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Background: The documentation of patient data on health records is a vital component of the care process. Accurate and complete recording of this data is a necessary practice. The adoption of electronic health records to improve the quality of nursing documentation is on the rise. Objectives: This study compares the accuracy and completeness of pressure ulcer data documentation between electronic and paper records. Design: A descriptive, comparative design with a retrospective review of patient records. Settings and sample: Two hospitals were chosen purposefully, one using electronic recording of patient data and the other using paper records. Methods: In the first phase, all hospitalised patients aged 18 years and over were inspected for pressure ulcers. In the second phase, the files of patients with pressure ulcers were audited. Results: Of the 52 patients with ulcers found in the hospital that used an electronic system, 43 of their records documented the pressure ulcers (83%). Of the 55 patients with pressure ulcers in the hospital using paper records, 39 files had corresponding documentation of the presence of a pressure ulcer (71%). Conclusion: In terms of accuracy and completeness, more comprehensive documentation practice was found on the electronic health records compared with paper records. However, both types of systems have shortcomings in the practice of pressure ulcer data documentation. [ABSTRACT FROM AUTHOR]

Objective: NovoSorb (Poly-Novo Ltd, Australia) biodegradable temporising matrix (BTM) is a novel artificial dermal matrix. Previous literature is weighted towards its use in burns reconstruction; however, this paper describes its use within a range of wound aetiologies. The authors present one of the largest and most diverse case series to date, and aim to provide an independent benchmark of clinical practice. Method: A retrospective observational study was performed. Patient demographics and clinical data (wound aetiology, site, total body surface area (TBSA), wound bed, number of debridements, time to BTM integration, time to skin grafting) were collected and subgroup analysis preformed. Results: The cohort consisted of 37 patients (acute trauma wounds, n=19; hard-to-heal wounds, n=9; acute infections, n=6; cancer, n=3). Successful BTM integration, allowing subsequent split-thickness skin grafting (STSG), occurred in 70% of cases, despite an overall complication rate of 51%. Mean time from BTM application to STSG was 53 days. There was no difference in STSG outcomes when grafting was performed either before or after the six-week BTM application period. There was no difference when various wound beds (fascia, tendon, periosteum) were compared. Patients >65 years of age were more likely to experience complications; however, this did not affect the speed of integration. The relation of diabetes and smoking to overall integration had no statistical significance. Conclusion: In comorbid patients in particular, the time between BTM application and STSG may be longer than the manufacturer's recommendation. Furthermore, data suggest greater wound bed optimisation and closer interval monitoring in hard-to-heal/malignant wounds, and in older patients and patients with comorbidities. However, BTM appears robust (even in infection) and is showing promise as a useful reconstructive tool. Declaration of interest: The authors confirm that there are no study sponsors. The authors have no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background: Several industry funded studies between 2001–2018 have compared the use of a single brand of baby wipes to cleansing with water and either cloth or cotton wool during nappy changes. All of these studies found that wipes were safe and effective from birth. Recommendations from these studies have included the need for brand or formula comparison but to date, no previous study has done this. Aims: The 'Baby skin integrity comparison survey' (BaSICS) study was designed to compare three brands of baby wipes to determine if there was any difference in the incidence of irritant diaper dermatitis (IDD or nappy rash) during the first eight weeks of life. Methods: Mothers who were allocated to a single brand of nappy but divided into three baby wipe allocation groups, collected and reported survey data on infant skin integrity during one nappy change daily with the use of a user-friendly smartphone application. Findings: All brands of wipes were acceptable to mothers and safe and effective when cleaning during nappy changes. The brand containing the fewest ingredients showed a clinically significant advantage of fewer incidents of rash than the other two brands. Conclusion: This study demonstrated that wipe formulation is a significant factor in prevention or reduction of IDD during the first eight weeks of life. [ABSTRACT FROM AUTHOR]

Aims: Skin breakdown is common in the intensive care unit (ICU). This pilot evaluation aimed to determine whether a nurse-constructed urinary catheter securement device using a silicone adhesive could reduce the complications of blistering and other skin breakdowns in a high-risk ICU population with Foley catheters. Design: A prospective, non-randomised performance improvement study using a convenience sample was carried out. Subjects and setting: The study sample consisted of 29 patients with urethral Foley catheters and any degree of thigh oedema in a surgical ICU at an academic quarternary medical center. Methods: Patients were fitted with a standard acrylic-adhesive catheter securement device on one thigh and a nurse-constructed device on the contralateral thigh. At the beginning of each 12-hour shift, the nurse moved the Foley catheter from one securement device to the other; the nurse recorded the assessment findings at the end of the shift. Results: The average age of the 29 patients was 61±16 (range 20–87) years. Visible skin compromise occurred in 21% of the time with the standard acrylic securement device; an equal percentage of men and women developed skin breakdown. Oedema status was a significant factor related to skin breakdown. There was no visible damage to the skin associated with the nurse-constructed silicone-adhesive device. Conclusions: A silicone adhesive urinary catheter securement device causes less skin damage than one with acrylic adhesive. One-step application, pain-free and atraumatic removal, and reliable securement are essential considerations in product development. [ABSTRACT FROM AUTHOR]

Background/Aims: Anaemia is a multifactorial condition and understanding its prevalence and associated factors is crucial for effective healthcare planning and interventions. The aim of this study was to explore the prevalence of anaemia during pregnancy and its potential risk factors in Oman. Methods: A retrospective approach was used to identify anaemia cases by examining medical records taken from 9321 women who gave birth at the hospital over 3 years. Chi-squared tests were used to establish differences in risk factors using a case-control design, with a 1:2 ratio. Results: The crude prevalence of anaemia was 31.2%, dropping to 4.9% after excluding women with chronic and/or acute diseases. Significant differences were found in nationality (χ2=4.738, P=0.030), body mass index (χ2=6.392, P=0.041) and gestational age (χ2=4.329, P=0.037) for women with anaemia compared to those without. Conclusions: These findings underscore the significance of assessing and managing anaemia in pregnancy, while considering the interaction of demographic and clinical variables in formulating anaemia prevention strategies. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of skin lesions and evaluate the clinical and sociodemographic factors associated with their presence in hospitalised patients. Method: This descriptive, cross-sectional, correlational study was performed in inpatient units and intensive care units of a cancer hospital in São Paulo, Brazil, after approval by the Institutional Research Ethics Committee. Data from hospitalised adult patients with cancer were collected during physical examinations and from medical records. A Chi-squared test, univariate analysis, a logistic regression model with results expressed as odds ratio (OR) and 95% confidence intervals (CI), and Classification and Regression Tree (CART) analysis were used to evaluate the data. Results: Of 341 patients, 80 had skin lesions, equating to an overall prevalence of 23.5%. The skin lesions included pressure injuries (10%), incontinence-associated dermatitis (6.7%), skin tears (6.5%), malignant wounds (3.8%) and complicated surgical wounds (3.2%). The factors associated with skin lesions in cancer patients were the use of disposable nappies (OR: 4.436) and age (59.1±15.1 years), according to the CART analysis, and the wearing of nappies (OR: 4.466, p<0.001), presence of ecchymosis (OR: 2.532, p<0.001) and infection (OR: 6.449, p=0.040), according to multiple regression analysis. Conclusion: This study contributed to knowledge about prevalence and associated factors of skin lesions in hospitalised patients with cancer, allowing the implementation of preventive measures. [ABSTRACT FROM AUTHOR]

