Contemporary nurse最新文献

Background: Despite APNs' advanced clinical autonomy, they still face significant role ambiguity and psychological challenges due to their complex professional positioning, and these issues have not been fully synthesized in existing studies.

Aim: To clarify the current status of APNs' role experience and congnition.

Methods: Using the scoping review methodology as the framework, a comprehensive search was conducted across multiple databases from the establishment of the databases to July 10, 2024. A total of 1183 studies were imported into EndNoteX9 for screening. Researchers used the thematic analysis method to classify the included studies.

Results: Three themes were identified from 14 included studies, including contradictory self-perception, professional self-recognition, and professional development ambiguity.

Conclusions: This review highlighted that despite APNs' strong professional identity, their professional development is significantly constrained by role ambiguity. Additionally, it revealed inadequacies across multiple dimensions, including systemic norms, organizational support, and team support.

Background: The United States' population is aging, and those aged 65 years or older are plagued by multiple co-morbidities that require strong community-based care to avoid emergency department visits (ED) or hospitalisations. The dominance of business-centric healthcare systems and health insurance structures combined with inadequate community-care paradigms are creating care gaps that force patients to rely on the acute care system. Concierge nursing, an innovative nurse-driven solution for acute care overutilisation and systemic cost conservation, has the potential to transform care delivery and improve clinical outcomes.

Aim & design: Drawing on peer reviewed evidence supporting the benefits of the concierge medicine model and validating the role corporately employed nurse navigators play in decreasing ED visits or acute care utilisation, this manuscript discusses the potential advantages of a novel concierge nursing model of care.

Findings: Nurses, with their robust clinical knowledge and skills, are poised to innovatively address barriers and restrictions to care imposed by large, corporate health systems, insurance companies, and an inadequate primary care model. Using an entrepreneurial approach, nurses can create solutions that improve care delivery and outcomes. Concierge nursing may circumvent existing barriers to providing the quality of evidence-based care that patients need. Research is needed on implementing a concierge nursing care model under discussion to study its clinical and financial effects.

Background: Out-of-hospital cardiac arrest survivors often face physical, cognitive, and psychosocial challenges that reduce health-related quality of life. While cardiac rehabilitation programs aim to aid recovery, their effectiveness in improving health-related quality of life for Out-of-hospital cardiac arrest survivors remains uncertain.

Aim: This narrative review evaluates the impact of cardiac rehabilitation and tailored rehabilitation programs on the health-related quality of life of out-of-hospital cardiac arrest survivors during their first year of recovery.

Methods: A literature review on cardiac rehabilitation was conducted using four databases (MEDLINE Complete, CINAHL, Scopus, and Embase). The review focused on studies published between 2014 and 2024. The inclusion criteria specified out-of-hospital cardiac arrest survivors aged eighteen years and older who were engaged in rehabilitation post-hospital discharge. A narrative review was conducted, adhering to the Joanna Briggs Institute guidelines. The database searches initially identified 365 articles, which were reduced to 347 after removing duplicates and non-English articles. Subsequent screening of titles and abstracts excluded 333 studies, leaving 57 full-text articles for further consideration. Ultimately, 14 studies were included.

Results: Traditional cardiac rehabilitation programs showed limited improvement in health-related quality of life, particularly in addressing cognitive and emotional needs. Tailored interventions, incorporating cognitive and emotional cardiac rehabilitation programs, multidisciplinary teams, and peer support, demonstrated better health-related quality of life outcomes, though physical health differences were minimal. Challenges in societal reintegration and return to work remained unaddressed by both approaches.

Conclusion: Person-centred, evidence-based rehabilitation programs addressing cognitive, emotional, and societal challenges are essential for improving the health-related quality of life of out-of-hospital cardiac arrest survivors. Further research is needed to establish robust guidelines and optimise outcomes for this vulnerable population.

Background: Interventions to promote heart failure self-care may be tailored to self-care needs, which are as yet unknown for patients with heart failure in Austria.

Aims: To describe the self-care needs of Austrian inpatients with heart failure and to examine the relationship of self-care with health-related quality of life, age, and living arrangement.

Methods: This cross-sectional pilot study was conducted at a university hospital. A convenience sample of thirty adult inpatients (53.3% female, mean age = 76.13 year) was included, who (2) were previously diagnosed with Heart Failure, (3) were able to speak and read in German language, and (4) gave informed consent. Otherwise eligible patients were excluded if they (1) were diagnosed with a mental disorder (ICD-10-Codes F00-F99), (2) showed signs of disorientation, (3) were living in a nursing facility, (4) suffered from immediately life-threatening or end-stage terminal illness. Self-care needs were assessed with the European Heart Failure Self-Care Behaviour Scale and the Kansas City Cardiomyopathy Questionnaire (KCCQ-23). Data were analysed with descriptive and inferential statistical methods.

