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open access article Aims To discuss how Husserl's descriptive phenomenology, as a philosophy and approach, has been used and reported in researching the experiences of others, using the topic of foreign-trained nurses. Design Discussion paper. Data sources A systematic search of MEDLINE (PubMed), CINAHL, SCOPUS, British Nursing Database and PsycInfo was carried out in December 2021. The inclusion criteria were peer-reviewed phenomenological research articles, grounded by Husserl's philosophy, conducted among foreign-trained nurses and published in English from 2000 to 2021. Findings Two main themes were the outcome of critically reviewing relevant selected literature, ‘referring to the original philosophy is not enough’ and ‘phenomenological findings need to be phenomenological’. These findings confirm some arguments about nurse researchers' discrepant use of phenomenology in their studies, including the proper application of phenomenological notions on the ground. Implication for Nursing Nurse researchers need to clearly distinguish between phenomenology and other qualitative research approaches and consider the uniqueness of philosophical underpinnings that are essential in Husserl's phenomenology, which also need to be clearly applied and reflected in their studies. Conclusion There are continually existing discrepancies and variations in using phenomenology by nurse researchers. These variations were uniquely evident when nurse researchers could not provide enough philosophical grounds and assumptions to their studies and underestimated the need to keep up with the various applications of Husserl's phenomenological notions, including the proper practice of phenomenological attitude. Therefore, it is recommended that nurse researchers should opt for different, less complex qualitative approaches if they do not adequately prepare and understand what constitutes phenomenology and the particulars of Husserl's philosophy.

AIM To present the first iteration of the caring life-course theory. BACKGROUND Despite requiring care from birth to death, a person's universal or fundamental care needs and the subsequent care provision, either by self or others, has yet to be presented within a life-course perspective. Accurately describing the care people require across their lifespan enables us to identify who, what type, how and where this care should be provided. This novel perspective can help to legitimise a person's care needs and the support they require from wider care systems and contexts. DESIGN Discussion paper outlines theory development. We adopted an inductive approach to theory development, drawing upon existing literature and the team's diverse experiences. Our theoretical insights were refined through a series of collaborative meetings to define the theory's constructs, until theoretical saturation was reached. DISCUSSION Fourteen constructs are identified as essential to the theory. We propose it is possible, using these constructs, to generate caring life-course trajectories and predict divergences in these trajectories. The novel contribution of the theory is the interplay between understanding a person's care needs and provision within the context of their lifespan and personal histories, termed their care biography, and understanding a person's care needs and provision at specific points in time within a given care network and socio-political context. IMPACT FOR NURSING The caring life-course theory can provide a roadmap to inform nursing and other care industry sectors, providing opportunities to integrate and deliver care from the perspective of the person and their care history, trajectories and networks, with those of professional care teams. It can help to shape health, social and economic policy and involve individuals, families and communities in more constructive ways of talking about the importance of care for improved quality of life and healthy societies.

With 'fake news' virulently disseminated on the internet, we should all be on the lookout for misleading or false information. In nursing, the doctrine of evidence-based practice depends on the quality of evidence, and research findings or theoretical argument should not be accepted uncritically, just because they appear in trusted journals. I raise this following an embarrassing hoax in the field of gender studies (Boghossian & Lindsay, 2017). This article is protected by copyright. All rights reserved.

AIMS A discussion of methodological issues and social media recruitment to a feasibility study to investigate mHealth resources for asthma and pregnancy care. BACKGROUND Pregnant women with asthma are reported to be poorly supported according to an international research. We sought to establish if a mHealth intervention might be feasible and acceptable to them. DESIGN A Phase I or modelling study. METHODS A project team designed an intervention to address UK national guidelines for the management of asthma during pregnancy, using other resources already accessible on the web. This was made available on a project website optimized for mobile phone usage. Links were Tweeted and advertised on Facebook, asking participants to access the project website, which included links to the resources and before- and after-use questionnaires to establish baseline symptom data and participant views of the resources. RESULTS Despite 55,700 Twitter impressions in a 76-day period over winter 2016-2017, this recruitment strategy garnered 402 engagements but only seven respondents for questionnaire 1 and zero respondents for questionnaire 2. CONCLUSIONS We could not recruit to this study despite believing that social media recruitment would be effective and we recommend that social media recruitment be used cautiously. Apparently, we did not sufficiently address the theoretical aspects of communications theory and were not clear enough about our key messages. Publication bias may exist about the non-publication of other failed telemedicine studies using social media; this goes largely unreported in some systematic reviews and may influence researchers' decision-making about social media recruitment.

Aim. To discuss the actual public image of nurses and other factors that influence the development of nurses’ self-concept and professional identity. Background. Nurses have become healthcare professionals in their own right who possess a great deal of knowledge. However, the public does not always value the skills and competences nurses have acquired through education and innovation. Design. Discussion paper. Data sources. We identified 1216 relevant studies by searching MEDLINE, CINAHL and PsycINFO databases in the period 1997–2010. Finally, 18 studies met our inclusion criteria. Discussion. The included studies show that the actual public image of nursing is diverse and incongruous. This image is partly self-created by nurses due to their invisibility and their lack of public discourse. Nurses derive their self-concept and professional identity from their public image, work environment, work values, education and traditional social and cultural values. Implications for nursing. Nurses should work harder to communicate their professionalism to the public. Social media like the Internet and YouTube can be used to show the public what they really do. Conclusion. To improve their public image and to obtain a stronger position in healthcare organizations, nurses need to increase their visibility. This could be realized by ongoing education and a challenging work environment that encourages nurses to stand up for themselves. Furthermore, nurses should make better use of strategic positions, such as case manager, nurse educator or clinical nurse specialist and use their professionalism to show the public what their work really entails. doi: 10.1111/jan.12177

This action research study was undertaken to address practical concerns over curriculum development in nursing. The applied physiology component of a post-registration nursing diploma was evaluated in terms of its impact on patients rather than on the nurses themselves. The reported data were triangulated, all the findings indicated that patient care could be enhanced when nurses applied their knowledge of physiology to practice. Despite its limitations of scale, this study contributes to the curriculum debate in nurse education.

The aim of this study was the translation, cross-cultural adaptation and validation of the Family Confusion Assessment Method in critically ill patients.Delirium is a frequently unrecognized disorder in critically ill patients. Visiting family members might be the first to notice subtle changes in a patient's cognition and behaviour. The Family Confusion Assessment Method was developed to detect delirium by family members, but has not been available for the German-speaking area yet.A prospective validation study was conducted between January 2020 and October 2020.The Family Confusion Assessment Method was translated into German according to the Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes. Subsequently, we compared the Family Confusion Assessment Method with the Confusion Assessment Method for the Intensive Care Unit in critically ill patients and their family members in a medical intensive care unit in Germany.We included 50 dyads of critically ill patients and their family members. The prevalence of delirium measured by Confusion Assessment Method for the Intensive Care Unit was 44%. Cohen's kappa coefficient was 0.84. The German Family Confusion Assessment Method had a high sensitivity of 95.5% and specificity of 89.3%. The positive predictive value and negative predictive value were 87.5% and 96.2% respectively.These findings suggest that the German Family Confusion Assessment Method is an accurate assessment tool for delirium detection in the intensive care unit by family members. Furthermore, the results indicate that family members may identify delirium by the Family Confusion Assessment Method without prior training.Collaborating medical staff with patients' family members to detect delirium in the intensive care unit may lead to early recognition of delirium.

Aim To describe the experiences of frontline nurses who are working in critical care areas during the COVID‐19 pandemic with a focus on trauma and the use of substances as a coping mechanism. Design A qualitative study based on content analysis. Methods Data were collected from mid‐June 2020 to early September 2020 via an online survey. Nurses were recruited through the research webpage of the American Association of Critical Care Nurses as well as an alumni list from a large, public Midwest university. Responses to two open‐ended items were analysed: (1) personal or professional trauma the nurse had experienced; and (2) substance or alcohol use, or other mental health issues the nurse had experienced or witnessed in other nurses. Results For the item related to psychological trauma five themes were identified from 70 nurses’ comments: (1) Psychological distress in multiple forms; (2) Tsunami of death; (3) Torn between two masters; (4) Betrayal; and (5) Resiliency/posttraumatic growth through self and others. Sixty‐five nurses responded to the second item related to substance use and other mental health issues. Data supported three themes: (1) Mental health crisis NOW!!: ‘more stressed than ever and stretched thinner than ever’; (2) Nurses are turning to a variety of substances to cope; and (3) Weakened supports for coping and increased maladaptive coping due to ongoing pandemic. Conclusions This study brings novel findings to understand the experiences of nurses who care for patients with COVID‐19, including trauma experienced during disasters, the use of substances to cope and the weakening of existing support systems. Findings also reveal nurses in crisis who are in need of mental health services. Impact Support for nurses’ well‐being and mental health should include current and ongoing services offered by the organization and include screening for substance use issues.