Background/Aims A family's economic resilience can impact a child's wellbeing, particularly in relation to parenting practice. This study aimed to identify the effect of family economic resilience on early childhood parenting in Indonesia, for children age 0-6 years old. Methods This study used cross-sectional data from a 2019 Indonesian survey. Simple and multiple logistic regression were used to analyse data for 20 413 families with children 0-6 years old in Indonesia. Results More than half of families had high economic function (56.2%) and demonstrated strong economic resilience (59.1%), although a similar proportion also demonstrated less effective parenting practices (63.3%). Families with high or moderate economic resilience were more likely to use more effective early childhood parenting practices than families with lower economic resilience (P=0.001 and P<0.001, respectively). Age, family type, number of family members and education significantly affected good parenting. Conclusions Family economic resilience has a significant impact on early childhood parenting. Interventions should be designed to simultaneously to strengthen family economic resilience and increase engagement with early childhood parenting practices. [ABSTRACT FROM AUTHOR]

Background and aims: Dysphagia is common after stroke, so feeding through a nasogastric (NG) tube may be necessary. These tubes are frequently dislodged, causing interruption to feeding and hydration, and potential aspiration of feed or fluids into the lungs. Interventions to prevent this may include taping tubes to the face; the application of hand mittens or bandaging patients’ hands; inserting the NG tube into the nostril on the stroke-affected side; and nasal bridles. The aims of this survey were to investigate the management of NG feeding for stroke patients, including current tube confirmation and securing techniques, and associated nurse education. This was part of a three-phased sequential mixed-methods study. This paper reports on the second quantitative phase. Methods: A quantitative postal survey, based on initial qualitative findings, was sent to registered nurses (n=528) from the National Stroke Nurses Forum and Scottish Stroke Nurses Forum, in addition to registered nurses working on stroke units within the local health board. Results: The overall response rate was 59% (n=314/528). Tape was the most commonly used method for securing tube position, followed by inserting the tube on the stroke-affected side. Hand mittens were used more frequently than the nasal bridle; bandaging hands was reported once. Taping was considered to be more acceptable and safer than hand mittens or the nasal bridle, but less effective. Training in inserting NG feeding tubes was received by 56% (n=176/314). Methods used for confirming tube position included aspiration and X-ray. Provision of training in confirmation techniques varied. Conclusions: This study shows that the management of NG feeding for dysphagic stroke patients requires standardisation, as does the education for nurses to ensure that this intervention is carried out safely, effectively and acceptably. [ABSTRACT FROM AUTHOR]

Objective: To identify the incidence of category II or higher hospitalacquired pressure ulcers (HAPU) and significantly associated factors in older patients with hip fractures. PUs are a frequent complication in hip fracture patients, negatively impacting patients' quality of life, the health-care system and society. Method: A prospective cohort study was conducted. A consecutive sample of patients with pertrochanteric, femoral neck or subtrochanteric fractures requiring surgical treatment, were included. A stepwise, multiple regression was performed to identify factors associated with PU development. Results: A total of 761 patients aged ≥65 years were sampled. The incidence of category II or higher PUs was 12%. The study identified five factors that were significantly, independently associated with category II or higher PU development, including a higher preoperative Braden score (Hazard Ratio [HR]: 0.884; 95% confidence interval [CI]: 0.806--0.969), surgical procedure with osteosynthesis (HR 1.876; 95%CI: 1.183--2.975), a higher percentage of days with the presence of foam valve before surgery (HR: 1.010; 95%CI: 1.010--1.023) and a urinary catheter (HR: 1.013; 95%CI: 1.006--1.019) and diaper (HR: 1.007; 95% CI 1.001--1.013) in the postoperative period. Conclusion: Attention should be given by clinical staff to avoiding the use of foam valves, to limiting the use of diapers and to early removal of urinary catheters. Declaration of interest: The authors have no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background/Aims Antenatal care is important for screening, monitoring and management of pregnancy risks. This study analysed determinants of antenatal care in Indonesia among women aged 18-24 years and older than 30 years, who are at greater risk of pregnancy and birth complications. Methods This cross-sectional study used secondary data from 4338 women in the 2017 Indonesian demographic health survey. Chi-square tests and binary logistic regression were used to explore the effects of individual, partner and social factors on antenatal care. Results Antenatal care attendance was associated with a younger age at first birth (adjusted odds ratio: 1.49; P<0.001), health insurance (adjusted odds ratio: 1.54; P=0.004) and the middle wealth quintile (adjusted odds ratio: 1.78; P=0.002). Conclusions Collaboration is needed to increase awareness of complications and the importance of antenatal care. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) is an incurable, progressive neurodegenerative disorder that gradually results in accumulating disability. Evidence suggests that specific interventions, for example, physical exercise and movement strategy training, can improve some of the PD-associated problems and enhance quality of life. The aim of this paper is to demonstrate the effect of a tailored rehabilitation programme, comprising of a combination of exercise therapy and movement strategy training, on falls risk, mobility, and quality of life in people with PD. Methods: A prospective longitudinal design, with 1- and 2-year follow-up, was conducted, where fifteen people with idiopathic PD and average age of 76.1 years attended weekly, then biweekly 90-minute rehabilitation sessions that focused on exercise therapy and movement strategy training. Outcome measures were assessed at baseline and at 1- and 2-year, which included self-reported number of falls, Freezing of Gait Questionnaire, Tinetti falls assessment tool, and Parkinson's Disease Questionnaire (PDQ-39). Results: At 1-year, a significant improvement was identified in gait freezing and Tinetti scores, as well as a statistically significant reduction in the number of falls and falls risk. Several aspects of the PDQ-39 have also improved. Some of the effects continued to exist through year two, but the improvement has not been consistent compared to year one. Conclusion: A combination of regular exercise and movement strategy training has the potential for reducing falls risk, and improving mobility (less gait freezing) and quality of life of people with PD. [ABSTRACT FROM AUTHOR]

