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Subsyndromal delirium is a dynamic, recognizable condition commonly observed in intensive care unit (ICU) patients that can lead to poor patient prognosis, and its prompt recognition and management can prevent disease progression. However, no evidence-based predictive tool has been developed specifically to assess the occurrence of subsyndromal delirium in the ICU. To develop and validate a novel, simple and effective tool for estimating the risk of subsyndromal delirium among ICU patients. A prospective, nested case-controlled study. A total of 731 patients were recruited from the central ICU of a tertiary hospital in southwestern China from August 2021 to November 2022. The least absolute shrinkage and selection operator was applied to screen potential features for univariate and multivariate logistic regression. A nomogram was constructed using the selected variables. The performance of the nomogram was evaluated by combining the area under the receiver operating characteristic curve (AUC), calibration curves and decision curve analysis (DCA). The prevalence of subsyndromal delirium among ICU patients was 23.06 %. Multiple logistic regression analysis revealed that the independent predictive factors for subsyndromal delirium among ICU patients were vision impairment, a history of falls, the use of restraint, blood transfusion, the use of antibiotics, surgery, the Caprini score, and the Braden score, all of which were used to construct the nomogram. The AUCs for the model were 0.710 (95 % CI, 0.654–0.766, P < 0.001) and 0.825 (95 % CI, 0.732–0.917, P < 0.001) in the training and validation cohorts, respectively, indicating that the model had high accuracy in distinguishing patients with and without subsyndromal delirium. The calibration curve of the nomogram showed good consistency between the predicted and actual probabilities. The DCA indicated that the nomogram has clinical application for patients in the ICU. We developed an easy-to-use nomogram for identifying subsyndromal delirium in ICU patients with satisfactory predictive ability based on simple and easily accessible clinical features. The nomogram can identify ICU patients at high-risk for subsyndromal delirium and may be a useful subsyndromal delirium tool for current ICU physicians. [ABSTRACT FROM AUTHOR]

While Malawi has made great strides increasing the number of facility-based births, maternal and neonatal mortality remains high. An intervention started in 2019 provided short-course training followed by year-long longitudinal bedside mentorship for nurse midwives at seven health facilities in Blantyre district. The intervention was initiated following invitation from the district to improve outcomes for patients during childbirth. This study examined the impact of the intervention on the reporting of obstetric and neonatal complications and related care. Patient level data were collected from the District Health Information System 2 database from intervention and non-intervention facilities. Bivariate analysis explored the impact of longitudinal bedside mentorship on select District Health Information System 2 variables at six-month intervals. Outcomes were then analyzed using nonlinear quantile mixed models to better account for the impact of time and clustering at the facility level. Significant changes were found in the reporting of obstetric and neonatal complications over time at intervention facilities compared to non-intervention facilities. Intervention facilities showed statistically significant increases in the reporting of prolonged labor, pre/eclampsia, fetal distress, retained placenta, and premature labor. There was also a statistically significant decrease in the reporting of no complications in the multivariate model (95%CI: − 0.8 to − 0.2). In both the bivariate and multivariate models, the reporting of 'None' significantly decreased (0.8 % median), while the reporting of prematurity (0.2 % median) and asphyxia (0.3 % median) both significantly increased. The missingness of data at intervention facilities decreased to almost zero compared to non-intervention facilities. The increase in reported maternal and neonatal complications suggests improved early identification of complications at the facility level. The improved accuracy of patient data from intervention facilities shows the impact mentorship has on data quality which is crucial for the allocation of resources. By highlighting the apparent dose–response relationship of longitudinal bedside mentorship, this study will inform the broader use of mentorship in training programs. Future research is needed to explore the impact of longitudinal mentorship on quality of care. [ABSTRACT FROM AUTHOR]

Frailty is commonly observed in stroke patients and it is associated with adverse outcomes. However, there remains a gap in longitudinal studies investigating the causal relationship between baseline frailty and short-term prognosis in discharged adult stroke patients. To examine the causal impact of frailty on non-elective readmission and major adverse cardiac and cerebral events, and investigate its associations with cognitive impairment and post-stroke disability. A multicenter prospective cohort study. Two tertiary hospitals in Central and Northwest China. 667 adult stroke patients in stroke units were included from January 2022 to June 2022. Baseline frailty was assessed by the Frailty Scale. Custom-designed questions were utilized to assess non-elective readmission and major adverse cardiac and cerebral events as primary outcomes. Cognitive impairment, assessed using the Mini-Mental State Examination Scale (MMSE), and post-stroke disability, measured with the Modified Rankin Scale (mRS), were considered secondary outcomes at a 3-month follow-up. The impact of baseline frailty on non-elective readmission and major adverse cardiac and cerebral events was examined using bivariate and multiple Cox regression analyses. Furthermore, associations between baseline frailty and cognitive impairment, or post-stroke disability, were investigated through generalized linear models. A total of 5 participants died, 12 had major adverse cardiac and cerebral events, and 57 had non-selective readmission among 667 adult stroke patients. Frailty was an independent risk factor for non-selective readmission (hazard ratio [HR]: 2.71, 95 % confidence interval [CI]: 1.59, 4.62) and major adverse cardiac and cerebral events (HR: 3.77, 95 % CI: 1.07, 13.22) for stroke patients. Baseline frailty was correlated with cognitive impairment (regression coefficient [β]: − 2.68, 95 % CI: − 3.78, − 1.58) adjusting for socio-demographic and clinical factors and follow-up interval. However, the relationship between frailty and cognitive impairment did not reach statistical significance when further adjusting for baseline MMSE (β: − 0.39, 95 % CI: − 1.43, 0.64). Moreover, baseline frailty was associated with post-stroke disability (β: 0.36, 95 % CI: 0.08, 0.65) adjusting for socio-demographic and clinical variables, follow-up interval, and baseline mRS. The finding highlights the importance of assessing baseline frailty in discharged adult stroke patients, as it is significantly associated with non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability at 3 months. These results highlight the crucial role of screening and evaluating frailty status in improving short-term prognosis for adult stroke patients. Interventions should be developed to address baseline frailty and mitigate the short-term prognosis of stroke. Baseline frailty predicts non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability in adult stroke patients. @haiyanhexyyy [ABSTRACT FROM AUTHOR]

Older adults' preference for home- and community-based service programs has been highlighted as an essential but usually ignored ingredient in current care models. Disentangling how preferences contribute to older adults' decision-making could facilitate finding optimal ways to deliver home- and community-based services in times of increasing scarcity. To identify Chinese community-dwelling older adults' preference structure for home- and community-based services and thus to optimize service provision. Conjoint analysis, a preference-based technique, was employed to study older adults' preferences. A stepwise qualitative approach was first adopted to identify the attributes and attribute levels of home- and community-based services. Scenarios were defined through an orthogonal fractional factorial design, and a cross-sectional survey was conducted through a face-to-face, anonymous questionnaire. Conjoint analysis was performed to determine preference weights representing the relative importance of the identified attributes, and cluster analysis was performed to identify clusters of participants with similar preference structures. All data analyses were performed using SAS v9.4 and SPSS 22.0. A total of 321 of 350 invited participants completed the questionnaire. Four attributes were identified and used to create the conjoint scenarios: care-giving attitude, price, technical care-giving skills, and the type of service provider. Care-giving attitude was the most valued attribute for older adults when making decisions (relative importance score = 48.28), followed by price (relative importance score = 21.618), technical care-giving skills (relative importance score = 19.518), and finally, the type of service provider (relative importance score = 10.585). Three preference phenotypes were identified by applying cluster analysis: "price-oriented", "comprehensively balanced", and "attitude-oriented". The present study underscored the importance of considering attributes valued by Chinese older adults in the design and delivery of home- and community-based services. The preference structure, including the utility score of the attribute levels, differs among older adults. The findings could inform future research and practice and suggest incorporating flexibility during the service delivery stage. [ABSTRACT FROM AUTHOR]

Peripherally inserted central catheters are widely used in clinical practice. Despite the many advantages of peripherally inserted central catheters, unplanned removals can occur owing to irreversible complications and may have adverse consequences for patients. However, the relationship between peripherally inserted central catheter type and the incidence of unplanned removal is unclear. To investigate the association between the type of peripherally inserted central catheter and unplanned catheter removal. A multicenter prospective cohort study. Sixty hospitals located in 30 cities across seven provinces in China. Three thousand two hundred and twenty-two patients aged 18 years or older with one peripherally inserted central catheter inserted for treatment were enrolled, and 3166 (98.3 %) patients with follow-up data were included in the final analysis. The included participants had peripherally inserted central catheters that either had a proximal valve (n = 2436) or were open-ended (n = 730). A competing risk Cox regression model was used, and both univariate and multivariate analyses were conducted. A sub-distribution hazard model was applied to test the validity of the results. Of the 2436 peripherally inserted central catheters with a proximal valve and 730 that were open-ended, 272 (11.2 %) and 46 (6.3 %) were removed unplanned, respectively. The whole incidence of unplanned removal was 10.04 %; multivariate Cox regression was conducted and it was determined that unplanned removal was statistically significantly associated with the proximal valve peripherally inserted central catheter type (hazard ratio: 1.86, 95 % confidence interval: 1.28 to 2.70, p = 0.001). In patients without cancer, the risk of unplanned removal of peripherally inserted central catheters with a proximal valve was 8.14 times higher than that of open-ended peripherally inserted central catheters (p < 0.001). In this study, peripherally inserted central catheters with a proximal valve had a higher risk of unplanned removals, especially in patients without cancer. The peripherally inserted central catheter type should be considered in advance, and clinical staff should take appropriate measures to prevent unplanned removals after insertion. [ABSTRACT FROM AUTHOR]

In recent years several authors have documented common problems in the use of statistics in nursing research, including failure to consider the effects of multiple testing, inattention to clinical significance, and under-reporting of effect sizes and confidence intervals. More subtle forms of multiple testing are not as widely recognized, and abuse of researcher degrees of freedom has received little attention in the nursing research literature. These and other unsound practices in applying and interpreting statistics are problematic in themselves, and they arguably reflect an insufficiently clear understanding of statistical inference as a method for dealing with randomness among many researchers. The goal of this educational paper is to improve the understanding and practice of inferential statistics among nursing researchers. An accessible explanation of hypothesis testing is provided, including discussion of the crucial concept of repeated sampling. Several pervasive mistakes and misconceptions in statistical inference are examined in detail, including misinterpretation of "non-significant" p -values as evidence for the null hypothesis, failure to account for forms of multiple testing that arise in model selection, abuse of researcher degrees of freedom, and hypothesis testing for baseline differences between arms in randomized trials. Recommendations for better statistical practice are offered. For the foreseeable future classical methods of statistical inference based on the idea of repeated sampling will be the primary tools for quantifying randomness in nursing research. The hypothesis testing framework, despite its limitations, can be helpful in ruling out chance as an explanation for observed effects. Nursing researchers who use quantitative methods, as well as journal reviewers and editors, should understand this framework well. Those involved in educating nursing researchers and those who teach statistics would do well to ask what changes need to be made to raise the level of statistical practice in nursing research. [ABSTRACT FROM AUTHOR]