Aim To identify factors influencing healthcare professionals’ engagement in health behaviour conversations with patients. Design Cross‐sectional survey. Methods Between April and June 2019, an online survey of 1338 nurses, midwives and healthcare support workers was conducted. The survey assessed whether staff felt comfortable initiating health behaviour conversations with patients about five behaviours (reducing alcohol intake; stop smoking; being more active; reducing their weight; and improving their diet) and barriers to conversation initiation. Health professionals’ own health‐related behaviours, self‐rated health and mental wellbeing, and socio‐demographic characteristics were recorded. Logistic regression models were built to assess factors associated with feeling comfortable initiating health behaviour conversations for each topic. Result Less than 50% of respondents reported feeling comfortable initiating health behaviour conversations with patients. Female staff, young professionals (18 to 29 years), those in lower staff grades and those with poorer health and low mental wellbeing were less likely to report feeling comfortable having health behaviour conversations across all topics. Those who did not adhere to physical activity and dietary guidelines were less likely to initiate a conversation about being more active and having a healthy diet, respectively. Not having time to discuss the topic, suitable space to hold a conversation, and feeling worried about offending/upsetting patients were the main barriers reported. Conclusion Around 6 in 10 members of the nursing, midwifery and healthcare support workforce in Wales potentially do not feel comfortable to initiate a health behaviour conversation with patients about health and wellbeing. Feeling less comfortable to initiate a conversation was associated with staff demographics and organizational factors. Impact We identified those less likely to initiate health behaviour conversations as well as personal and organizational barriers to initiation. This will help to target and tailor interventions to ensure staff are equipped and enabled to hold health behaviour conversations with patients.

To provide: (a) an overview of interventions aimed at improving mental health of student or novice nurses; and (b) an evaluation of their effectiveness on dropout-related outcomes.Systematic review.Research papers published between January 1971-February 2019 were identified from the following databases: Embase, Medline, PsycInfo, CINAHL, ERIC, the Cochrane Library, Web of Science, and Google Scholar.We followed the procedures recommended by the Editorial Board of the Cochrane Collaboration Back Review Group. We included peer-reviewed articles with a quantitative research design, examining interventions aimed at improving mental health of student and novice nurses and their effect on dropout-related outcomes. The large variation in studies prohibited statistical pooling and a synthesis without meta-analysis of studies was performed.We identified 21 studies with three areas of focus: managing stress or stressors (N = 4); facilitating the transition to nursing practice (N = 14); and a combined approach (N = 3). Five studies showed a statistically significant effect on dropout-related outcomes. The overall risk of bias was high.A wide range of interventions are available, but the evidence for their effectiveness is limited. There is a need for high-quality studies in this field, preferably with a randomized controlled design.目的: 提供：（a）旨在改善学生或新手护士心理健康的干预措施概述；（b）评估其对辍学相关结果的有效性。 设计: 系统评估。 数据源: 1971年1月至2019年2月之间发表的研究论文来自以下数据库：Embase、Medline、PsycInfo、CINAHL、ERIC、科克伦图书馆（Cochrane Library），科学网（Web of Science）和谷歌学术（Google Scholar）。 评估方法: 我们遵循了科克伦协作回顾评述小组（Cochrane Collaboration Back Review Group）编辑委员会推荐的程序。我们纳入了具有定量研究设计的同行评审文章，研究了旨在改善学生和新手护士心理健康及其对辍学相关结果影响的干预措施。研究中的巨大差异无法进行统计汇总，采用了无荟萃分析研究的综合。 结果: 我们确定了21个研究，重点关注三个领域：管理压力或压力源（N = 4）；促进向护理实践的过渡（N = 14）；以及组合方法（N = 3）。五项研究表明，与辍学相关的结果在统计上具有显著影响。总体偏倚风险很高。 结论: 干预措施的种类很多，但其有效性的证据有限。这一领域需要高质量的研究，最好采用随机对照设计。.

To provide a comprehensive collection of evidence on the effectiveness of exercise interventions to prevent falls and support clinical decision-making.A systematic literature review and meta-analysis of randomized controlled trails were performed by combining trials from published systematic reviews and more recent ones from a separate literature search.The literature search was performed using PubMed, CINAHL, Cochrane Databases, and Google Scholar dating January 2007 - March 2018.Comparable studies were pooled using the random-effects model. The GRADE approach was used to judge the evidence.Exercises with a balance component or with technical devices reduced falls significantly, however, with low confidence in the evidence. The evidence indicated that exercises conducted longer than 6 months were beneficial. In frail residents, exercise interventions seemed to have substantially negative effects on falls.Exercise interventions with technical devices, those with a balance component, and those performed longer than 6 months are recommended in long-term care settings. Frail residents need special attention when performing exercises due to their increased risk of falling.Exercises with a balance component and exercises carried out with technical devices have beneficial effects, whereas exercises performed longer than 6 months are more effective than short-term performances. No significant reduction or decrease in the number of falls was found for exercise in cognitively impaired residents. In frail residents, however, the number of fall events increased substantially as a result of exercise interventions. The results of this review are useful for clinical decision-makers in long-term care facilities with regard to the planning and performance of exercise interventions for residents.目的: 在于为预防跌倒和促进临床决策的运动干预有效性提供全面的证据收集。 设计: 通过结合已发表系统综述的试验和独立文献检索的近期试验,对随机对照试验进行系统文献综述和荟萃分析。 资料来源: 在PubMed、CINAHL、Cochrane Databases和Google Scholar上搜索了2007年1月至2018年3月的相关文献。 综述方法: 使用了随机效应模型来汇总了可比研究。采用了GRADE方法来判断证据。 结果: 减少使用平衡部件或技术设备的运动明显下降,但是对证据缺乏信心。有证据表明,锻炼时间超过6个月大有裨益。对于虚弱的居民,运动干预似乎对跌倒有很大的负面影响。 结论: 建议在长期护理环境中使用技术设备进行锻炼干预,使用平衡部件进行锻炼干预,以及采用时间超过6个月的锻炼干预。需要特别注意在进行锻炼时的虚弱居民,鉴于他们摔倒的风险与日俱增。 影响: 使用平衡部件的锻炼和使用技术设备进的锻炼同样大有裨益,而超过6个月的锻炼比短期锻炼更为有效。对于认知障碍类居民,没有发现因运动而导致跌倒次数显著减少或降低。然而,对于虚弱的居民,由于运动干预,跌倒事件的数量有所显著上升。本篇综述的结果能有助于长期护理机构的临床决策者规划和实施居民运动干预。.

To assess randomized controlled trials evaluating the impact of nurse practitioner-led cardiovascular care.Systematic review of nurse practitioner-led care in patients with cardiovascular disease has not been completed.Systematic review and meta-analysis.The Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, Web of Science, Scopus and ProQuest were systematically searched for studies published between January 2007 - June 2017.Cochrane methodology was used for risk of bias, data extraction and meta-analysis. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation approach.Out of 605 articles, five articles met the inclusion criteria. There was no statistical difference between nurse practitioner-led care and usual care for 30-day readmissions, health-related quality of life and length of stay. A 12% reduction in Framingham risk score was identified.There are a few randomized control trials assessing nurse practitioner-led cardiovascular care.Low to moderate quality evidence was identified with no statistically significant associated outcomes of care. Nurse practitioner roles need to be supported to conduct and publish high-quality research.目的: 在于评估随机对照试验,从而评估执业护士主导型护理心血管护理的影响。 背景: 尚未完成对心血管疾病患者进行执业护士主导型护理的系统综述。 设计: 系统综述和荟萃分析。 资料来源: 在 Cochrane Central Register of Controlled Trials (CENTRAL)、Medline、Embase、CINAHL、Web of Science、Scopus和ProQuest上系统地搜索了2007年1月至2017年6月间发表的研究。 综述方法: Cochrane方法学用于偏倚风险、数据提取和荟萃分析。证据质量的评估采用了GRADE(Grading of Recommendations Assessment, Development and Evaluation)法。 结果: 在605篇文章中,有5篇符合纳入标准。执业护士主导型护理和30天再度入院的常规护理、健康相关生活质量和住院天数之间没有统计学差异。确定Framingham 风险评分降低了12%。 结论: 有一些随机对照试验评估了执业护士主导型心血管护理。 影响: 确定了低等至中等质量的证据,没有统计学意义的相关护理结果。需要支持执业护士的角色,从而开展和发布高质量研究。.