This paper reports on a study conducted to determine the incidence of phlebitis related to peripheral cannulae, and its predisposing factors in a general surgery department. Phlebitis is a serious health problem that affects a large proportion of hospitalized patients receiving intravenous therapy. A data collection tool was developed based on the previous literature and was completed between 15 October and 30 November 2010 in a general surgery department. All patients with peripheral cannulae who fulfilled the inclusion criteria, and who agreed to participate in the study where monitored. This was a quantitative study, which used descriptive, inferential, and correlational analysis. A total of 171 patients and 286 peripheral cannulae were monitored. The average incidence of phlebitis was 61.5%, and factors such as diabetes and tobacco consumption were identified as relevant to the development of phlebitis. Other elements identified as predisposing to the development of phlebitis include administration of potassium chloride, the dwell time of the peripheral cannula, and the anatomical location of the cannula. Phlebitis associated with peripheral cannulae is still a current problem requiring knowledgeable staff who can prevent, recognize and act appropriately in a timely manner to minimize its severity. [ABSTRACT FROM AUTHOR]

Background: Integrated peripheral intravenous catheters (PIVCs) demonstrate clinical efficacy, however, device complexity and design differences may be a potential barrier to implementation. Aims: To assess nurse acceptability of integrated PIVC systems. Methods: A cross-sectional survey was nested within a multicentre randomised controlled trial. One hundred nurses caring for patients with integrated and non-integrated PIVCs completed a 17-item survey about key differences between devices (eg function and appearance, perceived patient comfort and skin injuries). Findings: Most nurses reported the integrated PIVC wings prevented device movement (80%), achieved patient comfort in areas of flexion (78%), and no patients developed skin injuries (100%). Nurses rated the ease of accessing and overall confidence using the integrated PIVC as significantly higher than the non-integrated design (P<0.001).Conclusion: The integrated PIVC received positive feedback from nurses and had few barriers to implementation. [ABSTRACT FROM AUTHOR]

Background: Little has been written on the availability of specialist level 2 supervision groups to support community practitioners regarding the emotional components of their palliative and end-of-life caseload. Adapted level 2 groups (AL2Gs) have been piloted in three community teams in the NHS to address this. Aims: This study aimed to evaluate whether access to AL2Gs benefited community palliative and end-of-life practitioners at three sites. The outcomes for those who attended and those unable to attend were considered. Findings: Attendees found AL2Gs beneficial, reporting better confidence and wellbeing, plus a sense of containment through group cohesion and trust in the facilitators and fellow AL2G members. Most would recommend the groups to all staff working in community palliative care. Practitioners who were not able to attend relied on informal and ad-hoc peer support, and had concerns about their skills in managing patients' psychological needs. Conclusion: Community nurses benefit from attending AL2Gs to support them with their palliative care/end-of-life caseloads. It is recommended that all community staff involved in this type of care have access to regular clinical supervision, especially in a group format. [ABSTRACT FROM AUTHOR]

Background: Contraceptive counselling and mobile applications may positively increase the use of contraceptives among married women. This study's aim was to examine the effect of structured counselling and mobile applications on knowledge, self-efficacy and the intention to use long-acting reversible contraceptives. Methods: This was a quasi-experimental study with participants who received either structured counselling and use of a mobile app (n=50) or only routine counselling (n=50) in two healthcare centres with family planning services in Langsa, Indonesia. Chi-squared and the independent t-test as well as a general equational model were used to analyse the results. Results: There was a significant improvement in knowledge, self-efficacy and the intention to use long-acting reversible contraceptives use after 12 weeks in both groups. The differences in knowledge, self-efficacy and intention to use long-acting reversible contraceptives between groups after 4 and 12 weeks were statistically significant (P<0.001). Conclusions: A combination of 12-week structured counselling and mobile application use can effectively increase knowledge and self-efficacy, affecting the intention to use long-acting reversible contraceptives of married women in Indonesia. [ABSTRACT FROM AUTHOR]

Background/Aims: This study aimed to translate the perceived insufficient milk questionnaire into the Chinese language, Mandarin, perform cultural adaptation, and evaluate its validity and reliability. Methods: The perceived insufficient milk questionnaire was translated using a forward-backward process. An expert panel evaluated content validity with both item and scale content validity indices. Construct validity was assessed by exploratory and confirmatory factor analysis. Internal consistency reliability was evaluated by the Cronbach alpha coefficient. With a 1-week interval, the test-retest reliability was assessed by intraclass correlation coefficient. Results: A total of 328 participants were recruited. The item-level content validity index was as high (0.83–1.0), and the scale-level content validity index was 0.92, indicating excellent validity. A single-factor model was verified as acceptable with good fit indices. The internal consistency (Cronbach alpha coefficient=0.943) and test-retest reliability (intraclass correlation coefficient range: 0.870–0.974) were good. Conclusions: The Chinese version of the perceived insufficient milk questionnaire had acceptable validity and reliability. It is helpful for healthcare providers to evaluate mother's beliefs about breastmilk quantity and nutritional quality, preventing early cessation of breastfeeding through timely interventions. [ABSTRACT FROM AUTHOR]

* Objective: Physical and psychosocial deficits have been reported in people living with chronic wounds. While the negative impact of these factors on an individual's quality of life (QoL) is well documented, there has been little research into the well-being of those living with chronic wounds, despite recent calls for increased attention to this related, yet distinct construct. This paper introduces the Well-being in Wounds Inventory (WOWI) and provides support for the WOWI as a valid and reliable measure of well-being in patients living with chronic wounds. * Method: A draft questionnaire was administered to a convenience sample of individuals with chronic wounds (n=85) and the resulting data subject to factor analysis in order to refine the structure of the questionnaire. The reliability, validity and responsiveness of the resulting questionnaire were then tested by administration to a second sample of individuals with wounds (n=49). Socio-demographic data, issues affecting patient well-being and well-being factors, such as, emotions; perceived coping skills; social support; personal control; hope for the future, were measured. * Results: Results confirmed the WOWI as a reliable and valid measure of well-being. Items loaded onto two subscales, 'personal resources' and 'wound worries'. Analysis revealed the WOWI to be highly feasible measure of well-being, with good test-retest reliability and responsiveness to changes in health status. * Conclusion: The current study highlights the importance of assessing well-being factors in individuals living with chronic wounds. It introduces the WOWI as a valid and reliable measure of well-being in chronic wound patients. The authors recommend health-care practitioners take account of well-being as part of a holistic treatment plan in order to maximise patient outcomes. * Declaration of interest: This project was funded by Urgo Medical. The authors have no conflict of interest to declare. [ABSTRACT FROM AUTHOR]

