 % CI: 1.02, 1.16), and significantly reduced both the likelihood of a supraumbilical position of the uterine fundus (RR: 0.39; 95 % CI: 0.20, 0.76) and the need for uterotonic administration (RR: 0.24; 95 % CI: 0.12, 0.48).
Conclusions
Skin-to-skin contact is a simple practice that can favourably influence the physiological processes of labour and improve various maternal outcomes. These benefits include reducing the duration of the third stage of labour, ensuring complete birth of the placenta, decreasing the need for uterotonic administration, and increasing the likelihood of a proper uterine fundal position. Therefore, it is recommended to include this practice in labour care protocols.
{"title":"Efficacy of skin-to-skin contact between mother and infant on maternal outcomes during the third stage of labour: A systematic review and meta-analysis","authors":"Sandra Martínez-Rodríguez , Julián Rodríguez-Almagro , Alberto Bermejo-Cantarero , Estíbaliz Laderas-Díaz , Noelia Sanchez-Millan , Antonio Hernández-Martínez","doi":"10.1016/j.ijnurstu.2024.104981","DOIUrl":"10.1016/j.ijnurstu.2024.104981","url":null,"abstract":"<div><h3>Background</h3><div>Postpartum haemorrhage is a preventable cause of maternal mortality that commonly occurs during the third stage of labour. Skin-to-skin contact is an intervention that can support the physiological processes of labour by increasing oxytocin levels, which can accelerate placental expulsion and enhance uterine contractions, thereby contributing to the prevention of postpartum haemorrhage.</div></div><div><h3>Objective</h3><div>This systematic review aims to evaluate the impact of skin-to-skin contact on key maternal variables during the third stage of labour, including the duration of this stage, placental integrity, the need for manual placental extraction, the administration of therapeutic uterotonics, and the position of the uterine fundus.</div></div><div><h3>Methods</h3><div>A systematic review with meta-analysis of randomised controlled trials and prospective quasi-experimental studies was conducted. Studies were searched in PubMed, Scopus, Cochrane, CINAHL, Google Scholar, and Web of Science. Statistical analysis was performed using STATA version 18. The results of the meta-analysis were reported using relative risk (RR) for dichotomous data and mean difference (MD) for continuous data, both with 95 % confidence intervals (CI). A random-effects model was employed due to the anticipated heterogeneity among the included studies. Sensitivity analyses were performed to assess the robustness of the findings, and a subgroup analysis was conducted based on the type of birth, study design, and country economic level.</div></div><div><h3>Results</h3><div>Twenty-five trials were included. Skin-to-skin contact significantly reduced the duration of the third stage of labour (MD: −<!--> <!-->4.26; 95 %; CI: −<!--> <!-->5.70, −<!--> <!-->2.81), increased the likelihood of complete placental integrity (RR: 1.09; 95 % CI: 1.02, 1.16), and significantly reduced both the likelihood of a supraumbilical position of the uterine fundus (RR: 0.39; 95 % CI: 0.20, 0.76) and the need for uterotonic administration (RR: 0.24; 95 % CI: 0.12, 0.48).</div></div><div><h3>Conclusions</h3><div>Skin-to-skin contact is a simple practice that can favourably influence the physiological processes of labour and improve various maternal outcomes. These benefits include reducing the duration of the third stage of labour, ensuring complete birth of the placenta, decreasing the need for uterotonic administration, and increasing the likelihood of a proper uterine fundal position. Therefore, it is recommended to include this practice in labour care protocols.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"162 ","pages":"Article 104981"},"PeriodicalIF":7.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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