To examine the association between nurse skill mix (the proportion of total hours provided by Registered Nurses) and patient outcomes in acute care hospitals.A quantitative systematic review included studies published in English between January 2000 - September 2018.Cochrane Library, CINAHL Plus with Full Text, MEDLINE, Scopus, Web of Science and Joanna Briggs Institute were searched. Observational and experimental study designs were included. Mix-methods designs were included if the quantitative component met the criteria.The Systematic Review guidelines of the Joanna Briggs Institute and its critical appraisal instrument were used. An inverse association was determined when seventy-five percent or more of studies with significant results found this association.Sixty-three articles were included. Twelve patient outcomes were inversely associated with nursing skill mix (i.e., higher nursing skill mix was significantly associated with improved patient outcomes). These were length of stay; ulcer, gastritis and upper gastrointestinal bleeds; acute myocardial infarction; restraint use; failure-to-rescue; pneumonia; sepsis; urinary tract infection; mortality/30-day mortality; pressure injury; infections and shock/cardiac arrest/heart failure.Nursing skill mix affected 12 patient outcomes. However, further investigation using experimental or longitudinal study designs are required to establish causal relationships. Consensus on the definition of skill mix is required to enable more robust evaluation of the impact of changes in skill mix on patient outcomes.Skill mix is perhaps more important than the number of nurses in reducing adverse patient outcomes such as mortality and failure to rescue, albeit the optimal staffing profile remains elusive in workforce planning.目的: 在于探讨护士技巧组合(注册护士提供的总时数比例)与急性护理医院患者结果之间的联系。 设计: 一项定量系统综述包括2000年1月至2018年9月期间以英语发表的各项研究。 资料来源: 搜索了Cochrane Library、CINAHL Plus with Full Text、MEDLINE、Scopus、Web of Science和Joanna Briggs Institute。纳入了观察性和实验性研究设计。如果定量成分符合标准,则纳入混合方法设计。 综述方法: 使用了Joanna Briggs Institute的系统综述指南及其关键评估工具。当75%或者更多具备显著结果的研究发现这种联系时,就确定了反向关联。 结果: 共纳入了63篇文章。12名患者的结果与护理技巧组合呈负相关(即,较高的护理技能组合与患者结果的改善显著相关)。这些是住院天数;溃疡、胃炎和上消化道出血;急性心肌梗死;约束使用;救援失败;肺炎;败血症;尿路感染;死亡率/30天死亡率;压力性损伤;感染和休克/心脏骤停/心力衰竭。 结论: 护理技巧组合影响了12例患者的结果。然而,需要使用实验性或纵向研究设计来进一步调查,从而建立因果关系。需要就技巧组合的定义达成共识,以便能够更有力地评估技巧组合变化对患者结果的影响。 影响: 在降低死亡率和救援失败等不良患者结果方面,技巧组合可能比护士人数更为重要,尽管最佳的人员配置在人力资源规划中仍然让人难懂。.

Aim This study aimed to explore the experiences of alcohol and other drug nurses transitioning to telehealth due to the COVID-19 pandemic. Background COVID-19 has caused immense disruption to healthcare services, and to reduce viral transmission, many services moved to off-site care delivery modalities such as telehealth. Design We used a qualitative descriptive design for this study. Methods Secondary analysis of semistructured interviews with alcohol and other drug nurses from Australia and New Zealand (n = 19) was conducted in July and August 2020. Data were analysed using thematic analysis and reported using COREQ guidelines. Results Three were identified: '"All our face-to-face contact ceased with clients": Changing service delivery', '"How do I do my job when I can't see you?": An anxious shift in service delivery' and '"A lot of Indigenous people don't like the FaceTiming and all that": Challenges to delivery of services through telehealth'. Conclusion Participants in our study reported challenges in transitioning to telehealth modalities. The perceived loss of therapeutic communication, difficulties in assessing risks to healthcare consumers such as domestic violence and challenges delivering telehealth care to a marginalized consumer cohort need to be overcome before telehealth is considered successful in alcohol and other drug treatment. However, telehealth was a successful adjunct to existing practices for nurses working with consumers in regional or remote areas or where consumers preferred this method of service delivery. Impact Nurses in this study described substantial issues with the delivery of alcohol and other drug treatment via telehealth, including a perception that telehealth was a barrier to addressing risks to consumers who use alcohol and other drugs, and difficulties working in a therapeutically beneficial way via telehealth. Telehealth is a means to reduce viral transmission through a reduction in face-to-face contact, and although it may be useful for some service functions, it may be detrimental to the clinical services nurses provide.

Aim To describe the nature and duration of nursing activities and how much time registered nurses allocate to the different dimensions of their scope of practice in a Swiss university hospital internal medicine ward. Design A single-centre observational descriptive study. Method Using a time and motion study, two researchers shadowed healthcare workers (N = 21) during 46 complete work shifts in 2018. They recorded each activity observed in real time using a tablet computer with a pre-registered list of 42 activities classified into 13 dimensions. Results A total of 507.5 work hours were observed. Less than one third of registered nurses' work time was spent with patients. They allocated the most time to the dimensions of 'communication and care coordination' and 'care planning', whereas 'optimizing the quality and safety of care', 'integrating and supervising staff' and 'client education' were allocated the least time. Conclusion This study provided a reliable description of nurses' time use at work. It highlighted suboptimal use of the full scope of nursing practice. Impact Both work organization and culture should be reconsidered to promote better use of nursing skills. Practice optimization should focus on the following three main areas: (1) greater involvement of registered nurses in building relationships and directly caring for patients and their families; (2) better use of registered nurses' skills in the activities required of their proper roles, including nursing clinical assessments and patient education and (3) more systematically updating registered nurses' knowledge.

AimTo evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse‐coordinated transitional care intervention in older cardiac patients to understand and interpret the study results.DesignA mixed‐methods process evaluation based on the Medical Research Council Process Evaluation framework.MethodsQuantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi‐structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data‐analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence.ResultsThe overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in‐hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention.ConclusionAlthough involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non‐significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population.ImpactIn addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.

To determine which factors other than child age play a role in the division and transfer of diabetes care responsibilities between parents and children with type 1 diabetes.Qualitative focus group study.Across four sites in the Netherlands, 18 parents (13 mothers) of children (9-14 years) with type 1 diabetes participated in four focus groups in 2015-2016, as part of the research project 'Whose diabetes is it anyway?'. Qualitative content analysis and the constant comparison method were used to analyse the data.According to parents, the transfer process included both direct and indirect tasks, had different levels (remembering, deciding, performing), was at times a difficult and stressful process, and showed large variation between families. A large number of child, parent and context factors were identified that affected the division and transfer of diabetes care responsibilities according to parents. Both positive and negative consequences of the transfer process were described for parental and child health, behaviour and well-being. Parental final evaluations of the division and transfer of diabetes care responsibilities appeared to be dependent on parenting values.How families divide and transfer diabetes care tasks appeared to be affected by a complex interplay of child, parent and context characteristics, which had an impact on several parent and child domains.Parents struggle with the right timing of transfer, which calls for more support from diabetes nurses. The identified factors can be used as input for integrating a more family-based approach into current age-based guidelines, to improve regular care.目的: 确定除儿童年龄外, 哪些因素可能对父母和患有1型糖尿病的儿童的糖尿病护理责任划分和转移产生影响。 设计: 定性焦点小组研究。 方法: 2015-2016年间, 在荷兰境内四地展开研究, 研究对象为18名患有1型糖尿病的儿童 (9-14岁) 的父母 (13名母亲) , 共分为四个重点小组, 此类研究作为‘谁患有糖尿病’研究项目的一部分。此外, 采用定性含量分析法和持续比较法对数据进行分析。 结果: 父母表示, 转移过程中, 需执行不同难度的直接和间接任务 (记忆、决定、执行) , 部分情况下, 面临较大困难和压力, 并且, 不同家庭的差异较大。经确定, 大量儿童、父母和背景因素可能对糖尿病护理责任的划分和转移造成影响。现已对转移过程对父母和儿童健康、行为和幸福的积极和消极后果进行描述。父母对糖尿病护理责任划分和转移的最终评估取决于其价值观。 结论: 家庭分配和转移糖尿病护理责任的方式似乎与儿童、父母及背景特征的复杂作用相关, 而此类作用对父母和儿童均有一定程度的影响。 影响: 父母忙于确定准确的转移时间, 因此, 糖尿病护士需予以更多支持。可考虑此类已确定的因素, 以便将更多家庭方法整合至现有基于年龄的指南中, 从而改善常规护理。.

