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Retraction notice to "Structural equation modelling of ethicomoral values and competence of nurses during the COVID-19 pandemic" [Collegian, Volume 30, Issue 4, August 2023, Pages 513-520] COVID-19大流行期间护士伦理道德价值观和能力的结构方程建模》撤稿通知[《校友》第30卷第4期,2023年8月,第513-520页]
IF 1.6 4区 医学 Q2 NURSING Pub Date : 2024-07-03 DOI: 10.1016/j.colegn.2024.06.004
Mohammed Hamdan Alshammari , Rizal Angelo N. Grande , Daniel Joseph E. Berdida
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引用次数: 0
Geographical variations in cancer nursing education and practice across Australia: A cross-sectional study 澳大利亚癌症护理教育和实践的地域差异:横断面研究
IF 1.6 4区 医学 Q2 NURSING Pub Date : 2024-06-26 DOI: 10.1016/j.colegn.2024.06.001
Elizabeth Moore , Natalie Williams , Karen Taylor , Deborah Kirk , Gemma McErlean , Olivia Cook , Lucy Gent , Theresa Beane , Jemma Still , Erin Pitt , Leanne Monterosso , Zerina Lokmic-Tomkins , Natalie Bradford , on behalf of the CNSA

Problem

Patients and health systems rely on a skilled and available cancer nursing workforce to deliver quality nursing care to optimise cancer outcomes. Understanding the education, qualifications, and roles of cancer nurses across Australia is an essential aspect of effective service planning.

Aim

To explore the associations between the geographical location of cancer nurses and their education, qualifications, roles, activities, and scope of practice.

Methods

A cross-sectional electronic survey was distributed through the Cancer Nurses Society Australia membership and social media platforms from October 2021 to February 2022. The self-report survey captured demographics, education, qualifications, roles, scope of practice, and salary. Descriptive statistics and bivariate analysis were used to summarise and report the findings.

Findings

Responses were received from 930 nurses. Most identified as female (94%), lived in metropolitan areas (69%), worked in dedicated cancer centres (79%), and in the public sector (69%). While 80% had more than 10 years of nursing experience and 70% possessed postgraduate qualifications, 58% indicated their intention to remain in the profession for 10 years or less. Roles, pay, education, and activities varied across regions, states, and territories, with regional nurses more likely to be involved in multiple activities and roles compared with their metropolitan counterparts.

Conclusion

This study highlights the importance of understanding geographic variations within the cancer nursing workforce to formulate strategies aimed at enhancing workforce sustainability and, consequently, patient outcomes. Addressing disparities in education and opportunities for career advancement is crucial to ensuring equitable access to quality cancer care nationwide.

问题患者和医疗系统都需要一支技术熟练、可用的癌症护理队伍来提供优质护理服务,以优化癌症治疗效果。了解澳大利亚各地癌症护士的教育、资质和角色是有效服务规划的一个重要方面。Aim To explore the associations between the geographical location of cancer nurses and their education, qualifications, roles, activities, and scope of practice.MethodsA cross-sectional electronic survey was distributed through the Cancer Nurses Society Australia membership and social media platforms from October 2021 to February 2022.方法在2021年10月至2022年2月期间,通过澳大利亚癌症护士协会会员和社交媒体平台进行横向电子调查。自我报告调查包括人口统计学、教育、资质、角色、执业范围和薪资。我们使用了描述性统计和双变量分析来总结和报告调查结果。大多数人认为自己是女性(94%),居住在大都市地区(69%),在专门的癌症中心工作(79%),在公共部门工作(69%)。虽然 80% 的人有 10 年以上的护理经验,70% 的人拥有研究生学历,但 58% 的人表示他们打算在护理行业工作 10 年或更短时间。不同地区、州和领地的护士在角色、薪酬、教育和活动方面各不相同,与大都市的护士相比,地区护士更有可能参与多种活动并扮演多种角色。解决教育和职业发展机会方面的差异对于确保全国范围内公平获得优质癌症护理服务至关重要。
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引用次数: 0
What is known about resilient healthcare systems in the context of natural disasters? A scoping review 人们对自然灾害背景下的弹性医疗保健系统了解多少?范围审查
IF 1.6 4区 医学 Q2 NURSING Pub Date : 2024-06-22 DOI: 10.1016/j.colegn.2024.05.007
Adele Ferguson , Kim Ward , Rachael Parke

Background

During natural disasters, priorities are frequently revised, and new strategies are adopted to deal with the enormity and outcome of the disaster. Understanding how resilient healthcare systems adapt and respond under these unexpected conditions is important in learning how to respond more effectively in future events to provide high-quality care.

