Journal of Advanced Nursing最新文献

Aim: To summarise the barriers and facilitators to the clinical implementation of perineal techniques and to provide evidence-based insights for decision-making based on existing research.

Design: A scoping review.

Data sources: Nine electronic databases (PubMed, Cochrane Library, Embase, CINAHL, ProQuest, CNKI, WanFang, VIP and SinoMed) were systematically searched on 4 February 2024.

Review methods: This study followed Joanna Briggs Institute's scoping review methodology. The barriers and facilitators identified in the included studies were mapped to the domains of the Consolidated Framework for Implementation Research (CFIR): intervention characteristics, outer setting, inner setting, characteristics of individuals and process.

Results: A total of 18 studies were finally included and analysed. The most frequently identified facilitator was theoretical education for midwives (inner setting). Common barriers included: lack of time to implement perineal techniques (intervention characteristics); labour pain and women's stress due to insufficient understanding of the birthing process, as well as women's reluctance to receive the perineal techniques (outer setting); risk factors for OASIS (inner setting); insufficient theoretical education for midwives and inadequate prenatal education for pregnant women (inner setting) and concerns about potential medical disputes among performers (characteristics of individuals).

Conclusions: Many of the factors influencing the implementation of perineal techniques identified in this review are modifiable. Developing implementation strategies based on these factors can promote the successful implementation of these perineal techniques in clinical settings.

Implications for the profession: This scoping review could serve as a reference framework for health authorities in developing strategies to promote the use of perineal techniques in clinical practice.

Impact: Existing research has primarily focused on the outer setting, inner setting and characteristics of individuals implementing perineal techniques. Therefore, there is a need for more high-quality studies focusing on intervention characteristics and the implementation process.

Reporting method: This study followed the PRISMA extension for scoping reviews.

Patient and public contribution: Not applicable.

Background: Loneliness is a significant public health problem due to the physical, cognitive and psychosocial changes that occur with ageing. Social support and empowerment can be particularly important for older people, alleviating loneliness and improving mental well-being.

Purpose: The present study aimed to investigate the mediating role of health empowerment in the relationship between perceived social support and loneliness among nursing home residents.

Study design: The study was conducted with a correlational design and reported based on STROBE checklist.

Methods: The study was completed with 277 older adults aged 65 years and over residing in nursing homes. Process Macro Model 4 was conducted to verify the mediating role.

Results: The response rate was 95.6%. Most older adults experienced a feeling of loneliness, and the level of social support and empowerment perceived by most of them was high. The study found a mediating role of health empowerment in the relationship between social support and loneliness. Social support was significantly positively correlated with health empowerment and negatively correlated with loneliness. The significant standardised indirect effect of health empowerment on loneliness evidenced a partial mediating role.

Conclusion: This study concluded that health empowerment has a partial mediating role in the effect of perceived social support and loneliness.

Implications for the profession and/or patient care: Nurses could develop effective strategies for preventing psychosocial problems in nursing home residents. Nurses could contribute significantly as educators, counsellors and leaders in planning interventions to empower older adults.

Impact: By empowering older adults regarding healthcare, nurses could increase their perception of social support, improving mental health by increasing effective coping with loneliness. Nurses could design intervention programmes to increase perceived social support, as well as health empowerment levels, and reduce older adults' loneliness in nursing homes.

Patient or public contribution: Older adults completed the instruments.

Objective: This paper explores the complexities that impact access to mental health services in rural New Zealand. Historical, cultural, social and political factors will be examined against the philosophical positioning of Foucault and Fairclough.

Study design: This research is a single-embedded case study design exploring participants' discourses in the context of a rural, bounded geographical area of New Zealand.

Results: The results show that mental health support that addresses people's actual needs rather than the needs that governments map against ever-changing policy is required and that an awareness of context within case study research is important.

Discussion: The process of case study design is described, including building upon a rationale for selecting the case, collecting data and conducting case analysis and interpretation. This study examines factors influencing the real-life rural context of accessing mental health support. This article demonstrates that case-study research can be valuable for navigating context complexity and developing nuanced understandings of complex phenomena.

Conclusion: The paper highlights how the multifaceted case study context is more than mapping discourses against a rural backdrop. It is necessary to consider the power dynamics that shape experiences and their impact on service creation and its consequent delivery.

Implications for research policy and practice: Rather than services being created that are complex and not meeting people's needs, there is a need to listen to the people who have experienced mental health distress and provide services and support in locations other than clinical settings.

Disengagement in the workplace can occur when people feel or experience a lack of connection or negative attitudes towards their work, their colleagues and/or their employers. Discretionary work, or the extra effort given by people in the workplace to go beyond the basic requirements of their position, is an expectation of many employers. Organisations often depend on employees undertaking discretionary work; disengaged employees, however, tend to do only what is necessary in the workplace. In nursing, such disengagement can negatively impact patients, families, multidisciplinary teams, services, organisations and communities. In this editorial, we discuss workplace disengagement, including what it is and why it occurs. We conclude by considering options for addressing disengagement in nursing.