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Timely recognition of dying is important for high quality end-of-life care however, little is known about how clinicians recognise dying. Late recognition is common and can lead to futile treatment that can prolong or increase suffering and prevent a change in the focus of care. To explore how clinicians caring for dying people recognise that they are in the last days or hours of life, as well as the factors that influence the recognition of dying. A systematically constructed integrative review of the literature. Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature, PsycInfo and Allied and Complementary Medicine were searched in July 2022. Papers were included if they were original research, discussed how clinicians recognise dying, available in English language and published in 2012 or later. A constant comparison approach was applied to the analysis and synthesis of the literature. 24 papers met the inclusion criteria. There were 3 main categories identified: 'Clues and signals' refers to prompts and signs that lead a clinician to believe a person is dying, incorporating the sub-categories 'knowing the patient over time', and 'intuition and experience'. 'Recognition by others' is where clinicians come to recognise someone is dying through others. This can be through a change in the context of care such as a tool or care plan or by communication with the team. 'Culture, system and practice' refers to the cultural beliefs of a setting that influences awareness of dying and denial of death as a possibility and avoidance of naming death and dying directly. System and practice of the setting also impact on recognition of dying. This involves work pace and intensity, shift systems and timing of senior reviews of patients. Uncertainty and its impact on recognition of dying are evident throughout the findings of this review. The seeking of certainty and the absence of the possibility of dying contributes to late recognition of dying. Recognition of dying is a complex process that occurs over time, involving a combination of intuition and gathering of information, that is influenced by contextual factors. A culture where dying is not openly acknowledged or even named explicitly contributes to late recognition of dying. A shared language and consistent terminology for explicitly naming dying are needed. Uncertainty is intrinsic to the recognition of dying and therefore a shift to recognising the possibility of dying rather than seeking certainty is needed. (PROSPERO) CRD42022360900. Registered September 2022. [ABSTRACT FROM AUTHOR]

Depression in older people living in residential aged care is a serious and highly prevalent health issue, with loneliness and social isolation being major contributors. The COVID-19 pandemic underscored the harm visiting restrictions have on the mental wellbeing of older people in residential aged care. However, there is a need to systematically review the relationship between family visits and depression in this population. This literature review seeks to explore the association between family visits and depression among those living in residential aged care. An integrative review was conducted in March 2022, based on a search of seven databases from inception to 2022. Papers were included if the studies were situated in a residential aged care facility and explored the impact of in-person family visits on depression of residents. Those that examined impact of family visits on community-dwelling older people and papers examining virtual family visits were excluded. The quality of the included papers was assessed using appropriate critical appraisal tools. Guided by the aim of this study, the included papers were narratively synthesised and presented thematically (PROSPERO ID CRD42022325895). Ten papers, published between 1991 and 2022, were included in the final synthesis. Multiple categorisations of frequency of visits and different scales were used to assess depression. Depression among residents in aged care facilities varied from 20 % to 58.7 % with 40 % of studies showing a positive association between the frequency of family visits and lower rate of depression. Three themes influencing the association between family visits and depression in residential aged care were identified. These were: (i) intersection of culture, filial values, and depression; (ii) resident-related factors including whether admission was voluntary and presence of functional impairment; and (iii) non-resident-related factors such as social activities for residents and staff involvement. Family visits ameliorated loneliness and depression among residents in aged care however, other factors such as culture, comorbidities and functional impairment, opportunities for socialisation and the social involvement of facility staff also influenced depression. Whilst the low number of studies reviewed limited comparison and generalisation of results, the review highlighted the broader and crucial role of healthcare staff in facilitating socialisation and promoting mental wellbeing of residents especially those who are not visited by families. Family visits ameliorate depression in institutionalised older people but may not be the "silver bullet" as depression is multifactorial. [ABSTRACT FROM AUTHOR]

Objectives: To establish the most effective securing devices and techniques for preventing nasogastric tube displacement or inadvertent extubation, mucosa and skin lesions, discomfort, and complications (ab ingestis pneumonia, reduced caloric intake, mortality) in adult patients. Design: Systematic review of published and unpublished reports in any language, identified by searching 5 electronic databases, websites, reference lists, and existing systematic reviews and papers identified by experts in the field. Eligibility criteria for selecting studies: Systematic reviews, randomised controlled trials, and comparative studies that compared ≥2 techniques or devices to secure nasogastric tubes in patients 18 years old or older. Results: Five studies (of which two were randomised controlled trials) were included. Four studies reported on bridle versus the tape technique (unbridled). The studies' population was comprised of mostly Intensive Care Unit patients. Four studies measured unintentional dislodgement or removal and found a statistically significant advantage in favour of the bridle. Three studies measured time until failure: two studies compared the bridle versus tape technique whereas the other compared different types of tape. One study did not find any significant difference between the two groups of patients whereas the second demonstrated a significantly longer time until failure in the bridled patients. Three studies comparing bridled and unbridled patients measured adverse events such as external nasal ulceration, epistaxis and sinusitis, and there was no agreement between their results. One study measured caloric intake and found that bridled patients received a higher percentage of their caloric goal than unbridled patients. Only one study analysed the cost-effectiveness of the bridle versus the tape technique and found a cost saving by implementing routine bridling of nasoenteric feeding tubes. Discomfort was not measured in the included studies. Conclusions: Despite the large number of patients receiving this intervention, there is insufficient evidence to suggest one securing technique or device over another. Data are lacking on the beneficial effects of the various methods or systems. There is little or no statistically significant evidence regarding bridling of nasogastric tubes but more research is needed. There is a need for more well-designed studies conducted in various clinical settings. [ABSTRACT FROM AUTHOR]

Many countries face substantial shortages of skilled nurses. With an aging population and global demographic changes, developing a skilled workforce of nurses has become one of the central challenges for public health care. The recent COVID-19 pandemic has exacerbated labor shortages, which pose a threat to the quality of publicly provided health care. Improving nurses' working conditions could be a means by which to address the global shortages of nurses. However, in countries with public health care, such improvements may come with additional costs in the form of higher taxes or social security contributions. Therefore, such improvements partly depend on people's willingness to pay (WTP) for them. In this paper, we investigate workers' willingness to pay for improvements in the working conditions of nurses. This study is a factorial survey experiment included as part of an online survey. The factorial survey experiment was implemented within the high-frequency online panel survey "Life and Employment in Times of Corona" (IAB-HOPP) conducted by the Institute for Employment Research (Germany). We analyze data from N = 2128 survey participants; our main analysis consists of N = 6384 responses from those participants. Our research is based on a factorial survey experiment (vignette analysis) designed to quantitatively measure the willingness to pay for various improvements in the working conditions of nurses. We use random effect models and mixed models to estimate the individual-level willingness to pay for these improvements. Our results show that the survey participants are generally willing to pay for particular policies aimed at improving the working conditions of nurses. However, the amount that respondents are willing to pay varies with the type of policy changes. Survey participants exhibit a high willingness to pay for increases in minimum wages for nurses and wage-related improvements in general. We find, however, a lower willingness to pay for the right to participate in training courses aimed at reducing work-related stress. The broad support for improvements in the working conditions of nurses provides policymakers with some guidance in implementing policy measures that might address labor shortages in the nursing sector. There was no preregistration. Many people are willing to pay extra to improve the working conditions of nurses. Wage-related increases for nurses show the highest willingness to pay. [ABSTRACT FROM AUTHOR]

Background: Apparent overconfidence and underconfidence in clinicians making clinical judgements could be a feature of evaluative research designs that fail to accurately represent clinical environments. Objectives: To test the effect of improved realism of clinical judgement tasks on confidence calibration performance of nurses and student nurses. Design: A comparative confidence calibration analysis. Settings: The study was conducted in a large university of Northern England. Methods: Ninety-seven participants rated their confidence - using a scale that ranged from 0 (no confidence) to 100 (totally confident) on dichotomous clinical judgements of critical event risk. The judgements were in response to 25 paper-based and 25 higher fidelity scenarios using a computerised patient simulator and clinical equipment. Scenarios, and judgement criteria of 'correctness', were generated from real patient cases. Using a series of calibration measures (calibration, resolution and over/underconfidence), participants' confidence was calibrated against the proportion of correct judgements. The calibration measures generated by the paper-based and high fidelity clinical simulation conditions were compared. Results: Participants made significantly less accurate clinical judgements of risk in the high fidelity clinical simulations compared to the paper simulations (P = 0.0002). They were significantly less confident in high fidelity clinical simulations than paper simulations (P = 0.03). However, there was no significant difference of over/underconfidence for participants between the two simulated settings (P = 0.06). Participants were no better calibrated in the high fidelity clinical simulations than paper simulations, P = 0.85. Likewise, participants had no better ability of discriminating correct judgements from incorrect judgements as measured by the resolution statistic in high fidelity clinical simulations than paper simulations, P = 0.76. Conclusions: Improving the realism of simulated judgement tasks led to reduced confidence and judgement accuracy in participants but did not alter confidence calibration. These findings suggest that judgemental miscalibration of confidence in nurses may be a systematic cognitive bias and that simply making scenarios more realistic may not be a sufficient condition for correction. [ABSTRACT FROM AUTHOR]

Early mobilization is only carried out to a limited extent in the intensive care unit. To address this issue, the robotic assistance system VEMOTION® was developed to facilitate (early) mobilization measures more easily. This paper describes the first integration of robotic assistance systems in acute clinical intensive care units. Feasibility test of robotic assistance in early mobilization of intensive care patients in routine clinical practice. Two intensive care units guided by anesthesiology at a German university hospital. Patients who underwent elective surgery with postoperative treatment in the intensive care unit and had an estimated ventilation time over 48 h. Participants underwent robot-assisted mobilization, scheduled for twenty-minute sessions twice a day, ten times or one week, conducted by nursing staff under actual operational conditions on the units. No randomization or blinding took place. We assessed data regarding feasible cutoff points (in brackets): the possibility of enrollment (x ≥ 50 %), duration (pre- and post-setup (x ≤ 25 min), therapy duration (x = 20 min), and intervention-related parameters (number of mobilizing professionals (x ≤ 2), intensity of training, events that led to adverse events, errors or discontinuation). Mobilizing professionals rated each mobilization regarding their physical stress (x ≤ 3) and feasibility (x ≥ 4) on a 7 Point Likert Scale. An estimated sample size of at least twenty patients was calculated. We analyzed the data descriptively. Within 6 months, we screened thirty-two patients for enrollment. 23 patients were included in the study and 16 underwent mobilization using robotic assistance, 7 dropped out (enrollment eligibility = 69 %). On average, 1.9 nurses were involved per therapy unit. Participants received 5.6 robot-assisted mobilizations in mean. Pre- and post-setup had a mean duration of 18 min, therapy a mean of 21 min. The robot-assisted mobilization was started after a median of 18 h after admission to the intensive care unit. We documented two adverse events (pain), twelve errors in handling, and seven unexpected events that led to interruptions or discontinuation. No serious adverse events occurred. The mobilizing nurses rated their physical stress as low (mean 2.0 ± 1.3) and the intervention as feasible (mean 5.3 ± 1.6). Robot-assisted mobilization was feasible, but specific safety measures should be implemented to prevent errors. Robotic-assisted mobilization requires process adjustments and consideration of unit staffing levels, as the intervention does not save staff resources or time. clinicaltrials.org TRN: NCT05071248 ; Date: 2021/10/08; URL https://clinicaltrials.gov/ct2/show/NCT05071248. Robot-assisted early mobilization in intensive care patients is feasible and no adverse event occurred. [ABSTRACT FROM AUTHOR]

