Aims: To identify the use of telehealth for people with disabilities in community or primary care settings and to explore effective telehealth interventions for this group.
Design: Systematic literature review and narrative synthesis.
Data sources: The literature search was conducted in January 2024 using five electronic databases including PubMed, EMBASE, CINAHL, Cochrane library and PsycINFO.
Methods: The review followed the Tawfik's guideline and adhered to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines for reporting. Out of 7363 retrieved articles, 1871 duplicates were removed, 5389 were excluded after title and abstract review, and 4 were excluded due to unavailable full text. One additional article was obtained through citation and hand searching. Thirteen studies were quality assessed using the Mixed Methods Appraisal Tool. Quantitative data were narratively synthesised.
Results: Thirteen quantitative studies were selected including three quasi-experimental studies and ten randomised controlled trials. The types of telehealth included telemonitoring, computerised intervention, virtual reality, telephone care, mHealth tools, decision support tools, digital storytelling and technology-assisted language interventions. The most common type of disability was intellectual disability, and the most common telehealth provider was the digital device itself. Most studies used surveys as the data collection method and the interventions were mostly conducted individually. Computer-based telehealth interventions demonstrated significant improvement in attention, health knowledge and psychological well-being. Telephone, virtual reality and tablet interventions also had positive impacts on body weight, motor coordination and pragmatic language skills. Telemonitoring was also beneficial.
Conclusions: This systematic review examined the current state and effectiveness of telehealth interventions for people with disabilities. However, few intervention studies were found, and some studies were of poor quality. Continued interest and efforts from the government and researchers are needed targeting people with disabilities.
Impact: Results provide valuable insights for healthcare providers, policymakers and researchers. They raise awareness about the potential of telehealth to address healthcare disparities and improve access to care for people with disabilities.
Patient or public contribution: No patient or public contribution: Systematic review.
Aim: To uncover perspectives and refine 12 initial program theories concerning the implementation of pain management interventions in intensive care units. Contexts enabling implementation are delineated, and causal mechanisms within these contexts are described.
Design: A realist evaluation approach was employed.
Methods: Fourteen purposively selected Australian nurses of variant roles were virtually and individually interviewed between July and September 2023. Participants were presented with initial program theory, and their perspectives were collated. Data were analysed using an integrated approach of context (C), mechanism (M), outcome (O) categorisation coding, CMO configurations connecting and pattern matching.
Findings: Pain management interventions work if perceived to be beneficial, precise, comprehensive and fit for purpose. Nurses should be willing to change attitudes and update knowledge. Unit leaders should nurture the development of nurses' professional identity, access to learning, autonomy and self-determination. Organisations should change the infrastructure, provide resources, mitigate barriers, develop shared mental models, update evidence and institute quality assurance. Adherence to interventions is affected by the outcomes of implementation and intrinsic merits of interventions. In these contexts, confidence is boosted; feelings of empowerment, self-efficacy, reflective motivation, trust, awareness and autonomy are developed; and capacity is built. Furthermore, frustration from the variability of practices is reduced, accountability and ownership are augmented, yielding positive implementation outcomes.
Implications for the profession: Findings have implications on nurses, team leaders and organisations concerned with implementation.
Impact: The findings provided a fortified understanding of conditions favouring successful implementation of pain management interventions. Actions should be undertaken at an individual, unit and organisation level to ensure successful implementation.
Reporting method: RAMESES II Reporting Standards for Realist Evaluations informed presentation of study.
Patient or public contribution: Intensive care nurses contributed insights to refine the program theory.
Aim: This study aimed to develop a theory to guide family members caring for young people with depressive disorders and suicidal ideations.
Design: Strauss and Corbin's Grounded Theory.
Methods: Theoretical sampling was used to recruit primary family caregivers (aged 22-60) of young people experiencing depressive disorders and suicidal ideations from hospitals and psychiatric clinics in Taiwan. Data were collected using interviews (n = 23) in 2023. Data were analysed using Corbin & Strauss' analytical framework, including open, axial and selective coding until theoretical saturation was reached.
Results: A paradigm model was used to link the 13 categories and develop a substantive theory to help guide family members in the care of their young persons with depressive disorders and suicidal ideations. The core category that emerged was 'Struggling to contain the young person's life by adjusting, assisting, and protecting them from diving into depression'. Other key categories interconnected with this core category were-creating a nurturing environment, adjusting to changes, protecting the young person's safety and assisting with their medical treatment.
Conclusion: Family caregivers could use this theory as a guide to enhance the care of young persons experiencing depressive disorders and suicidal ideations and accompany them alongside the healing process.
Implications for the profession: Nursing professionals could provide psychoeducation to family caregivers on how to hold the young person gently and acquire compassion for the young persons' lived experience, thoughts and emotions, by creating a nurturing environment, adjusting to changes, protecting their safety and assisting with their medical treatment.