Fatigue resulting from shift work and extended hours can compromise patient care and the safety and health of nurses, as well as increasing nursing turnover and health care costs. This research aimed to identify aspects of nurses' work patterns associated with increased risk of reporting fatigue-related outcomes. A national survey of work patterns and fatigue-related outcomes in 6 practice areas expected to have high fatigue risk (child health including neonatology, cardiac care/intensive care, emergency and trauma, in-patient mental health, medical, and surgical nursing). The 5-page online questionnaire included questions addressing: demographics, usual work patterns, work in the previous two weeks, choice about shifts, and four fatigue-related outcomes – having a sleep problem for at least 6 months, sleepiness (Epworth Sleepiness Scale), recalling a fatigue-related error in clinical practice in the last 6 months, and feeling close to falling asleep at the wheel in the last 12 months. The target population was all registered and enrolled nurses employed to work in public hospitals at least 30 h/week in one of the 6 practice areas. Participation was voluntary and anonymous. Respondents (n = 3133) were 89.8% women and 8% Māori (indigenous New Zealanders), median age 40 years, range 21–71 years (response rate 42.6%). Nurses were more likely than New Zealand adults in general to report chronic sleep problems (37.73% vs 25.09%, p < 0.0001) and excessive sleepiness (33.75% vs 14.9%, p < 0.0001). Fatigue-related error(s) in the last 6 months were recalled by 30.80% and 64.50% reported having felt sleepy at the wheel in the last 12 months. Logistic regression analyses indicated that fatigue-related outcomes were most consistently associated with shift timing and sleep. Risk increased with more night shifts and decreased with more nights with sleep between 11 p.m. and 7 a.m. and on which nurses had enough sleep to feel fully rested. Risk also increased with roster changes and more shift extensions greater than 30 min and decreased with more choice about shifts. Comparisons between intensive care/cardiac care and in-patient mental health nursing highlight that fatigue has different causes and consequences in different practice areas. Findings confirm the need for a more comprehensive and adaptable approach to managing fatigue. We advocate an approach that integrates safety management and scientific principles with nursing and management expertise. It should be data-driven, risk-focused, adaptable, and resilient in the face of changes in the services required, the resources available, and the overall goals of the healthcare system. [ABSTRACT FROM AUTHOR]

Anxiety has a powerful impact on learning due to activation of anxiety hormones, which target related receptors in the working memory. Experiential learning requires some degree of challenge and anxiety. Patient simulation, as a form of experiential learning, has been an integrated component of health professional education internationally over the last two decades, especially in undergraduate nursing education. Little information is available to determine if and how anxiety impacts nursing students' clinical performance during simulation. To investigate physiological and psychological anxiety during emergency scenarios in high-fidelity simulation and understand the effect of anxiety on clinical performance. First2Act was the model for the simulation intervention. Second and third year undergraduate nursing students attended a two-hour simulation session and completed a demographic questionnaire plus pre-simulation self-reported psychological anxiety scale. A heart rate variability monitor was attached to each student's chest to measure heart rate variability (as a sign of anxiety) before engaging in two video-recorded simulated emergency scenarios (cardiac and respiratory) with a professional actor playing the patient. Performance was rated by a clinician followed by video-assisted debriefing. Finally, heart monitors were removed and students repeated self-reports of psychological anxiety. Students' psychological anxiety was high pre-simulation and remained high post-simulation. With regard to physiological anxiety, students were anxious at the start of the simulation but became more relaxed toward the end as they gained familiarly with the simulation environment (p <.007). Clinical performance increased significantly in the second scenario (p <.001). Factors found to positively affect clinical performance were length of enrolment in the nursing degree (p =.001), current employment in a nursing or allied healthcare field (p =.030), and previous emergency experience (p =.047). The relationship between physiological anxiety and clinical performance was statistically not significant, although there was an indication that low level anxiety led to optimal performance. High-fidelity patient simulation has the capacity to arouse novice nurses psychologically and physiologically while managing emergency situations. Indicative outcomes suggest that optimal performance was apparent when anxiety levels were low, indicating that they had received insufficient training to deal with situations that induced moderate to high anxiety levels. [ABSTRACT FROM AUTHOR]

Caregivers of people with dementia experience high stress levels. Mindfulness-based cognitive therapy has been found to be effective in reducing stress and improving the psychological well-being of several populations. To explore the feasibility and preliminary effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia. In a single-blinded, parallel-group, randomized controlled trial, 36 caregivers of people with dementia were randomized to either the intervention group, receiving the 7-session modified mindfulness-based cognitive therapy in 10 weeks; or the control group, receiving the usual family care and brief education on dementia care. The brief education sessions were similar in frequency and duration to the intervention group. Various psychological outcomes of caregivers were assessed and compared at baseline, immediately post-intervention, and at the 3-month follow-up. A focus group with eight participants from the intervention group was conducted to identify the strengths, limitations, and difficulties of the intervention. Intervention feasibility was established with a high completion rate of 83% (completing ≥5 out of the 7 sessions) and a low attrition rate of 11.1%. The duration of the average weekly home-based mindfulness practice of the caregivers was 180 minutes (S.D. = 283.8). The intervention group experienced a statistically significant decrease in stress levels (Z = -1.98, p = 0.05, Cohen's d = 0.7) and depressive symptoms (Z = -2.25, p = 0.02, Cohen's d = 0.8) at the post-test; and a decrease in stress (Z = -2.58, p = 0.01, Cohen's d = 0.9), depressive symptoms (Z = -2.20, p = 0.03, Cohen's d = 0.7), and burden (Z = - 2.74, p = 0.006, Cohen's d = 1.0), and improved quality of life (physical) (Z = -1.68, p = 0.09, Cohen's d = 0.6) at the 3-month follow-up compared to the controls. A focus group conducted immediately after the intervention revealed three major themes: Impacts on the family caregivers, Impacts on the people with dementia, and Difficulty in practicing mindfulness. The findings support the feasibility and preliminary effects of the modified mindfulness-based cognitive therapy on reducing the stress of caregivers and improving their psychological well-being. Some potential effects on people with dementia (e.g., improvements in behavioral problems) were reported by the caregivers. A future study with a larger and more diverse sample is proposed to evaluate the longer-term effects and generalizability of the modified mindfulness-based cognitive therapy and the impacts on people with dementia. [ABSTRACT FROM AUTHOR]

Compassion fatigue is a syndrome resulting from long-term work-related traumatic event stress exposure of medical staff. The emergency department is considered to be a high-risk, high-intensity and high-stress work environment, with a high prevalence of trauma and violence. Nurses in the emergency department are more prone to compassion fatigue than nurses in other departments. Compassion fatigue not only affects the physical and mental health, and job satisfaction of emergency department nurses, but also causes serious consequences for patients, such as poor patient outcome, medical errors, and increased patient mortality during hospitalization. Our study aims to develop and evaluate a predictive model for compassion fatigue among emergency department nurses. A cross-sectional study. The emergency department nurses (N = 1014) were recruited from 21 tertiary hospitals (from Chengdu, Chongqing, Guiyang, Guangzhou and Shanghai) in central, southwestern, southern, and eastern China from July 25, 2022 to October 30, 2022. Univariate and multiple logistic regression analyses were used to determine the potential predictive factors associated with compassion fatigue in emergency department nurses. A nomogram was built based on the predictive factors and internally evaluated using a bootstrap resampling method (1000 bootstrap resamples). The performance of the predictive model was evaluated by measuring the Hosmer–Lemeshow goodness of fit test and calibration curve. The prevalence of compassion fatigue among emergency department nurses was 75.9 %. The multiple logistic regression analysis revealed that the independent predictive factors for compassion fatigue among emergency department nurses were working position, job satisfaction, diet habit, sleep hours per day, occupational stress, physical harassment and the level of workplace violence, all of which were identified to create the nomogram. The Hosmer–Lemeshow goodness of fit test indicated that the predictive model was well calibrated (χ2 = 11.520, P = 0.174). The bootstrap-corrected concordance index of nomogram was 0.821 (95 % CI: 0.791–0.851). The calibration curve of the nomogram showed good consistency between the predicted and actual probabilities. A predictive model of compassion fatigue among emergency department nurses has been developed, based on the general demographic, work-related and lifestyle characteristics, occupational stress, and workplace violence, with satisfactory predictive ability. This model can identify emergency department nurses who are at high risk of compassion fatigue. Our study provides an empirical basis for early detection, early diagnosis and early intervention of emergency department nurses at high risk of compassion fatigue. [ABSTRACT FROM AUTHOR]

The elderly patients admitted to cardiac intensive care unit (CICU) are at relatively high risk for developing delirium. A simple and reliable predictive model can benefit them from early recognition of delirium followed by timely and appropriate preventive strategies. To explore the role of frailty in delirium prediction and develop and validate a delirium predictive model including frailty for elderly patients in CICU. A prospective, observational cohort study. CICU at China–Japan Friendship Hospital from March 1, 2022 to August 25, 2022 (derivation cohort); CICU at Beijing Anzhen Hospital affiliated to Capital Medical University from March 14, 2023 to May 8, 2023 (external validation cohort). A total of 236 and 90 participants were enrolled in the derivation and external validation cohorts, respectively. Participants in the derivation cohort were assigned into either the delirium (n = 70) or non-delirium group (n = 166) based on the occurrence of delirium. The simplified Chinese version of the Confusion Assessment Method for the Diagnosis of Delirium in the Intensive Care Unit was used to assess delirium twice a day at 8:00–10:00 and 18:00–20:00 until the onset of delirium or discharge from the CICU. Frailty was assessed using the FRAIL scale during the first 24 h in the CICU. Other possible risk factors were collected prospectively through patient interviews and medical records review. After processing missing data via multiple imputations, univariate analysis and bootstrapped forward stepwise logistic regression were performed to select optimal predictors and develop the models. The models were internally validated using bootstrapping and evaluated comprehensively via discrimination, calibration, and clinical utility in both the derivation and external validation cohorts. The study developed D-FRAIL predictive model using FRAIL score, hearing impairment, Acute Physiology and Chronic Health Evaluation-II score, and fibrinogen. The area under the receiver operating characteristic curve (AUC) was 0.937 (95% confidence interval [CI]: 0.907–0.967) and 0.889 (95%CI: 0.840–0.938) even after bootstrapping in the derivation cohort. Inclusion of frailty was demonstrated to improve the model performance greatly with the AUC increased from 0.851 to 0.937 (p < 0.001). In the external validation cohort, the AUC of D-FRAIL model was 0.866 (95%CI: 0.782–0.907). Calibration plots and decision curve analysis suggested good calibration and clinical utility of the D-FRAIL model in both the derivation and external validation cohorts. For elderly patients in the CICU, FRAIL score is an independent delirium predictor and the D-FRAIL model demonstrates superior performance in predicting delirium. [ABSTRACT FROM AUTHOR]

Active warming reduces risk of surgical complications. Implementation of a perioperative thermal care bundle increased use of active warming for surgical patients. This study aimed to determine if implementing a thermal care bundle to prevent inadvertent perioperative hypothermia is cost-effective. A model-based cost-effectiveness analysis was undertaken using Monte Carlo simulations from input distributions to estimate costs and effects. Hospitals undertaking between 5,000 and 40,000 surgeries per year, which either implemented or did not implement the thermal care bundle, were modelled. The decision tree guiding the structure of the model was populated with clinical outcomes (surgical site infection, blood transfusion requirement and morbid cardiac events) of a hypothetical cohort of surgical patients. Implementation or non-implementation of the thermal care bundle. Net monetary benefit was calculated by multiplying the health benefits (quality-adjusted life years) by the willingness-to-pay threshold minus the cost. We tested a range of values for willingness to pay per quality-adjusted life year thresholds and plotted results for expected incremental benefits and probability of cost-effectiveness. The incremental cost-effectiveness ratio was also calculated. Thermal care bundle implementation simultaneously reduced costs and increased quality-adjusted life years in the majority of simulations (88.1%). The average cost reduction was $689,659 (95% credible intervals spanned from a $2,718,364 decrease in costs to $379,826 increase in costs) and average difference in quality-adjusted life years was 54 (95% CI = 0.4 less to 176 more). This equated to an incremental cost-effectiveness ratio of $12747 saved per quality-adjusted life year gained. It is likely that increasing use of active warming by implementing the thermal care bundle would generate cost-savings and improve the quality of life for surgical patients. It would be good value for hospitals with similar characteristics to those included in our model to allocate the extra resources required for implementation. [ABSTRACT FROM AUTHOR]