Results: Overall self-care was reported as adequate (Mean = 74.26). Inadequate self-care was reported in 7 out of 9 self-care behaviours. Self-Care was adequate in fluid Intake (Median = 1.0) and medication adherence (Median = 1.0). Participants had a poor to fair health-related quality of life (Median = 36.85) and clinical condition (Median = 43.22). The sample was highly socially limited (Median = 21.87) but had a fair to good self-efficacy (Median = 62.50). Self-Care did not correlate with age, health-related quality, and living arrangements.

Conclusions: Self-care needs were identified in all self-care dimensions. Symptom perception, self-care management as well as patients' clinical condition and social limitations should be considered in Self-Care interventions. Health-related quality of life, age, and living arrangement were not identified as self-care needs.

Background: Post-thyroidectomy haematoma is a life-threatening emergency. As first-responders, it is crucial for nurses to possess training in prompt recognition and escalation.

Aims: Evaluate and enhance the preparedness of first-responders in recognising and managing post-thyroidectomy haematoma.

Design: Closed-loop quality improvement project.

Methods: Knowledge and confidence in managing post-thyroidectomy haematoma was audited over a 2-week period. Data was collected at a primary elective surgical site. Interventions focusing on clinical education were implemented and the results re-audited.

Results: Mean confidence scores in recognising and managing post-thyroidectomy haematoma increased on re-audit (2.94-3.22; 2.62-2.83, respectively). Following the intervention, the number of participants who had received prior training rose from 49.1% to 66%. Awareness of the SCOOP protocol increased from 13.2% to 66.7% (p < 0.001).

Conclusions: This quality improvement project highlighted a key knowledge gap, improved confidence in management of post-thyroidectomy haematoma, and emphasised a requirement and desire for further teaching.

Background: Studies of group versus individual education for T2DM have shown favourable outcomes but evidence to support group-based education for patients affected by obesity and T2DM is scant.

Methods: A parallel-group, randomised pilot trial was designed to determine the feasibility and acceptability of group-based education compared to individualised (usual care) education for patients affected by obesity, and T2DM requiring insulin. Adults (>18 years, N = 51) completing the 'Living Healthy with Diabetes' education program in a specialist bariatric service, with a body mass index (BMI) of greater than 35 kg/m² and T2DM requiring more than 1u/kg/day of insulin were invited to participate. Program delivery was one-on-one (Control, n = 25) or in group sessions (Intervention, n = 26), face-to-face in clinic, or via telehealth during COVID-19 lockdowns. Feasibility endpoint measures were recruitment, protocol adherence, participation rates, and engagement. Secondary endpoints were depression and anxiety, quality of life, sleepiness, body weight, diabetes distress score, metabolic parameters, and daily insulin dose.

Results: Protocol adherence and participation rates indicate group sessions were feasible and acceptable. There were no group differences in anthropometric or biochemical baseline measures, 12-month follow-up was complete. Both groups reduced and sustained weight loss with significant within-group improvements in diabetes distress score and daily dose of Insulin. Improvements in health-related quality of life were evident within and between groups but there was no evidence to indicate a difference in the effectiveness of the two educational approaches on weight loss.

Conclusions: Group-based education is feasible and acceptable but efficacy in achieving superior outcomes compared to individual education needs further investigation. Optimising nurse-led education delivery methods could enhance intervention effectiveness for patients affected by obesity and T2DM.

Background: Postoperative delirium is believed to be preventable in up to 40% of all cases. Researchers have proposed various preoperative risk prediction models for postoperative delirium in patients undergoing cardiac surgery, however, no consensus exists on which model is the most suitable.

Aim: To identify and map existing preoperative risk prediction models, detecting cardiac surgery patients at elevated risk of developing postoperative delirium.

Design: This scoping review considered cohort and case-control studies eligible if they developed or validated preoperative prediction models for postoperative delirium, in adult patients admitted for cardiac surgery via sternotomy.

Data sources: The primary search was conducted on May 6th, 2022, and a secondary search was conducted on September 18th, 2024. We searched MEDLINE, CINAHL, Embase, and PsycINFO where 2126 references were identified and 15 were included for full-text analysis.

Method: This scoping review was conducted in line with the Systematic Reviews and Meta-Analyses extension for Scoping Reviews (the PRISMA-ScR) guideline.

Results: Twelve unique risk prediction models and three validation studies were included in this review, comprising between 77 and 45,744 participants. In total, 157 candidate prognostic variables were investigated of which 40 had a predictive value and thus, were included in the prediction models. The included models revealed an AUC from 0.68-0.93 in the derivation cohorts and 0.61-0.89 in the validation cohorts.

Conclusions: Twelve unique prediction models and 3 validation studies were identified and mapped. Collectively, the models demonstrated an AUC ranging from 0.61-0.93, indicating a fair to good discrimination performance.

Protocol registration: A protocol is registered at Open Science Framework (OSF) https://osf.io/wr93y/?view_only=d129c3bb6be04357bac35c2c41ba2a40.