Workloads and other job demands jeopardize nurses' well-being, especially during evening shifts when there are less resources than during the day. The current study aims to shed light on how the addition of a nurse assistant to ward staffing during evening shifts has an impact on nurses' perceptions of job demands, job resources, and well-being.We performed a pre-post pilot study, whereby we compared nurses' perceptions of job demands, job resources, and well-being before and after the addition of a nurse assistant to ward staffing during evening shifts.All nurses at the ward of a top-clinical hospital (N = 28) completed a baseline and follow-up survey including validated measures on job demands (workload and physical demands), job resources (autonomy and task clarity), and well-being (recovery from work and sleep problems).Compared with baseline, nurses reported fewer job demands (lower workloads and fewer physical demands) and sleep problems at follow-up. No statistically significant changes in job resources (autonomy and task clarity) and recovery difficulties were found.We found preliminary evidence that the addition of a nurse assistant during evening shifts could reduce workloads, physical demands, and sleep problems among nurses.This study highlighted that heavy job demands and sleep problems associated with evening shifts may be addressed by adding a nurse assistant to the nursing team. Future studies with larger samples and a control group are needed to provide better estimates of the magnitude of the beneficial effects and of the cost-effectiveness of an intervention of this kind.目的: 超负荷的工作量及其他工作需求会危及护士的健康,人员资源比白天少的夜班尤其如此。本研究旨在阐明在晚班期间增加护士助理将在护士对感知工作需求、工作资源和幸福感方面产生影响。 设计: 我们进行了一项前‐后试点研究,比较了在夜班病房增加护士助理前后,护士对工作需求、工作资源和幸福感的看法。 方法: 顶级临床医院病房的所有护士(N=28)都完成了一项基线调查和一项随访调查,其中包括对工作需求(工作量和身体需求)、工作资源(自主性和任务清晰度)和幸福感(从工作和睡眠问题中恢复)的有效测量。 结果: 与基线相比,护士在随访中上报的工作需求更少(更少的工作量和更少的身体需求),睡眠问题更轻。而在工作资源(自主性和任务清晰度)和工作状态恢复方面的困难上没有发现数据方面的显著变化。 结论: 已发现的初步证据表明,在夜班期间增加一名护士助理可以减少护士的工作量、身体需求并减轻其睡眠问题。 影响: 此项研究着重强调,夜班将带来加重护士工作需求和睡眠问题的严重程度,而此类问题可通过在护理团队中增加一名护士助理进行解决。现需针对更多样本进行更多研究,并生成对照组,以便对此种干预措施的有益效果和成本效益更好地进行预估。.

Contains fulltext : 243574.pdf (Publisher’s version ) (Open Access) AIMS: Establishing the prevalence of inappropriate sexual behaviour, concurrent challenging behaviours and the determinants of inappropriate sexual behaviour among patients with acquired brain injury ≤65 years of age in Dutch nursing homes. DESIGN: Cross-sectional, observational study in acquired brain injury special care units spreads throughout the country. METHODS: Nursing homes were recruited through the national expertise network for patients with severe acquired brain injury, regional brain injury teams and by searching the Internet. Patient characteristics were collected through digital questionnaires. Inappropriate sexual behaviour was assessed with the St. Andrews Sexual Behaviour Assessment, concurrent challenging behaviours with the NeuroPsychiatric Inventory-Nursing Home Version and the Cohen-Mansfield Agitation Inventory, cognition with the Mini-Mental State Examination and activities of daily living with the Disability Rating Scale. Psychotropic drug use was retrieved from the electronic prescription system. Associations between determinants and inappropriate sexual behaviour were examined using multilevel multivariate linear regression model analyses. Data collection started in June 2017 and ended in April 2019. RESULTS: Of the 118 included patients, 38.1% had one or more inappropriate sexual behaviours. Verbal comments (30.1%) and non-contact behaviour (24.8%) were the most prevalent types of inappropriate sexual behaviour. Less severe behaviours were more common than more severe behaviours. The most frequent concurrent challenging behaviours were agitation, aggression and hyperactivity. Physical aggression was associated with more inappropriate sexual behaviour. Being married and pain were associated with less inappropriate sexual behaviour. CONCLUSION: Inappropriate sexual behaviour is prevalent in patients with acquired brain injury ≤65 years of age residing in nursing homes. IMPACT: Inappropriate sexual behaviour may have impact not only on the patients themselves but also on nursing staff. Insight into the magnitude, severity, course and concurrent challenging behaviours, sexuality and quality of life could give direction to the kind of interventions and education that is needed. The ultimate goal is to develop appropriate care for this vulnerable group of patients, specifically psychosocial interventions and appropriate use of psychotropic drugs.

Determine sex- and age-associated psychophysical and neurophysiological differences in the processing of pain across the adult lifespan.Preliminary, exploratory, cross-sectional study.Using psychophysics (to measure intensity and unpleasantness) and functional magnetic resonance imaging blood oxygenation level dependent methods (to measure stimulus-evoked brain activation), we will examine sex- and age-associated differences in thermal pain processing and their underlying neurophysiology in a broad range of healthy adults (ages 30-89). We will acquire resting state functional connectivity data for secondary analyses exploring whether resting state connectivity predicts psychophysical and neurophysiological responses to thermal pain. To examine the effects of altered blood flow, we will acquire resting-state arterial spin labeling magnetic resonance imaging data to quantify resting cerebral blood flow. We will interpret findings in the context of a proposed neural model of pain, ageing, and sex. Study funding was received in June of 2014. Ethical approval was obtained from the Vanderbilt University IRB prior to study initiation.Exploring the biological reasons for age- and sex-associated differences in pain processing will increase our understanding of pain in older adults. The paucity of neurobiological evidence to support best practice pain management in older adults places these individuals at risk for poor pain management.Poorly treated pain in older adults is a critical public health problem associated with a poor quality of life and increased healthcare costs. Understanding how age and sex have an impact on central processing of pain across the lifespan is a critical step toward improving personalized pain medicine.目的: 确定成年期疼痛处理中与性别和年龄相关的心理、生理和神经生理学差异。 设计: 初步、探索性、分类排列研究。 方法: 利用心理物理学 (测量强度和不愉快程度) 和功能磁共振成像血氧水平依赖法 (测量刺激诱发的脑激活) , 我们将在广泛的健康成年人 (30-89岁) 中研究与性别和年龄相关的热痛处理差异及其潜在的神经生理学。我们将获得静息状态功能连接数据, 用于二次分析, 以便探索静息状态连接是否能预测热痛的心理、生理和神经生理学反应。为检测血液流动改变的影响, 我们将获取静息状态动脉自旋标记磁共振成像数据, 以量化静息脑血流。我们将按照提出的疼痛、衰老和性别的神经模型解释这些发现。我们已于2014年6月收到研究资金。研究开始前, 我们已获得范德堡大学IRB的伦理批准。 结论: 探索与年龄和性别相关的疼痛处理差异的生物学原因将增加我们对老年人疼痛的了解。缺乏神经生物学证据来支持老年人疼痛管理的最佳实践, 将这些个体置于疼痛管理不善的风险之中。 影响: 老年人疼痛治疗不当是严重的公共卫生问题, 其与生活质量差和保健费用增加有关。了解年龄和性别对整个生命周期内疼痛中枢处理的影响是改善个体化疼痛医学的关键一步。.

to identify: (1) nursing competencies for FCC in a hospital setting; and (2) to explore perspectives on these competencies among Dutch and Australian professionals including lecturers, researchers, Registered Nurses and policy makers.A multinational cross-sectional study using Q-methodology.First, an integrative review was carried out to identify known competencies regarding FCC and to develop the Q-set (search up to July 2018). Second, purposive sampling was used to ensure stakeholder involvement. Third, participants sorted the Q-set using a web-based system between May and August 2019. Lastly, the data were analysed using a by-person factor analysis. The commentaries on the five highest and lowest ranked competencies were thematically analysed.The integrative review identified 43 articles from which 72 competencies were identified. In total 69 participants completed the Q-sorting. We extracted two factors with an explained variance of 24%. The low explained variance hampered labelling. Based on a post-hoc qualitative analysis, four themes emerged from the competencies that were considered most important, namely: (a) believed preconditions for FCC; (b) promote a partnership between nurses, patients and families; (c) be a basic element of nursing; and (d) represent a necessary positive attitude and strong beliefs of the added value of FCC. Three themes appeared from the competencies that were considered least important because they: (a) were not considered a specific nursing competency; (b) demand a multidisciplinary approach; or (c) require that patients and families take own responsibility.Among healthcare professionals, there is substantial disagreement on which nursing competencies are deemed most important for FCC.Our set of competencies can be used to guide education and evaluate practicing nurses in hospitals. These findings are valuable to consider different views on FCC before implementation of new FCC interventions into nursing practice.目的: 确定: (1) 医院环境中FCC的护理能力; (2) 探讨荷兰和澳大利亚专业人员 (包括讲师、研究者、注册护士和决策者) 对这些能力的看法。 设计: 采用Q方法的跨国横断面研究。 方法: 首先进行综合评估, 以确定与FCC有关的已知能力, 并制定Q集 (检索截至2018年7月) 。第二, 采用目的性抽样来确保利益相关者参与度。第三, 参与者在2019年5月至8月期间使用基于网络 (web)的系统对Q集进行排序。最后, 采用个人因素分析法对数据进行分析。对排名最高和最低的5项能力的评注进行了专题分析。 结果: 在综合评估中, 研究了43篇文章, 从中确定了72项能力。共有69名参与者完成了Q分类。我们提取了两个因素, 解释方差为24%。低解释方差阻碍了标签化。基于事后定性分析, 从被视为是最重要的能力中衍生出四个主题, 即: (a) 所信的FCC先决条件; (b) 促进护士、患者和家属之间的合作关系; (c) 成为护理工作的基本要素; (d) 代表一种必要的积极态度和对FCC附加价值的强烈信念。从被视为是最不重要的能力中衍生出三个主题, 因为它们: (a) 没有被视为是一种特定的护理能力; (b) 需要采用多学科方法; 或 (c) 要求患者和家属自行承担责任。 结论: 在医疗保健专业人员中, 对于哪些护理能力被视为对FCC而言最重要, 存在很大的分歧。 影响: 我们的一系列能力可以用来指导教育和评估医院的执业护士。在护理实践中实施新的FCC干预措施之前, 在考虑不同的FCC观点方面, 这些研究结果很有价值。.