Aim

We aimed to understand concepts and definitions of resilient healthcare from a systems perspective in the context of natural disasters.

Methods

Using scoping review methodology, as described by Joanna Briggs Institute.

Findings

Of 1011 articles screened, 18 met eligibility criteria and were included in the review. Natural disasters in the included papers were bushfires, floods, earthquakes, hurricanes, and tsunamis, ranging across five geographical locations.

Discussion

We identified broad definitions of resilient healthcare that reflect the varied healthcare systems’ responses to disasters. Definitions of resilient healthcare came from the ecology field, resilient engineering, and resilience in healthcare systems. The adaptive capacity of health systems during a natural disaster response is key to ecological resilience. Moreover, resilient engineering and resilience in healthcare determined the proposed potential of a resilient system by monitoring, anticipating, responding, and learning from disasters. Consequently, healthcare systems are recognised as complex adaptive systems.

Conclusion

This review identified that adapting and adjusting at a systems level is crucial for effective resilience in healthcare and natural disasters. Further research is needed to explore what concepts of resilience healthcare are used from a whole system perspective and how the system’s adaptive capacity supports handling the event before, during, and after the disaster.

背景在发生自然灾害时,人们经常会修改优先事项,并采取新的策略来应对灾害的严重性和结果。了解具有抗灾能力的医疗保健系统如何在这些意外情况下进行调整和应对,对于学习如何在未来事件中更有效地应对以提供高质量的医疗保健服务非常重要。AimWe aimed to understand concepts and definitions of resilient healthcare from a system perspective in the context of natural disasters.MethodsUsing scoping review methodology, as described by Joanna Briggs Institute.FindingsOf 1011 articles screensed, 18 met eligibility criteria and were included in the review.在筛选出的 1011 篇文章中,有 18 篇符合资格标准并被纳入综述。讨论我们确定了抗灾医疗保健的广泛定义,这些定义反映了医疗保健系统对灾害的不同反应。抗灾医疗保健的定义来自生态学领域、抗灾工程学和医疗保健系统的抗灾能力。医疗系统在应对自然灾害时的适应能力是生态复原力的关键。此外,抗灾工程和医疗保健中的抗灾能力决定了抗灾系统通过监测、预测、应对和从灾害中学习所建议的潜力。因此,医疗保健系统被认为是复杂的适应性系统。还需要进一步研究,从整个系统的角度来探讨抗灾医疗保健的概念,以及系统的适应能力如何支持灾前、灾中和灾后的事件处理。
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引用次数: 0
A mixed method approach to how shiftworking emergency department (ED) nurses reduce the effects of fatigue and differences in strategies between those with varying levels of fatigue 采用混合方法研究轮班工作的急诊科(ED)护士如何减少疲劳的影响,以及不同疲劳程度的护士在策略上的差异
IF 1.6 4区 医学 Q2 NURSING Pub Date : 2024-06-17 DOI: 10.1016/j.colegn.2024.05.005
Jane Gifkins , Ashlea Troth , Rebecca Loudoun , Amy Johnston

Background

Fatigue is commonly reported in shiftworking emergency department nurses. Fatigue can be both acute and chronic, with both types impacting organisational outcomes. However, chronic fatigue is reported to have a greater impact on nurses’ health and wellbeing.

Aim

To understand ways shiftworking emergency department nurses with varying levels of fatigue attempt to overcome and mitigate the effects of fatigue at work and home and essentially recover.

Methods

A mixed method approach utilised nurses’ free-text responses as part of an online survey. Shiftworking emergency department nurses’ responses were compared between those with low chronic fatigue and high chronic fatigue.

Findings

Regardless of fatigue level, shiftworking emergency department nurses reported sleep and rest, exercise and self-care activities at home, and caffeine consumption and work breaks at work to reduce the effects of fatigue. However, at work, only nurses with low chronic fatigue described using more and varied strategies, such as staying active, socialising with colleagues, and making healthy dietary choices, to mitigate fatigue effects.