Depressive symptoms are common in patients with cancer and more prevalent in Chinese patients. The Center for Epidemiologic Studies Depression Scale is one of the most widely used self-report scales to assess depressive symptoms in both community and hospitalized samples. A revised Center for Epidemiologic Studies Depression Scale has been created, but the evidence on psychometric properties is limited. To develop the Chinese version of the scale, and to examine the cross-cultural validity, structural validity, construct validity, internal consistency, test-retest reliability, measurement error, responsiveness, and floor/ceiling effect of the scale among patients with cancer according to the recommendation in the consensus-based standards for the selection of health status measurement instruments checklist. A cross-sectional survey design with 33 participants (approximately 10%) completing the follow-up survey for evaluating the test-retest reliability. Randomly selected eight wards of an oncology hospital in China. Of the 595 patients we approached in the randomly selected eight wards, 310 gave their informed consent and completed the survey. The Chinese version of the Center for Epidemiologic Studies Depression Scale-Revised was developed by four researchers (two translators and two reviewers) who were proficient in both English and Chinese. Participants completed the scale and the depression module of the Patient Health Questionnaire. Principal components analyses, Spearman's correlation, the Mann-Whitney U test, Cronbach's alpha, and the intraclass correlation coefficient were used. The cross-culture validity was excellent based on the consensus-based standards for the selection of the health status measurement instruments checklist. A two-factor structure was determined: somatic symptoms and affective-cognitive symptoms. The sufficient construct validity was supported by that the score of the Center for Epidemiologic Studies Depression Scale-Revised was strongly correlated with the depression module of the Patient Health Questionnaire score (rho = 0.73, p < 0.001) and patients who had received chemotherapy (p = 0.002)/radiotherapy (p = 0.035) reported higher scores of depression than those who have not. The Cronbach's alphas of the total scale and subscales ranged from 0.82–0.88. The test-retest reliability was sufficient (intraclass correlation coefficient = 0.73–0.81, all p < 0.001) for total scale and subscales. The smallest detectable change was 2.98 and the responsiveness was adequate, with no floor/ceiling effect. This study supports the Chinese version of the Center for Epidemiologic Studies Depression Scale-Revised as a valid and reliable measurement of depressive symptoms in patients with cancer. [ABSTRACT FROM AUTHOR]

Decreases in s ubjective sleep quality are prevalent among nurses and midwives engaged in rotating shift work. The present study aimed to examine the relationship between differences in work schedules and subjective sleep quality among female nursing staff. A cross-sectional survey design was used for descriptive and logistic regression analyses. Data collection was conducted from December 2016 to September 2017. Participants were recruited from five regional core hospitals in Japan. A total of 1253 nurses and midwives were included in the final analysis. Subjective sleep quality was assessed using the Japanese version of the Pittsburgh Sleep Quality Index. Chronotype and social jet lag were calculated for both work day and work-free day. Symptoms related to restless legs syndrome/Willis-Ekbom disease were assessed using the Japanese version of the Cambridge-Hopkins questionnaire short form 13. Participants with the urge to move their legs, though not fulfilling the restless legs syndrome/Willis-Ekbom disease criteria, were classified as having leg motor restlessness. Logistic regression analyses for poor sleep were adjusted for age, body mass index, smoking, drinking, menstruation status, the presence of premenstrual syndrome, and the presence of a spouse. Rates of poor sleep (Pittsburgh Sleep Quality Index score ≥6) among those working, day shifts, rotating 12.5 hour night shifts, rotating 16 hour night shifts, and three-shift rotations were 41.2%, 51.1%, 44.5%, and 60.4%, respectively. Approximately 40% of three-shift rotation workers experienced difficulty initiating sleep. Shift workers tended to exhibit evening chronotype, delayed sleep phase, and high social jet lag. The prevalence of restless legs syndrome/Willis-Ekbom disease was 2.5%. Leg motor restlessness was observed in. 15.5% of participants. The adjusted odds ratios (95% confidence interval) of three-shift work (vs. day shift), evening chronotype (vs. morning chronotype), and the presence of leg motor restlessness (vs. no leg motor restlessness) for those with poor sleep were 2.20 (1.47–3.30), 1.95 (1.29–2.94), and 1.66 (1.15–2.39), respectively. Regardless of the working schedules, rates of poor sleep were high among female hospital nurses and midwives. Our findings suggest that poor sleep quality is influenced by three-shift rotation, the evening chronotype, and leg motor restlessness. [ABSTRACT FROM AUTHOR]

The regularity of menstrual cycles is one of the important indicators of female reproductive health. However, the current evidence on the association of occupational exposures and menstrual disorders is scarce. This study aims to elucidate the relationship between occupational hazards and menstrual characteristics in female nurses and non-nurse health care workers in China. We conducted a national cross-sectional study on the reproductive health of female nurses in China. A total of 1, 300 medical institutions in 15 provincial administrative regions in China participated in the study. There were 8, 904 nurses and 3, 977 non-nurse health care workers who were selected using simple random sampling method. All participants were administered a face-to-face standardized questionnaire, including personal socio-demographic information, occupational activities, and self-reported menstrual characteristics. Univariate and multivariate logistic regressions were used for statistical analyses. The results demonstrated that 41% of nurses experienced menstrual disorders. We found handling disinfectants was the most significant risk factor for menstrual disorders (OR = 1.53, 95% CI : 1.39–1.68), followed by abnormal workload (OR = 1.28, 95% CI : 1.19–1.39), and occupation as a nurse (OR = 1.28, 95% CI : 1.18–1.40). Noise, prolonged standing or frequent heavy lifting, night work, anti-cancer drug exposure, and overtime work were moderately associated with the occurrence of menstrual disorder (OR > 1). This national-wide cross-sectional study has revealed the significant association between menstrual disorders and occupational hazards among female nurses in China. [ABSTRACT FROM AUTHOR]

Effective communication between family and clinicians has been identified as one of the most important factors in end-of-life care. Family members' perception of communication quality with clinicians may be associated with their psychological symptoms. To examine the association between family-clinician (physicians or nurses) communication quality and symptoms of anxiety, depression, and stress among family members of chronically critically ill patients in intensive care units (ICUs). A cross-sectional study. The participants were 71 adult family members of 71 patients who required prolonged mechanical ventilation in ten ICUs at three medical centres in Korea. Participants completed the Quality of Communication (QOC) questionnaire, Hospital Anxiety and Depression Scale (HADS), and Impact of Event Scale-Revised (IES-R). The data were analysed using correlation, bivariate regression, and multiple regression analysis. The mean (SD) QOC score for physicians and nurses was 50.3 (15.2) and 42.9 (14.2), respectively. Forty-six participants (64.8%) were identified as being at risk for having anxiety symptoms; 22 (31%) had a mild risk and 24 (33.8%) had a moderate or severe risk. More family members (76.1%) were at risk for having depressive symptoms; 15 (21.1%) had a mild risk and 39 (54.9%) had a moderate or severe risk. For post-traumatic stress symptoms, 48 (67.6%) were at risk. While the QOC scores for nurses were negatively associated with participants' HADS-depression scores (β = −.01, p =.03), the QOC scores for physicians were not associated with the HADS or IES-R scores. This conclusion held after consideration of covariates. The findings suggest that communication between family members and ICU nurses may be more influential than that with ICU physicians on psychological distress of family members in Korea. However, further research is warranted to confirm this relationship. Future interventions to reduce psychological distress in family members of chronically critically ill patients may need to target ICU nurses for improving communication skills. [ABSTRACT FROM AUTHOR]

The retention of psychiatric nurses is an important concern for healthcare administrators in China. However, Chinese psychiatric nurses' intention to leave their jobs and the factors associated with it have been scarcely studied. To investigate Chinese psychiatric nurses' intention to leave their jobs, and to explore the associations between the intention to leave and individual characteristics, job-related factors and job satisfaction. A cross-sectional, anonymous survey of a nationwide sample was conducted. Thirty-two tertiary psychiatric hospitals in 29 provincial capital cities in China. All 9907 nurses in 32 hospitals were targeted for this survey conducted in December 2017; 8493 responded (response rate = 85.7%), and 7933 (without logic errors in the data) were included in the analysis. A questionnaire was used to investigate the respondent's intention to leave their job and to collect data on related factors, including individual characteristics (gender, age, marital status, educational background and self-rated health), job-related factors (professional title, working years, income, work hours, history of patient-initiated violence, perceived respect from patients, social recognition as well as physician-nurse coordination and trust) and job satisfaction. The short version of the Minnesota Satisfaction Questionnaire was used to assess job satisfaction. Chi-square tests and multilevel logistic regression analysis were used to examine associations between an intention to leave and other factors. Among 7933 respondents, 20.2% reported an intention to leave their current jobs. The multiple regression analysis showed that better self-rated health (i.e. OR = 0.373, 95%CI = 0.308-0.452 for good health, reference: poor health), working more than 20 years (OR = 0.479, 95%CI = 0.389-0.590, reference: 20 years or less), higher monthly income (i.e. OR = 0.521, 95%CI = 0.399-0.680 for 6001–8000 RMBs, reference: 4500 RMB or less), perceived patient respect (OR = 0.727, 95%CI = 0.623-0.849), physician-nurse coordination (OR = 0.549, 95%CI = 0.480-0.629) and being satisfied with one's job (OR = 0.373, 95%CI = 0.308-0.452) were negatively associated with an intention to leave; while those who were male (OR = 1.879, 95%CI = 1.605–2.199), working more than 40 hours per week (OR = 1.584, 95%CI = 1.374–1.825) and experienced patient-initiated violence in the past 12 months (OR = 1.566, 95%CI = 1.376–1.781) had a higher odds of reporting an intention to leave. Self-rated health, monthly income, work hours, patient-initiated violence, perceived patient respect, physician-nurse coordination and job satisfaction are significant factors associated with a nurse's intention to quit their job. In order to retain nurses in Chinese tertiary psychiatric hospitals, the government and hospital administrators should consider ways to address these factors. [ABSTRACT FROM AUTHOR]

Abstract Background Childbearing women commonly access maternity services via the telephone. A midwife receiving these calls listens to the woman's concerns and then triages women according to their assessment. This may result in the provision of advice and instruction over the telephone or inviting the woman into the health service for further assessment. Midwives are responsible for all care and advice given to women, including via the telephone. Objectives The purpose of this study was to explore the experiences and practices of midwives regarding their management of telephone triage. Design A cross-sectional survey. Setting and participants Purposive non-probabilistic sampling of currently practising midwife members of professional organisations was used to recruit participants. From this, 242 midwives responded and 230 returned valid surveys were used in data analysis. Methods Participant demographics, telephone triage processes, skills, educational preparation, confidence and anxiety levels, and external factors that influence midwives' management of telephone triage were collected via an on-line survey. Descriptive statistics and further analyses were conducted to explore relationships between variables. Results Eighty-three percent of midwives respond to 2–5 telephone calls per shift, with only 11.7% (n = 24) of midwives reporting that this is included in their workloads. Telephone triage is frequently managed in environments with distractions. Most midwives (84%; n = 177) report receiving no training in this skill. Confidence in performing telephone triage was reported, with higher confidence levels related to midwives' increased years of experience (p < 0.05) and age (p < 0.01). Anxiety related to managing telephone triage has been experienced by 73% (n = 151) of midwives, with this being greater in midwives with less years of experience. Anxiety is reported less by midwives in rural or remote settings compared to metropolitan or regional (p < 0.05) settings in this study. A variety of standards and aids to guide practice, and document calls are utilised in a range of ways. Conclusion To the authors' knowledge, this is the first study conducted to explore midwives' practises in telephone triage. The findings suggest the need for appropriate environments to conduct telephone calls and the inclusion of telephone triage in midwifery workloads. In addition, consistent education and processes are required to reduce anxiety and support midwives provision of this service to women. [ABSTRACT FROM AUTHOR]

Abstract Background Although most mental disorders have their onset in early life, the mental health needs of young people are often not addressed adequately. Open Dialogue is a need-adapted approach that mobilizes psychosocial resources in a crisis struck person's social network. Open Dialogue is organised as a series of network meetings and seeks to promote collaborative integrated care, and a non-directive psychotherapeutic stance. Its effectiveness for young people has not previously been assessed. Objectives The aim of the study was to examine whether a Danish Open Dialogue approach directed at young people, who sought help from Child and Adolescent Mental Health Services, reduced their utilisation of psychiatric and other health services, compared to peers receiving usual psychiatric treatment. Design A retrospective register-based cohort study. Methods Using clinical and national register data, a cohort of patients aged 14–19 years (n = 503) enrolled from one region during 2000 to 2015 were compared to a matched comparison group from two other regions using propensity scores. Utilisation of psychiatric health services, GP services, and social markers were assessed after 1, 2, 5 and 10 year of follow-up using logistic and Poisson regression models. Results Patients receiving Open Dialogue intervention had more psychiatric outpatient treatments at one year of follow-up (RR = 1.2, CI: 1.1–1.4) than the comparison group, but not at subsequent follow-ups. Recipients of the intervention had fewer emergency psychiatric treatments (1 year follow-up: RR = 0.2, CI: 0.1-0.5; 10 years follow-up: RR = 0.5, CI: 0.3-0.8) and less use of general practitioner services (1 year follow-up: RR = 0.90, CI: 0.82-0.99; 10 years follow-up: RR = 0.85, CI: 0.78-0.92). There was no significant reduction in the number of psychiatric hospitalisation contacts or treatment days. Conclusions Open Dialogue was significantly associated with some reduced risks of utilising health care services. These mixed results should be tested in a randomized design. [ABSTRACT FROM AUTHOR]