To analyse the interactions of associated factors with post stroke fatigue (PSF) after discharge home and determine the predictors of PSF and their impact on stroke survivors.A prospective observational study.A total of 94 patients with acute stroke were recruited between May 2019 -July 2020. The main outcomes were fatigue, depression, insomnia, sarcopenia, and health-related quality of life (HRQOL) and were assessed at admission and 1 month after discharge. Fatigue was measured using the Fatigue Assessment Scale. Depression and Insomnia were assessed using the Hospital Anxiety and Depression Scale-Depression and Insomnia Severity Index, respectively. Sarcopenia was measured using the SARC-F questionnaire, and HRQOL was assessed using the Short Form-8.Acute phase PSF was an independent predictor of PSF after discharge home. Moreover the path analysis revealed that this effect is mediated through both the direct effect of acute-phase PSF on PSF after discharge home and through the indirect effect of interaction with pre-stroke SARC-F, acute phase depression, and acute phase insomnia, which remains a separate predictor of acute-phase PSF. In total, 17% of the survivors had persistent PSF. Persistent PSF was significantly associated with depression, insomnia, sarcopenia, and a lower quality of life scores.Post-stroke fatigue may occur in the acute phase and persists after discharge, it will not only affect later depression, insomnia, and quality of life, but also sarcopenia.Acute phase PSF was found to be an independent predictor of PSF after discharge home. In addition, the interaction with pre-stroke SARC-F, acute phase depression and insomnia had an indirect connection with PSF after discharge home, which remains a separate predictor of acute-phase PSF. Thus, early assessment and management of mental status, sleep problems, and sarcopenia during hospitalization might be an important step in post-stroke rehabilitation and home transition.目的: 分析出院回家后脑卒中后疲劳 (PSF) 相关因素的相互作用, 确定脑卒中后疲劳的预测因素及其对脑卒中幸存者的影响。 设计: 一项前瞻性观察研究。 方法: 2019年5月至2020年7月, 共招募94名急性脑卒中患者。主要结果是疲劳、抑郁、失眠、少肌症和健康相关生活质量 (HRQOL) , 并在入院时和出院后1个月进行评价。使用疲劳评价量表进行疲劳测量。分别使用医院焦虑抑郁量表--抑郁失眠严重程度指数进行抑郁和失眠评估。使用简易五项评分问卷 (SARC-F) 测量少肌症, 使用简表-8评估健康相关生活质量。 结果: 急性期脑卒中后疲劳是出院回家后脑卒中后疲劳的独立预测因子。而且路径分析显示, 这种效应既通过急性期脑卒中后疲劳对出院回家后脑卒中后疲劳的直接影响, 也通过与脑卒中前SARC-F、急性期抑郁和急性期失眠的相互作用的间接影响来介导, 而后者仍是急性期脑卒中后疲劳的独立预测因子。总的来说, 17%的幸存者有持续性脑卒中后疲劳。持续性脑卒中后疲劳与抑郁、失眠、少肌症和较低的生活质量评分显著相关。 结论: 可能在急性期发生脑卒中后疲劳, 且在出院后持续存在脑卒中后疲劳, 这不仅会在后期产生抑郁症状、失眠症状、少肌症, 还会影响生活质量。 影响: 急性期脑卒中后疲劳是出院回家后脑卒中后疲劳的独立预测因子。此外, 与脑卒中前SARC-F、急性期抑郁和失眠的相互作用与出院回家后的脑卒中后疲劳有间接联系, 而急性期脑卒中后疲劳仍是一个独立预测因子。因此, 对住院期间的精神状态、睡眠问题和少肌症进行早期评估和管理, 可能是脑卒中后康复和家庭过渡的重要步骤。.

To achieve profession-wide consensus on clinical practice standards for six broad Australian nurse practitioner specialty areas (termed metaspecialties).Sequential mixed methods with initial interpretive study (Interpretive Phase) followed by modified three-round Delphi study (Survey Phase).Participants from all Australian jurisdictions were recruited. Main eligibility criterion was current endorsement as a nurse practitioner for 12 or more months. Interpretive Phase comprised in-depth interviews of purposeful sample of nurse practitioners to identify clinical care activities and practice processes. Six sets of draft clinical practice standards relevant to six previously identified metaspecialties were developed. Outcome informed Round 1 of Survey Phase (six nested web-based Delphi surveys), with draft standards reviewed profession-wide. Responses comprised scoring using Likert scales to calculate content validity indexes for individual standards with qualitative responses supporting decision-making. For Rounds 2 and 3, participants rated relevancy of original or revised standards after consideration of individual and group feedback. The study was conducted 2014-2017.Interpretive Phase: Analysis of interview data with 16 nurse practitioners provided 75 draft standards. Survey Phase: 221 nurse practitioners completed Round 1 (20% of then eligible Australian nurse practitioners). Weighted respondent retention was 92%. Seventy-three standards were validated, with final content validity indices of 92-100%. Scale-level indices were 98%, strongly validating metaspecialty taxonomy.A research-derived, professionally endorsed suite of nurse practitioner clinical practice standards was developed. This provides a broad clinical learning structure with metaspecialties guiding nurse practitioner student clinical education.The clinical practice standards and metaspecialty taxonomy strengthen nurse practitioner clinical education and professional development nationally and internationally. These novel study methods and findings are applicable to advanced specialty roles in other health professions.目的: 就六大澳大利亚执业护士专业领域的临床实践标准达成专业共识 (称为元专业) 。 设计: 序贯混合法和初步解释研究 (解释阶段) , 随后是修正的三轮德尔菲研究 (调查阶段) 方法: 招募了来自澳大利亚所有司法管辖区的参与者。主要的资格标准是目前认可的具有12个月或以上经验的执业护士。解释阶段包括对有目的的执业护士进行深度访谈, 以确定临床护理活动和实践过程。制定了六套与先前确定的六个元专业相关的临床实践标准草案。调查阶段的第一轮结果将被告知 (六项基于网络的德尔福调查) , 并在整个专业范围内审查标准草案。回答包括使用李克特量表进行评分, 以计算单个标准的内容有效性指数, 以及提供支持决策的定性回答。在第二轮和第三轮, 参与者在考虑个人和小组反馈后, 对原始标准或修订标准的相关性进行评级。该研究于2014年‐2017年进行。 结果: 解释阶段: 对16名执业护士的访谈数据进行分析, 得出了75项标准草案。调查阶段: 221名执业护士完成第一轮 (20%合格的澳大利亚执业护士) 。加权受访者保留率为92%。共验证了73项标准, 最终的内容效度指数为92‐100%。规模级指数为98%, 对元专业分类法具有很强的验证性。 结论: 制定了一套由研究衍生并经专业认可的执业护士临床实践标准。这提供了一个广泛的临床学习结构与元专业指导执业护士学生临床教育。 影响: 临床实践标准和元专业分类加强了国内外护士临床教育和专业发展。这些新颖的研究方法和发现适用于其他保健专业的高级专业角色。.