Purpose: Intensive care unit (ICU) patients are at risk for central line-associated bloodstream infection (CLABSI) with significant attributable mortality and increased hospital length of stay, readmissions, and costs. Chlorhexidine (di)gluconate (CHG) is used as a disinfectant for central line insertion; however, the feasibility and efficacy of using CHG as a locking solution is unknown. Methods: Patients with a central venous access device (CVAD) in situ were randomized to standard care or a CHG lock solution (CHGLS) within 72 hours of ICU admission. The CHG solution was instilled in the lumen of venous catheters not actively infusing. CVAD blood cultures were taken at baseline and every 48 hours. The primary outcome was feasibility including recruitment rate, consent rate, protocol adherence, and staff uptake. Secondary outcomes included CVAD colonization, bacteraemia, and clinical endpoints. Results: Of 3,848 patients screened, 122 were eligible for the study and consent was obtained from 82.0% of the patients or substitute decision makers approached. Fifty participants were allocated to each group. Tracking logs indicated that the CHGLS was used per protocol 408 times. Most nurses felt comfortable using the CHGLS. The proportion of central line colonization was significantly higher in the standard care group with 40 (29%) versus 26 (18.7%) in the CHGLS group (P=0.009). Conclusions: Using a device that delivers CHG into CVADs was feasible in the ICU. Findings from this trial will inform a full-scale randomized controlled trial and provide preliminary data on the effectiveness of CHGLS. Trial Registration: ClinicalTrials.gov Identifier NCT03309137, registered on October 13, 2017 [ABSTRACT FROM AUTHOR]

Resilience in nursing and midwifery involves being able to manage ethically adverse situations without suffering moral distress and is key to mental wellbeing, staff retention and patient safety. The aim of this research was to ask what the psychological effects were for nursing and midwifery students who had been deployed to work in the NHS during the COVID-19 pandemic. This study looked at the incidence of burnout in a small cohort of nursing and midwifery students who were employed as band 4 aspirant nurses and midwives in acute NHS trusts in the south of England. The findings suggested that student midwives reported higher levels of emotional exhaustion and depersonalisation than student nurses but overall, both cohorts of students reported moderate levels of burnout. Part 2 will present the lived experience of deployment as described by students. [ABSTRACT FROM AUTHOR]

Peristomal skin problems are common in ostomy patients and are connected to decreased quality of life and patient independence, as well as increased treatment costs. This study analysed the factors related to peristomal skin changes in order to better define the clinical profile of patients with optimal peristomal skin status. Secondary analysis of data from a nationwide, cross-sectional, retrospective, multicentre study performed in Spain (Uses and Attitudes in Ostomy) (Bueno Cruz et al, 2021) evaluated clinical data, including demographics, preoperative stoma site marking, type of ostomy, device used, frequency of leakage and scores from the Ostomy Skin Tool (OST) and quality of life (QoL) questionnaires. Risk factors for peristomal skin changes were analysed using multivariate analysis, and a predictive nomogram to anticipate optimal peristomal skin status (defined here as discolouration (D), erosion (E), and tissue overgrowth (T) (DET) score of 0) was developed. Some 871 patients with an ostomy using different commercial devices in Spain were evaluated. Multivariate analysis to predict optimal peristomal skin status revealed leakage frequency, patient age, type of ostomy, preoperative siting and type of baseplate used were independent predictors of peristomal skin status. Optimal peristomal skin care should be a treatment goal for nurse specialists in stomal therapy, and its individual influencing variables should be taken into account by nurses specialising in ostomy care. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to evaluate the incidence of, and risk factors for, the occurrence of pressure injuries (PIs) in a paediatric surgical intensive care unit (ICU). Method: This is a prospective cohort study of 153 children in the postoperative period. Patients were assessed daily by physical examination and data were collected. All independent variables were included in a logistic regression. Results: The mean age of the cohort was 2 years, and the incidence of PI was 15.7%. According to the Braden Q Scale, 58.2% of patients were at high risk of developing PI; 79.3% of PIs were related to immobility and 69.0% were at stage 1. Risk factors were ICU length of stay and the number of medical devices used. Conclusion: The incidence of PI was high because patients were mostly at a considerable risk of developing a PI. PI was associated with several factors, especially length of ICU stay and number of devices, both of which are indirect indicators of the severity of patient condition and healthcare costs. [ABSTRACT FROM AUTHOR]

Background Occupational stress is one of the undesirable risk factors found in the midwifery profession. It can lead to job burnout, job loss and negatively affect the quality of patient care. This study aimed to estimate the prevalence of occupational stress among Iranian midwives. Methods Through searching national and international databases, a total of 11 observational studies with full texts were extracted. Observational studies in Persian or English that reported the prevalence or frequency of job stress among Iranian midwives were included in the analysis. Irrelevant studies, those conducted on midwifery students and gray literature were excluded. The metaanalysis was conducted using the random-effects model. Results 11 articles reviewed occupational stress in 1196 midwives (an average of 108 midwives per study). Analysis of the articles showed that the pooled prevalence of occupational stress was 70.82% in Iranian midwives. Meta-regression analysis showed that the prevalence of occupational stress was not related to mean age, work experience, articles' publication year or sample size. Conclusions The prevalence of occupational stress is high among Iranian midwives and it can have harmful consequences for them and their patients. Therefore, the training of stress coping strategies seems to be appropriate for this group. [ABSTRACT FROM AUTHOR]

Regular physical activity improves glycaemic control in pregnant women with gestational diabetes. Motivational interviewing is an effective technique for increasing activity levels. This report evaluates a clinical pathway developed to integrate physical activity motivational interviewing into routine gestational diabetes care. Women attending a single-centre NHS clinic were invited to engage in a physical activity-focused motivational interview. The aerobic physical activity levels of 62 women were evaluated at baseline and at a 2-week telephone follow up, coded into three categories by minutes of moderate intensity physical activity per week: red (<30 minutes), amber (30–149 minutes) and green (≥150 minutes). At baseline, 30.6% of participants were coded red, 41.9% amber and 27.4% green. At follow up, 4.8% women coded red, 38.7% amber and 56.5% green, demonstrating a significant association for increased activity levels after motivational interviewing (P<0.001). This clinical pathway provides encouraging results that physical activity increased significantly in the short term. [ABSTRACT FROM AUTHOR]