Objectives To identify recommendations for determining patient panel/caseload size for nurse practitioners in community-based primary health care settings. Design Scoping review of the international published and grey literature. Data sources The search included electronic databases, international professional and governmental websites, contact with experts, and hand searches of reference lists. Eligible papers had to (a) address caseload or patient panels for nurse practitioners in community-based primary health care settings serving an all-ages population; and (b) be published in English or French between January 2000 and July 2014. Level one testing included title and abstract screening by two team members. Relevant papers were retained for full text review in level two testing, and reviewed by two team members. A third reviewer acted as a tiebreaker. Data were extracted using a structured extraction form by one team member and verified by a second member. Descriptive statistics were estimated. Content analysis was used for qualitative data. Results We identified 111 peer-reviewed articles and grey literature documents. Most of the papers were published in Canada and the United States after 2010. Current methods to determine panel/caseload size use large administrative databases, provider work hours and the average number of patient visits. Most of the papers addressing the topic of patient panel/caseload size in community-based primary health care were descriptive. The average number of patients seen by nurse practitioners per day varied considerably within and between countries; an average of 9–15 patients per day was common. Patient characteristics (e.g., age, gender) and health conditions (e.g., multiple chronic conditions) appear to influence patient panel/caseload size. Very few studies used validated tools to classify patient acuity levels or disease burden scores. Discussion The measurement of productivity and the determination of panel/caseload size is complex. Current metrics may not capture activities relevant to community-based primary health care nurse practitioners. Tools to measure all the components of these role are needed when determining panel/caseload size. Outcomes research is absent in the determination of panel/caseload size. Conclusion There are few systems in place to track and measure community-based primary health care nurse practitioner activities. The development of such mechanisms is an important next step to assess community-based primary health care nurse practitioner productivity and determine patient panel/caseload size. Decisions about panel/caseload size must take into account the effects of nurse practitioner activities on outcomes of care. [ABSTRACT FROM AUTHOR]

Objectives: To provide a comprehensive scoping review of evidence of the impact and effectiveness of 12 h shifts in the international nursing literature, supplemented by a review of evidence in other, non-nursing related industries. Data sources: A search of the academic literature was undertaken in electronic databases (AMED, MEDLINE, CINAHL, PsychInfo, Scopus, HMIC, the Cochrane Library, Business Source Premier, Econ Lit, ASSIA and Social Policy and Practice). Review methods: A total of 158 potentially relevant nursing research papers and reviews were published between 1973 and 2014. Two reviewers independently reviewed the articles, leaving 85 primary research studies and 10 review papers in the nursing field to be included in the scoping review. Thirty-one relevant primary research papers and reviews were also identified in the non-nursing related industries literature. Results: Research into 12 h nursing shifts fell within five broad themes: 'risks to patients', 'patient experience', 'risks to staff', 'staff experience' and 'impact on the organisation of work'. There was inconclusive evidence of the effects of 12 h shift patterns in all five themes, with some studies demonstrating positive impacts and others negative or no impacts. This also mirrors the evidence in other, non-nursing related industries. The quality of research reviewed is generally weak and most studies focus on the risks, experience and work/life balance for staff, with few addressing the impact on patient outcomes and experience of care or work productivity. Conclusions: There is insufficient evidence to justify the widespread implementation or withdrawal of 12 h shifts in nursing. It is not clearly understood where there are real benefits and where there are real and unacceptable risks to patients and staff. More research focusing on the impact of 12 h nursing shifts on patient safety and experience of care and on the long term impact on staff and work organisation is required. [ABSTRACT FROM AUTHOR]

People with intellectual disability have poorer health than the general population and experience difficulties accessing healthcare. In addition, attitude and stigmatisation by healthcare professionals can lead to poorer health outcomes for people with intellectual disability. This is often driven by the fact that many healthcare professionals lack the knowledge, skill or experience in supporting people with intellectual disability. As lead roles within the nursing profession Clinical Nurse Specialists and Advanced Nurse Practitioners have a key role in supporting person-centred care and health outcomes. However, little is known about the effects of these roles on care provision for people with intellectual disability. To identify the effect of Clinical Nurse Specialists and Advanced Nurse Practitioners on care provision for people with intellectual disability. A systematic search of six academic databases (CINAHL, EMBASE, PsycINFO, Scopus, Medline and Academic Search Complete) relevant to nursing and health care was performed. Nursing care environment. Clinical Nurse Specialists and Advanced Nurse Practitioners providing care to people with intellectual disability. A pre-defined systematic search of six academic databases was conducted and two reviewers screened each study against the inclusion criteria. Additional hand searching of the reference lists (backward chaining) and citations (forward chaining) of papers that met the inclusion criteria was conducted. The methodological details of each paper were extracted and assessed for quality and rigour utilizing the Mixed Methods Appraisal Tool and the AACODS checklist for appraising grey literature. Thematic analysis was undertaken (Braun and Clarke, 2006) and the review is reported in line with PRISMA guidelines (Page et al. 2021). All papers included in this review were from Ireland and spanned an eighteen-year period. Seven papers met the inclusion criteria: quantitative (n = 2), qualitative (n = 2), mixed methods (n = 2) and grey literature (n = 1). Thematic analysis enabled the development of three themes; maintaining core nursing skills; the maintenance of professional competence and providing a quality service. It is evident from the findings of this review that intellectual disability nursing in Ireland is actively engaged in research and professional development. Intellectual disability nursing in Ireland positively contributes to the individual, family and community and the international body of evidence that supports individualised care provision for persons with intellectual disability. [ABSTRACT FROM AUTHOR]

Objectives: To (a) assess the statistical power of nursing research to detect small, medium, and large effect sizes; (b) estimate the experiment-wise Type I error rate in these studies; and (c) assess the extent to which (i) a priori power analyses, (ii) effect sizes (and interpretations thereof), and (iii) confidence intervals were reported. Design: Statistical review. Data sources: Papers published in the 2011 volumes of the 10 highest ranked nursing journals, based on their 5-year impact factors. Review methods: Papers were assessed for statistical power, control of experiment-wise Type I error, reporting of a priori power analyses, reporting and interpretation of effect sizes, and reporting of confidence intervals. The analyses were based on 333 papers, from which 10,337 inferential statistics were identified. Results: The median power to detect small, medium, and large effect sizes was .40 (interquartile range [IQR] = .24-.71), .98 (IQR = .85-1.00), and 1.00 (IQR = 1.00-1.00), respectively. The median experiment-wise Type I error rate was .54 (IQR = .26-.80). A priori power analyses were reported in 28% of papers. Effect sizes were routinely reported for Spearman's rank correlations (100% of papers in which this test was used), Poisson regressions (100%), odds ratios (100%), Kendall's tau correlations (100%), Pearson's correlations (99%), logistic regressions (98%), structural equation modelling/confirmatory factor analyses/path analyses (97%), and linear regressions (83%), but were reported less often for two-proportion z tests (50%), analyses of variance/analyses of covariance/multivariate analyses of variance (18%), t tests (8%), Wilcoxon's tests (8%), Chi-squared tests (8%), and Fisher's exact tests (7%), and not reported for sign tests, Friedman's tests, McNemar's tests, multi-level models, and Kruskal-Wallis tests. Effect sizes were infrequently interpreted. Confidence intervals were reported in 28% of papers. Conclusion: The use, reporting, and interpretation of inferential statistics in nursing research need substantial improvement. Most importantly, researchers should abandon the misleading practice of interpreting the results from inferential tests based solely on whether they are statistically significant (or not) and, instead, focus on reporting and interpreting effect sizes, confidence intervals, and significance levels. Nursing researchers also need to conduct and report a priori power analyses, and to address the issue of Type I experiment-wise error inflation in their studies. [ABSTRACT FROM AUTHOR]

Exploratory factor analysis (hereafter, factor analysis) is a complex statistical method that is integral to many fields of research. Using factor analysis requires researchers to make several decisions, each of which affects the solutions generated. In this paper, we focus on five major decisions that are made in conducting factor analysis: (i) establishing how large the sample needs to be, (ii) choosing between factor analysis and principal components analysis, (iii) determining the number of factors to retain, (iv) selecting a method of data extraction, and (v) deciding upon the methods of factor rotation. The purpose of this paper is threefold: (i) to review the literature with respect to these five decisions, (ii) to assess current practices in nursing research, and (iii) to offer recommendations for future use. The literature reviews illustrate that factor analysis remains a dynamic field of study, with recent research having practical implications for those who use this statistical method. The assessment was conducted on 54 factor analysis (and principal components analysis) solutions presented in the results sections of 28 papers published in the 2012 volumes of the 10 highest ranked nursing journals, based on their 5-year impact factors. The main findings from the assessment were that researchers commonly used (a) participants-toitems ratios for determining sample sizes (used for 43% of solutions), (b) principal components analysis (61%) rather than factor analysis (39%), (c) the eigenvalues greater than one rule and scree tests to decide upon the numbers of factors/components to retain (61% and 46%, respectively), (d) principal components analysis and unweighted least squares as methods of data extraction (61% and 19%, respectively), and (e) the Varimax method of rotation (44%). In general, well-established, but out-dated, heuristics and practices informed decision making with respect to the performance of factor analysis in nursing studies. Based on the findings from factor analysis research, it seems likely that the use of such methods may have had a material, adverse effect on the solutions generated. We offer recommendations for future practice with respect to each of the five decisions discussed in this paper. [ABSTRACT FROM AUTHOR]