Discussion

Shiftworking emergency department nurses with varying fatigue levels differ in strategies utilised to reduce the effects of fatigue. The use of diverse and numerous strategies to combat fatigue was associated more with low chronic fatigue than high chronic fatigue. These findings may be of benefit to shiftworking emergency department nurses and nursing managers to assist nurses in recovering from the effects of fatigue at home and through the allocation of rostering and resources to support nurses’ working lives.

背景据报道,轮班工作的急诊科护士经常感到疲劳。疲劳既可能是急性的,也可能是慢性的,两种类型的疲劳都会影响组织的成果。目的了解不同疲劳程度的轮班急诊科护士如何尝试克服和减轻工作和家庭疲劳的影响,并从根本上恢复健康。方法采用混合方法,将护士的自由文本回答作为在线调查的一部分。结果无论疲劳程度如何,轮班工作的急诊科护士都表示睡眠和休息、运动和家庭自理活动以及咖啡因摄入量和工作间歇能减轻疲劳的影响。然而,在工作中,只有慢性疲劳程度较低的护士描述使用了更多不同的策略来减轻疲劳的影响,如保持活跃、与同事交往、选择健康的饮食等。 讨论不同疲劳程度的轮班急诊科护士在减轻疲劳影响的策略上存在差异。与高度慢性疲劳相比,低度慢性疲劳护士更倾向于使用多种多样的策略来消除疲劳。这些发现可能对轮班工作的急诊科护士和护理管理者有帮助,他们可以通过轮班和资源分配来帮助护士在家中从疲劳的影响中恢复过来,从而支持护士的工作生活。
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引用次数: 0
A cost-effectiveness analysis of community nurse-led self-care education for heart failure patients 以社区护士为主导的心力衰竭患者自我护理教育成本效益分析
IF 1.6 4区 医学 Q2 NURSING Pub Date : 2024-06-12 DOI: 10.1016/j.colegn.2024.05.003
Paolo Iovino , Daniela D’Angelo , Ercole Vellone , Matteo Ruggeri

Background

Community nurses delivering heart failure self-care education improve patient outcomes, but the cost-effectiveness of this type of nurse-led intervention has not been recently established.

Aim

To determine the cost-effectiveness of community nurses’ self-care education for heart failure patients compared with usual care.

Methods

We performed a cost-effectiveness analysis from the perspective of the Italian National Health Service. A Markov model simulated the progression of a cohort of 1000 heart failure patients receiving remote self-care education after hospital discharge or usual care. Outcomes included costs, quality-adjusted life years, and incremental cost-effectiveness ratio. The willingness-to-pay threshold was established at €40,000/quality-adjusted life years.

Findings

Over the 20-year time horizon, community nurses’ care incurred an extra cost of €1.3 million while gaining 247 quality-adjusted life years compared with usual care, and the incremental cost-effectiveness ratio was €5490/quality-adjusted life years.

Conclusions

The involvement of community nurses in self-care education is a potential cost-effective way of delivering home self-care education to heart failure patients.

背景社区护士提供心力衰竭自我护理教育可改善患者的预后,但这种由护士主导的干预措施的成本效益最近尚未确定。一个马尔可夫模型模拟了 1000 名心衰患者在出院后接受远程自我护理教育或常规护理的过程。结果包括成本、质量调整生命年和增量成本效益比。研究结果在20年的时间跨度内,与常规护理相比,社区护士的护理产生了130万欧元的额外费用,同时获得了247个质量调整生命年,增量成本效益比为5490欧元/质量调整生命年。
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引用次数: 0
Patient safety — Are we speaking the same language? 患者安全--我们说的是同一种语言吗?
IF 1.6 4区 医学 Q2 NURSING Pub Date : 2024-06-10 DOI: 10.1016/j.colegn.2024.05.006

Background

Since the radical years following the To Err is Human report, patient safety research has become settled on standardisation and audit cultures. Recent work suggests a change in direction. Current efforts exploring the intricate relationship between stability and change within organisations establish a more balanced patient safety perspective. Frontline staff insights are key to this new knowledge.

Aim

This study aims to explore the patient safety perceptions of registered nurses working directly with patients in acute care settings.

Method

Facilitated reflexive workshops were conducted with nine wards from October to November 2022. Data analysis explored creative works and reflective notes of group discussions with frontline registered nurses using a critical lens.