We describe an innovative research protocol to: (a) examine patient-level longitudinal associations between nurse staffing practices and the risk of adverse events in acute care hospitals and; (b) determine possible thresholds for safe nurse staffing.A dynamic cohort of adult medical, surgical and intensive care unit patients admitted to 16 hospitals in Quebec (Canada) between January 2015-December 2019.Patients in the cohort will be followed from admission until 30-day postdischarge to assess exposure to selected nurse staffing practices in relation to the subsequent occurrence of adverse events. Five staffing practices will be measured for each shift of an hospitalization episode, using electronic payroll data, with the following time-varying indicators: (a) nursing worked hours per patient; (b) skill mix; (c) overtime use; (d) education mix and; and (e) experience. Four high-impact adverse events, presumably associated with nurse staffing practices, will be measured from electronic health record data retrieved at the participating sites: (a) failure-to-rescue; (b) in-hospital falls; (c) hospital-acquired pneumonia and; and (d) venous thromboembolism. To examine the associations between the selected nurse staffing exposures and the risk of each adverse event, separate multivariable Cox proportional hazards frailty regression models will be fitted, while adjusting for patient, nursing unit and hospital characteristics, and for clustering. To assess for possible staffing thresholds, flexible non-linear spline functions will be fitted. Funding for the study began in October 2019 and research ethics/institutional approval was granted in February 2020.To our knowledge, this study is the first multisite patient-level longitudinal investigation of the associations between common nurse staffing practices and the risk of adverse events. It is hoped that our results will assist hospital managers in making the most effective use of the scarce nursing resources and in identifying staffing practices that minimize the occurrence of adverse events.目的: 我们描述了一份创新的研究方案: (a) 检查急诊护理医院护士配置方法与不良事件风险之间的患者水平纵向关联; (b) 确定安全护士配置的可能阈值。 设计: 2015年1月至2019年12月期间, 魁北克省 (加拿大) 16家医院收治的成人医疗、外科和重症监护病房患者动态队列研究。 方法: 将从入院到出院后30天里, 对队列研究中的患者进行随访, 以评估与随后发生的不良事件相关的选定护士工作实践的暴露情况。将使用电子工资单数据, 测量住院期间各轮班的五种人员配置方法, 并采用以下时变指标: (a) 各患者的护理工作时间; (b) 技能混合; (c) 加班使用; (d) 教育混合和; 以及 (e) 经验。将从参与站点检索的电子健康记录数据中测量四个可能与护士配置方法相关的高影响不良事件: (a) 抢救失败; (b) 住院量下降; (c) 院内获得性肺炎和; 以及 (d)静脉血栓栓塞。为检测所选护士人员配置暴露与各种不良事件风险之间的关系, 将拟合单独的多变量Cox比例风险脆弱性回归模型, 同时调整患者、护理单位和医院特征, 并进行聚类分析。为评估可能的人员配置阈值, 将拟合灵活的非线性样条函数。我们于2019年10月, 获得该项研究的资助,于2020年2月获得研究伦理/机构的批准。 讨论: 据我们所知, 此项研究是第一次多地点患者水平的纵向调查, 其针对普通护士配置方法与不良事件风险之间的关联。希望我们的研究结果能帮助医院管理者最有效地利用稀缺的护理资源, 并找出减少不良事件发生的人员配置方法。.

To define both competencies and envisaged outcomes for registered nurses in expanded roles in Swiss nursing homes to be implemented and evaluated within a new model of care.In regions where Advanced Practice Nurses are rare or absent, registered nurses take up clinical leadership and expanded roles. To allow effective implementation, monitoring and evaluation of these nurses, stakeholders need a shared understanding of the competencies they require and what outcomes they should achieve.RAND/UCLA Appropriateness Method - a modified Delphi method.A critical literature review and case studies were conducted to identify possible competencies and outcomes for registered nurses in expanded roles. In 2017, a two-round rating process and an in-person panel discussion was completed by a group of multi-professional stakeholders.Two rounds generated 190 competencies and 72 outcomes relevant to registered nurses in expanded roles.The relevant competencies and outcomes of registered nurses in expanded roles indicate their support for care teams and development of nursing care in nursing homes. Their geriatric expertise allows them to function as role models and innovators, reinforcing overall perceptions of nursing as a profession. These nurses are especially important in countries and settings where Advanced Practice Nurses are scarce or unavailable.The identified competencies clarify the duties of expanded-role registered nurses, thereby differentiating them from other care providers. Although conducted in the Swiss healthcare system, our methods and findings can be adapted to other healthcare settings. The results of this study will guide the development of an educational programme in a multi-centre study to reduce avoidable hospitalizations, while the defined outcomes guide the evaluation of their impact.目的: 定义在瑞士养老院中,在新型护理模式下所实施并评估的,角色拓展的注册护士的能力和设想结果。 背景: 在高级执业护士稀缺或缺乏的地区,注册护士充当了临床领导以及各种拓展的角色。为了能够有效实施、监测、评估这些护士,相关人员需要就他们所需的能力和应取得的结果达成共识。 设计: RAND/UCLA适当方法--改进的德尔菲法 方法: 进行关键文献综述及个案研究,以识别注册护士的合理能力和结果,这些护士充当了各种拓展的角色。2017年,一组多专业的相关人员完成了两轮评分程序,并亲自参加了一场专题讨论会。 发现: 两轮评分程序产生了190种能力和72种结果,均和充当了各种扩展角色的注册护士相关。 结论: 充当各种扩展角色的注册护士,就其相关能力和结果而论,表明了他们在护理团队和养老院护理发展中的支撑作用。他们对老年人的专业知识使其成为榜样和创新者,巩固了护理作为一种职业的整体看法。在高级执业护士稀缺或缺乏的城市中,这些护士更为重要。 影响: 这些能力可明确充当各种扩展角色的注册护士职责,将其区别于其他护理提供者。尽管是在瑞士医疗系统中进行,我们的方法和发现同样可适用于其他医疗环境。可利用本研究结果指导制定多中心研究的教育计划,减少可避免的住院治疗,并且,明确的结果将可适用于影响评估。.

To describe the characteristics of medication administration (MA) incidents reported to have occurred in patients' own homes (reporters' profession, incident types, contributing factors, patient consequence, and most common medications involved) and to identify the connection terms related to the most common contributing factors based on free text descriptions.A retrospective study using descriptive statistical analysis and text mining.Medication administration incidents (N = 19,725) reported to have occurred in patients' homes between 2013-2018 in one district in Finland were analysed, describing the data by the reporters' occupation, incident type, contributing factors, and patient consequence. SAS® Text Miner was used to analyse free text descriptions of the MA incidents to understand contributing factors, using concept linking.Most MA incidents were reported by practical (lower level) nurses (77.8%, N = 15,349). The most common category of harm was 'mild harm' (40.1%, N = 7,915) and the most common error type was omissions of drug doses (47.4%, N = 9,343). The medications most commonly described were Marevan [warfarin] (N = 2,668), insulin (N = 811), Furesis [furosemide] (N = 590), antibiotic (N = 446), and Panadol [paracetamol] (N = 416). The contributing factors most commonly reported were 'communication and flow of information' (25.5%, N = 5,038), 'patient and relatives' (22.6%, N = 4,451), 'practices' (9.9%, N = 1,959), 'education and training' (4.8%, N = 949), and 'work environment and resources' (3.0%, N = 598).There is need for effective communication and clear responsibilities between home care patients and their relatives and health providers, about MA and its challenges in home environments. Knowledge and skills relating to safe MA are also essential.These findings about MA incidents that have occurred in patients' homes and have been reported by home care professionals demonstrate the need for medication safety improvement in home care.目的: 描述所报道患者家中用药事件(MA)事件的特征(报道者的职业、事件类型、影响因素、患者后果以及所涉及的最常见药物),并通过自由文本确定与最常见的影响因素相关的连接项。 设计: 使用描述性统计分析和文本挖掘方法,进行回顾性研究。 方法: 2013年至2018年间,芬兰境内某一地区发生多起患者家中用药事件(N = 19,725),现已对这些事件进行分析,按报道者的职业、事件类型、影响因素和患者后果等对相关数据进行描述说明。利用SAS®Text Miner,对患者家中用药事件的自由文本描述进行分析,从而了解影响因素,并使用相关概念链接。 结果: 大多数患者家中用药事件都是由实习(低级)护士报道(77.8%,N=15,349)。最常见的伤害类别是“轻度伤害”(40.1%,N=7915),且最常见的错误类型是药物剂量不足(47.4%,N=9343)。最常见的药物包括华法林钠片【华法林】(N=2668)、胰岛素(N=811)、Furesis【呋塞米】(N=590)、抗生素(N=446)和必理通【扑热息痛】(N=416)。最常见的影响因素包括“沟通和信息流”(25.5%,N=5038)、“患者和亲属”(22.6%,N=4451)、“实践”(9.9%,N=1959)、“教育和培训”(4.8%,N=949)以及“工作环境和资源”(3.0%,N=598)。 结论: 有必要确保家庭护理患者、其亲属和健康提供者之间的有效沟通,明确各方责任,了解患者家中用药事件及其可能对家庭环境带来的挑战。此外,应该学习与患者家中安全用药相关的知识和技能。 影响: 这些调查结果与患者家中用药事件相关,由专业家庭护理人员报告,可证明在家庭护理中提高药物安全性的必要性。.

Aims To identify the key common components of knowledge transfer and exchange in existing models to facilitate practice developments in health services research. Background There are over 60 models of knowledge transfer and exchange designed for various areas of health care. Many of them remain untested and lack guidelines for scaling-up of successful implementation of research findings and of proven models ensuring that patients have access to optimal health care, guided by current research. Design A scoping review was conducted in line with PRISMA guidelines. Key components of knowledge transfer and exchange were identified using thematic analysis and frequency counts. Data sources Six electronic databases were searched for papers published before January 2015 containing four key terms/variants: knowledge, transfer, framework, health care. Review methods Double screening, extraction and coding of the data using thematic analysis were employed to ensure rigour. As further validation stakeholders' consultation of the findings was performed to ensure accessibility. Results Of the 4,288 abstracts, 294 full-text articles were screened, with 79 articles analysed. Six key components emerged: knowledge transfer and exchange message, Stakeholders and Process components often appeared together, while from two contextual components Inner Context and the wider Social, Cultural and Economic Context, with the wider context less frequently considered. Finally, there was little consideration of the Evaluation of knowledge transfer and exchange activities. In addition, specific operational elements of each component were identified. Conclusions The six components offer the basis for knowledge transfer and exchange activities, enabling researchers to more effectively share their work. Further research exploring the potential contribution of the interactions of the components is recommended.