Abstract Background Transitioning into a new professional role is challenging. Unfortunately, little is currently known about how to reduce experiences of stress among new professionals. The socialization processes role clarity, task mastery, and social acceptance are assumed to reduce experiences of stress as they mediate new professionals' acquisition of knowledge, skills, attitudes, and behaviors. However, little prospective data is available on the actual effect of the processes on stress. Objectives To prospectively investigate how the socialization processes relate to experiences of stress among new nurses during the first three months of professional working life. Specifically, to investigate development over time, as well as how episodes of increased or decreased levels of the socialization processes relate to concurrent levels of stress. The general purpose of this investigation was to examine the suitability of the socialization processes as targets of an intervention seeking to reduce stress among new professionals. Design An intensive longitudinal study with weekly data collections over three months. Participants 264 newly graduated Swedish nurses who started their first job during the period of the study. Methods The participants were followed prospectively during 14 consecutive weeks after their professional entry. Data on stress (Stress and Energy Questionnaire), role clarity (General Questionnaire for Psychological and Social Factors at Work), task mastery, and social acceptance (Needs Satisfaction and Frustration Scale) were collected weekly using digital surveys (mean response rate 82.7%). Data was analyzed using a multilevel model for intensive longitudinal data. Results For the typical nurse, stress decreased by 0.13 units per month, role clarity and task mastery increased by 0.08 and 0.05 units, and social acceptance decreased by 0.08 units. In addition, the slopes of 95 percent of the new nurses varied within 1.18 (stress), 0.72 (role clarity), 0.44 (task mastery), and 0.86 (social acceptance) units of the typical nurse. Most importantly, when the new nurses experienced higher levels of task mastery, role clarity, and social acceptance, they experienced lower levels of stress (within-person parameter estimates: task mastery −0.40, p =.001; role clarity −0.34, p =.001; and social acceptance −0.33, p =.001). Conclusions Supporting the development of the socialization processes could be one theoretically based strategy to reduce levels of stress among new nurses. As stress among new professionals is not unique to the nursing profession, and the processes are considered important mediators of new professionals' adaptation in general, the results from this study should likely be generalizable to other professions. [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]

Abstract Background Vascular access devices are widely used in healthcare settings worldwide. The insertion of a vascular access device creates a wound, vulnerable to irritation, injury and infection. Vascular access-associated skin complications are frequently reported in the literature, however very little evidence is available regarding the incidence and risk factors of these conditions to inform practice and technology development. Objectives To estimate the incidence of vascular access-associated skin complications, and to identify patient, catheter and healthcare-related characteristics associated with skin complication development. Design Secondary data analysis from 13 multi-centre randomised controlled trials and observational studies evaluating technologies and performance of vascular access devices in clinical settings between 2008 and 2017. Settings Six hospitals (metropolitan and regional) in Queensland, Australia. Participants The 13 studies involved paediatric and adult participants, across oncology, emergency, intensive care, and general hospital settings. A total of 7669 participants with 10,859 devices were included, involving peripheral venous (n = 9933), peripheral arterial (n = 341), and central venous access (n = 585) devices. Analysis Standardised study data were extracted into a single database. Clinical and demographic data were descriptively reported. Cox proportional hazards regression models (stratified by peripheral vs central) were used for time-to-event, per-device analyses to examine risk factors. Univariate associations were undertaken due to complexities with missing data in both outcomes and covariates, with p < 0.01 to reduce the effect of multiple comparisons. Results Over 12% of devices were associated with skin complication, at 46.2 per 1000 catheter days for peripheral venous and arterial devices (95% confidence interval, CI 42.1–50.7), and 22.5 per 1000 catheter days for central devices (95% CI 16.5–306). The most common skin complications were bruising (peripheral n = 134, 3.7%; central n = 33, 6.8%), and swelling due to infiltration for peripheral devices (n = 296; 2.9%), and dermatitis for central devices (n = 13; 2.2%). The significant risk factors for these complications were predominantly related to device (e.g., skin tears associated with peripheral arterial catheters [hazard ratio, HR 16.0], radial insertion [HR 18.0] basilic insertion [HR 26.0])) and patient characteristics (e.g., poor skin integrity associated with increased risk of peripheral device bruising [HR 4.12], infiltration [HR 1.98], and skin tear [HR 48.4]), rather than management approaches. Conclusions Significant skin complications can develop during the life of peripheral and central vascular access devices, and these are associated with several modifiable and non-modifiable risk factors. Further research is needed to evaluate effectiveness technologies to prevent and treat skin complications associated with vascular access devices. [ABSTRACT FROM AUTHOR]

Abstract Background Surgical wounds healing by secondary intention can be difficult and costly to manage and are profoundly under researched. This prospective inception, cohort study aimed to derive a better understanding of surgical wounds healing by secondary intention and to facilitate the design of future research investigating effective treatments. Objectives To investigate the clinical characteristics of patients with surgical wounds healing by secondary intention and the surgeries that preceded their wounds; to clearly delineate the clinical outcomes of these patients, specifically focusing on time to wound healing and its determinants; to explore the types of treatments for surgical wounds healing by secondary intention; and to assess the impact surgical wounds healing by secondary intention have on patients' quality of life. Design Prospective, inception cohort study. Setting Acute and community settings in eight sites across two large centres in the United Kingdom (Hull and Leeds, UK). Methods Patients with a surgical wounds healing by secondary intention (an open wound, <3 weeks' duration, resulting from surgery), were recruited and followed up for at least 12 months. Key outcome events included: time to healing; treatment type; infection; hospital re-admission and further procedures; health-related quality of life and pain. Results In total, 393 patients were recruited. Common co-morbidities were cardiovascular disease (38%), diabetes (26%) and peripheral vascular disease (14.5%). Baseline median SWHSI area was 6 cm2 (range 0.01–1200). Abdominal (n = 132), foot (n = 59), leg (n = 58) and peri-anal (n = 34) wounds were common. The majority of wounds (236, 60.1%) were intentionally left open following surgery; the remainder were mostly dehisced wounds. Healing was observed in 320 (81.4%) wounds with a median time to healing of 86 days (95% CI: 75–130). Factors associated with delayed healing included wound infection at any point and baseline wound area above the median. Health-related quality of life scores were low at baseline but improved with time and healing. Conclusions This is the first inception cohort study in patients with surgical wounds healing by secondary intention. Patient characteristics have been clearly defined, with prolonged healing times and adverse events being common impacting on patient's health-related quality of life. Areas for, and factors crucial to the design of, future research have been identified. [ABSTRACT FROM AUTHOR]

Abstract Background Although there is evidence that use of restraints in home care is increasing, research into the factors associated with restraints in this setting is scarce. Objective To gain insight into the factors associated with restraints in older adults receiving home care. Design A s econdary analysis of a cross-sectional survey about restraint use in home care. Settings Older adults receiving home care in Belgium. Participants 8000 subjects were randomly selected from a total of 45,700 older adults. The mean age of the sample (n = 6397) was 80.6 years, 66.8% were women and 46.4% lived alone. Methods A cross-sectional survey of restraint use on older adults receiving home care from a nursing organisation in Belgium was completed by the patients' primary care nurses. A binary logistic regression model with generalised estimating equations was used to evaluate factors associated with restraint use. Additional analyses focused on the subgroups with and without an informal caregiver and living alone / with others. Data from 6397 participants were analysed in detail. Results Multivariate logistic regression indicated that restraint use was associated with supervision [OR = 2.433, 95% CI = 1.948–3.038]; dependency in activities of daily living (i.e. eating [OR = 2.181, 95% CI = 1.212–3.925], transfer [OR = 2.131, 95% CI = 1.191–3.812] and continence [OR = 1.436, 95% CI = 0.925–2.231]; perceived risk of falling in the nurses' clinical judgement [OR = 1.994, 95% CI = 1.710–2.324], daily behavioural problems [OR = 1.935, 95% CI = 1.316–2.846] and less than daily behavioural problems [OR = 1.446, 95% CI = 1.048–1.995]; decreased well-being of the informal caregiver [OR = 1.472, 95% CI = 1.126–1.925], the informal caregiver's dissatisfaction with family support [OR = 1.339, 95% CI = 1.003–1.788]; patient's cognitive impairment [OR = 1.398, 95% CI = 1.290–1.515]; and polypharmacy [OR = 1.415, 95% CI = 1.219–1.641]. The nurses' perception of risk of falling, cognitive impairment (observed with the Cognitive Performance Scale) and supervision are the only variables consistently associated with restraint use across all the analyses. Conclusion The study results provide insight into new and context-specific factors associated with restraint use in home care (e.g. supervision, informal caregiver's decreased well-being and dissatisfaction with family support). These insights could support the development of interventions to reduce restraint use in home care. [ABSTRACT FROM AUTHOR]

Abstract Background Although misuse of social networking sites, particularly Twitter, has occurred, little is known about the prevalence, content, and characteristics of uncivil tweets posted by nurses and nursing students. Objective The aim of this study was to describe the characteristics of tweets posted by nurses and nursing students on Twitter with a focus on cyberincivility. Method A cross-sectional, data-mining study was held from February through April 2017. Using a data-mining tool, we extracted quantitative and qualitative data from a sample of 163 self-identified nurses and nursing students on Twitter. The analysis of 8934 tweets was performed by a combination of SAS 9.4 for descriptive and inferential statistics including logistic regression and NVivo 11 to derive descriptive patterns of unstructured textual data. Findings We categorized 413 tweets (4.62%, n = 8934) as uncivil. Of these, 240 (58%) were related to nursing and the other 173 (42%) to personal life. Of the 163 unique users, 60 (36.8%) generated those 413 uncivil posts, tweeting inappropriately at least once over a period of six weeks. Most uncivil tweets contained profanity (n = 135, 32.7%), sexually explicit or suggestive material (n = 37, 9.0%), name-calling (n = 14, 3.4%), and discriminatory remarks against minorities (n = 9, 2.2%). Other uncivil content included product promotion, demeaning comments toward patients, aggression toward health professionals, and HIPAA violations. Conclusion Nurses and nursing students share uncivil tweets that could tarnish the image of the profession and violate codes of ethics. Individual, interpersonal, and institutional efforts should be made to foster a culture of cybercivility. [ABSTRACT FROM AUTHOR]

Abstract Background Patients with inflammatory bowel disease have lifelong needs to learn how to manage their symptoms and life situation. The range of actions that patients take in order to manage daily life and maintain health is referred to as self-care. Assessment of self-care in patients with inflammatory bowel disease could allow targeted support and education by health care professionals. There are no existing measures assessing self-care in patients with inflammatory bowel disease. Objectives The aim was to develop and evaluate the self-care questionnaire for assessment of self-care among patients with inflammatory bowel disease. Methods Qualitative and quantitative methods were used to develop the inflammatory bowel disease self-care questionnaire. The development and evaluation process was performed in three phases: (1) item generation based on interviews with patients with inflammatory bowel disease (n = 20), (2) content validation in a panel of experts (n = 6) and patients (n = 100) assessed with the content validity index, cognitive interviews and quantifying and ranking the items to determine the usability of the questionnaire, and (3) final evaluation through a pilot study (n = 93) with test-retest evaluation (n = 50). An expert review group of three nurses and one physician continuously discussed the result during the development process. Results A total of 91 patients with Crohn's disease and 102 with ulcerative colitis participated. The final self-care questionnaire consists of 22 items. Assessment of content validity indicated that the items were adequate and easy to understand. Test-retest reliability was confirmed with intraclass correlations above 0.6 after a three week interval, for all items except one. Conclusion An inflammatory bowel disease-specific self-care questionnaire was developed using structured methods. The evaluation indicated good validity and reliability. The questionnaire may be a useful tool to assess the ability of patients with inflammatory bowel disease to perform routine self-care. [ABSTRACT FROM AUTHOR]