Impact: This theory provides valuable guidance for future intervention research aimed at improving family caregivers' ability to care for young persons with depressive disorders and suicidal ideations.
Reporting method: The COREQ guidelines were utilised.
Patient or public contribution: No patient or public contribution.
Aim: To analyse the concept of frailty through a literature review and in-depth interviews.
Design: A hybrid model of concept analysis.
Methods: The theoretical phase identified 43 articles for reviewing the definition and measurement of frailty. Seven frail older adults were invited in the fieldwork phase for in-depth interviews. In the final analysis phase, results from the fieldwork and theoretical phases were integrated to obtain a final definition of frailty.
Results: Attributes of frailty were heterogeneous, involving dynamic/bidirectional, multidimensional and multiple systems. The antecedents of the concept were exposure to various stimuli and challenges in responding to these stimuli. Consequences included losing autonomy and adverse health outcomes. Four themes of frailty were identified based on the fieldwork data: 'accumulation of functional decline', 'powerlessness of coping with', 'vicissitudes of lived experience' and 'loss of autonomy and positivity'.
Conclusions: The final definition of frailty was 'a dynamic and fluctuating process of powerlessness to manage biopsychosocial and environmental stimuli, involving functional decline and vicissitudes of life, which results in losing autonomy and positivity or adverse health outcomes'.
Implications for the profession and/or patient care: Characterising the definition of frailty is essential for nurses to address the lived experiences of older adults when providing person-centred care and for developing interventions that meet the needs of frail older adults.
Impact: Since some discrepancies existed in the definition of frailty from individual perception of older adults, combined in-depth interviews with a theoretical literature review were used to provide comprehensive insight. This concept analysis provides guidelines of training for nurses and opportunities to improving quality of life for community dwelling older adults.
Reporting method: N/A.
Patient or public contribution: No Patient or Public Contribution.
Aim(s): This study reports on the implementation of a registered advanced nurse practitioner intervention. Aims include improving access, service user outcomes and integration between primary and secondary care.
Design: This paper reports the quantitative results of a mixed methods implementation study. Qualitative data are reported separately. The PARiHS framework informs the implementation process itself, with considerations for nurses and other healthcare professionals explored.
Methods: The CORE-OM 34 item rating scale was administered both pre- and post-intervention. Service user attendances in secondary care was monitored.
Results: Findings suggest that the intervention was associated with clinically significant improvements in global or generic distress, reported by service users, as evidenced by changes in the CORE-OM scores. Access to care was recorded at an average of 3.6 days. Implementation science supported effective and safe implementation with clear governance structures.
Conclusion: Registered advanced nurse practice in mental health clinics which provide full episodes of care results in improved integration and may be associated with positive patient outcomes. Implementation science is taught on Irish nursing programmes and this is important if innovative services are to be embedded in the healthcare system.
Impact: The development of a model of care for mental health Registered Advanced Nurse Practitioners at the interface of primary and secondary care settings may be merited. Positive Advanced Recovery Connections may be associated with improving mental health outcomes and bolstering integration of primary and secondary care services. The utilisation of implementation science highlights the need for collaboration with all stakeholders to overcome barriers and recognise facilitators to attain the necessary model of integrated care.
Patient and public contribution: Peer recovery input was provided by members of the service Recovery College, with participation evident in all stages of the project. The psychosocial assessment template was also co-designed.
Aim: To explore the role of public health nurses (PHNs) in Norwegian primary school health services in supporting siblings who have a brother or a sister with complex care needs.
Design: A qualitative, exploratory design using focus groups combined with visual methods.
Methods: Nineteen Norwegian PHNs participated in three focus group discussions between May and September 2022. The nurses were asked to draw themselves as PHNs working in primary schools. Braun and Clarke's reflexive thematic approach was used to analyse the transcribed interviews. The drawings were analysed using critical visual analysis methodology.
Results: The findings revealed that PHNs in primary schools focused on establishing good relationships and found it important to be flexible and creative. However, a challenge to successful service provision in supporting siblings and their families was that the nurses lacked support for the implementation of health promotion interventions and often felt alone. The analysis elicited three main themes: 'the importance of relationships and flexibility in meeting siblings' needs', 'feeling alone with responsibility for supporting siblings' and 'the forgotten children: a need for coordinated services'.
Conclusion: PHNs in school health services are in a unique position to provide support to improve siblings' mental health and well-being. To fully benefit from PHNs' potential to support siblings, there is a need to clarify guidelines and develop evidence-based interventions.
Impact: This study provides valuable insights for health authorities, educators and practitioners on what inhibits sibling support in Norway. The study highlights the potential for PHNs to play a significant role in delivering timely health-promoting interventions for these siblings in school settings independent of context.
Reporting method: This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ).
Patient or public contribution: No patient or public contribution.
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