Delirium is a multifactorial syndrome closely associated with negative hospitalisation outcomes. Given the global growth of the ageing population, delirium becomes increasingly prevalent among older persons. Nurses play a pivotal role in delirium management and receive direct impacts of delirious presentations. Yet, there is a dearth of literature reviewing nurses' experiences. To synthesise the best available evidence exploring nurses' experiences in managing delirium of older persons in acute care wards. Systematic review of qualitative studies and meta-aggregation. Published and unpublished literature between January 2010 and December 2020 were identified from PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, PsycINFO and ProQuest. A systematic search strategy was applied in October 2020, with an update in January 2021. Two reviewers independently screened the titles and abstracts and selected the eligible studies after reading the full texts. This review included studies focusing on licensed nurses providing care to patients aged 65 and above, having any type of delirium during their hospitalisation stays in acute care settings. Studies included are qualitative papers with research designs such as phenomenology, ethnography, qualitative descriptive and grounded theory. The eligible studies were appraised independently using The JBI Critical Appraisal Checklist for Qualitative Research. Data of included studies were extracted by two independent reviewers using a standardised form. Findings were synthesised by the meta-aggregative approach. Thirty-one papers that considered nurses' (n = 464) experiences in managing older persons' delirium were included. A total of 375 findings were extracted, aggregated into 23 categories, and developed 5 synthesised findings: (i) delirium detection could be hindered when nurses possess a narrowed view of delirium, (ii) nurses navigate through complexity when providing multi-faceted care, (iii) nurses carry personal emotions, assumptions, and identities, (iv) various stakeholders have double-edged influences, and (v) nurses display preferences in their learning needs. This review informed about nurses' perceptions of delirium, delirious older persons, and their nursing management which were specific to older persons and acute care settings. Nurses should practise self-awareness regarding their own knowledge and attitudes while performing delirium management in older adults. Meanwhile, healthcare professionals and policymakers should make a concerted effort in cultivating a better working environment. Future research of delirium care that specifically investigates with a geriatric perspective would better contribute to the improvement of evidence-based nursing practices for older persons. [ABSTRACT FROM AUTHOR]

Background: Family carers provide strong support for many older adults, often enabling older adults to remain at home. Little is known about the care recipients' perspectives of the role and contributions of family carers, particularly when hospital admissions occur as part of end of life care. Aim: This paper explores the meanings of family caring for care recipients by drawing on older adults' perspectives about the impact of hospital admission on established family caring relationships. Design: Exploratory semi-structured qualitative interviews. Key findings reported in this paper emerged from within the inductive research design. Setting: Interviews were conducted in older adults' place of residence in northwest England between June 2009 and July 2010. Participants: Participants were 27 older adults living with heart failure (n = 13) or lung cancer (n = 14), aged 69-89 years (mean 79 4.3 years) and considered by their health professionals to be in their last year of life. In 12 of the interviews, a family carer was also present and made contributions. Findings: For community-dwelling older adults, family carers are conceptualised as 'conductors'; making strong contributions to maintaining the rhythm of good care throughout the illness trajectory. Following older adults' hospital admission, family carers find themselves in the role of 'second fiddle', their ability to work with the individual and to make or influence decisions vastly reduced. Despite this, carers continue to invest considerable effort in maintaining continuity in the carer relationship to maximise the individual's wellbeing by identifying needs, filling gaps in provision and advocating on patients' behalf. Family carers act flexibly to provide continuity, support and take responsibility for older adults' wellbeing across settings. Conclusions: Nurses and family carers working together, and greater appreciation of the contribution and role of family carers by health professionals may contribute to improving the quality and continuity of care for older adults. [ABSTRACT FROM AUTHOR]

Background: Knowledge translation is attracting different professional, educational and institutional strategies mainly focused on how new knowledge should be tailored and transferred at bedside. Less attention is dedicated to the antecedent of knowledge translation, which is the availability of the knowledge itself. Knowledge diffusion is a process by which an innovation is communicated through certain channels among members of a social system over time. Publishing in peer review journals is recognised as the main method for knowledge diffusion: nevertheless publication efficiency has received little attention to date. Objectives: Describing publication efficiency via nursing journals as the time occurring between data collection and manuscript publication was the main aim of the study. The secondary aim was to discover the differences, if any, in publication efficiency within manuscripts reporting results from different study designs. Design: A retrospective study design was adopted in 2010. Methods: The 2009 Impact Factor List of Nursing Journals published by the ISI web of Knowledge in 2010 was obtained. The first top ten IF Nursing Journals available as a full text and for which the overall ISI 5-Year Impact Factor was also available, was eligible. The articles published on paper by the selected journals, from 1st January to 31st December 2009, were then included. Commentaries, editorials and book reviews were excluded. For each article included, the following were evaluated: (a) the time occurring between each step of publication, from data collection to article submission, acceptance and publication online and on paper; and (b) the differences in the publication efficiency within articles reporting different study designs. Results: 1152 articles were included. From the end of data collection to manuscript publication online/on paper it takes an average of 981 days [CI95% 929-1032] (2.5-3 years). Meta-analysis and systematic reviews have demonstrated the fastest process, requiring an average 1.3 years and 1.9 years respectively. Case-control, cohort and quasiexperimental studies have required more time to enjoy publication in nursing journals, 4 years, 3.5 years and 3.2 years respectively. Conclusions: The production time of an article from its data collection involves significant processes and skills. However, the time may also be lengthened by factors not related to the processes of research, such as the time available to researchers. The scientific world needs to reflect on publication efficiency because lateness can potentially have a negative impact on patients and on further research. In the future, the same emphasis given to the evaluation of knowledge translation effectiveness should be given also to the complex process of knowledge diffusion, discovering facilitators and barriers. [ABSTRACT FROM AUTHOR]

Background: As health services research (HSR) expands across the globe, researchers will adopt health services and health worker evaluation instruments developed in one country for use in another. This paper explores the cross-cultural methodological challenges involved in translating HSR in the language and context of different health systems. Objectives: To describe the pre-data collection systematic translation process used in a twelve country, eleven language nursing workforce survey. Design and settings: We illustrate the potential advantages of Content Validity Indexing (CVI) techniques to validate a nursing workforce survey developed for RN4CAST, a twelve country (Belgium, England, Finland, Germany, Greece, Ireland, Netherlands, Norway, Poland, Spain, Sweden, and Switzerland), eleven language (with modifications for regional dialects, including Dutch, English, Finnish, French, German, Greek, Italian, Norwegian, Polish, Spanish, and Swedish), comparative nursing workforce study in Europe. Participants: Expert review panels comprised of practicing nurses from twelve European countries who evaluated cross-cultural relevance, including translation, of a nursing workforce survey instrument developed by experts in the field. Methods: The method described in this paper used Content Validity Indexing (CVI) techniques with chance correction and provides researchers with a systematic approach for standardizing language translation processes while simultaneously evaluating the cross-cultural applicability of a survey instrument in the new context. Results: The cross-cultural evaluation process produced CVI scores for the instrument ranging from .61 to .95. The process successfully identified potentially problematic survey items and errors with translation. Conclusions: The translation approach described here may help researchers reduce threats to data validity and improve instrument reliability in multinational health services research studies involving comparisons across health systems and language translation. [ABSTRACT FROM AUTHOR]

Abstract: Background: Nurses guide and support learning of students and new graduates in the workplace. A plethora of literature exists about learners needs in the workplace however nursing leadership teams also need to support experienced nurses who facilitate others’ learning. Aim: This study sought to develop a tool for Registered Nurses’ to report on the support they receive when they facilitate the learning of others. Scale development: An extensive literature review identified 28 papers about support RNs need to facilitate learning. Five re-occuring themes pertaining to workload, communication, acknowledgement, teamwork and preparation for role emerged from analysis of these papers. These were verified independently through focus groups. A 30-item instrument was generated based on the themes; further RN focus groups were conducted to ensure clarity of items. Testing of instrument: Data were collected from RNs working in medical and surgical areas across three acute care hospitals (ranging from 300 to 750 beds). A total of 372 registered nurses responded. Principle component analysis identified 5 distinct sub scales represented by 17 items with good reliability: workload 0.953; communication 0.847; acknowledgement 0.858; teamwork 0.852; preparation 0.942. Conclusion: This newly developed tool measures Registered Nurses perceptions of support they receive to fulfil their role in supporting the learning of others. The data generated from use of this tool can inform nursing leadership about the effectiveness of existing infrastructure and resources to support RNs. [Copyright &y& Elsevier]

Catheter associated urinary tract infections are one of the most common infections acquired in hospital. A recent randomised control study demonstrated the benefit of using chlorhexidine (0.1%) for meatal cleaning prior to urinary catheter insertion, by reducing both catheter associated asymptomatic bacteriuria and infection. These findings raise the important question of whether a decision to switch from saline to chlorhexidine was likely to be cost-effective. The aim of this paper was to evaluate the cost-effectiveness of adopting routine use of chlorhexidine for meatal cleaning prior to urinary catheter insertion The outcomes of this cost-effectiveness study are changes to health service costs in $AUD and changes to quality adjusted life years from a decision to adopt 0.1% chlorhexidine for meatal cleaning prior to urinary catheter insertion as compared to saline. Effectiveness outcomes for this study were taken from a 32 week stepped wedge randomised controlled study conducted in three Australian hospitals. The changes in health costs from switching from saline to 0.1% chlorhexidine per 100,000 catheterisations would save hospitals AUD$387,909 per 100,000 catherisations, prevent 70 cases of catheter associated urinary tract infections, release 282 bed days and provide a small improvement in health benefits of 1.43 quality adjusted life years. Using a maximum willingness to pay for a marginal quality adjusted life year threshold of AUD$28,000 per 100,000 catherisations, suggests that adopting chlorhexidine would be cost effective and potentially cost-saving. The findings from our work provide evidence to health system administrators and those responsible for drafting catheter associated urinary tract infections prevention guidelines that investing in switching from saline to chlorhexidine is not only clinically effective but also a sensible decision in the context of allocating finite healthcare resources. [ABSTRACT FROM AUTHOR]

To identify experiences, needs, interventions and outcomes for caregivers of persons with Alzheimer's disease or related dementia as they transition into this new role following diagnosis. Scoping review of published literature. A search for published articles was conducted in PsycINFO, Scopus, Ovid and Web of Science databases. The Arksey and O'Malley methodological framework guided the review. Studies were screened independently for inclusion by two persons. A total of 955 studies, after duplicates removed, were found by the database search. From these, 127 full-text articles were retained through the screening of titles and abstracts by two reviewers. The two reviewers assessed 46 full-text articles for eligibility. The final 29 studies identified caregiver experiences, needs, and interventions during the period following a diagnosis of Alzheimer's disease or related dementia in the scoping review. Twenty-nine studies were organized around three major categories: i) family caregiver experiences on receiving the diagnosis (n = 23), ii) needs during this time of transition (n = 18), and iii) interventions and outcomes to support their transition into the caregiver role (n = 5). While studies may have addressed more than one topic, 16 studies intersected categories of both caregiver experience and needs, and one study intersected categories of needs and interventions. There were several studies that focused more specifically on the caregiver's initial reactions to a diagnosis of Alzheimer's disease or related dementia (n = 9), the emotional responses to the diagnosis (n = 14), changes in personal relationships and responsibilities with a new role (n = 16). Caregiver needs following the diagnosis included knowledge and information (n = 14), emotional and psychological support (n = 11), and assistance with care planning (n = 7). Five papers examined interventions specifically tailored to caregiver needs at this juncture, which support the transition into the caregiver role. The time of receiving a diagnosis of Alzheimer's disease or related dementia is a critical period in the process of transitioning into caregiver role. This period marks a new phase in the process of caring by family caregivers. Thus, it is important to fully understand the experiences and needs of caregivers and effective interventions in order to better support their transition into this new role. [ABSTRACT FROM AUTHOR]