Findings

We offer four analytical interpretations of how frontline registered nurses understand and experience patient safety. These are as follows: buzzwords, keep ME safe, listen to US, and this is MY role. These manifest the business of patient safety where nurses are, under siege, the silenced team member and experience tension between accountability and responsibility.

Discussion

Critical questioning and reappraisal of patient safety practices require the vast knowledge of frontline staff to be fully utilised.

Conclusion

This research reveals much of what is avoided in patient safety literature — the tension between what registered nurses understand, experience, and can deliver in patient safety practice. It challenges organisational leaders to enable and support frontline nurses in driving local change.

背景自 "出错即是人"(To Err is Human)报告发表后的激进年代以来,患者安全研究一直停留在标准化和审计文化上。最近的研究表明,研究方向发生了变化。目前,研究机构内部稳定与变化之间错综复杂关系的工作建立了一个更加平衡的患者安全视角。本研究旨在探讨在急症护理环境中直接与患者打交道的注册护士对患者安全的看法。研究方法:2022 年 10 月至 11 月,在九个病房开展了促进性反思研讨会。研究结果我们对一线注册护士如何理解和体验患者安全提供了四种分析性解释。它们是:流行语、保证我的安全、倾听我们的意见、这是我的职责。讨论对患者安全实践的批判性质疑和重新评估需要充分利用一线员工的丰富知识。结论这项研究揭示了患者安全文献中被回避的大部分内容--注册护士在患者安全实践中的理解、体验和能力之间的紧张关系。它向组织领导者提出了挑战,要求他们支持一线护士推动当地的变革。
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引用次数: 0
Right in it: The experiences of South Australian COVID-19 quarantine medihotel nurses 就在其中:南澳大利亚 COVID-19 隔离医疗旅馆护士的经历
IF 1.6 4区 医学 Q2 NURSING Pub Date : 2024-06-08 DOI: 10.1016/j.colegn.2024.05.004
Paula Medway , Svatka Micik

Background

Until late 2021, mandatory quarantine for travellers returning to Australia was an important part of the national response to the COVID-19 pandemic. In South Australia, a nurse-led quarantine medihotel model was used.

Aim

To explore the lived experiences of nurses who worked in South Australian quarantine medihotels at the height of the pandemic.

Methods

The study employed a qualitative research design using van Manen’s phenomenology of practice method.

Findings

Four themes emerged: united on the frontline, moving in sync with traveller’s needs, the paradox of being yet not being right in it, and feeling let down by organisational systems. These themes emerged from the organisational structures, work design, and public understanding of the COVID-19 risk.

Discussion

Clashing priorities of the travellers and the organisation, travellers’ physical and psychological adjustments to quarantine, and substantial public anxiety around COVID-19 contributed to high levels of stress experienced by the quarantine medihotel nurses and presented challenges to uphold an image of nursing as a caring profession. Understanding, which was driven by novel ways of multi-agency problem-solving and compassionate provision of care, made it possible for nurses to act authentically and in ways congruent with their professional values.

Conclusion

Cross-functional teams will be required when responding to increasingly more complex problems, including future pandemics. Enhancing cross-functional leadership capacity through support and skills development promotes frontline pandemic nurses’ response capability.

Opportunity exists to learn from the nurse’s experiences, mitigate the negative mental health impact, and support the longer-term wellbeing of the quarantine medihotel nurses.

背景直到2021年底,对返回澳大利亚的旅行者实施强制隔离是国家应对COVID-19大流行的重要措施之一。该研究采用了范马南的实践现象学方法,进行了定性研究设计。研究结果出现了四个主题:团结在第一线、与旅行者的需求同步、身在其中却又身不由己的悖论,以及被组织系统辜负的感觉。这些主题来自于组织结构、工作设计和公众对 COVID-19 风险的理解。讨论 旅客和组织的优先事项发生冲突、旅客对隔离的生理和心理适应以及公众对 COVID-19 的巨大焦虑,这些都导致了隔离医疗酒店护士所承受的高度压力,并对维护护士作为一个充满关爱的职业的形象提出了挑战。在多机构解决问题的新方法和富有同情心的护理服务的推动下,护士们的理解使她们能够以符合其职业价值观的方式真实地行动起来。通过支持和技能发展来提高跨职能领导能力,可以促进一线大流行病护士的应对能力。我们有机会从护士的经历中汲取经验,减轻对心理健康的负面影响,并支持隔离医疗酒店护士的长期健康发展。
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引用次数: 0
Impact of educational interventions for professionals on infection control practices to reduce healthcare-associated infections and prevent infectious diseases: A systematic review 针对专业人员的感染控制措施教育干预对减少医护人员相关感染和预防传染病的影响:系统回顾
IF 1.6 4区 医学 Q2 NURSING Pub Date : 2024-05-31 DOI: 10.1016/j.colegn.2024.04.006
Elina Koota , Johanna Kaartinen , Hanna-Leena Melender