Background Prenatal supplementation has been introduced to pregnant women during early pregnancy to prevent complication to both mother and fetus. The complications include anaemia, postpartum haemorrhage, low birth weight and fetal defects. Aim To assess compliance with vitamin and mineral supplementation in pregnant women. Methods A cross-sectional design with simple random sampling was used in this study with 100 respondents who attended the maternal and child clinic in Selangor, Malaysia. Findings The findings showed that 86 respondents (86%) were compliance towards vitamin and mineral supplementation, whereas 35 respondents (35%) were non-compliance mainly due to forgetfulness. The result indicated a significant association between compliance with race (p=0.02), occupation (p<0.01), household income (p=0.02), education (p<0.01), parity (p<0.01) and trimester (p=0.02). Conclusion Majority of the respondents acknowledge that side effects and forgetfulness were the main influencing factors towards non-compliance. [ABSTRACT FROM AUTHOR]

Background: Women report similar functional outcomes after pessary treatment or surgery for pelvic organ prolapse (POP). Aims: To assess the documentation of pessary counselling in women who underwent surgery for POP. Methods: This was a retrospective cohort study conducted on women who underwent hysterectomy for prolapse. The primary outcome measure was documentation regarding offer of pessary. 'Pessary offer' was defined as documentation that clearly stated that the care provider offered pessary to the patient. Findings: Over the study period, 81 hysterectomies took place for POP; pessary offer was documented for only 19 (23.5%) case records. Characteristics significantly associated with pessary offer were history of chronic cough (P=0.031), previous pelvic surgery (P<0.001), no secondary indication for surgery (P=0.012), concomitant surgery performed other than hysterectomy (P=0.046), age range (P<0.001) and BMI range (P<0.001). Conclusion: Pessary offer was documented in less than quarter of cases. This denotes a need to strengthen documentation of offer, counselling for pessary, or both of these. [ABSTRACT FROM AUTHOR]

Background: Knowledge of traditional and complementary medicine (TCM) and its use by patients are essential for patient safety. Aims: To examine knowledge of TCM among practitioners in a nephrology unit and their advice to patients. Methods: This was a descriptive, observational, cross-sectional study. Sociodemographic data were collected and an ad hoc closed response survey was used. Findings: This study included 62 practitioners, of whom: 32.26% had been trained in TCM, with no significant differences between professional groups; 41.93% used TCM and 67.74% recommended TCM to patients, with no significant difference between personal use and training received. The majority (62.90%) approved of TCM being included in clinical practice, 77.42% were in favour of it being included in formal health teaching programmes, 27.42% said patients had requested information on TCM and 50% knew it could interact with conventional treatment. Conclusion: Although the majority of practitioners had not been trained in TCM, they were interested in including such treatments in clinical practice. They recommended TCM to patients, but neither training nor personal experience were significant factors in relation to these recommendations. Training in TCM is required to ensure advice is safe. [ABSTRACT FROM AUTHOR]

Background: Online self-management education programmes are now recommended for people with type 2 diabetes to improve self-management capacities. There is limited evidence to determine whether such programmes improve the health outcomes for midlife adults with diabetes. Aims: The purpose of this systematic review was to assess the impact of online self-management interventions with digital consulting on glycated haemoglobin (HbA1c), total cholesterol, blood pressure, diabetes distress, self-efficacy, and depression in midlife adults. Methods: A systematic review was undertaken searching Medline, Embase and CINAHL. Studies were appraised using the Cochrane Collaboration's tool. Results: Eight studies were included. Online interventions resulted in the improvement of HbA1c (pooled mean difference on HbA1c: -0.35%, 95% CI (-0.52, -0.18), P<0.001). A narrative synthesis was conducted for all secondary outcomes. No conclusions could be drawn on the impact of these outcomes. Conclusion: Online interventions improve HbA1c. Further research is needed for secondary outcomes. [ABSTRACT FROM AUTHOR]

Background: Term babies born smaller than expected for a given gestation are at greater risk of short- and long-term health conditions. Breastmilk is the optimum nutrition for all babies and offers specific protection from the risks that follow from being born small for gestational age. Aim: To explore breastfeeding outcomes for babies born with a birthweight below the 10th centile. Methods: Data were collected on all women giving birth in one maternity unit in the north of England over a year. Method of feeding at three time points was compared between small-for-gestational-age and appropriately grown babies. Findings: Small-for-gestational-age babies were significantly less likely to be breastfeeding at discharge from hospital and community services compared to larger babies. Conclusion: This study suggests that small-for-gestational-age babies are disadvantaged in establishing breastfeeding. [ABSTRACT FROM AUTHOR]

Multifocal motor neuropathy (MMN) is a rare immune-mediated disease that presents with predominantly distal motor weakness in one or more limbs without sensory loss. Symptoms may give rise to functional impairment and consequently may affect quality of life. High-dose intravenous immunoglobulin's therapy (IVIg) is the current mainstay treatment, however, subcutaneous immunoglobulin (SCIg) is emerging as a viable alternative. The purpose of this study was to explore the patients' experience of SCIg and ascertain if those receiving it had an improved quality of life and treatment satisfaction compared to those receiving IVIg. Using a mixed method approach this paper will present its findings and key implications for clinical and research practice are considered. The results from this study suggest that home SCIg therapy may prove a more desirable treatment option than IVIg for a proportion of MMN patients. [ABSTRACT FROM AUTHOR]

Aim: this study examined a brief lifestyle self-management intervention, based on self-determination theory, to manage seizure frequency, and its effects on health-related quality of life and resilience in people with epilepsy aged over 18 years. Background: most people with epilepsy can identify factors that may trigger seizures and may try to avoid these; however, education from clinicians on this varies. Design: a cohort study with control design. Method: sixty participants were purposively sampled and allocated to an intervention or a control group. Results: moderate correlations were found, particularly between: resilience and satisfaction with life; medication adherence and psychological quality of life; and psychological quality of life and satisfaction with life. The mean seizure occurrences between the control and intervention groups were 12.71 (SD 24.55) and 6.76 (SD 13.40) respectively after the intervention. While the study was not powered to assess this, the intervention may be most effective regarding medication adherence and physical health quality of life. Conclusion: the relationship between self-efficacy and seizure management appeared to be strengthened by the programme. This study is the first known to measure resilience in relation to lifestyle self-management for seizure control in people with epilepsy. Relevance to practice: nurses are well placed to work with patients' strengths towards self-efficacy and potentially resilient coping. [ABSTRACT FROM AUTHOR]