Abstract Background: Tape blisters are common complications in the peri-lesional area of the surgical incision, forming below the layer of dressing adhesive applied and causing numerous complications for patients. Objectives: The purpose of this study was to investigate the incidence of the phenomenon, and to identify and quantify the main prognostic factors associated. Design: Multicentric, prognostic prospective cohort study. Setting: Shoulder Orthopaedic surgery, General surgery, Advanced Oncology therapies, Gastro-entero mininvasive surgery and Endocrine surgery. Participants: One thousand and two patients who underwent chest, abdominal, upper limb and joint laparotomic surgery consecutively admitted to the surgical units involved, were included. Methods: Data regarding individual and patient care variables, such as intrinsic (e.g. age and gender) and extrinsic (e.g. surgery type and time) data were collected. A multivariate logistic regression model was used to identify the variables which independently influenced the onset of the tape blister. Results: In the multivariate analysis, patients who underwent chest (Odds Ratio = 8.99, 95% CI 5.33–15.13), and upper limb and joint surgery (Odds Ratio = 2.09, 95% CI 1.22–3.58) were more likely to develop tape blisters in the postoperative period, At the same time, having drainage (Odds Ratio = 1.98, 95% CI 1.11–3.53), being female (Odds Ratio = 1.56, 95% CI 1.01–2.44) and having a high Body Mass Index (BMI) score (Odds Ratio: 1.06, 95% CI 1.02–1.11) were also predictors of tape blister formation. Conclusions: A higher BMI score, chest, upper limb and joint surgery, female gender and the presence of drainage were predictive factors of the tape blister event while, in contrast with the literature, the type of dressing used in this study was not significantly associated with the event. [ABSTRACT FROM AUTHOR]

Traumatic brain injury has a significant effect on uninjured family members. Typically, this has been examined with a focus on psychopathological outcomes including stress, depression and anxiety. However, in recent years there has been increasing interest in the subjective experiences of families post-injury leading to a plethora of qualitative studies. Therefore, an in-depth examination and synthesis of this literature is now relevant and timely. To examine the subjective experiences of families following traumatic brain injury in adult populations in the sub/post-acute period through the synthesis of original qualitative research. This paper presents a meta-synthesis using Thomas and Harden's framework of 'thematic synthesis' rooted in a critical realist philosophy. In July 2019 five electronic databases, were searched for the terms 'traumatic brain injury', 'family' and 'qualitative'. Studies were included if the primary research reported qualitative data about the subjective experiences of family members of adults with traumatic brain injury and had been published in a peer reviewed journal. Studies with mixed brain injury samples, child or adolescent traumatic brain injury or disorders of consciousness were excluded. Hand searching and citation searches were also completed. Two reviewers screened titles, abstracts and full text and reached consensus through critical discussion. Thirty papers were finally agreed for inclusion in this review. Each study was then assessed for relevance, resonance and rigour using the Critical Appraisal Skills Programme (CASP) tool. Line by line coding of the findings in each paper was conducted as the basis for a thematic analysis and synthesis. Descriptive themes were identified followed later by analytical themes. This final stage was informed by a narrative lens and from these, eight narrative functions belonging to four dimensions were identified from the subjective experiences of families post-traumatic brain injury. Specifically, these were: (1) Displacing and Anchoring; (2) Rupturing and Stabilising; (3) Isolating and Connecting; (4) Harming and Healing. The interpretation of the narrative functions revealed the substantial existential work involved in negotiating lives, maintaining family system equilibrium and moving forward. As such, family members have their own unique narrative needs. Despite contemporary service models built around the injured person, service providers are well placed to support families in this everyday narrative work through actively attending to narrative structures and understanding the implications of these for family experience. The study protocol was registered with PROSPERO (International prospective register of systematic reviews) in July 2018 (Registration number: CRD42018085824). Tweetable abstract: This synthesis showed the immense and invisible work required for family members to maintain family system equilibrium and negotiate their lives post-TBI. [ABSTRACT FROM AUTHOR]

Safe and high-quality end of life care is not always achieved in acute care hospitals. Nurses represent a key source of information about current practice, and active participants in interventions to improve end of life care in these settings. Examining the volume, type and quality of publications in this field can help to determine whether research is following a natural scientific progression to inform best-practice end of life care. To systematically review: (i) whether the volume and type of publications (i.e. measurement, descriptive or interventions studies) examining nurses' perceptions of, and involvement in, end-of-life care delivered in acute hospitals changed over time (i.e. since 2000); (ii) the proportion of intervention studies involving nurses that meet Risk of Bias research design criteria; and (iii) the effectiveness of intervention studies that met minimum Risk of Bias criteria. MEDLINE, Embase, CINAHL, and PsychInfo were searched for data-based papers published in English between Jan 2000 and Dec 2020. Studies were included if they focused on nurses' perceptions of, or role in, the provision of end-of-life care in hospitals. Eligible papers were classified as descriptive, measurement or intervention studies. Intervention studies were assessed against the Risk of Bias methodological criteria for research design, and their effectiveness examined. A total of 131 papers met eligibility criteria for inclusion in the review. The number increased by 31% in each time period (p < 0.0001). Most studies were descriptive (n = 70; 53%), 11 were measurement studies (8%), and the remainder were intervention studies (n = 50; 38%). Thirteen intervention studies (26%) met eligibility criteria. Methodological quality of the eligible intervention studies was variable. Randomisation and blinding of outcome assessors were the domains of greatest concern. Results were variable, with larger, system-wide interventions that incorporated the expertise of the multidisciplinary healthcare team showing the most promise. There is an increasing number of studies examining nurses' perceptions of, and involvement in, end-of-life care delivered in acute hospitals. The difficulties of conducting intervention research in this field mean that many studies are descriptive in nature. Given the importance of intervention research in establishing causal relationships, larger-scale intervention studies are essential to improving the quality of end-of-life care provided to patients dying in hospital. [ABSTRACT FROM AUTHOR]

Moral distress is a pervasive phenomenon that can negatively impact healthcare professionals and has been well studied in nursing populations. Much of the evidence suggests that it is associated with intention to leave high acuity areas and the profession. Despite the increasing amounts of research to explore the causes and effects of moral distress, there is limited research on interventions that mitigate the negative effects of moral distress. The aims of this systematic review were to: (a) identify and examine interventions developed to address moral distress experienced by health care professionals (b) examine the quality of the research methods and (c) report on the efficacy of these interventions. We conducted a systematic review of interventional studies developed to mitigate moral distress. Medline, Embase, PsycINFO, CINAHL and Cochrane were searched for relevant studies (July 2019- September 2019). Additional bioethics databases and reference lists were also hand-searched. The first author reviewed all retrieved titles and abstracts with a low tolerance for borderline papers based on inclusion and exclusion criteria, and those papers were reviewed and discussed by all authors to determine inclusion. Quality appraisal was conducted on the included studies using narrative synthesis to compare the findings. Data were extracted and compared by all authors and then reviewed by the first author for consistency. Sixteen papers were included for full text review and the following interventions identified: educational interventions of varying length and breadth; facilitated discussions ranging from 30 to 60 minutes; specialist consultation services; an intervention bundle; multidisciplinary rounds; self-reflection and narrative writing. Researchers reported statistically significant reductions in moral distress using pre and post surveys, including one mixed methods program evaluation (n=7). The qualitative program evaluation provided participant quotations to suggest their program was beneficial. There were no statistically significant findings in the other studies (n=8). All studies had limitations in design and methodology presenting significant threats to validity. Designing rigorous research studies that measure the impact of interventions aimed at mitigating moral distress continues to be challenging. The primary reason being that moral distress is a subjective ethical phenomenon with a number of different causes and effects. This calls for interventions that are flexible and sensitive to individual's needs. To build an evidence-base, interventions should also be measurable and research methods need to be scientifically rigorous. To achieve rigor and innovation, researchers should clearly justify their methodological choices. Tweetable abstract: Interventions to mitigate moral distress: a systematic review of the literature. Educational interventions offer a promising direction but more research is needed. [ABSTRACT FROM AUTHOR]

Background The predicted demographic changes internationally have implications for the nature of care that older people receive and place of care as they age. Healthcare policy now promotes the implementation of end-of-life care interventions to improve care delivery within different settings. The Gold Standards Framework in Care Homes (GSFCH) programme is one end-of-life care initiative recommended by the English Department of Health. Only a small number of care homes that start the programme complete it, which raises questions about the implementation process. Aim To identify the type, role, impact and cost of facilitation when implementing the GSFCH programme into nursing care home practice. Design A mixed-methods study. Setting Nursing care homes in south-east England. Participants Staff from 38 nursing care homes undertaking the GSFCH programme. Staff in 24 nursing care homes received high facilitation. Of those, 12 also received action learning. The remaining 14 nursing care homes received usual local facilitation of the GSFCH programme. Methods Study data were collected from staff employed within nursing care homes (home managers and GSFCH coordinators) and external facilitators associated with the homes. Data collection included interviews, surveys and facilitator activity logs. Following separate quantitative (descriptive statistics) and qualitative (template) data analysis the data sets were integrated by ‘following a thread’. This paper reports study data in relation to facilitation. Results Three facilitation approaches were provided to nursing home staff when implementing the GSFCH programme: ‘fitting it in’ facilitation; ‘as requested’ facilitation; and ‘being present’ facilitation. ‘Being present’ facilitation most effectively enabled the completion of the programme, through to accreditation. However, it was not sufficient to just be present. Without mastery and commitment, from all participants, including the external facilitator, learning and initiation of change failed to occur. Implementation of the programme required an external facilitator who could mediate multi-layered learning at an individual, organisational and appreciative system level. The cost savings in the study outweighed the cost of providing a ‘being present’ approach to facilitation. Conclusions Different types of facilitation are offered to support the implementation of end-of-life care initiatives. However, in this study ‘being present’ facilitation, when supported by multi-layered learning, was the only approach that initiated the change required. [ABSTRACT FROM AUTHOR]