Background

Educational interventions can decrease the rates of healthcare-associated infections (HAIs). We do not know current evidence on what kind of educational interventions are the most effective to reduce HAIs and infectious diseases. The aim of this systematic review was to examine the impact of educational interventions for health and social care professionals on infection control practices to reduce HAIs and prevent infectious diseases.

Methods

We searched for papers published between January 1, 2006 and November 16, 2021, using the CINAHL, Medic, MEDLINE, and Scopus databases. Quality appraisal was conducted using the Cochrane risk of bias tool for randomised controlled trials and ROBINS-I for quasi-experimental studies. Data were analysed using a deductive content analysis with The Guideline for Reporting Evidence-based Practice Educational interventions and Teaching checklist and The Classification Rubric for Evidence-based Practice Assessment Tools in Education as frameworks.

Findings

The data included 12 studies. Educational interventions on infection control practices have been developed as single, one-time interventions on a local basis. Two studies reported statistically significant outcomes in three of the areas evaluated, which were skills, knowledge, and self-efficacy for the first study, and benefits to the patient, behaviours, and knowledge for the second one. Benefits to the patient were evaluated in seven studies, and out of these, five showed statistically significant improvement.

Conclusions

There is currently no evidence of long-term learning paths or comparisons of different interventions to determine the most effective way to educate healthcare professionals. Statistically significant findings indicate that educational interventions on infection control practices should include both theoretical and practical learning activities.

背景教育干预可以降低医疗相关感染(HAIs)的发生率。目前我们还不知道哪种教育干预措施对减少 HAIs 和传染病最有效。本系统综述旨在研究针对医疗和社会护理专业人员的教育干预措施对感染控制实践的影响,以减少 HAIs 和预防传染病。对随机对照试验采用 Cochrane 偏倚风险工具进行质量评估,对准实验研究采用 ROBINS-I 进行质量评估。数据分析采用演绎式内容分析法,以《循证实践教育干预措施报告指南》和《教学检查表》以及《循证实践教育评估工具分类标准》为框架。有关感染控制实践的教育干预措施都是在当地开展的一次性干预措施。有两项研究在三个评估领域取得了有统计学意义的结果,第一项研究的评估领域是技能、知识和自我效能,第二项研究的评估领域是对患者的益处、行为和知识。结论目前还没有证据表明,长期学习路径或不同干预措施的比较可以确定教育医护专业人员的最有效方法。具有统计学意义的研究结果表明,有关感染控制实践的教育干预措施应包括理论和实践学习活动。
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引用次数: 0
Are inherent requirements a barrier to diversity? An analysis of course entry information 固有要求是否是实现多样性的障碍?课程报名信息分析
IF 1.6 4区 医学 Q2 NURSING Pub Date : 2024-05-29 DOI: 10.1016/j.colegn.2024.05.002
Joanna Tai , Kalpana Raghunathan , Mollie Dollinger , Lisa McKenna

Background and aim

Increasing the diversity of future healthcare professionals is essential to support inclusive patient care. However, course inherent requirements (IRs) may act as (un)intentional and potentially harmful gatekeepers to diverse students entering entry-to-practice courses. A decade beyond the establishment of formal IRs, it is timely to reconsider if and how IRs might be impacting diversity and inclusion.

Methods

This study analysed IRs published by the 37 Australian universities offering nursing and midwifery entry-to-practice courses.

Findings

IRs were not uniform across all institutions. Most universities placed the responsibility to meet IRs solely upon the student, without sufficient information about possible reasonable adjustments. When institutional support was offered, the level of and means of accessing support were often unclear, again putting the onus to navigate support structures on the student.