Background: Literature on the management of gestational diabetes mellitus (GDM) and other pre-existing diabetic conditions in pregnancy suggest treatments that may ameliorate outcomes for both mother and neonates. Aims: To examine the effects of GDM on outcomes for mothers and neonates and the effects of maternal age, body mass index and gestational age at birth with or without induction of labour for women with GDM. Methods: Audit data of outcomes for GDM groups were analysed against outcomes for the general population of women giving birth in this unit. Descriptive statistics organised the data and inferential statistics determined the significant differences between frequencies. Findings: Most of the results were predictive when comparing women with and without GDM for mode of birth and outcomes for mothers and neonates. This included significant differences for hospital birth, induction of labour and caesarean section. Conclusion: Good glycaemic control and healthy lifestyle measures are advised to minimise development of obesity in women with GDM and diverse outcomes for both mothers and neonates. [ABSTRACT FROM AUTHOR]

Background: Depression and fatigue have been recognised as common postpartum morbidities. One of the proposed well established aetiologies is vitamin D deficiency, which is prevalent among Iranian women. Aim: To determine the efficiency of vitamin D supplement on postnatal depression and fatigue. Method: In this double blind, randomised controlled trial, 80 primiparous women, who scored ≥13 and ≥20 on the Edinburgh Postnatal Depression Scale and the Fatigue Identification Form, respectively, were randomly distributed into the control and intervention groups over 4-10 months following birth. Groups received vitamin D3 1000IU and placebo pills daily for 6 months. Logistic regression tests assessed the relation between variables. Findings: Vitamin D decreased depression scores and fatigue scores in the intervention group (P>0.001). Conclusion: Considering vitamin D supplements as routine postpartum care among high-risk women would be useful. However, more studies are needed to support this conclusion. [ABSTRACT FROM AUTHOR]

Background: Antidepressants for postnatal depression may not be acceptable to women and so many may seek alternative therapies. Aim: To evaluate the effectiveness and safety of acupuncture for postnatal depression compared with antidepressant treatment. Methods: A literature search was conducted in English, Chinese, Japanese and Korean databases. Details of the trials were extracted and analysed. Findings: Of the 1592 studies reviewed, three met the inclusion criteria for quantitative analysis. Two studies reported no significant differences between acupuncture and fluoxetine for depression, while the third reported significant improvements. Conclusions: Acupuncture in postpartum depression was at least as effective as fluoxetine hydrochloride, supporting the notion that acupuncture may be a safe and effective option. [ABSTRACT FROM AUTHOR]

Identifying frail older people, and in particular, people who are psychologically frail in a community setting is difficult. This article investigates predictors of psychological frailty and constructs a short and effective pre-detection tool for highly psychologically frail older people. The Belgian Ageing Studies, a cross-sectional study (n=28.245) was used. Measures included four items of the Geriatric Depression Scale, the psychological domain of the Comprehensive Frailty Assessment Instrument. First bivariate analyses were used. Afterwards, Chi-squared automatic interaction detector (CHAID) analysis was applied to gain an insight into the hierarchical order of predictors for high psychological frailty. Findings indicate that the combination of hopelessness and life dissatisfaction predicts high psychological frailty in 68.4% of cases. Early detection of frailty offers opportunities to start early interventions, and can delay or reduce frailty. In order to detect older people who are psychologically frail, a simple two question pre-detection tool was developed. To conclude: if a patient answers ‘yes’ to feeling hopeless and ‘no’ to having life satisfaction, this predicts with great probability (68.4%) high psychological frailty. [ABSTRACT FROM AUTHOR]

Background: secondary prevention programmes help manage risk factors, prevent progression of disease, minimise complications and reduce readmissions to hospitals. Referrals to these programmes are suboptimal even though they improve survival and quality of life. Aim: to explore referral of individuals with a primary diagnosis of acute coronary syndrome, cerebrovascular disease or peripheral vascular disease to secondary prevention programmes. Methods: a non-experimental descriptive retrospective design was used to analyse 176 patient records from a tertiary referral hospital in Melbourne, Australia. The study population consisted of individuals over 18 years of age admitted to hospital with a primary diagnosis of acute coronary syndrome, cerebrovascular disease or peripheral vascular disease within a 12-month period in 2009. Findings: from the patient records reviewed, 34% (n=60) were referred to secondary prevention programmes compared with 66% (n=116) not referred. Individuals with acute coronary syndrome were more likely to be referred than those with peripheral vascular disease or cerebrovascular disease. Those most likely to be referred were young males, married, living in a rural area and English speaking. Discussion: the study highlights that referrals to secondary prevention programmes are suboptimal. There is a need to investigate reasons for under-referral and the best approach to manage referrals. Conclusion: referrals to secondary prevention programmes are an important area of research: these are beneficial, yet some individuals are not being referred. Nurses are well placed to promote referrals to these programmes potentially. reducing under-referral. [ABSTRACT FROM AUTHOR]

Background: A pressure ulcer (PU) steering group was set up in Zhongda Hospital in China to develop a campaign to increase knowledge of PUs, to improve management and reduce incidence. Method: Questionnaires were completed by 275 nurses to ascertain their knowledge of PUs. The initial questionnaire indicated that the nurses had insufficient knowledge of PUs. The steering group then ran a campaign focusing on standardising the management of PUs. The measurement of PU knowledge for all nurses was tested after 2 years of training. Results: After 2 years, the nursing staff's knowledge of PUs had improved. Usage of the Braden scale had risen from (60.0±22.9) to (88.0±9.0) and showed a statistically significant difference (p<0.01). Moreover, the rate for patients reported as being at high risk of developing a PU had increased from 0.98% in 2012 to 1.24% in 2013, while the occurrence rate of PUs in the hospital had decreased from 0.09% in 2012 to 0.05% in 2013. Conclusion: The campaign significantly enhanced the knowledge of PUs and improved the ability of nursing staff to evaluate PU risks, resulting in a decrease in the occurrence of PUs. [ABSTRACT FROM AUTHOR]

Background: Women who give birth by caesarean section are more likely to require readmission to hospital following birth compared to women who give birth vaginally. Aims: To examine the reasons, management and outcomes for women readmitted to hospital following birth by caesarean section (CS). Methods: A retrospective audit of maternity records was undertaken. Findings: The total number of births for the period of data extraction was 8580, of which 2470 (28.79%) women gave birth by CS. A total of 107 women (4.33% of those who gave birth by CS) were readmitted to hospital between 1 August 2014 and 31 July 2015, of which 46 women (1.86%) were readmitted following elective CS and 61 (2.47%) following emergency CS. The average length of hospital stay was 2.64 and 4.61 nights, respectively, and the average timeline for readmission was 14.6 days following elective CS and 15.7 following emergency CS. The most common reason for readmission was wound infection, with the majority of women requiring analgesics (n=29, 63.05% following elective CS and n=51, 83.61% following emergency CS) and intravenous antibiotics (n=23, 50% following elective CS and n=34, 55.74% following emergency CS). Conclusions: Abdominal wound infection is one of the most common reasons for readmission of women to hospital following birth by CS. These findings will make it easier to understand and identify women at risk of postpartum morbidity following birth by CS. [ABSTRACT FROM AUTHOR]