Disgust is a common emotion experienced by healthcare professionals which in extreme cases can contribute to neglect and abuse of patients. However, little research has explored how healthcare professionals experience disgust and what coping strategies they use to manage it. To identify, evaluate and synthesise results from empirical papers that have explored how healthcare professionals experience, understand and manage disgust in clinical work. A narrative literature review. Using the EBSCOHost interface, a range of databases were systematically searched alongside manual searches and citation chaining which yielded the 11 papers included in this review. Qualitative synthesis. Three major themes were identified: The professionals' struggle to talk about disgust; the importance of boundaries: boundary breaching and boundary building; and the role of empathy in caring. This review found that disgust is a common experience for healthcare professionals, yet it is not talked about or openly expressed. Professionals have developed ways to cope with disgust and use empathy as a main strategy to overcome it. The review suggests that healthcare professionals should consider ways of making disgust part of a wider conversation, allowing clinicians to engage with their feelings, rather than feel ashamed of them and hiding disgust away as a silent part of care. [ABSTRACT FROM AUTHOR]

Background Ability to elicit individuals’ perceptions of complex behavioral processes can be challenging, as it hinges not only upon the skill of the researcher, but also upon assumptions of a shared language and individuals’ ability to recall, analyze, and effectively communicate events. In a case-based qualitative-descriptive study about teens’ experiences of asthma self-management, we found that variations in terminology and descriptions of events, symptoms, and responses made it difficult to understand teens’ experiences of asthma. In particular, teens’ conceptualization of their asthma symptoms and self-management responses differed from situation to situation, from other teens in the study, from the interviewer, and from prior reports in the literature. These differences across many levels made it difficult to identify patterns in individual processes of self-management, and among teens in general.. Objectives To address these challenges, we developed a card sorting activity to facilitate in-depth exploration of teens’ experiences of asthma. Design Case-based qualitative description. Setting: Teen-parent dyads (N=28) were recruited from the community, Emergency Department, Pediatric Pulmonary Department, and prior study subjects of a major medical center. Methods Teens first identified and then sequenced their own unique sets of asthma symptoms and self-management responses. Teens then developed contextually grounded narratives using the card sort they had created as a visual aid. Results This technique not only allowed us to bridge teen-interviewer communication barriers and develop shared terminology, but also resulted in a visible sequence of asthma symptoms and self-management responses. Conclusions The card sort technique facilitated researcher-teen discussion and enabled comparison of self-management patterns across teens in our study. This technique is potentially useful for other areas of research exploring behavioral processes with complex and individual-specific experiences, in particular those involving sequences of events and self-management responses. This paper delineates the development, utility, and potential applications of the symptom-response card sorting technique for research and clinical practice. [ABSTRACT FROM AUTHOR]

Background Fever phobia is a term that has been used to describe the exaggerated and unrealistic fear of fever expressed by parents and carers. Since the term was first used in the early 1980s, there have been numerous publications and guidelines’ stating that fever is not, in itself dangerous, however these fears persist. Objectives Investigate the extent of fever phobia and to explore potential associations with time, under-5 mortality rate and geography. Data sources Embase (1980 to week 1 2015) and Medline (1946 to week 1 2015) were searched using the terms ‘fever’ and ‘phobia’; and ‘fever phobia’ as a free text term. One additional paper was published during the review period. Study eligibility criteria Studies giving proportion of parents, carers or professionals expressing fear of fever. Study appraisal and synthesis methods Meta-analysis and cluster analysis using metafor, meta and Cluster in R. Results Fear of brain damage, coma, convulsions, death and dehydration was high across many of the studies; however there was significant variation as shown by the high I 2 scores which exceeded 95%. This was not explained by the two predictive variables of year of publication, or background mortality apart from a reduction in the fear of brain damage (−0.0185, CI −0.0313 to −0.0057, p = 0.0046) and dehydration (−0.0831, −0.1477 to −0.0184, p = 0.0118) associated with increased child mortality. Limitations Studies were all cross-sectional surveys with a high risk of bias. The pooled estimate, although statistically significant is not the outcome of interest and so should be interpreted with caution. Conclusions and implications Fever phobia is common and has not significantly declined over time. This may suggest that it is a cultural, rather than individually learned trait and that individual educational programmes are unlikely to be successful in the face of widespread cultural transmission. [ABSTRACT FROM AUTHOR]

Background and objectives Interdisciplinary geriatric consultation teams are implemented in the acute hospital setting in several high-income countries to provide comprehensive geriatric assessment for the increasing numbers of older patients with a geriatric profile hospitalized on non-geriatric units. Given the inconclusive evidence on this care model's effectiveness to improve patient outcomes, health care policy and practice oriented recommendations to redesign the structure and process of care provided by interdisciplinary geriatric consultation teams are needed. A scoping review was conducted to explore the structure and processes of interdisciplinary geriatric consultation teams in an international context. As nurses are considered key members of these teams, their roles and responsibilities were specifically explored. Design The revised scoping methodology framework of Arksey and O’Malley was applied. Data sources An electronic database search in Ovid MEDLINE, CINAHL and EMBASE and a hand search were performed for the identification of descriptive and experimental studies published in English, French or Dutch until April 2014. Review methods Thematic reporting with descriptive statistics was performed and study findings were validated through interdisciplinary expert meetings. Results Forty-six papers reporting on 25 distinct interdisciplinary geriatric consultation teams in eight countries across three continents were included. Eight of the 12 teams (67%) reporting on their composition, stated that nurses and physicians were the main core members with head counts varying from 1 to 4 members per profession. In 80% of these teams nurses were required to have completed training in geriatrics. Advanced practice nurses were integrated in eleven out of fourteen interdisciplinary geriatric consultation teams from the USA. Only 32% of teams used formal screening to identify patients most likely to benefit from their intervention, using heterogeneous screening methods, and scarcely providing information on the responsibilities of nurses. Nurses were involved in the medical, functional, psychological and social assessment of patients in 68% of teams, either in a leading role or in collaboration with other professions. Responsibilities of interdisciplinary geriatric consultation teams’ nurses regarding in-hospital follow-up or transitional care at hospital discharge were infrequently specified (16% of teams). Conclusions This scoping review identified that the structure and processes of care provided to geriatric patients by interdisciplinary geriatric consultation teams are highly heterogeneous. Despite nurses being key team members, only limited information on their specific roles and responsibilities was identified. More research in this area is required in order to inform health care policy and to formulate practice oriented recommendations to redesign the interdisciplinary geriatric consultation team care model aiming to improve its effectiveness. [ABSTRACT FROM AUTHOR]

Background Venous leg ulcer management in the UK varies significantly. Judgements made by nurses contribute to this variability and it is often assumed that specialist nurses make better judgements than non-specialist nurses. This paper compares the judgements of community tissue viability specialist nurses and community generalist nurses; specifically, the ways they use clinical information and their levels of accuracy. Objectives To compare specialist and non-specialist UK community nurses’ clinical information use when managing venous leg ulceration and their levels of accuracy when making diagnoses and judging the need for treatment. Design Judgement analysis. Setting UK community and primary care nursing services. Participants 18 community generalist nurses working in district (home) nursing teams and general practitioner services and 18 community tissue viability specialist nurses. Methods Data were collected in 2011 and 2012. 18 community generalist nurses and 18 community tissue viability specialist nurses made diagnostic and treatment judgements on 110 clinical scenarios and indicated their confidence in each of their judgements. Scenarios were generated from real patient cases and presented online using text and photographs. An expert panel made judgements, and reached consensus on the same scenarios. These judgements were used as a standard against which to compare the participants. Logistic regression models and correlational statistics were used to generate various indices of judgement “performance”: accuracy, consistency, confidence calibration and information use. Differences between groups of nurses with different levels of characteristics linked to expertise were explored using analysis of variance. Results Specialist nurses had similar cue usage to the generalist nurses but were more accurate when making diagnostic and treatment judgements. Conclusion It is not obvious why the tissue viability specialist nurses were more accurate. One possible reason might be the greater opportunities for ‘deliberate practice’ afforded to specialists. However, restricting aspects of practice only to specialist nurses is likely to hinder the judgement performance of generalists. [ABSTRACT FROM AUTHOR]

Background Nurses are often portrayed as possessing specific traits and dispositions associated with care and empathy. The assumption has been that possessing these traits makes nurses competent, engaged, and well suited to their job. This proposition has been mostly normative, and few studies have investigated how this plays out empirically. Objective The aims of this study were to investigate (a) whether possessing a personality trait related to empathy and care was more common among nursing students than students in teaching and social work programs and (b) whether nursing students possessing an affirming personality trait judged themselves to be more suited to their future work – understood as commitment to the profession – than students in teaching and social work. Design A cross-sectional survey design was used. Participants and setting All first-year students attending seven Norwegian universities and university colleges were invited to participate in the study. Of the 1675 students who participated in the survey, 527 were nursing students, 668 were students in teaching, and 480 were social work students. A response rate of 65 percent was achieved. Methods The survey was conducted by Oslo and Akershus University College in the autumn of 2012. Data collection methods included both a paper-and-pencil questionnaire and an online survey. Instruments used included Blau's Career Commitment Scale and Orlinsky and Rønnestad's Interpersonal Adjective Scale. Analysis of variance and regression analysis were performed on the data. Results Nursing students did not differ from students in teaching and social work programs in terms of the degree of affirming personality trait. Furthermore, the regression analysis revealed an equally strong association between having an affirming personality trait and being committed to the profession among all these student groups. Conclusion The results of this study indicate that the narrative of nursing students as individuals who possess a special personality characteristic does not entirely reflect reality. [ABSTRACT FROM AUTHOR]

Background Studies estimate that approximately one-third of episodes of delirium are preventable and that delirium prevention and management are often suboptimal in practice. While there is no doubt that prevention is desirable, the evidence of the benefits of early intervention and treatment for older hospitalised patients with dementia is unclear. Aim To determine the effects of DemDel, a comprehensive delirium management programme, in inpatient acute care elders with cognitive impairment. Design and methods This paper reports the quantitative part of a mixed methods study, comparing an intervention with treatment as usual using validated outcome measures. After training, ward nurses and physicians administered the intervention based on the DemDel algorithm that focused on delirium prevention, including an intensive systematic screening schedule for cognitive impairment and delirium, as well as comprehensive delirium management. The delirium management regimen included timely administration of pro re nata medication. Settings The study was conducted within four medical wards of an acute care university hospital in urban Switzerland. Participants A total of 268 patients with cognitive impairment participated in the pre/post comparison study. The intervention and treatment as usual groups consisted of 138 and 130 patients, respectively. Results Eighty-seven (32.5%) out of 268 patients developed delirium, of whom 51 (58.6%) were of mixed, 10 (11.5%) hyperactive and 26 (29.9%) hypoactive delirium subtypes. Delirium appeared within the first five days after admission in 81.6% of cases. The 44 (31.9%) patients with delirium in the intervention group with systematic delirium management had less severe episodes of delirium and required medication for management than the 43 (33.1%) delirious patients in the control group. Intervention compliance was good on three of the four units. Conclusions The DemDel programme was effective with regard to improvement of outcomes associated with delirium in patients with cognitive impairment. The intervention was feasible and possible to be embedded within routine practice on four busy general medical wards. [ABSTRACT FROM AUTHOR]