Discussion and conclusions

Whilst it is helpful for prospective students to understand the types of tasks they will be required to undertake as part of learning within the course and upon graduation, many IRs may be better positioned as expected learning. With increasing student diversity, alternate models requiring all students to demonstrate readiness for clinical placement immediately before placement may be helpful. Rather than presenting a static list of requirements, diverse students and practitioners may be better supported through the concept of ‘fitness to practice’ where more flexible and in-the-moment evaluations can be made.

背景和目的增加未来医疗保健专业人员的多样性对于支持包容性的病人护理至关重要。然而,课程的固有要求(IRs)可能会成为(非)有意的、潜在有害的 "守门人",阻碍多样化学生进入执业课程。本研究分析了澳大利亚 37 所开设护理和助产士入职实习课程的大学公布的固有要求。研究结果所有院校的固有要求并不一致。大多数大学将满足 IR 的责任完全推给了学生,而没有提供有关可能的合理调整的充分信息。讨论与结论虽然让未来的学生了解他们在课程中和毕业后作为学习的一部分需要完成的任务类型是有帮助的,但许多 IRs 最好定位为预期学习。随着学生的多样性不断增加,要求所有学生在实习前立即展示临床实习准备情况的替代模式可能会有所帮助。与其提出一成不变的要求清单,不如通过 "适于实习 "的概念为多样化的学生和从业人员提供更好的支持,从而可以进行更灵活的即时评估。
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引用次数: 0
Delirium prevention and management in an adult intensive care unit through evidence-based nonpharmacological interventions: A scoping review 通过循证非药物干预预防和管理成人重症监护病房中的谵妄:范围界定综述
IF 1.6 4区 医学 Q2 NURSING Pub Date : 2024-05-28 DOI: 10.1016/j.colegn.2024.05.001
Gideon U. Johnson , Amanda Towell-Barnard , Christopher McLean , Beverley Ewens

Objective

To map and review current literature to describe evidence-based nonpharmacological interventions for delirium prevention and management in adult critically ill patients.

Introduction

Previous research has demonstrated the efficacy of nonpharmacological interventions for intensive care unit (ICU) delirium; however, the heterogeneity and complexity of these interventions make it challenging to disseminate and integrate into clinical practice.

Design

This scoping review follows the Joanna Briggs Institute (JBI) Protocol Guidelines.

Data sources

Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, PsycINFO, JBI, ProQuest, and Excerpta Medica databases were searched until August 2023.

Review methods

Double screening, extraction, and data coding using thematic analysis and frequency counts. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using the extension for scoping reviews.

Results

Thirty-three primary research articles were included; thirty-one were quantitative, and two were qualitative. Four categories of interventions were identified: instrument-based therapeutic interventions (n = 10) consisting of the use of music, light, mirror, and occupational therapy; nurse-led interventions (n = 5) consisting of interventions directly delivered by the nurses with mobilisation, orientation, and cognitive stimulation being the most common types of intervention. Family-delivered interventions (n = 5) are delivered directly by family members, with extended visitation and orientation being the most utilised. Multicomponent interventions (n = 13) combine different aspects of single interventions into care bundles and programs.

Conclusion

This review identified a lack of consistency in applying nonpharmacologic interventions to prevent and manage delirium in adult ICUs. Standardised evidence-based guidelines addressing all aspects of single-component or multicomponent nonpharmacological delirium interventions, along with support for ICU staff utilising these interventions and family member education and support, are required. Without consistent involvement from the healthcare team and patient families, opportunities may have been lost to optimise family-centred care practices in critical care settings.

Patient or public contribution

No patient or public contribution was necessary for this review.

Protocol registration

The protocol registration for this review can be accessed via Open Science Framework at https://doi.org/10.17605/OSF.IO/CMQWG.