Background: Awareness about the extent of maternal physical and emotional health problems after childbirth is increasing, but few longitudinal studies have been published. Aims: The aim of this study was to describe changes in the prevalence of maternal health problems in the 5 years after birth and their association with parity. Methods: A population-based cohort study was conducted in Mahabad, a city in the West Azerbaijan province of Iran. The study population comprised women who visited public health-care centres for routine antenatal care from May 2009 to September 2013. Findings: Based on a sample size analysis, 311 women were recruited to the study. Over the 5-year period, 32 participants were lost to follow-up, with a total of 279 participants completing all five stages of the research. Overall, the majority (94%) of postpartum morbidities did not resolve within the first week, and 26% of participants reported experiencing issues 5 years postpartum. Adjusting for the method of birth, primiparous women were more likely than multiparous women to report fatigue at all stages, and sexual problems were most frequently reported by multiparous women. Conclusions: Health problems commonly occurred after childbirth, with some resolution over the 5 years after childbirth. Important differences in prevalence of postpartum morbidities were evident when parity was considered. [ABSTRACT FROM AUTHOR]

This study examined factors contributing to the knowledge and attitudes of nursing home staff regarding palliative care for advanced dementia in Japan. A cross-sectional survey of 275 nurses and other care workers from 74 long-term care facilities was conducted across three prefectures in August 2014. The Japanese versions of the Questionnaire on Palliative Care for Advanced Dementia (qPAD) and Frommelt Attitudes Toward Care of the Dying scale, Form B (FATCOD-B-J) were used. Greater knowledge was exhibited among nursing home staff in facilities that established a manual for end-of-life care. Higher levels of positive attitudes were observed among nursing home staff in facilities that had established a manual and those in facilities with a physician's written opinions on end-of-life care. An organisational effort should be explored to establish end-of-life care policies among nursing home staff for advanced dementia. [ABSTRACT FROM AUTHOR]

Background: Social adversity and poor maternal mental health during pregnancy can have long-term adverse effects on the infant's health, social and educational outcomes. Stress in pregnancy may have direct physiological effects on the fetus, as well as impairing development of maternal sensitivity to the infant. Improved antenatal support and more effective engagement with 'high-risk' expectant mothers is needed. Method: Pregnant women meeting high-risk criteria were invited to participate. Participants (n=35) were randomly allocated in clusters of six to either Mellow Bumps (a 6-week antenatal parenting programme that aims to decrease maternal stress levels and emphasises the importance of early interaction in enhancing brain development and attachment), Chill-out in Pregnancy (a 6-week stress reduction programme) or care-as-usual. Results: The interventions are promising in terms of maternal mental health. Qualitative feedback suggested that the interventions' format was acceptable. A larger trial may be justified if effect sizes can be estimated with more precision. [ABSTRACT FROM AUTHOR]

Background: Guidance from the National Institute for Health and Care Excellence advocates the use of two case-finding questions about depressed mood and loss of interest in activities to identify perinatal depression. However, there are no studies of their acceptability when administered in the antenatal and postnatal period. Methods: The study was an intra-mixed methods cohort study set in an antenatal clinic in an inner-city hospital in the North of England. Pregnant women attending a routine antenatal appointment at approximately 26 weeks' gestation completed a self-report survey at a routine hospital antenatal appointment and a postal survey between 5 and 13 weeks postnatal. Survey responses and free-text commentaries of women's views were analysed using descriptive statistics and qualitative content analysis. Results: Ninety-three percent of participants felt it was desirable to ask about perinatal mental wellbeing, and 97% felt comfortable answering the questions. Free-text comments revealed depressed and non-depressed women found the questions easy, simple and straightforward to answer . Conclusions: Case-finding questions to identify perinatal depression were generally acceptable to depressed and non-depressed pregnant and newly delivered mothers. Health professionals should consider the acceptability and appropriateness of this strategy in order to facilitate identification of perinatal mental health issues in routine maternity care practice. [ABSTRACT FROM AUTHOR]

Background: International standard practice for the correct confirmation of the central venous access device is the chest X-ray . The intracavitary electrocardiogram-based insertion method is radiation-free, and allows real-time placement verification, providing immediate treatment and reduced requirement for post-procedural repositioning. Methods: Relevant databases were searched for prospective randomised controlled trials (RCTs) or quasi RCTs that compared the effectiveness of electrocardiogram-guided catheter tip positioning with placement using surface-anatomy-guided insertion plus chest X-ray confirmation. The primary outcome was accurate catheter tip placement. Secondary outcomes included complications, patient satisfaction and costs. Results: Five studies involving 729 participants were included. Electrocardiogram-guided insertion was more accurate than surface anatomy guided insertion (odds ratio: 8.3; 95% confidence interval (CI) 1.38; 50.07; p=0.02). There was a lack of reporting on complications, patient satisfaction and costs. Conclusion: The evidence suggests that intracavitary electrocardiogram-based positioning is superior to surface-anatomy-guided positioning of central venous access devices, leading to significantly more successful placements. This technique could potentially remove the requirement for post-procedural chest X-ray, especially during peripherally inserted central catheter (PICC) line insertion. [ABSTRACT FROM AUTHOR]

Meticillin-resistant Staphylococcus aureus (MRSA) is a significant global problem. One response to the growing threat of this organism has been the introduction of routine screening of patients before admission to hospital. In midwifery, this has been applied to those undergoing caesarean section, and although these women are at low-risk of hospital-associated MRSA, one rationale for continuing this policy could be that it identifies cases of community-associated MRSA. This audit was undertaken to determine local compliance with MRSA screening in the maternity setting, and the utility of routine screening in one London Hospital. The prevalence of MRSA was 2.8% in those having elective caesarean sections and 1.1% in emergency cases. Although staff generally understood the need for screening, significant barriers included consent, time and material constraints. Given the low prevalence and risk of severe infection in this generally healthy group; it is recommended that routine screening be stopped. [ABSTRACT FROM AUTHOR]