Abstract Aim We explored the impact of gender role orientation (masculinity and femininity) on student nurses' caring behaviour and critical thinking. Background Caring and critical thinking are at the core of professional nursing education. Previous studies revealed inconsistent findings regarding the impact of gender roles on caring behaviour and critical thinking. Design and Methods We employed a quantitative correlational study. Nursing students (N = 449; female = 310, male = 139) who had at least had one month of clinical practice experience were recruited from four universities in Taiwan. Students' ages ranged from 19 to 29 years (Mean age = 21.24 years, SD = 1.28). Data were collected from August 2016 to July 2017, using three questionnaires: Taiwan Critical Thinking Disposition Inventory (CTDI), Caring Assessment Report Evaluation Q-sort Scale (CARE-Q), and Bem Sex Role Inventory (BSRI). Partial least squares structural equation modelling and generalized linear models were conducted to test the research model and hypotheses. Results Findings indicated that students who reported higher caring and masculinity presented greater critical thinking (ß =.37 and ß = 0.24, respectively; p s <.001). Students' gender, age, femininity, or clinical practice experience, however, were not significantly associated with critical thinking (ß = -0.01, ß = 0.09, ß =.10, and ß = 0.01, respectively; p s >.05). In addition, students who reported higher masculinity and femininity presented greater caring behaviour (ß =.22 and ß = 0.38, respectively; p s <.001). Students' gender, age or clinical practice experience were not significantly associated with caring behaviour (ß =.04, ß =.03, and ß = -0.05, respectively; ps > 0.05). The findings confirmed a direct influence of caring and masculinity on critical thinking. Masculinity indirectly affected critical thinking via caring behaviour. Caring and masculinity accounted for 34.4% of the variance in critical thinking, and masculinity and femininity accounted for 29.1% of the variance in caring behaviour. Conclusion Our study confirms the effect of age, gender role, and caring behaviour on critical thinking. We recommend that the cultivation of nursing care behaviour focus on students' gender role orientation. In addition, clinical nurse educators, when working with male students on patient caring, should consider their gender role orientation and support male nursing students' ways of presenting caring behaviours. [ABSTRACT FROM AUTHOR]

Abstract Background Prevalence of hospital-acquired pressure injuries has declined over time. However, it is unknown if this decline is consistent for different stages of pressure injuries. It is also unknown if risk factors differ between superficial (stage 1 and 2) and severe (stage 3, 4, deep tissue, and unstageable) pressure injuries. Objective To examine changes in prevalence of superficial and severe hospital-acquired pressure injuries from 2011 to 2016. To evaluate differences between risk factors associated with superficial versus severe hospital-acquired pressure injuries. Design Retrospective analysis of the 2011–2016 International Pressure Ulcer Prevalence™ data. Setting Acute care hospitals in the USA. Participants 216,626 patients had complete data. Methods Prevalence of all, superficial, and severe hospital-acquired pressure injuries was calculated annually from 2011 to 2016 and linear trendlines were generated. Two logistic regressions examined risk factors for superficial and severe hospital-acquired pressure injuries. Results Prevalence of superficial hospital-acquired pressure injuries declined significantly from 2011 to 2016. However, prevalence of severe pressure injuries did not show a reduction. Risk factors that significantly increased the risk of both superficial and severe pressure injuries were: increased age, male gender, unable to self-ambulate, all types of incontinence, additional linen layers, longer lengths of stay, and being in an intensive care unit. Body mass index (BMI) had a U-shaped relationship, where the likelihood of having either type of pressure injury was highest for low and high BMIs. Conclusions A decline in superficial, but not severe, hospital-acquired pressure injuries suggests current prevention techniques might not adequately prevent severe pressure injuries. Generally, risk factors for superficial and severe pressure injuries were highly similar where all 14 of the risk factors were significant in both regression models. However, five risk factors in particular – ICU stay, presence of an ostomy, patient age, ambulatory status, and presence of a fecal management system – had substantially different effect sizes. [ABSTRACT FROM AUTHOR]

Abstract Background Researchers advocate developing empirically-derived prognostic models to predict pressure ulcer risk. However, there remains a scarcity of evidence about the performance and clinical value of these models. Objectives To identify and describe empirically-derived models for predicting pressure ulcer risk; to assess the predictive performance of these models; and to evaluate their clinical impact in reducing pressure ulcer incidence. Methods We performed a comprehensive database search up to February 2017 and searched other resources to identify longitudinal studies that developed and/or validated prognostic models for predicting pressure ulcer risk and studies evaluating the clinical effects of such models. There were no language or publication date restrictions. Two reviewers independently conducted study selection. Using a pre-prepared data extraction form, one reviewer collected data on the characteristics and performance of the included models and assessed study risk of bias. A second reviewer checked all the data. Using narrative synthesis, we summarised the characteristics of the included studies and models. Using meta-analysis, we combined performance (discrimination and calibration) measurement statistics for relevant models. Results We included 24 studies with 28 data sources in the review and identified 22 models that were developed using these data. Of the 22 models, only seven had further external validations (one model was validated twice). In development, a third of models used univariate analysis alone to identify statistically significant predictors for subsequent multivariable analysis; and nine of the 16 developed models were formed using stepwise selection processes in multivariable analysis. Missing data were often incompletely reported, and continuous predictors were correctly handled in only two models (e.g., using restricted cubic spline). Sample sizes of the model development studies were small with 13 models involving fewer than 10 events per variable. The risk of bias associated with the development of all 22 models and eight validations was judged as high or unclear. The predictive performance was reported as: c-statistic point estimates ranging from 0.65 to 0.89, and total Observed:Expected risk ratios between 0.94 and 1.00. Compared with heuristic tools, relevant included models had better discrimination and calibration. No eligible study was identified that evaluated the clinical impact of any included model. Conclusions Whilst many prognostic models for predicting ulcer risk have been developed few have been validated. The methods used for model development are generally flawed which reduces the potential for using these models in practice. Future research should address these weaknesses. [ABSTRACT FROM AUTHOR]

Abstract Background Workplace bullying is one of the most prevalent work-related psychological and physical issues in health care facilities. Workplace bullying has detrimental effects not only on the bullied person/persons but also on health care facilities and care quality and patient safety. Aims To examine the prevalence of workplace bullying and the relationship between workplace bullying and perceived competence among Jordanian registered nurses working in private hospitals Design A cross-sectional survey study. Setting Data were collected from registered nurses working in seven private hospitals in the Capital of Amman. Participants Participants were 269 registered nurses who had a minimum of a bachelor degree, passed the hospital's competency nursing examinations, able to read and understand English, and were able and willing to complete the survey. Methods The Negative Act Questionnaire-Revised, and Nurse Professional Competence scale were used for data collection. Multiple linear regression analysis was conducted to assess predictors of greater reporting of perceived workplace bullying. Findings Almost 43% of the participants perceived themselves to be victims of severe workplace bullying while more than 31% perceived themselves to be victims of occasional workplace bullying. Person-related bullying was the most frequently reported type of workplace bullying followed by work-related bullying. Age, gender, and sum score on Nurse Professional Competence scale explained significant amount of variance in perceived workplace bullying. Conclusion The majority of Jordanian nurses working in private hospitals perceive themselves as victims of either occasional or severe workplace bullying. Amongst all related variables, perceived competence is the most significant predictor of perceived workplace bullying. [ABSTRACT FROM AUTHOR]

Abstract Background Violence and aggression are common in inpatient mental health hospital settings and cause problems for staff, patients and organisations. An important factor in treatment efficacy is ward atmosphere, and one element of this is the violence prevention climate. Objectives To develop and test the psychometric properties of a new scale to measure perceptions of the violence prevention climate among staff and patients in mental health inpatient settings. Design Scale development and cross-sectional validation study. Setting and participants: Three hospital sites within an independent sector provider of secure mental health care. Participants were patients and staff residing in/working on wards in the adult male and female mental health care pathways. Methods The study was conducted in three stages: scale development, pilot testing and psychometric evaluation. The scale items were developed from systematic literature review, informant interviews (staff) and focus groups (patients) and expert review. The resulting scale was subject to pilot testing with staff and patients (n = 58 and n = 25). The reliability and validity of the scale was examined by administering it to 326 staff and 95 patients. Exploratory factor analysis was used to establish construct validity, and this was further assessed with Rasch modelling. Internal consistency was assessed by calculation of Cronbach's alpha coefficients. Convergent and discriminant validity were measured by comparing results with existing validated instruments. Temporal stability of the items was assessed using test-retest reliability coefficients. Results The VPC-14 is a 14-item scale demonstrating good psychometric properties. Exploratory factor analysis revealed two subscales, staff actions and patient actions, each demonstrating good internal consistency (Cronbach's alpha.89 and.76). All items demonstrated good temporal stability. Rasch modelling confirmed the unidimensionality of the two subscales, and items demonstrated high construct validity. Moderate correlations were found between subscales of the VPC-14 and the EssenCES, whilst no correlations were found with items in the ACMQ, thus demonstrating good convergent and discriminant validity. Conclusion The VPC-14 is currently the most robust available measure of the inpatient violence prevention climate. It is quick and easy to administer, considers views of both staff and patients and thus can be introduced as standard practice in a ward setting. Potential uses include tracking the violence prevention climate longitudinally and in evaluation of new policy and procedural interventions. [ABSTRACT FROM AUTHOR]

Abstract Background Family caregivers provide the foundation for long-term home care of stroke survivors. The overwhelming stress associated with caregiving hinders the ability of family caregivers to utilise their internal and external resources to cope with this situation, thereby placing their own health at risk. We conducted a randomised controlled trial of a strength-oriented psychoeducational programme on conventional stroke rehabilitation for family caregivers. Objectives To evaluate the effectiveness of a strength-oriented psychoeducational programme on the caregiving competence, problem-solving coping abilities, caregiver's depressive symptoms, caregiving burden and resources (family functioning, social support) and physical health (such as caregiving-related injury), as well as potential placement of stroke survivors. Design A prospective multi-centre and single-blinded randomised controlled trial stratified by survivors' history of stroke. Setting and participants Adult stroke patients and their family caregivers were recruited from the medical wards of a regional acute and two rehabilitation hospitals in the Eastern New Territories of Hong Kong. Methods The design of the trial was based on the relational/problem-solving model. Family caregivers of stroke survivors who had been admitted to the study hospitals completed a set of questionnaires before randomisation, immediately, one- and three-months post-intervention. The control group received usual care, whereas the intervention group received an additional 26-week strength-oriented psychoeducational programme (two structured individual face-to-face pre-discharge education sessions on stroke and its associated caregiving skills and six biweekly post-discharge telephone-based problem-solving coping skills training sessions). Data were analysed using the generalized estimating equation and multiple regression models and chi-square tests. Results We recruited 128 caregiver–survivor dyads. The intervention group demonstrated significantly greater improvements throughout the study (p < 0.01) in terms of caregiving competence, problem-solving coping abilities and social support satisfaction. This group also displayed significantly greater improvements in terms of family functioning (p < 0.05) at one-month post-intervention, an increased number of social support (p < 0.001) and a lower level of burden at three-month post-intervention. However, there was no significant effect on enabling stroke survivors to remain in their home. Post-hoc analysis showed a significant and indirect effect of problem-solving coping abilities, which suggested its mediating effect on caregiving competence of stroke caregivers. Conclusions Findings suggest that incorporating a strength-oriented psychoeducational programme into the existing stroke rehabilitation protocol can foster a healthy transition to caregiving among family members of stroke survivors. [ABSTRACT FROM AUTHOR]