目的对目前的文献进行梳理和回顾,以描述成人重症患者谵妄预防和管理的循证非药物干预方法。引言以往的研究已经证明了重症监护病房(ICU)谵妄非药物干预方法的有效性;然而,这些干预方法的异质性和复杂性使其在临床实践中的推广和整合面临挑战。数据来源检索了《护理与专职医疗文献累积索引》、《医学文献分析与检索系统在线》、PsycINFO、JBI、ProQuest 和 Excerpta Medica 等数据库,检索期至 2023 年 8 月。报告遵循《系统综述和元分析首选报告项目》指南,并使用了范围界定综述的扩展项。结果共纳入 33 篇主要研究文章;其中 31 篇为定量研究,2 篇为定性研究。共确定了四类干预措施:基于仪器的治疗干预措施(n = 10),包括使用音乐、灯光、镜子和职业疗法;由护士主导的干预措施(n = 5),包括由护士直接提供的干预措施,其中最常见的干预类型是移动、定向和认知刺激。家庭成员提供的干预(5 人)由家庭成员直接提供,其中最常用的是延伸探视和引导。多组分干预措施(n = 13)将单一干预措施的不同方面结合到护理捆绑和计划中。结论本综述发现,在应用非药物干预措施预防和管理成人重症监护病房谵妄方面缺乏一致性。需要制定标准化的循证指南,以解决单组分或多组分非药物性谵妄干预措施的各个方面问题,同时为使用这些干预措施的 ICU 员工提供支持,并为家庭成员提供教育和支持。如果没有医疗团队和患者家属的持续参与,可能会失去在重症监护环境中优化以家庭为中心的护理实践的机会。患者或公众贡献本综述无需患者或公众贡献。协议注册本综述的协议注册可通过开放科学框架访问:https://doi.org/10.17605/OSF.IO/CMQWG。
{"title":"Delirium prevention and management in an adult intensive care unit through evidence-based nonpharmacological interventions: A scoping review","authors":"Gideon U. Johnson ,&nbsp;Amanda Towell-Barnard ,&nbsp;Christopher McLean ,&nbsp;Beverley Ewens","doi":"10.1016/j.colegn.2024.05.001","DOIUrl":"https://doi.org/10.1016/j.colegn.2024.05.001","url":null,"abstract":"<div><h3>Objective</h3><p>To map and review current literature to describe evidence-based nonpharmacological interventions for delirium prevention and management in adult critically ill patients.</p></div><div><h3>Introduction</h3><p>Previous research has demonstrated the efficacy of nonpharmacological interventions for intensive care unit (ICU) delirium; however, the heterogeneity and complexity of these interventions make it challenging to disseminate and integrate into clinical practice.</p></div><div><h3>Design</h3><p>This scoping review follows the Joanna Briggs Institute (JBI) Protocol Guidelines.</p></div><div><h3>Data sources</h3><p>Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, PsycINFO, JBI, ProQuest, and Excerpta Medica databases were searched until August 2023.</p></div><div><h3>Review methods</h3><p>Double screening, extraction, and data coding using thematic analysis and frequency counts. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using the extension for scoping reviews.</p></div><div><h3>Results</h3><p>Thirty-three primary research articles were included; thirty-one were quantitative, and two were qualitative. Four categories of interventions were identified: instrument-based therapeutic interventions (n = 10) consisting of the use of music, light, mirror, and occupational therapy; nurse-led interventions (n = 5) consisting of interventions directly delivered by the nurses with mobilisation, orientation, and cognitive stimulation being the most common types of intervention. Family-delivered interventions (n = 5) are delivered directly by family members, with extended visitation and orientation being the most utilised. Multicomponent interventions (n = 13) combine different aspects of single interventions into care bundles and programs.</p></div><div><h3>Conclusion</h3><p>This review identified a lack of consistency in applying nonpharmacologic interventions to prevent and manage delirium in adult ICUs. Standardised evidence-based guidelines addressing all aspects of single-component or multicomponent nonpharmacological delirium interventions, along with support for ICU staff utilising these interventions and family member education and support, are required. Without consistent involvement from the healthcare team and patient families, opportunities may have been lost to optimise family-centred care practices in critical care settings.</p></div><div><h3>Patient or public contribution</h3><p>No patient or public contribution was necessary for this review.</p></div><div><h3>Protocol registration</h3><p>The protocol registration for this review can be accessed via Open Science Framework at <span>https://doi.org/10.17605/OSF.IO/CMQWG</span><svg><path></path></svg>.</p></div>","PeriodicalId":55241,"journal":{"name":"Collegian","volume":"31 4","pages":"Pages 232-251"},"PeriodicalIF":1.6,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1322769624000295/pdfft?md5=ba2aaaafa709411c08d8506fd3a2823f&pid=1-s2.0-S1322769624000295-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141540082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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