Background: Palliative care patients experience many debilitating symptoms and functional loss, but few longitudinal studies on the subject are available. Aims: To assess the symptoms and functional status of patients admitted to specialised palliative care, to investigate whether changes occur over the admission period, and to establish whether symptoms and physical and cognitive function differ, based on the service setting. In addition, to participate in the development of the interRAI Palliative Care instrument (interRAI PC). Methods: A prospective longitudinal study (N=123) was conducted at three time points: at admission to specialised palliative care, 14 days post-admission, and at discharge or death. The interRAI PC version 8 was used for data collection. Descriptive statistics were used, together with the Friedman statistical test and Wilcoxon post-hoc test. Results: Patients experienced a wide spectrum of symptoms; the most frequent were fatigue, loss of appetite, pain, difficulty sleeping, insufficient nutritional intake and nausea. Some symptoms stayed relatively stable over time, but others increased, while physical and cognitive function decreased over time. The interRAI PC version 8 proved comprehensive and simple to use. Conclusions: Patients experienced a significant symptom burden and functional loss from admission to discharge or death. Symptoms indicating progressive deterioration became more frequent and severe, while physical and cognitive function decreased at all levels. Overall, inpatients had more symptoms and functional decline than home-care patients. The interRAI PC version 8 proved valuable in collecting clinical information and detecting changes over time as other interRAI suite instruments. [ABSTRACT FROM AUTHOR]

Introduction: Effectively discussing palliative care with patients and families requires knowledge and skill. The purpose of this study was to determine perceived needs of inpatient nurses for communicating with patients and families about palliative and end-of-life (EoL) care. Method: A non-experimental design was used. In total, 60 inpatient nurses from one hospital in Idaho completed the End of Life Professional Caregiver Survey (EPCS), which examines three domains: patient and family-centered communication, cultural and ethical values, and effective care delivery. Results: The number of years’ experience nurses had (F(9,131.57)=2.22, p=0.0246; Wilk’s ^=0.709) and the unit they worked on (F(6,110)=2.49, p=0.0269; Wilk’s ^=0.775) had a significant effect on their comfort discussing EoL and palliative care with patients and their families. For all three domains, years of nursing experience was positively associated with comfort in communicating about EoL care. Oncology nurses were most comfortable with regard to patient and family-centered communication. Discussion: The success and sustainability of this service is dependent on education for health-care providers. Studies are needed to determine the most effective ways to meet this educational challenge. [ABSTRACT FROM AUTHOR]

Aim: Evidence suggests chronic whiplash is associated with sensory hypersensitivity. Understanding the degree of sensory impairment could enhance rehabilitation strategies. This preliminary study determined whether differences in sensory evaluation occur post whiplash injury. Methods: Single-blinded, case control observational study using a convenience sample of 20 participants (median age 28.5 years, low disability) with chronic grade II whiplash-associated disorder (CWADII) and 22 control participants (median age 26 years) with no history of whiplash/neck injury. Outcome measures included vibration and cold pain perception threshold, and joint position error. Results: Significant associations using Kendall's tau correlation coefficient were found between: vibration thresholds (thenar and hypothenar eminences) for the CWADII group (p<0.01); cold pain thresholds (thenar, 5th metacarpophalangeal, mid cervical spine) in both groups (p<0.01); joint positioning errors (global positioning following right/left rotations, left rotation/extension) (p<0.01) in the CWADII group; and between vertical direction errors (following right/left rotation) in both groups (p<0.01). Discrimination between groups was not identified using separate logistic regressions on vibration or cold pain thresholds (thenar eminence) or on global flexion/extension/right rotation position errors (p>0.01). Conclusions: The findings do not support the use of vibration, cold pain threshold or joint position error to identify individuals with CWADII with low disability. [ABSTRACT FROM AUTHOR]

Background: The Liverpool Care Pathway for the Dying Patient (LCP) was developed to transfer palliative care standards for the last hours or days of life, including family support, from hospice to other care settings. Aim: This study sought to explore family members’ experiences of end-of-life care in a palliative care unit and in a general geriatric ward in Sweden before and after implementation of the LCP. Methods: Experiences were evaluated in relation to the goals of the LCP. Family members o f patients deceased before and after implementation answered a questionnaire 3-6 months after the death. Comparisons between the samples were assessed by non-parametric tests. Results: There were significant differences concerning dialogue about existential issues that arise and about emotions and practical issues faced in bereavement. Significant improvements after the implementation of the LCP were reported in experiences regarding physicians’ ability to listen to family members’ concerns. Conclusion: The results suggest that using a structure such as that provided by the LCP may improve communication between physicians and the families of dying patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Nurses with higher levels of work engagement tend to be highly efficient in their work and more willing to keep working and to provide patient-centred care. However, whether more engaged nurses provide end-of-life care more proactively has not been examined in the home-care setting. AIM: This study aimed to examine work engagement among home-visiting nurses in Japan and its relationship with their attitudes toward caring for dying patients and their families. METHODS: A total of 343 nurses working in 62 agencies across Chiba prefecture, eastern Japan, received an anonymous self-administered questionnaire from July to August 2012. The authors performed multiple regression analysis to explore the relationships between home-visiting nurses' work engagement and attitudes. RESULTS: Data from 184 nurses (53.6%) was analysed. Work engagement was significantly positively related to the nurses' attitudes toward caring for dying patients and their families. CONCLUSION: As more engaged nurses tend to have more positive attitudes toward caring for dying patients and their families, further research is needed to identify the factors that might help nursing managers to enhance their staff's engagement and perhaps thereby improve their attitudes, with the ultimate aim of achieving better outcomes for patients and families. [ABSTRACT FROM AUTHOR]

• Objective: This study aimed to evaluate the internal consistency reliability and construct validity of the Fitzpatrick Skin Type Scale during radiation therapy in a cohort of women receiving treatment for breast cancer. • Method: The assessment of the scale was performed as a nested study within a randomised controlled trial of two creams used for radiation therapy skin care for breast cancer patients. The sample consisted of 244 female patients undergoing radiation therapy for breast cancer. Participants completed a modified version of the Fitzpatrick Skin Type Scale. • Results: Internal consistency as measured by Cronbach’s alpha was 0.505, 0.829 and 0.339 for the Genetic Disposition, Sun Exposure and Tanning Habits subscales respectively. Only the Sun Exposure subscale surpassed the 0.70 cut-off, indicating good internal consistency. Maximum likelihood factor analysis with promax rotation method confirmed the a priori factor structure for the Sun Exposure subscale as well as providing evidence of construct validity for this subscale. Analysis for the other two subscales highlighted issues with internal reliability and construct validity suggesting that not all items on each subscale truly measure the intended trait. • Conclusion: The study findings support reliability and validity of the Sun Exposure subscale of the Fitzpatrick Skin Type Scale in a convenience sample of women receiving radiation therapy for cancer. Despite limitations with two of the three subscales, this tool continues to be used in clinical practice. [ABSTRACT FROM AUTHOR]