Abstract Background Peripherally-inserted central catheter-related venous thrombosis has serious complications including the loss of vascular access, recurrent venous thrombosis, and post-thrombotic syndrome. Current guidelines recommend non-pharmacological strategies to prevent peripherally-inserted central catheter-related venous thrombosis. There is little evidence for the effectiveness of handgrip exercise on the prevention of peripherally-inserted central catheter-related venous thrombosis. Objectives To examine the effectiveness of handgrip exercise using an elastic ball to prevent peripherally-inserted central catheter-related venous thrombosis in patients with solid cancers. Design A randomized controlled trial. Settings One teaching hospital in Nanjing, China. Participants In total, 120 subjects with solid cancers were eligible; each had a new peripherally-inserted central catheter. They were recruited and randomly assigned into two exercise groups and one control group. Methods Subjects from exercise groups 1 and 2 performed a 3-week, 25-repetition handgrip exercise, 3 and 6 times daily, respectively. The control group subjects performed a gentle limb exercise with no frequency and intensity requirements. Ultrasound was used to detect venous thrombosis development and examine axillary vein blood flow over the three points. Results There were 32 cases of peripherally-inserted central catheter-related venous thrombosis detected. Two venous thrombosis cases in the control group were symptomatic, but all venous thrombosis cases in the exercise groups were asymptomatic. All venous thromboses were partial. There were significant differences in the incidence of venous thrombosis among the three groups (χ2 = 12.813, p = 0.002; χ2 = 9.340, p = 0.009; χ2 = 11.480, p = 0.003; and χ2 = 10.534, p = 0.005, respectively) at days 2, 3 and 21. The incidence of venous thrombosis in the two exercise groups was lower than that in the control group over the 3 time points (all, p < 0.05). The between-group effects and interaction effect in vein maximum velocity and time-mean flow velocity showed significant differences (F = 4.180, p = 0.025; F = 4.010, p = 0.045; and F = 2.928, p = 0.025) at days 2, 3, and 21, respectively. The axillary vein blood flow parameters in the control group were lower than those in the two exercise groups at day 21 (all, p < 0.05). However, no significant differences occurred in the incidence of venous thrombosis and axillary vein blood flow parameters between the two exercise groups. Conclusion Handgrip exercise using an elastic ball daily for three weeks could decrease the incidence of peripherally-inserted central catheter-related venous thrombosis. The method is simple, with no negative consequence reported. Further studies are required to confirm this conclusion and to explore the optimal frequency of handgrip exercise. [ABSTRACT FROM AUTHOR]

Abstract Background In the last decade interdisciplinary teamwork and collaboration are increasingly favoured as strategies to improve healthcare delivery. The need for collaboration is especially evident in acute care medical-surgical wards of hospitals. Doctors, nurses, pharmacists, doctors and other healthcare professionals work in shifts to provide a multiplicity of services to a rapidly changing caseload of patients. Traditionally, pharmacists have been assigned to a ward or wards for which they provided all clinical services. An alternative clinical pharmacy service model which aligns pharmacists with medical teams is being introduced into Australian hospitals. This newer model, teambased pharmacy, is intended to provide better clinical services overall to patients, but the effect on the working relationship between pharmacists and nurses has not been examined. Objective To compare nurses' perceptions of the pharmacist's role, collaboration with and support for nurses for two models of clinical pharmacy: wardbased pharmacy and teambased pharmacy. Design Quantitative and qualitative analysis of survey data from nurses. Settings and participants A total of 90 nurses from five acute-care wards located in two tertiary hospitals in Sydney, Australia participated in the survey. Methods Statistical comparison of quantitative data from Likert-type questionnaire, and qualitative thematic analysis of nurses' written responses to an open-ended question. Results The qualitative data analysis indicated that the team-based pharmacy clinical service model, resulted in a perceived increase in nursing workload and a decreased collaboration with pharmacists. These findings were corroborated by the quantitative data analysis findings of statistically significant perceived reductions in collaboration. Conclusions Efforts to align pharmacists with medical teams by replacing the traditional ward-based pharmacy model with an alternative model resulted in a perceived reduction in collaboration with and support for nursing teams. Evaluation of the impact of new pharmacy service models should involve all health professionals contributing to the safe and effective use of medicines. Intervention is recommended to provide resources to satisfy nurses' needs for information and education about medication for hospitals that operate team-based clinical pharmacy services. [ABSTRACT FROM AUTHOR]

Abstract Background People typically seek primary health care for daytime symptoms and impairments they experience in association with their insomnia. However, few studies address the question of whether insomnia treatment can improve such symptomatology. Objectives To investigate whether a nurse-led group treatment program, based on the techniques of cognitive behavioral therapy for insomnia (CBT-I), improved daytime symptomatology in primary care patients with insomnia. Outcomes Fatigue (Fatigue Severity Scale [FSS]; main outcome), mood (General Health Questionnaire and Montgomery-Asberg Depression Rating Scale), health-related quality of life (Short-Form Health Survey), general daytime functioning, specific daytime symptoms (individual items from the Insomnia Severity Index and Uppsala Sleep Inventory), and dysfunctional beliefs (Dysfunctional Beliefs and Attitudes about Sleep). Design A randomized controlled trial including baseline and post-treatment assessment and a 1-year post-treatment follow-up of the intervention group. Settings Seven primary health care centers (Stockholm, Sweden). Participants One hundred and sixty-five primary care patients who meet the criteria for insomnia disorder (mean age 54 years, SD 16). Most were women (73%). Exclusion criteria: severe untreated illness, bipolar disorder, current stressful life event, night shift work, and untreated sleep disorder other than insomnia. Methods Data came from a randomized controlled trial of a 10-week nurse-led group treatment for insomnia based on CBT-I (n = 90). The control condition was treatment as usual (n = 75). In accordance with intention-to-treat principles, analyses included data on patients who completed baseline assessments (intervention n = 82, and control group n = 71; post-treatment dropout rate 20%). Fifty-four patients were included in the 1-year follow-up. Results Fatigue severity improved significantly more (p < 0.001) in the intervention than in the control group (intervention, total FSS score 37.2 [SD 11.9] to 31.0 [SD 13.4] vs. control 35.9 [SD 12.1] to 35.7 [SD 12.8]). This was true also for measurements on mood (psychological distress and depressive symptoms), health-related quality of life (mental functioning), general daytime functioning, specific daytime symptoms (worry about sleep, sleepiness, bodily tiredness, and difficulty concentrating) and dysfunctional beliefs. All improvements were maintained one year after group treatment. Conclusions Many aspects of the daytime symptomatology of insomnia were improved via nurse-led group treatment based on CBT-I in primary health care. [ABSTRACT FROM AUTHOR]

Abstract Background Collaboration among healthcare providers has been considered a promising strategy for improving care quality and patient outcomes. Despite mounting evidence demonstrating the impact of collaboration on outcomes of healthcare providers, there is little empirical evidence on the relationship between collaboration and patient safety outcomes, particularly at the patient care unit level. Objectives The purpose of this study is to identify the extent to which interdisciplinary collaboration between nurses and physicians and intradisciplinary collaboration among nurses on patient care units are associated with patient safety outcomes. Methods This is a cross-sectional study using nurse survey data and patient safety indicators data from U.S. acute care hospital units. Collaboration at the unit level was measured by two 6-item scales: nurse-nurse interaction scale and nurse-physician interaction scale. Patient outcome measures included hospital-acquired pressure ulcers (HAPUs) and patient falls. The unit of analysis was the patient care unit, and the final sample included 900 units of 5 adult unit types in 160 hospitals in the U.S. Multilevel logistic and Poisson regressions were used to estimate the relationship between collaboration and patient outcomes. All models were controlled for hospital and unit characteristics, and clustering of units within hospitals was considered. Results On average, units had 26 patients with HAPUs per 1000 patients and 3 patient falls per 1000 patient days. Critical care units had the highest HAPU rate (50/1000 patients) and the lowest fall rate (1/1000 patient days). A one-unit increase in the nurse-nurse interaction scale score led to 31% decrease in the odds of having a HAPU (OR, 0.69; 95% CI, 0.56–0.82) and 8% lower patient fall rate (IRR, 0.92; 95% CI, 0.87–0.98) on a nursing unit. A one-unit increase in the nurse-physician interaction scale score was associated with 19% decrease in the odds of having a HAPU (OR, 0.81; 95% CI, 0.68–0.97) and 13% lower fall rates (IRR, 0.87; 95% CI, 0.82–0.93) on a unit. Conclusions Both nurse-physician collaboration and nurse-nurse collaboration were significantly associated with patient safety outcomes. Findings from this study suggest that improving collaboration among healthcare providers should be considered as an important strategy for promoting patient safety and both interdisciplinary and intradisciplinary collaboration are critical for achieving better patient outcomes. [ABSTRACT FROM AUTHOR]

Background Nurses play an important role in medical and health services but anxiety among those in this profession is widespread. Anxiety not only damages the physical and mental health of the individual, but also reduces the efficiency of their work and the quality of care, ultimately impacting on patient care. Therefore, it is necessary to elucidate the factors that lead to anxiety and explore measures to reduce the impact these factors have on nurses. Objective The purpose of this study was to investigate the serial-multiple mediation of psychological capital (PsyCap), organizational commitment, job burnout, and anxiety among Chinese female nurses. Design A cross-sectional stratified cluster sampling study. Participants The study consisted of 1354 Chinese female nurses from two tertiary grade A hospitals in Heilongjiang Province, China. Methods The Zung Self-Rating Anxiety Scale, the Chinese psychological capital questionnaire, the Chinese Maslach Burnout Inventory, and the Chinese Employee Organizational Commitment Questionnaire were used to gather data. Descriptive analysis, independent-samples T -test, one-way analysis of variance, Spearman correlation analyses, ordinary least-squares regression and the bootstrap method were used to analyze data. Results The prevalence rate of anxiety among nurses was found to be 41.1%, and there were significant differences in anxiety symptoms in age (F = 15.54, p < 0.001) and marital status (F = 5.41, p < 0.001), but not education (F = 1.50, p = 0.224) among nurses. Overall, the serial-multiple mediation of organizational commitment and job burnout in the relationship between PsyCap and anxiety was found to be statistically significant. Conclusions The results of the present study showed that positive PsyCap was sequentially associated with increased organizational commitment first, and then decreased job burnout, which was in turn related to reduced symptoms of anxiety among female nurses. [ABSTRACT FROM AUTHOR]

Background Accurate diagnosis for Arabic speaking critically ill patients suffering from delirium is limited by the need for a valid/reliable translation of a standardized delirium instrument such as the Confusion Assessment Method for the ICU (CAM-ICU). Objective To determine the validity and reliability of the Arabic version of the CAM-ICU. Design A prospective cohort study design was used to conduct the current study. Settings Data collection took place in Geriatric, Emergency and Surgical intensive care units. Participants Fifty-eight adult patients met the inclusion criteria and participated in the study. Among the participants 22(38%) patients were on mechanical ventilation. Methods After translating the CAM-ICU into Arabic language, the Arabic CAM-ICU was administered by two well-trained critical care nurses and compared with reference standard assessments by delirium experts using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM -IV-TR), along with assessment of severity of illness using Sequential Organ Failure Assessment (SOFA). Concurrent validity was assessed by calculating sensitivity, specificity and positive and negative predictive value (PPV and NPV) for the two Arabic CAM-ICU raters, where calculations were based on considering the DSM-IV-TR criterion as the reference standard. The convergent validity of the Arabic CAM-ICU was explored by comparing the Arabic CAM-ICU ratings and the total score of SOFA (severity of illness) and MMSE (cognitive impairment). Results A total of 58 ICU patients were included, of whom 27 (47%) were diagnosed with delirium during their ICU stay via DSM-IV criteria. Interrater reliability for the Arabic CAM-ICU, overall and for mechanically ventilated patients assessed using Cohen's kappa (κ) were 0.82 and 1, respectively, p < 0.001. The sensitivities (95% CI) for the two critical care nurses when using the Arabic CAM-ICU compared with the reference standard were 81% (60%–93%) and 85% (65%–95%), respectively, whereas specificity (95% CI) was 81%(62%–92%) for both nurses. High sensitivity and specificity measures were also observed across subgroups; 100% for mechanically ventilated patients, 88% (60%–98%) and 79% (49%–94%) for those aged 65 years or older and 82% (56%–95%) and 75% (43%–93%) for those with SOFA scores at or above the median value. Conclusions The Arabic CAM-ICU appeared to be valid and reliable tool for diagnosing delirium. Future investigations may lead to a better understanding of the prevalence, predictors, and consequences of delirium among critically ill Arabic speaking patients. [ABSTRACT FROM AUTHOR]