The last few years have witnessed a growing concern with the well-being of healthcare professionals internationally because of increasing recognition of its impact on patient outcomes and staff retention. The COVID-19 pandemic, which has placed additional and substantial pressure on frontline healthcare professionals, gives added urgency to the topic. While numerous, and successful, interventions have been developed to address compromised well-being among healthcare professionals, they have not always been able to support the needs of frontline staff, specifically those working in high-pressure environments. This paper presents findings of an evaluative research study of an intervention, named the Resilience and Well-being Training Programme, developed and implemented within an Acute Assessment Unit in a hospital in the UK. The 8 week-long programme followed a combined approach (both person-directed and work-directed), with mindfulness training as well as lectures and discussions to deepen participants' understanding of organisational life. The training, delivered from January to July 2018, involved a total of 72 healthcare professionals from a wide range of levels (UK bands 2–8), trained in three cohorts. The research followed a pre-post design to explore participants' experiences of working on the Unit, the programme and its impact on themselves and their working life. The study was conducted in a large NHS district general hospital in South London, UK. Participants included healthcare assistants and nurses who had completed their preceptorship, worked in the hospital's acute assessment unit, and had undertaken the resilience and well-being training programme. The study employed mixed methods (online questionnaire, face-to-face focus groups/interviews) to collect data. Findings showed participants' positive experience with the programme, however it had limited positive impacts on aspects of compromised well-being at the personal level and a statistically significant enhancement of the quality of relationships and communication on the Unit, with medium effect size (Cohen's D). The programme had a positive impact on the culture of the Unit. Results highlight the demand for and value of programmes designed in ways that enable this group of professionals to take part, because these professionals are often not able to participate in such programmes. A strong commitment from the leadership to enable staff attendance in time-protected programmes is one approach that works well in the short-term. However, this may be challenging to accomplish and raises issues of sustainability. [ABSTRACT FROM AUTHOR]

Background: On arrival to the emergency department many older persons are accompanied by family/carers. Yet the role of family/carers in the emergency department is unclear. We know very little about how emergency department nurses balance care practices to accommodate family/carers while specifically meeting the needs of cognitively impaired older persons experiencing pain. Objectives: The aim of this paper was to understand emergency nurses' perceptions of the role of family/carers in caring for the older cognitively impaired person experiencing pain. Design: Emergency nurses were invited to participate in focus group interviews. A semi-structured interview tool was developed from the literature and comprised open-ended questions and three Likert scale items which assisted to focus nurses' thoughts on their perceived role of family/carers in the emergency department. Settings: The study was undertaken across four emergency departments in Sydney, Australia and included two district hospitals and two tertiary referral hospitals. Participants: Emergency nurses were invited to participate in one face to face, focus group interview. Purposive sampling was used and inclusion criteria included at least one year emergency department experience. Methods: Interview data were analysed and organised thematically. Two expert qualitative researchers independently reviewed transcripts and emerging coding and interpretation. Results: Eighty nurses participated in 16 focus group interviews across four hospitals. Participating nurses included 67 (84%) females and 13 (16%) males with 8.6 years (mean; SD ±8.64) experience in the emergency department. Three key themes relating to family/ carers emerged from the analysis. The themes included (i) the role of families and carers in building a clinical picture; (ii) family and carers as a hidden workforce; and (iii) family and carer roles in pain management decision making. Conclusions: The study has provided insight into the role of family/carers as perceived by emergency nurses. There were many benefits in partnering with family/carers when information gathering on the older cognitively impaired person in pain. Family/carers are sensitive to health behaviour changes of older cognitively impaired people, which can assist nurses to optimise pain management. [ABSTRACT FROM AUTHOR]

Background: As yet there is no firm evidence about the types of intervention that can reduce emergency room revisits. However, the literature on emergency room revisits suggests patient difficulties with managing their health problems and treatments after discharge may play a role. Objectives: We carried out a randomized trial of an emergency department-based nursing intervention, but results showed no reduction in revisits (primary outcome). This paper describes the secondary outcomes of the trial: patient perceptions of continuity of care, illness perceptions, self-care capacities, psychological symptoms and medication adherence 30 days after emergency room discharge. Design: Randomized, controlled trial. Settings: The trial was conducted in the emergency department of a tertiary cardiac hospital in Montreal, Canada between November 2007 and March 2010. Participants: The study involved 203 patients, including 108 in the experimental group and 95 in the control group. Methods: The intervention included one nurse patient encounter before discharge and two phone calls in the 10 days after discharge. Participants provided data 30 days post-discharge on secondary outcomes potentially related to emergency department revisits. Results: Although, as previously reported, the intervention had no impact on the primary outcome of emergency department revisits, the present study demonstrated a significant positive effect on patients’ perceived continuity of care (p = .033), self-care capacities (p = .037), anxiety (p = .007) and depressive symptoms (p = .043), and the illness perceptions treatment control subscale (p = .037). No differences were found for other illness perception subscales or medication adherence (all p’s > .05). Conclusion: Although the intervention did not influence emergency department revisits it did improve secondary outcomes, suggesting pathways for future research. [ABSTRACT FROM AUTHOR]

Background: The Clinical Learning Environment, Supervision and Nurse Teacher scale is a reliable and valid instrument to evaluate the quality of the clinical learning process in international nursing education contexts. Objectives: This paper reports the development and psychometric testing of the Spanish version of the Clinical Learning Environment, Supervision and Nurse Teacher scale. Design: Cross-sectional validation study of the scale. Setting: 10 public and private hospitals in the Alicante area, and the Faculty of Health Sciences (University of Alicante, Spain). Participants: 370 student nurses on clinical placement (January 2011--March 2012). Methods: The Clinical Learning Environment, Supervision and Nurse Teacher scale was translated using the modified direct translation method. Statistical analyses were performed using PASW Statistics 18 and AMOS 18.0.0 software. A multivariate analysis was conducted in order to assess construct validity. Cronbach's alpha coefficient was used to evaluate instrument reliability. Results: An exploratory factorial analysis identified the five dimensions from the original version, and explained 66.4% of the variance. Confirmatory factor analysis supported the factor structure of the Spanish version of the instrument. Cronbach's alpha coefficient for the scale was .95, ranging from .80 to .97 for the subscales. Conclusion: This version of the Clinical Learning Environment, Supervision and Nurse Teacher scale instrument showed acceptable psychometric properties for use as an assessment scale in Spanish-speaking countries. [ABSTRACT FROM AUTHOR]

Background: Pressure ulcers are associated with a nearly three-fold increase in in-hospital mortality. It is essential to investigate how other factors besides the Braden scale could enhance the prediction of pressure ulcers. Data mining modeling techniques can be beneficial to conduct this type of analysis. Data mining techniques have been applied extensively in health care, but are not widely used in nursing research. Purpose: To remedy this methodological gap, this paper will review, explain, and compare several data mining models to examine patient level factors associated with pressure ulcers based on a four year study from military hospitals in the United States. Methods: The variables included in the analysis are easily accessible demographic information and medical measurements. Logistic regression, decision trees, random forests, and multivariate adaptive regression splines were compared based on their performance and interpretability. Results: The random forests model had the highest accuracy (C-statistic) with the following variables, in order of importance, ranked highest in predicting pressure ulcers: days in the hospital, serum albumin, age, blood urea nitrogen, and total Braden score. Conclusion: Data mining, particularly, random forests are useful in predictive modeling. It is important for hospitals and health care systems to use their own data over time for pressure ulcer risk prediction, to develop risk models based upon more than the total Braden score, and specific to their patient population. [ABSTRACT FROM AUTHOR]

Aims: To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. Background: The delivery of quality care in the emergency department is emerging as one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. Data sources: A comprehensive search of four electronic databases from 2006 to 2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. Review methods: A three step approach was used. Following a comprehensive search, two reviewers assessed all identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data were extracted using standardised tools. Results: Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding outcomes of a cost benefit analysis. Conclusion: Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reform of emergency service provision. The findings suggest that further high quality research is required for comparative measures of clinical and service effectiveness [ABSTRACT FROM AUTHOR]

Background: Longer life expectancy and changes in family patterns in Western societies have increased the need for professional caregivers to the elderly. A detailed understanding of job resources, especially of job control, may help preserve eldercare workers' work-related well-being. Objectives: The aim of the present study was to determine optimal levels of job control for eldercare workers' work-related well-being. Design: Cross-sectional (Study 1) and longitudinal (Study 2) data were used to assess the linear and non-linear relations between job control and eldercare workers' work-related well-being. As indicators of well-being, irritation was examined cross-sectionally, whereas burnout and engagement were used in the longitudinal study. In both studies, demographic variables and time pressure were included as controls. In Study 2, results were additionally controlled for baseline levels of the outcome variables. Participants: Study participants were recruited from the nursing staff of 10 publicly ?nanced nursing homes for the elderly (Study 1) and from 18 privately and 20 publicly ?nanced nursing homes for the elderly (Study 2). In both studies, eldercare workers (i.e., registered nurses, orderlies, and nursing assistants) were invited to answer paper-pencil questionnaires. In Study 1, 606 persons followed this invitation (response rate: 65%). In Study 2, 591 persons provided data on both measurement points (response rate: 35% of Time 1 participants). The samples of both studies were predominantly female and between 20 and 65 years of age. Methods: Hierarchical multiple regressions with linear and quadratic terms were conducted. Results: Curvilinear effects of job control were found in both studies. In Study 1, low as well as high levels of job control were associated with higher levels of irritation compared to medium levels of job control. The longitudinal data from Study 2 supported these results. Eldercare workers with higher and lower levels of job control reported a higher tendency to depersonalize care recipients and a lower tendency to feel dedicated to, absorbed by and vigorous at work than those with medium levels of job control. Conclusions: Higher levels of job control are not necessarily advantageous for work-related well-being of eldercare workers. [ABSTRACT FROM AUTHOR]