To evaluate the effects of internet-based support program for primiparous women in terms of improving the levels of maternal self-efficacy, social support, and satisfaction; and reducing their postpartum depression symptoms.A single-blinded, multicentre, randomized, controlled, parallel-group pre-test and repeated post-test design.Based on the self-efficacy theory and the social exchange theory, the internet-based support program has five modules: (a) learning forum of parenting knowledge and skills; (b) communication forum; (c) ask-the-expert forum; (d) baby home forum; and (e) reminder forum. Primiparous women will be recruited in the obstetric wards of two university-affiliated hospitals in China. The participants (N = 258) will be randomly allocated to the intervention group that receive routine care and access to the internet-based support program and the control group that receive routine care during the 3 months postpartum. Maternal self-efficacy, social support, and postpartum depression symptoms will be measured at baseline, immediately after the intervention (post-test 1) and 3 months after the intervention (post-test 2). The study was funded in January 2018 and was ethically approved in May 2020.If the internet-based support program has positive outcomes, it will contribute to the scientific and practical knowledge of nursing interventions to support primiparous women on parenting; and could become the routine health care for health professionals to enhance parenting ability and mental well-being of new mothers.As the first RCT study on parenting outcomes using a rigorous research design and a theoretical framework in China, this research will contribute to evidence on the effectiveness of using internet platform to support women after childbirth. The results could help to advance research about the use of internet-based intervention methods to improve women's maternal self-efficacy, social support, satisfaction, and to alleviate depression symptoms. Chinese Clinical Trial Registry: ChiCTR2000033154.目标: 评价基于互联网的支持计划对初产妇女在提高母亲自我效能感、社会支持和满意度、减轻产后抑郁症状方面的效果。 设计: 单盲、多中心、随机、对照、平行组试验前和重复试验后设计。 方法: 基于自我效能感理论和社会交换理论,基于互联网的支持计划分为五个模块:(a)育儿知识和技能学习论坛;(b)交流论坛;(c)专家咨询论坛;(d)婴儿之家论坛;(e)注意事项提示论坛。中国两所大学附属医院的产科病房将招募初产妇女。参与者(N=258)将被随机分配到接受常规护理和基于互联网的支持计划的干预组和产后3个月接受常规护理的对照组。在基准线位置、干预后(试验后1)和干预后3个月(试验后2)测量母亲的自我效能感、社会支持和产后抑郁症状。该研究于2018年1月获得资助,并于2020年5月获得道德批准。 讨论: 如果基于互联网的支持计划取得积极成果,它将有助于提高护理干预措施的科学性和实用性,以支持初产妇女的育儿技能;并可能成为保健专业人员的常规保健,以提高新妈妈的育儿能力和心理健康。 影响: 作为中国第一个运用严谨研究设计和理论框架开展的育儿效果随机对照研究,本研究将有助于证明利用互联网平台支持产后妇女的有效性。本研究结果有助于推动基于互联网的干预方法提高女性作为母亲的自我效能感、社会支持、满意度以及缓解抑郁症状的研究。 中国临床试验注册中心:ChiCTR2000033154.

Aim To determine the effectiveness of a hydrophobic dressing (Cutimed Sorbact® ) against a silver dressing (Aquacel® Ag Extra) in the level of colonization of chronic venous leg ulcers. The secondary endpoints are health-related quality of life, level of pain, and time to complete healing. Design Open randomized controlled trial, with blinded endpoint. Methods Patients with chronic venous leg ulcers with signs of critical colonization will be randomized in a concealed sequence using computer software to receive one of the alternative dressings. A total of 204 participants recruited in Primary Health Care and nursing homes will be necessary to assure statistical power. Measures will include sociodemographic variables, wound-related variables (area, exudate, and time to healing), level of pain, adverse effects, and health-related quality of life. Smear samples will be collected from the ulcers and will be subject to DNA-typing technique through polymerase chain reaction to obtain the level of colony-forming units. Measures will be collected at baseline, 4, 8, and 12 weeks. Discussion Elevated levels of microorganisms prevent wound healing and favour its chronification. The main target when colonization is present is to reduce the bacterial load to levels that promote immune system mobilization. Hydrophobic dressings prevent the formation of biofilm in the wound by means of physical effect, so that the possibility of antimicrobial resistance is significantly reduced. Impact Current evidence about the effectiveness of dressings to minimize venous leg ulcers colonization is very limited. Previous studies have important methodological flaws. This study will permit to obtain the effectiveness of hydrophobic dressings against silver dressings with a robust design based on conditions of routine clinical practice in Primary Health Care and nursing homes.

Getting insight in the most crucial organizational job stressors for novice nurses' professional commitment and whether the job stressors are mediated through negative emotions.The study used an observational cohort design.Organizational job stressors were derived from 580 diary entries by 18 novice nurses combined with measures on emotions and commitment. The diaries were collected from September 2013-September 2014.Path modelling revealed that lack of support from colleagues, negative experiences with patients and confrontations with existential events were most strongly negatively related to professional commitment through negative emotions. Other indirectly and negatively related organizational job stressors to commitment were complexity of care, lack of control and work-life imbalance; only conflicting job demands, and lack of control related to professional commitment directly.To enhance professional commitment, it is important to reduce negative emotions in novice nurses by collegial support in dealing with negative experiences with patients, complexity of care and existential events and to prevent lack of control and an imbalance between private life and work. Nurse supervisors and managers can encourage nurses to share negative patient experiences, issues related to complexity of care and existential events.Considering the worldwide nursing shortage and early turnover, more understanding is needed about how negative emotions mediate the relationship between organizational negative job stressors and professional commitment and the relative impact of organizational job stressors to professional commitment. The study stresses the importance of a supportive role of supervisors and nurse managers to improve the work environment and hence increase novice nurses' commitment and retention.目的: 了解新手护士专业承诺中最为突出的组织工作压力源,以及工作压力源是否通过负面情绪进行调节。 设计: 本项研究采用观察性定群设计。 方法: 根据18名新手护士的580篇日记,结合情绪和承诺衡量结果,调查组织工作压力源。这些日记的收集工作于2013年9月至2014年9月进行。 结果: 路径模型显示,缺乏同事的支持,患者的消极经历以及与生存事件的冲突通过负面情绪与专业承诺之间呈显著负相关。对于承诺,其他间接负相关的组织工作压力源包括护理复杂度、控制不足以及工作生活失衡,仅有相互冲突的工作需求,缺乏与专业承诺直接相关的控制。 结论: 为加强专业承诺,在处理患者消极经历、护理复杂度和生存事件,防止出现缺乏控制、个人生活与工作失衡情况时,应通过提供同事支持来减少新手护士的负面情绪。护士长和管理者可鼓励护士分享消极的病人经历以及护理复杂度和生存事件相关问题。 影响: 考虑到全球范围内护理人员短缺和过早离职的局面,亟需进一步了解负面情绪如何对组织消极工作压力源与专业承诺的关系进行调节,以及组织工作压力源对专业承诺的相对影响。本项研究突出强调了护士长和护士管理者提供支持的重要性,以改善工作环境,从而坚定新手护士的承诺,增强其留职意愿。.

To explore and understand the views of clients and formal and informal caregivers about the experienced quality of home care for older people.A descriptive qualitative study was conducted using individual interviews.Six home care clients, four formal and six informal caregivers were recruited from two Dutch home care organizations. Individual, semi-structured interviews took place between April - November 2018. The INDividually EXperienced QUAlity of Long-term care framework was used to guide data collection and content analyses.The analyses revealed several important attributes contributing to experienced quality of home care such as a preferred small number of caregivers, perceived sufficient time for care provision and a caring atmosphere facilitating open communication and humour. Participants indicated that care routines fitting with the care receiver's former way of living were important. A more 'close' personal care relationship related to trust, openness and empathy was preferred over a more 'detached' professional care relationship.This study identified a wide range of attributes related to experienced quality of care from the perspectives of clients and formal and informal caregivers in home care.Care providers are being challenged to structurally assess individual experienced quality of home care. This study underlines the importance of incorporating care preferences and experiences throughout the care process from a relationship-centred care approach. Relevant care measures and outcomes should be determined to gain insight and further improve individual care provision.目的: 探讨和了解客户和正式和非正式护理人员对老年人体验居家护理的质量的看法。 设计: 采用个体访谈进行描述性定性研究。 方法: 从荷兰两家家庭护理机构招募了6名家庭护理接受客户、4名正式护理人员和6名非正式护理人员。在2018年4月至11月期间对每个人进行了个人半结构化访谈。长期护理框架的个人体验质量被用来指导数据收集和内容分析。 结果: 分析揭示了影响居家护理质量的几个重要因素,如首选看护者数量较少、有充足的看护时间、有利于开放交流和幽默的关怀氛围。参与者还表示护理程序符合接受照顾人以前的生活方式很重要。一种更“亲密”的富有信任、率真和同情心的个人护理关系比“分离”式的专业护理关系更好。 结论: 本研究从病人和家庭护理中正式和非正式护理人员的角度确定了与护理质量相关的一系列属性。 影响: 护理提供者正面临着从结构上评估家庭护理个人体验质量的挑战。此研究的重点在于强调将以关系为中心的护理方法中的看护偏好和经验融入整个护理过程的重要性。应确定相关的护理措施和结果,以深入了解并进一步改善个人护理。.