Background While assessment made by nurses of themselves (self-assessment) and assessment made of them by others (other-assessment) provide unique and valuable information as to individual nurses’ competence, the subjective nature of both assessments often causes a disagreement between them. This is problematic when educational interventions to foster nurses’ competence are designed. However, the question of what factors contribute to the self-other disagreement in competence assessment has rarely been investigated in nursing. Objectives The aims of this study were to compare competence assessments made by nurses with that by others, and to investigate what types of demographic variables of nurses and others, and which personality traits of nurses were associated with the self-other agreement/disagreement in the competence assessment. Design A cross-sectional survey design. Settings Three hospitals in Japan. Participants A total of 1167 registered nurses, who were practising in these three hospitals, were invited to participate in the study. The inclusion criteria of the participants were as follows: 1) currently working in an inpatient department, and 2) directly involved in patient care. Methods The survey package included two sets of questionnaires: one for self-assessment and the other for other-assessment, each of which was accompanied by an ID number for matching. Collected data were analysed using a Wilcoxon signed-rank test to compare the scores on competence assessed by nurses and others, and using multiple regression to examine the relationships between the demographics, personality traits, and the degree of self-other disagreement. Results A total of 207 matched questionnaires were obtained. The results showed that the scores on the assessment made by others were statistically significantly higher than those made by nurses of themselves. Moreover, regression analysis suggested that the age of nurses (i.e., younger nurses) and that of others (i.e., older evaluators), and nurses’ personality traits of conscientiousness and extraversion were statistically significantly related to the agreement in self-other competence assessment. Conclusions Nurse managers need to understand which factors contribute to self-other disagreement in competence assessment, and to identify a way to precipitate mutual agreement between them. By doing so, both nurses and managers can comprehend nurses’ own strengths and weaknesses, and can determine educational needs and goals regarding nurses’ competence development. [ABSTRACT FROM AUTHOR]

Background Vaccination has been proven the most effective method to prevent seasonal influenza. Nurses’ vaccination can provide protection against influenza not only for themselves but also for patients they take care of. However, vaccination coverage of nurses is suboptimal worldwide, especially in China. The influencing factors need to be explored so as to develop specific, workable strategies to improve nurses’ vaccination behaviour. Objectives To explore predictors of their vaccination behaviour, identify the motivators and barriers of vaccination, and provide implications for future interventions. Design A cross-sectional convenience sampling questionnaire survey. Settings Nine hospitals including five tertiary hospitals, two secondary hospitals, and two primary hospitals in Shanghai, China. Participants A total of 1000 nurses from the nine hospitals were invited to participate in this survey. Among them, 921 nurses responded and 895 returned valid questionnaires that were used in data analysis. Methods The Chinese version of the King’s Nurses’ Influenza Vaccination Questionnaire was used as the survey instrument and distributed to the participants during February-November 2012. Descriptive statistics, univariate analyses, and multivariate analyses were conducted to explore the predictors of nurses’ vaccination behaviour. Results Overall, 8.8% of the respondents received seasonal influenza vaccination in the past influenza season (2011/2012 season). Nurses had averagely received 0.38 ± 0.71 influenza vaccines during the past five influenza seasons (2007/2008 to 2011/2012 season). Predictors of nurses’ vaccination status were clinical specialty, knowledge about influenza vaccination [1.331 (1.102, 1.608), p  = 0.003], internal health locus of control [0.910 (0.845, 0.980), p  = 0.013], chance health locus of control [1.075 (1.023, 1.130), p  = 0.004]and powerful others health of locus control [1.166 (1.083, 1.255), p <  0.001]. Predictors of their vaccination times were hospital level, clinical specialty, and knowledge about influenza vaccination [1.458 (1.242, 1.711), p  < 0.001]. Self-protection was the most common cited reason for getting vaccinated, and “no need” was cited as the most common refusal reason. Conclusions This is the first well-designed study conducted in mainland China to explore nurses’ vaccination behaviour against seasonal influenza. Vaccination coverage in this population was suboptimal. Mandatory vaccination policy should be implemented and attempts of multi-faceted interventions including specific education might also be needed. [ABSTRACT FROM AUTHOR]

Background postpartum haemorrhage is one of the leading causes of maternal morbidity and mortality worldwide. Despite the use of uterotonics agents as preventive measure, it remains a challenge to identify those women who are at increased risk of postpartum bleeding. Objective to develop and to validate a predictive model to assess the risk of excessive bleeding in women with vaginal birth. Design retrospective cohorts study. Setting “Mancha-Centro Hospital” (Spain). Participants the elaboration of the predictive model was based on a derivation cohort consisting of 2336 women between 2009 and 2011. For validation purposes, a prospective cohort of 953 women between 2013 and 2014 were employed. Women with antenatal fetal demise, multiple pregnancies and gestations under 35 weeks were excluded Methods we used a multivariate analysis with binary logistic regression, Ridge Regression and areas under the Receiver Operating Characteristic curves to determine the predictive ability of the proposed model. Results there was 197 (8.43%) women with excessive bleeding in the derivation cohort and 63 (6.61%) women in the validation cohort. Predictive factors in the final model were: maternal age, primiparity, duration of the first and second stages of labour, neonatal birth weight and antepartum haemoglobin levels. Accordingly, the predictive ability of this model in the derivation cohort was 0.90 (95% CI: 0.85–0.93), while it remained 0.83 (95% CI: 0.74–0.92) in the validation cohort. Conclusions this predictive model is proved to have an excellent predictive ability in the derivation cohort, and its validation in a latter population equally shows a good ability for prediction. This model can be employed to identify women with a higher risk of postpartum haemorrhage. [ABSTRACT FROM AUTHOR]

Background Because not every scientific question on effectiveness can be answered with randomised controlled trials, research methods that minimise bias in observational studies are required. Two major concerns influence the internal validity of effect estimates: selection bias and clustering. Hence, to reduce the bias of the effect estimates, more sophisticated statistical methods are needed. Aim To introduce statistical approaches such as propensity score matching and mixed models into representative real-world analysis and to conduct the implementation in statistical software R to reproduce the results. Additionally, the implementation in R is presented to allow the results to be reproduced. Method We perform a two-level analytic strategy to address the problems of bias and clustering: (i) generalised models with different abilities to adjust for dependencies are used to analyse binary data and (ii) the genetic matching and covariate adjustment methods are used to adjust for selection bias. Hence, we analyse the data from two population samples, the sample produced by the matching method and the full sample. Results The different analysis methods in this article present different results but still point in the same direction. In our example, the estimate of the probability of receiving a case conference is higher in the treatment group than in the control group. Both strategies, genetic matching and covariate adjustment, have their limitations but complement each other to provide the whole picture. Conclusion The statistical approaches were feasible for reducing bias but were nevertheless limited by the sample used. For each study and obtained sample, the pros and cons of the different methods have to be weighted. [ABSTRACT FROM AUTHOR]

Early warning scores based on vital signs are used in hospitals to estimate patient deterioration and to initiate an adequate and timely response when necessary. These scores show acceptable performance in predicting patient outcomes. However, they tend to generate many false positives leading to an increased workload in clinical practice. Additionally, nurses feel a tension between the application of an early warning score and their own clinical judgement. Nurse intuition is often included as an extra call criterion next to an early warning score. It is therefore important to investigate its predictive value. The aim of this study was to develop and validate a Nurse Intuition Patient Deterioration Scale (NIPDS). The NIPDS was developed using the latest evidence after which relevant items were selected by an expert panel. The scale was tested in a prospective observational study in 2 surgical and 2 medical wards in a Belgian hospital. Data were collected from December 1st, 2019 until March 31st, 2020. A NIPDS registration was done at each patient admission and whenever the attending nurse felt worried. The studied outcomes were urgent physician assistance call, resuscitation team call, patient death, and unplanned transfer to intensive/medium care. Psychometric analyses and scale optimisation were carried out using Rasch modelling techniques. Finally, the scale's accuracy and an optimal threshold were determined. The scale item content validity index is 0.88 indicating that the selected items should be included in the instrument according to the expert panel. Item-total score correlation coefficients range between 0.573 (item 9 – pain) and 0.874 (item 6 – behaviour). The Person Separation Index is 0.814 indicating satisfactory discriminatory power. An overall fit of the NIPDS data to the Rasch model was confirmed. Rasch modelling showed that the item 'pain' signalled misfit. Furthermore, the person-item map showed disordered items which were corrected in the final model. The AUROC to predict an event within 24 h after registration was 0.957 (95% CI 0.932–0.982; p < 0.001) indicating excellent model performance. The results showed that the NIPDS is a valid and accurate instrument to predict events in surgical and medical patients. It showed better performance compared to an existing score estimating nurse intuition. In practice, the NIPDS could be used by nurses to estimate clinical deterioration in addition to an early warning score. It remains unclear if the combination of NIPDS with an early warning score could reduce workload without losing accuracy and this should be explored in future research. Newly developed nurse intuition scale, which uses clinical cues to estimate deterioration in hospitalised patients, is brief and performs well in predicting physician assistance, resuscitation team calls, patient death and unplanned transfer to intensive or medium care. [ABSTRACT FROM AUTHOR]

The use of midline catheters (MCs) in intravenous therapy has increased over the last few years; however, scientific evidence is scarce. The recommendations for its specific tip position and safe use in antimicrobial therapy are not well established, which increases the risk of catheter-related complications. This study aimed to provide evidence for selecting MC tip positions for safe use in antimicrobial therapy. This prospective, randomized controlled trial compared catheter-related complications with different tip positions. Participants were assigned to three different catheter tip groups, and the relationship between the tip position and catheter-related complications was observed during antimicrobial therapy. Multicenter trial based in intravenous therapy centers at six Chinese hospitals. A fixed-point continuous convenience sampling method was used to enroll 330 participants. Three different study groups with equal numbers of participants (n = 110) were established using a randomization technique. The incidence of catheter-related complications and catheter retention time was compared among the three groups. The catheter measurement data between the three groups were compared using one-way ANOVA or the Kruskal-Wallis tests. Counting data were compared using chi-square tests, Fisher's exact tests, and Kruskal-Wallis tests. Post-hoc tests were conducted to compare the incidence of complications among the three groups. We followed a time-to-event analysis approach and used Kaplan–Meier curves and log-rank tests to analyze the relationship between catheter-related complications and different tip positions. The total incidence of catheter-related complications in Experimental Groups 1 and 2 as well as the control group were 10.09%, 17.98%, and 33.73%, respectively. Statistically significant differences existed between the groups (p < 0.0001). In pairwise comparisons of the three groups, significant differences were evident in the incidence of complications between Experimental Group 1 and the control group (RD 19.40%, confidence interval 7.71–31.09). No statistical significance in the incidence of complications between Experimental Group 1 and Experiment Group 2 (RD − 4.93%, confidence interval − 14.80–4.95) and in the incidence of complications between Experimental Group 2 and the control group (RD 14.47%, confidence interval 1.82–27.12) were noted. Catheter-related complications were reduced when the tip of the Midline Catheter was located in the subclavian or axillary vein of the chest wall. NCT04601597 (https://clinicaltrials.gov/ct2/show/NCT04601597). Registration date: September 1, 2020. [ABSTRACT FROM AUTHOR]