Background: Quality improvement (QI) Programmes, like the Productive Ward: Releasing-time-to-care initiative, aim to 'engage' and 'empower' ward teams to actively participate, innovate and lead quality improvement at the front line. However, little is known about the relationship and impact that QI work has on the 'engagement' of the clinical teams who participate and vice-versa. Objective: This paper explores and examines the impact of a large-scale QI programme, the Productive Ward, on the 'work engagement' of the nurses and ward teams involved. Design/methods: Using the Utrecht Work Engagement Scale (UWES), we surveyed, measured and analysed work engagement in a representative test group of hospital-based ward teams who had recently commenced the latest phase of the national 'Productive Ward' initiative in Ireland and compared them to a control group of similar size and matched (as far as ispossible) on variables such as ward size, employment grade and clinical specialty area. Results: 338 individual datasets were recorded, n = 180 (53.6%) from the Productive Ward group, and n = 158 (46.4%) from the control group; the overall response rate was 67%, and did not differ significantly between the Productive Ward and control groups. The work engagement mean score (±standard deviation) in the Productive group was 4.33 (±0.88), and 4.07 (± 1.06) in the control group, representing a modest but statistically significant between-group difference (p = 0.013, independent samples t-test). Similarly modest differences were observed in all three dimensions of the work engagement construct. Employment grade and the clinical specialty area were also significantly related to the work engagement score (p < 0.001, general linear model) and (for the most part), to its components, with both clerical and nurse manager grades, and the elderly specialist areas, exhibiting substantially higher scores. Conclusions: The findings demonstrate how QI activities, like those integral to the Productive Ward programme, appear to positively impact on the work engagement (the vigour, absorption and dedication) of ward-based teams. The use and suitability of the UWES as an appropriate measure of 'engagement' in QI interventions was confirmed. The engagement of nurses and front-line clinical teams is a major component of creating, developing and sustaining a culture of improvement. [ABSTRACT FROM AUTHOR]

To describe and examine the theories, components, and effectiveness of self-management support interventions for individuals experiencing cancer-related fatigue. A systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement. CINAHL, PubMed, Cochrane CENTRAL, and EMBASE were searched (from inception to June 2021) for randomised controlled trials examining self-management support interventions for managing cancer-related fatigue. Data were screened, extracted, and appraised by two authors. Data extraction was guided by the Self-management Support Taxonomy (i.e., a modified version of the Practical Reviews in Self-Management Support Taxonomy tailored to cancer). The Revised Cochrane Risk of Bias tool was used for study appraisal. A critical narrative synthesis was conducted. Fifty-one papers representing 50 different studies (n = 7383) were identified. Most interventions were delivered post-treatment (40%) using in-person (i.e., 'face-to-face') encounters (40%), and were facilitated by health professionals (62%). A range of intervention approaches and self-management support strategies were used across studies. The average number of Self-management Support Taxonomy components used across studies was 6.1 (of 14). Thirty-one studies (62%) described a specific behavior change theory to guide their self-management support intervention development. Twenty-nine studies (n = 29/50; 58%) reported a positive intervention effect for fatigue immediately post-intervention. Of these 29 studies, 10 (34%) reported at least one sustained positive effect on fatigue over follow-up periods between two and 12 months. Self-management support that is delivered after cancer treatment, facilitated by health professionals, and incorporating at least one in-person contact appears to produce the most favourable fatigue and behavioral outcomes. However, further work is needed to better understand how individual self-management support strategies and the application of a behavioral theory influence behavior change. Program developers should guide self-management support with a behavioral theory, and describe their theory application in intervention development, implementation, and evaluation; ensure facilitators receive adequate support training; and seek the delivery preferences of cancer survivors. Future research should incorporate adequate follow-up to sufficiently evaluate the impact of programs on cancer-related fatigue and associated self-management behaviors. Findings from this review are relevant to all healthcare professionals, but are of most relevance to nurses as the largest cancer care workforce with a key role in delivering self-management support. [ABSTRACT FROM AUTHOR]

Background: Around half of people aged over 70 years admitted as an emergency to general hospital have dementia, delirium or both. Dissatisfaction is often expressed about the quality of hospital care. A Medical and Mental Health Unit was developed to provide best practice care to cognitively impaired older patients. The Unit was evaluated by randomised controlled trial compared to standard care wards. Part of this evaluation involved structured non-participant observations of a random subample of participants and the recording of field notes. Objectives: The aim of this paper is to compare and contrast the behaviours of staff and patients on the Medical and Mental Health Unit and standard care wards and to provide a narrative account that helps to explain the link between structure, process and reported outcomes. Design: Field notes were analysed using the constant comparison method. Setting: A large hospital within the East Midlands region of the United Kingdom. Participants: Patient participants were aged over 65, and identified by Admissions Unit physicians as being 'confused'. Most patients had delirium or dementia. Results: Sixty observations (360 h) were made between March and December 2011. Cognitively impaired older patients had high physical and psychological needs, and were cared for in environments which were crowded, noisy and lacked privacy. Staff mostly prioritised physical over psychological needs. Person-centred care on the Medical and Mental Health Unit was mostly delivered during activity sessions or meal times by activities coordinators. Patients on this unit were able to walk around more freely than on other wards. Mental health needs were addressed more often on the Medical and Mental Health Unit than on standard care wards but most staff time was still taken up delivering physical care. More patients called out repetitively on the Unit and staff were not always able to meet the high needs of these patients. Conclusion: Care provided on the Medical and Mental Health Unit was distinctly different from standard care wards. Improvements were worthwhile, but care remained challenging and consistent good practice was difficult to maintain. Disruptive vocalisation may have been provoked by concentrating cognitively impaired patients on one ward. [ABSTRACT FROM AUTHOR]

Background: An implementation gap exists between policy aspirations for provision and the delivery of self-management support in primary care. An evidence based training and support package using a whole systems approach implemented as part of a randomised controlled trial was delivered to general practice staff. The trial found no effect of the intervention on patient outcomes. This paper explores why self-management support failed to become part of normal practice. We focussed on implementation of tools which capture two key aspects of self-management support - education (guidebooks for patients) and forming collaborative partnerships (a shared decision-making tool). Objectives: To evaluate the implementation and embedding of self-management support in a United Kingdom primary care setting. Design: Qualitative semi-structured interviews with primary care professionals. Settings: 12 General Practices in the Northwest of England located within a deprived inner city area. Participants: Practices were approached 3-6 months after undergoing training in a selfmanagement support approach. A pragmatic sample of 37 members of staff - General Practitioners, nurses, and practice support staff from 12 practices agreed to take part. The analysis is based on interviews with 11 practice nurses and one assistant practitioner; all were female with between 2 and 21 years' experience of working in general practice. Methods: A qualitative design involving face-to-face, semi-structured interviews audio- recorded and transcribed. Normalisation Process Theory framework allowed a systematic evaluation of the factors influencing the work required to implement the tools. Findings: The guidebooks were embedded in daily practice but the shared decision- making tools were not. Guidebooks were considered to enhance patient-centredness and were minimally disruptive. Practice nurses were reluctant to engage with behaviour change discussions. Self-management support was not formulated as a practice priority and there was minimal support for this activity within the practice: it was not auditable; [ABSTRACT FROM AUTHOR]

Background: In 2008, we conducted a systematic review on the effects of nurse prescribing using studies with a comparative design. In view of the growing number of countries that are introducing nurse prescribing and the fact that several studies into nurse prescribing have been conducted recently, there is a need for an updated review to reassess the available information on the effects of nurse prescribing when compared to physician prescribing. Objective: To identify, appraise and synthesise the evidence on the effects of nurse prescribing when compared to physician prescribing on the quantity and types of medication prescribed and on patient outcomes. Design: A systematic review. Data sources: In addition to the previous review, which covered the literature up to 2005, 11 literature databases and four websites were searched for relevant studies from January 2006 up to January 2012 without limitations as to language or country. Moreover, full-text copies of all studies included in the previous review were reviewed. Review methods: A three-stage inclusion process, consisting of an initial sifting, checking full-text papers for inclusion criteria and methodological assessment, was performed independently by two reviewers. Data on effects were synthesised using narrative and tabular methods. Results: Thirty-five studies met the inclusion criteria. All but five studies had a high risk of bias. Nurses prescribe in comparable ways to physicians. They prescribe for equal numbers of patients and prescribe comparable types and doses of medicines. Studies comparing the total amount of medication prescribed by nurses and doctors show mixed results. There appear to be few differences between nurses and physicians in patient health outcomes: clinical parameters were the same or better for treatment by nurses, perceived quality of care was similar or better and patients treated by nurses were just as satisfied or more satisfied. Conclusions: The effects of nurse prescribing on medication and patient outcomes seem positive when compared to physician prescribing. However, conclusions must remain tentative due to methodological weaknesses in this body of research. More randomised controlled designs in the field of nurse prescribing are required for definitive conclusions about the effects of nurse prescribing. [ABSTRACT FROM AUTHOR]

Background: The nature of end-stage renal disease and the need for continuous ambulatory peritoneal dialysis require patients to manage various aspects of the disease, its symptoms and treatment. After attending a training programme, patients are expected to adhere to the renal therapeutic regimen and manage their disease with the knowledge and skills learned. While patients are the stakeholders of their health and related behaviour, their perceptions of adherence and how they adhere to their renal therapeutic regimen remains unexplored. Aims: To understand adherence from patients' perspectives and to describe changes in adherence to a therapeutic regimen among patients undergoing continuous ambulatory peritoneal dialysis. Design: This study used a mixed methods design with two phases - a survey in phase I and semi-structured interviews in phase II. This paper presents phase II of the study. Settings: The study was conducted at a renal unit of an acute hospital in Hong Kong. Participants: Based on the phase I survey results, maximum variation sampling was employed to purposively recruit 36 participants of different genders (18 males, 18 females), ages (35-76 years), and lengths of dialysis experience (11-103 months) for the phase II interviews. Methods: Data were collected by tape-recorded semi-structured interviews. Content analysis was employed to analyse the transcribed data. Data collection and analysis were conducted simultaneously. Findings: Adherence was a dynamic process with three stages. At the stage of initial adherence, participants attempted to follow instructions but found that strict persistent adherence was impossible. After the first 2-6 months of dialysis, participants entered the stage of subsequent adherence, when they adopted selective adherence through experimenting, monitoring and making continuous adjustments. The stage of long-term adherence commenced after 3-5 years of dialysis, when participants were able to assimilate the modified therapeutic regimen into everyday life. Conclusions: The process of adherence was dynamic as there were fluctuations at each stage of the participants' adherence. With reference to each stage identified, nursing interventions can be developed to help patients achieve smooth transition throughout all the stages. [ABSTRACT FROM AUTHOR]

Background: The present shortage of registered nurses (RNs) in many European countries is expected to continue and worsen, which poses a substantial threat to the maintenance of healthcare in this region. Work-family conflict is a known risk factor for turnover and sickness absence. Objective: This paper empirically examines whether the nurse practice environment is associated with experienced work-family conflict. Design: A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analyzed here is based on a national sample of 8356 female and 592 male RNs from 369 hospital departments. Results: We found that 6% of the variability in work-family conflict experienced by RNs was at the department level. Organizational level factors significantly accounted for most of the variability at this level with two of the work practice environment factors examined, staffing adequacy and nurse involvement in hospital affairs, significantly related to work- family conflict. Due to the design of the study, factors on ward and work group levels could not be analyzed, but are likely to account for additional variance which in the present analysis appears to be on the individual level, with private life factors likely explaining another major part. Conclusion: These results suggest that higher level organizational factors in health care have a significant impact on the risk of work-family conflict among RNs through their impact on the nurse practice environment. Lower level organizational factors should be investigated in future studies using hierarchical multilevel sampling. [ABSTRACT FROM AUTHOR]