Background Errors in infection control practices risk patient safety. The probability for errors can increase when care practices become more multifaceted. It is therefore fundamental to track risk behaviours and potential errors in various care situations. Objective The aim of this study was to describe care situations involving risk behaviours for organism transmission that could lead to subsequent healthcare-associated infections. Design & setting Unstructured nonparticipant observations were performed at three medical wards. Participants & methods Healthcare personnel (n = 27) were shadowed, in total 39 h, on randomly selected weekdays between 7:30 am and 12 noon. Content analysis was used to inductively categorize activities into tasks and based on the character into groups. Risk behaviours for organism transmission were deductively classified into types of errors. Multiple response crosstabs procedure was used to visualize the number and proportion of errors in tasks. One-Way ANOVA with Bonferroni post Hoc test was used to determine differences among the three groups of activities. Results The qualitative findings gives an understanding of that risk behaviours for organism transmission goes beyond the five moments of hand hygiene and also includes the handling and placement of materials and equipment. The tasks with the highest percentage of errors were; ‘personal hygiene’, ‘elimination’ and ‘dressing/wound care’. The most common types of errors in all identified tasks were; ‘hand disinfection’, ‘glove usage’, and ‘placement of materials’. Significantly more errors (p<0.0001) were observed the more multifaceted (single, combined or interrupted) the activity was. Conclusion The numbers and types of errors as well as the character of activities performed in care situations described in this study confirm the need to improve current infection control practices. It is fundamental that healthcare personnel practice good hand hygiene however effective preventive hygiene is complex in healthcare activities due to the multifaceted care situations, especially when activities are interrupted. A deeper understanding of infection control practices that goes beyond the sense of security by means of hand disinfection and use of gloves is needed as materials and surfaces in the care environment might be contaminated and thus pose a risk for organism transmission. [ABSTRACT FROM AUTHOR]

Background The development of child behaviour and parenting difficulties is understood to undermine treatment outcomes for children with atopic dermatitis. Past research has reported on correlates of child behaviour difficulties. However, few research studies have sought to examine parenting confidence and practices in this clinical group. Objectives To examine relationships between child, parent, and family variables, parent-reported and directly-observed child and parent behaviour, parents’ self-efficacy with managing difficult child behaviour, self-reported parenting strategies, and disease severity. Design Cross-sectional study design. Participants Parent-child dyads ( N = 64) were recruited from the dermatology clinic of a paediatric tertiary referral hospital in Brisbane, Australia. Children had a diagnosis of atopic dermatitis of ≥3 months and no other chronic health conditions except asthma, allergic rhinitis, or allergy. Methods Parents completed self-report measures assessing child behaviour; parent depression, anxiety, and stress; parenting conflict and relationship satisfaction; self-efficacy with managing difficult child behaviour, and use of ineffective parenting strategies; and self-efficacy for managing atopic dermatitis, and performance of atopic dermatitis management tasks. The Scoring Atopic Dermatitis index was used to assess disease severity. Routine at-home treatment sessions were coded for parent and child behaviour. Results Pearson’s and Spearman’s correlations identified relationships ( p < 0.05) between self-efficacy with managing difficult child behaviour and child behaviour problems, parent depression and stress, parenting conflict and relationship satisfaction, and household income. There were also relationships between each of these variables and use of ineffective parenting strategies. Greater use of ineffective parenting strategies was associated with more severe atopic dermatitis. Using multiple linear regressions, child behaviour and household income explained unique variance in self-efficacy for managing difficult child behaviour; household income alone explained unique variance in use of ineffective parenting strategies. Self-efficacy for managing difficult child behaviour and self-efficacy for managing atopic dermatitis were positively correlated (rho = 0.48, p < 0.001), and more successful self-reported performance of atopic dermatitis management tasks correlated with less permissive ( r = 0.35, p = 0.005) and less authoritarian ( r = 0.41, p = 0.001) parenting. Directly observed aversive child behaviour was associated with more severe atopic dermatitis, parent stress, and parent-reported child behaviour problems. Conclusion This study revealed relationships between parents’ self-efficacy and parenting practices across the domains of child behaviour management and atopic dermatitis management. Parents of children with more severe atopic dermatitis may have difficulty responding to child behaviour difficulties appropriately, potentially impacting on illness management. Incorporating parent and parenting support within treatment plans may improve not only child and family wellbeing, but also treatment outcomes. [ABSTRACT FROM AUTHOR]

Background As newcomers to the clinical workplace, nursing students will encounter a high degree of role stress, which is an important predictor of burnout and engagement. Professional identity is theorised to be a key factor in providing high-quality care to improve patient outcomes and is thought to mediate the negative effects of a high-stress workplace and improve clinical performance and job retention. Objectives To investigate the level of nursing students' professional identity and role stress at the end of the first sub-internship, and to explore the impact of the nursing students' professional identity and other characteristics on role stress. Design A cross-sectional study. Settings Three nursing schools in China. Participants Nursing students after a 6-month sub-internship in a general hospital (n = 474). Methods The Role Stress Scale (score range: 12–60) and the Professional Identity Questionnaire for Nursing students (score range: 17–85) were used to investigate the levels of nursing students' role stress and professional identity. Higher scores indicated higher levels of role stress and professional identity. Basic demographic information about the nursing students was collected. The Pearson correlation, point-biserial correlation and multiple linear regression analysis were used to analyse the data. Results The mean total scores of the Role Stress Scale and Professional Identity Questionnaire for Nursing Students were 34.04 (SD = 6.57) and 57.63 (SD = 9.63), respectively. In the bivariate analyses, the following independent variables were found to be significantly associated with the total score of the Role Stress Scale: the total score of the Professional Identity Questionnaire for Nursing Students (r = −0.295, p < 0.01), age (r = 0.145, p < 0.01), whether student was an only child or not (r = −0.114, p < 0.05), education level (r = 0.295, p < 0.01) and whether student had experience in community organisations or not (r = 0.151, p < 0.01). In the multiple linear regression analysis, the total score of the Professional Identity Questionnaire for Nursing Students (standardised coefficient Beta: −0.260, p < 0.001), education level (standardised coefficient Beta: 0.212, p < 0.001) and whether or not student had experience in community organisations (standardised coefficient Beta: 0.107, p < 0.016) were the factors significantly associated with the total score of the Role Stress Scale. The multiple linear regression model explained 18.2% (adjusted R 2 scores 16.5%) of the Role Stress Scale scores variance. Conclusions The nursing students’ level of role stress at the end of the first sub-internship was high. The students with higher professional identity values had lower role stress levels. Compared with other personal characteristics, professional identity and education level had the strongest impact on the nursing students’ level of role stress. This is a new perspective that shows that developing and improving professional identity may prove helpful for nursing students in managing role stress. [ABSTRACT FROM AUTHOR]

Dry skin is a common skin problem in older persons. Aim of this study was to determine the prevalence, associated factors of dry skin in older inpatients. A multicenter cross-sectional study was designed and conducted. On 31 March and 29 May in 2021 two days, fifty hospitals and two nursing homes in China participated in the study. In total, 33,769 participants were included. The mean age was 73.2 (SD 8.9) years. A whole-body skin examination and associated data collection were performed by 1067 trained nurses based on a standardized data form and methods. Descriptive and univariable analyses and multivariable logistic regressions were conducted. In total, 11,602 participants had dry skin with a prevalence of 34.4%, mainly located on the upper and lower limbs with very severe skin dryness, 21.2% of the participants reported that their dry skin had pruritus, and 12.5% complained that sleep was affected by dry skin. The stronger predictor for dry skin was nursing homes (OR 5.07, 95% CI 3.99–6.45). Other predictors for dry skin were age, male sex, nutrition, lower activity level, skincare dependence, renal and pulmonary impairment, diabetes mellitus, varicose veins, cardiovascular diseases and Parkinsonism, diuretics, statins and antibiotics. The predictive model of area under ROC curve was 0.628(95% CI 0.622–0.634). The prevalence of dry skin among Chinese older patients was at high level and was associated with multiple factors. Persons with skin dryness have a higher proportion of skin itching and poor sleep. It has been registered in the Chinese Clinical Trial Registry (ChiCTR2100042893). [ABSTRACT FROM AUTHOR]

Background Semi-recumbent position is recommended to prevent ventilator-associated pneumonia. Its implementation, however, is below optimal. Objectives We aimed to assess real semi-recumbent position compliance and the degree of head-of-bed elevation in Spanish intensive care units, along with factors determining compliance and head-of-bed elevation and their relationship with the development of pressure ulcers. Finally, we investigated the impact that might have the diagnosis of pressure ulcers in the attitude toward head-of-bed elevation. Methods We performed a prospective, multicenter, observational study in 6 intensive care units. Inclusion criteria were patients ≥18 years old and expected to remain under mechanical ventilator for ≥48 h. Exclusion criteria were patients with contraindications for semi-recumbent position from admission, mechanical ventilation during the previous 7 days and prehospital intubation. Head-of-bed elevation was measured 3 times/day for a maximum of 28 days using the BOSCH GLM80 ® device. The variables collected related to patient admission, risk of pressure ulcers and the measurements themselves. Bivariate and multivariate analyses were carried out using multiple binary logistic regression and linear regression as appropriate. Statistical significance was set at p < 0.05. All analyses were performed with IBM SPSS for Windows Version 20.0. Results 276 patients were included (6894 measurements). 45.9% of the measurements were <30.0°. The mean head-of-bed elevation was 30.1 (SD 6.7)° and mean patient compliance was 53.6 (SD 26.1)%. The main reasons for non-compliance according to the staff nurses were those related to the patient's care followed by clinical reasons. The factors independently related to semi-recumbent position compliance were intensive care unit, ventilation mode, nurse belonging to the research team, intracranial pressure catheter, beds with head-of-bed elevation device, type of pathology, lateral position, renal replacement therapy, nursing shift, open abdomen, abdominal vacuum therapy and agitation. Twenty-five patients (9.1%) developed a total of 34 pressure ulcers. The diagnosis of pressure ulcers did not affect the head-of-bed elevation. In the multivariate analysis, head-of-bed elevation was not identified as an independent risk factor for pressure ulcers. Conclusions Semi-recumbent position compliance is below optimal despite the fact that it seems achievable most of the time. Factors that affect semi-recumbent position include the particular intensive care unit, abdominal conditions, renal replacement therapy, agitation and bed type. Head-of-bed elevation was not related to the risk of pressure ulcers. Efforts should be made to clarify semi-recumbent position contraindications and further analysis of its safety profile should be carried out. [ABSTRACT FROM AUTHOR]

Background Joint contractures are frequent conditions in individuals in geriatric care settings and are associated with activity limitations and participation restrictions. As such, relevant intervention programs should address these aspects, and the effectiveness of such programs should be determined by assessing improvement in activities and participation. However, no patient-centred and psychometrically sound outcome measures for this purpose are available so far. Objectives The objectives of this study were to develop and to validate a new outcome measure, the PaArticular Scales, to quantify activities and participation in older individuals with joint contractures. Specific aims were (A) to operationalize the content of an International Classification of Functioning, Disability and Health-based standard set towards meaningful questions and to combine them to a questionnaire and (B) to assess the psychometric properties of the developed questionnaire, in detail to evaluate test–retest reliability, objectivity, internal consistency reliability and criterion validity. Design Operationalization was reached by an expert consensus conference and a subsequent expert Delphi survey. Psychometric properties were assessed in a cross-sectional study. Settings Nursing homes, geriatric rehabilitation facilities. Participants 23 experts (nurses, physicians, physical and occupational therapists) participated in the consensus conference and the Delphi survey. A total of 191 individuals with joint contractures (as confirmed by physician, nurse or physical therapist) between 65 and 102 years, living in nursing homes or as patients in geriatric rehabilitation were enrolled in the cross-sectional study. Methods Rasch Partial Credit Modelling. Results The consensus conference and Delphi survey resulted in a questionnaire with 86 items of the International Classification of Functioning, Disability and Health. Test–retest-reliability among those was acceptable (Cohen's weighted kappa: 0.779). The Rasch analysis revealed two independent interval-scaled scales with 24 items for the Activities scale and 11 items for the Participation scale with high internal consistency reliability. Cronbach's alpha was 0.96 for the Activities scale and 0.92 for the Participation scale. Criterion validity was −0.40 and −0.30 for the Activities scale and for the Participation scale, respectively. Conclusions The PaArticular Scales, a new patient-centred and psychometric sound outcome measures to comprehensively assess the impact of joint contractures in geriatric care, are available now. These developed scales will serve as primary outcomes in a scheduled evaluation of a complex intervention to improve participation and quality of life in nursing home residents with joint contractures. [ABSTRACT FROM AUTHOR]