Background: Although trust has been investigated in the health context, limited research explores nurse and nurse manager perceptions of trust. Objective: To explore the concept of trust amongst nurses and nurse managers at individual, interpersonal and organisational levels. Design: Our paper reports the findings from an interpretivist study conducted within the British National Health Service, involving thirty-nine semi-structured interviews with nurses and nurse managers. Settings: Large acute and small community organisation within the British National Health Service. Participants: 28 nurses and 11 nurse managers working within an Acute and a Community sector organisation - 20 and 19 in each organisation. Participants were selected through a process of purposive sampling, reflecting variations in terms of age, grade, ward and tenure. Methods: We utilise a concept analysis framework in exploring the antecedents, attributes and consequences of trust amongst nurses and nurse managers at individual, interpersonal and organisational levels. Results: Key findings suggest that trust is formed within the immediate ward environment, and is significantly influenced by the role of line manager. Other positively influencing factors include professionalism and commitment to the nursing profession. These form the basis for the teamwork, delegation, support, open communication systems, confidentiality and discretion essential to delivering quality patient care. Negatively influencing factors include new management concepts, practices and styles overseen by managers recruited from the private sector. New management concepts were associated with reductions in the number of qualified nurses and increasing numbers of untrained nursing staff, reduced direct patient contact, less opportunities for professional training and development and deteriorating terms and conditions of employment. Conclusions: Our findings offer insight for managers, nurses and human resource practitioners to help build high trust relationships in a health care context. Of particular import is the need for managers to communicate more effectively organisational and financial constraints, in a manner that does not 'alienate' nurses and nurse managers, by highlighting their value and acknowledging their role in delivering high quality patient care. [ABSTRACT FROM AUTHOR]

Background: International studies have generally defined nursing as a female-dominated occupation. The almost absence of male nurses seems universal, except as a privileged minority occupying positions within nursing specialties ('islands of masculinity'). Nursing is associated with relatively low status owing to gender and income, and is also influenced by cultural perceptions of social status, the nature of the work and sexuality. Objective: This study aims to describe and analyse how gender and cultural perceptions influenced the development of nursing in Mauritius. This paper examines why nursing in Mauritius became gendered in different ways due to the impact of gender equivalence in the work force, the gendered segregation in clinical practice and the absence of caring feminisation in nursing. Design and setting: This qualitative study is based on in-depth, semi-structured interviews and convenience sampling. The sample includes nurses working at five hospitals. They all come from the central and southern part of Mauritius. The data were collected over a fivemonth period during 2006. Participants: Individual qualitative interviews were conducted with 47 nurses, both men (27) and women (20), of different grades, ages, religions and ethnic backgrounds. Results: Nursing practice is gender segregated, influenced and supported by cultural traditions and perceptions of gender relations, sexuality and touch in nursing. However, the professional identity and role is considered non-gendered, implied by the title of 'nursing officer' and the presence of male nurses who constitute almost 50 percent of the work force. Male nurses do not face similar barriers deterring them from entering nursing profession. Nursing did not develop the image of women's work and a low status job in Mauritius. Conclusions: The nursing profession in Mauritius has been shaped by a different 'history of origin', social, cultural and societal conditions on the basis of the absence of gender imbalance in the work force and caring feminisation in nursing. Moreover, the increase of men's presence in nursing influenced its name, status and perception, shifting nursing into a masculine sphere with advantageous impacts on nursing. [ABSTRACT FROM AUTHOR]

Objectives: Cancer treatment can impair fertility. The aim of this review was to investigate (1) fertility information needs, receipt and provision, (2) fertility information preferences, and (3) factors associated with receiving/providing fertility information. Cancer patients' and professional caregivers' perspectives were considered. Design: Mixed-methods systematic review. Data sources: Six electronic databases (PubMed, Web of Science, CINAHL, CRD, Embase) were systematically screened to retrieve articles published between January 2001 and March 2012. Reference lists and conference abstracts were checked for additional publications. Review methods: The principles outlined in the Cochrane Handbook for Systematic Reviews of Intervention were applied. Publications were included if they explored fertility-related information/communication in cancer patients/survivors of reproductive age or professional caregivers. The Critical Appraisal Skills Programme for Qualitative Studies and the Quality Assessment Tool for Quantitative Studies were used to assess the methodological quality. A standardised form based on the Cochrane guidelines for systematic reviews was used to extract the data. Two independent reviewers performed all methodological steps. Results: Of the 1872 papers found, 27 were included in this review. The majority (66- 100%) of the cancer patients wanted information about the impact of cancer therapy on fertility. The need and importance were higher in younger and childless patients, and in patients having childbearing plans. The number of patients receiving this information ranged from 0% to 85%. Several factors were associated with the lack of information receipt, including female gender and age 35 years or older. Patients preferred information via an individual consultation. In the diagnostic phase patients needed information about the impact of the treatment on fertility and preservation options. At the end or after the treatment, information needs shifted towards long term effects. Professional caregivers experienced several barriers in providing fertility information, including caregiver-, patient- and institutional-related factors. Nurses in particular, perceived difficulty in providing fertility-related information due to additional barriers associated with limited responsibility and opportunity in fertility information provision. Conclusion: Professional caregivers experienced multiple barriers that hinder information provision. Further exploration of the role of Advanced Nurse Practitioners/Midwifes and the development of an evidence based intervention to overcome caregiver-related barriers are recommended to improve information provision. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is one of the most common non-communicable long-term conditions in the world and is linked to high mortality, morbidity, loss of quality of life and high social and economic cost. Diabetes presents a serious health challenge, as it is a significant cause of ill health and premature death. Identification of barriers to self-care is critical for finding ways to reduce the adverse effects of this long-term condition. Objective: This review identified issues that influence ability to self-care for adults living with diabetes types 1 or 2. Design: A systematic review of qualitative research studies using the Joanna Briggs Institute (JBI) approach. Data sources: An electronic search of Health Sciences databases for primary published qualitative studies was conducted April 2011. Reference lists of included articles were reviewed to identify other potential papers. Review methods: Studies that investigated issues identified by individuals living with diabetes type 1 or 2 that influenced ability to self-care were analysed using a process of meta-aggregation. Meta-aggregation involves the extraction of findings, the synthesis of findings through grouping or aggregating similar findings into themes and labelling with appropriate names and a statement that defines the theme and meta-aggregating the themes into overarching syntheses. Methodological quality was assessed by two reviewers against the JBI quality appraisal criteria for qualitative studies. Results: Thirty-seven qualitative studies were reviewed. The main issues impacting on an individual's ability to self-care were 'communication', 'education', 'personal factors', 'provider issues' and 'support'. Multiple barriers were found to influence the day-to-day management of diabetes. Key issues related to communication with health care providers, an education programme that allowed for incremental knowledge gain and experiential and vicarious learning and the provision of culturally sensitive care. Conclusions: People living with diabetes face many issues in their day-to-day manage- ment of the disease, compounded by vulnerability to wider situational, cultural and social issues. Self-care ability is a dynamic, evolutionary process that varies from person to person and involves moving from a disease focused existence to maximising life. [ABSTRACT FROM AUTHOR]

Objectives: This paper provides a quantitative review that estimates exposure rates by type of violence, setting, source, and world region. Design: A quantitative review of the nursing violence literature was summarized. Data sources: A literature search was conducted using the CINAHL, Medline and PsycInfo data bases. Studies included had to report empirical results using a nursing sample, and include data on bullying, sexual harassment, and/or violence exposure rates. A total of 136 articles provided data on 151,347 nurses from 160 samples. Procedure: Articles were identified through a database search and by consulting reference lists of review articles that were located. Relevant data were coded by the three authors. Categories depended on the availability of at least five studies. Exposure rates were coded as percentages of nurses in the sample who reported a given type of violence. Five types of violence were physical, nonphysical, bullying, sexual harassment, and combined (type of violence was not indicated). Setting, timeframe, country, and source of violence were coded. Results: Overall violence exposure rates were 36.4% for physical violence, 66.9% for nonphysical violence, 39.7% for bullying, and 25% for sexual harassment, with 32.7% of nurses reporting having been physically injured in an assault. Rates of exposure varied by world region (Anglo, Asia, Europe and Middle East), with the highest rates for physical violence and sexual harassment in the Anglo region, and the highest rates of nonphysical violence and bullying in the Middle East. Regions also varied in the source of violence, with patients accounting for most of it in Anglo and European regions, whereas patents' families/friends were the most common source in the Middle East. Conclusions: About a third of nurses worldwide indicated exposure to physical violence and bullying, about a third reported injury, about a quarter experienced sexual harassment, and about two-thirds indicated nonphysical violence. Physical violence was most prevalent in emergency departments, geriatric, and psychiatric facilities. Physical violence and sexual harassment were most prevalent in Anglo countries, and nonphysical violence and bullying were most prevalent in the Middle East. Patients accounted for most physical violence in the Anglo region and Europe, and patient family and friends accounted for the most in the Middle East. [ABSTRACT FROM AUTHOR]

Background: Indwelling urinary catheters (IUC) are the primary cause of urinary tract infection in acute care. Current research aimed at reducing the use of IUCs in acute care has focused on the prompt removal of catheters already placed. This paper evaluates attempts to minimise the initial placement of IUCs. Objectives: To evaluate systematically the evidence of the effectiveness of interventions to minimise the initial placement of IUCs in adults in acute care. Design: Studies incorporating an intervention to reduce the initial placement of IUCs in an acute care environment in patients aged 18 and over that reported on the incidence of IUC placement were included in the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist has been used as a tool to guide the structure of the review. Data sources: MEDLINE, CINAHL, EMBASE, National Health Service Centre for Review and Dissemination and Cochrane Library. Review methods: A systematic review to identify and synthesise research reporting on the impact on interventions to minimise the use of IUCs in acute care published up to July 2011. Results: 2689 studies were scanned for eligibility. Only eight studies were found that reported any change (increase or decrease) in the level of initial placement of IUCs as a result of an intervention in acute care. Of the eight, six had an uncontrolled before-after design. Seven demonstrated a reduction in the initial use of IUCs post-intervention. There was insufficient evidence to support or rule out the effectiveness of interventions due to the small number of studies, limitations in study design and variation in clinical environments. Notably, each study listed the indications considered to be acceptable uses of an IUC and there was substantial variation between the lists of indications. Conclusions: More work is needed to establish when the initial placement of an IUC is appropriate in order to better understand when IUCs are overused and inform the development of methodologically robust research on the potential of interventions to minimise the initial placement of IUCs. [ABSTRACT FROM AUTHOR]