Aim Frontline nurses’ willingness to work has significant implications for maintaining workforce stability and quality of care during the COVID‐19 pandemic; however, few studies have investigated their willingness and the corresponding reasons. This study aims to examine frontline nurses’ willingness to work, identify its predictors and explore its corresponding reasons. Design A mixed‐methods design was conducted. Methods Based on a multilevel behavioural‐diagnostic model, a questionnaire survey was used to collect quantitative and qualitative data concurrently from 13 February to 24 February 2020 to explore frontline nurses’ willingness to work and the corresponding reasons in two hospitals in Wuhan, China. One was a designated hospital which only received COVID‐19 patients, and the other was built up temporarily for COVID‐19 patients. Results Of the 2014 participants, most (n = 1950, 96.8%) indicated their willingness to work, and a few (n = 64, 3.2%) expressed their unwillingness. Binary logistic regression analysis identified five predictors of participants’ willingness to work, including monthly family income, average working hours per shift, belief in their colleagues’ preparedness, belief in their hospitals’ preparedness and levels of depression. These indicators explained 27% of the variance (p

Aim To explore primary healthcare nurses' psychological well-being related to the COVID-19 pandemic. Design Qualitative descriptive study. Methods Semi-structured interviews were conducted with 25 participants between June and August 2020 who indicated their willingness to participate in an interview following a national survey. Interviews were audio-recorded and transcribed verbatim by professional transcribers. Data were analysed using thematic analysis. Results The importance of professional and public support and acknowledgement of the nurses' role during the pandemic positively influenced feelings of being valued. The psychological impact of negative experiences increased anxiety and stress levels. Participants reported a range of self-care strategies, including increased vigilance with infection control at home and work and attention to physical exercise and diet. Most participants remained positive about their roles and career decisions, although some indicated that the negative psychological impacts prompted re-evaluation of their career. Conclusions Primary healthcare nurses have been exposed to a range of personal and professional stressors during the pandemic that have impacted their psychological well-being. Awareness of stressors and an understanding of what has helped and what has impacted well-being are important in guiding future workplace support systems. Further work to explore the long-term impact of these stressors and the effectiveness of coping strategies employed by primary healthcare nurses is warranted. Impact Managers and professional organisations need to consider the personal and professional stressors that have impacted on primary healthcare nurses' psychological well-being to promote health and well-being among nurses following COVID-19.

To explore the differences in perceived patient safety culture in cancer nurses working in Estonia, Germany, the Netherlands, and the United Kingdom.An exploratory cross-sectional survey.In 2018, 393 cancer nurses completed the 12 dimensions of the Hospital Survey on Patient Safety Culture.The mean score for the overall patient safety grade was 61.3. The highest rated dimension was "teamwork within units" while "staffing" was the lowest in all four countries. Nurses in the Netherlands and in the United Kingdom, scored higher on "communication openness", the "frequency of events reported", and "non-punitive response to errors", than nurses from Estonia or Germany. We found statistically significant differences between the countries for the association between five of the 12 dimensions with the overall patient safety grade: overall perception of patient safety, communication openness, staffing, handoffs and transitions and non-punitive response to errors.Patient safety culture, as reported by cancer nurses, varies between European countries and contextual factors, such as recognition of the nursing role and education have an impact on it. Cancer nurses' role in promoting patient safety is a key concern and requires better recognition on a European and global level.Cancer Nursing Societies in any country can use these data as an indication on how to improve patient care in their country. Recognition of cancer nursing as a distinct specialty in nursing will help to improve patient safety.目的: 探讨在爱沙尼亚、德国、荷兰和英国工作的癌症护士对病人安全文化的认知差异。 设计: 探索性横向调查。 方法: 2018年,393名癌症护士完成了医院患者安全文化调查的12个维度。 结果: 总体患者安全等级的平均分数为61.3。评分最高的维度是“单位内的团队合作”,而“人员配备”在所有四个国家中都是最低的。荷兰和英国的护士在“沟通开放性”、“事件报告频率”和“对错误的非惩罚性反应”方面得分高于爱沙尼亚和德国的护士。我们发现,在12个维度中,有5个维度与患者总体安全等级之间存在统计学上的显著差异:患者总体安全感知、沟通开放性、人员配备、交接和过渡以及对错误的非惩罚性反应。 结论: 癌症护士所报告的患者安全文化在欧洲国家之间存在差异,而护理角色的认知和教育等环境因素也会对其产生影响。癌症护士在促进患者安全方面的作用是一个关键问题,需要在欧洲和全球层面上得到更好的认识。 影响: 任何国家的癌症护理协会都可以利用这些数据作为改善本国患者护理的指示。认识到癌症护理是护理的一个独特的专业将有助于提高患者安全性。.

Establishing the prevalence of neuropsychiatric symptoms (NPS), quality of life and psychotropic drug use in people aged ≤65 years with acquired brain injury in nursing homes.Cross-sectional, observational study among patients aged 18-≤65 years with acquired brain injury admitted to special care units in Dutch nursing homes.According to the Committee on Research Involving Human Subjects in January 2017 this study did not require ethics approval. Nursing homes will be recruited through the national acquired brain injury expertise network for patients with severe brain injury, the regional brain injury teams and by searching the internet. Patient characteristics will be collected through digital questionnaires. Neuropsychiatric symptoms will be assessed with the NeuroPsychiatric Inventory-Nursing Home version, the Cohen-Mansfield Agitation Inventory and the St. Andrews Sexual Behaviour Assessment; cognition with the Mini-Mental State Examination, quality of life with the Quality of Life after Brain Injury Overall Scale and activities of daily living with the Disability Rating Scale. Medication will be retrieved from the electronic prescription system. Data collection commenced in 2017 and will be followed by data analysis in 2019. Reporting will be completed in 2020.Little is known about NPS among patients with acquired brain injury in nursing homes. In patients up to the age of 65 years, only six studies were found on prevalence rates of NPS.Patients with severe acquired brain injury experience lifelong consequences, that have a high impact on them and their environment. Although there is increasing attention for the survival of this vulnerable group of patients, it is also important to enlarge awareness on long-term consequences, specifically the NPS, quality of life and psychotropic drug use in acquired brain injury. Insight into the magnitude of these issues is necessary to achieve appropriate care for these patients.目的: 确定神经精神病症状的患病率(NPS)、住在疗养院的年龄≤65 岁的脑损伤老年人的生活质量和精神药物。 设计: 针对疗养院内年龄在18--≤65 岁的特殊护理病房的脑损伤病人的横段截面观察性研究。 方法: 根据人体研究委员会在2017年一月的报告,本研究不需要道德批准。疗养院将通过数据问卷调查收集病人的特征。神经疾病将根据神经精神病学目录-疗养院版本、Cohen-Mansfield精神激动目录和St. Andrews的性行为评估评估神经精神疾病、认识精神状态检查量表脑损伤后总体评分和残疾评定量表。电子处方系统为开具药物。我们在2017年开始数据收集,并且将在2019 年进行数据分析,2020年完成报告。 讨论: 针对疗养院中脑损伤病人患有神经精神疾病的研究甚少。仅有6项研究针对的是65岁老年人的神经精神疾病患病率。 影响: 严重脑损伤可能会影响病人的一生,不仅对其自身也会其周围环境产生严重的后果。尽管有越来越多的人关注弱势病人群体的生存问题。但也有必要提高其对长期后果的认识,尤其是NPS、生活质量、对后天脑损伤的神经精神药物治疗。深入了解这些疾病的也是为病人提供正确治疗所必要的步骤。.

To develop and psychometrically test the needs of children questionnaire (NCQ), a new instrument to measure school-aged children's self-reported psychosocial physical and emotional needs in paediatric wards.This is an instrument development study based on recommendations for developing a reliable and valid questionnaire.The NCQ was developed over three phases between February 2013-April 2017 and included item generation; content adequacy assessment; questionnaire administration; factor analysis; internal consistency assessment and construct validity. Psychometric properties were assessed after 193 school-aged children completed the needs of children's questionnaire in four paediatric areas in Australia and New Zealand.The development and validation of the NCQ over two countries resulted in a 16-item, four-category tool to measure the self-reported importance and fulfilment of school-aged children's needs in hospital. Cronbach's alpha for the combined samples was 0.93.The NCQ bridges a gap to measure the level of importance and fulfilment of school-aged children's self-reported needs in hospital. Future testing and validation is needed in other paediatric areas and countries.The 16-item NCQ is a valid measure to evaluate if the quality of care delivered and received in hospital is in line with what children self-report as important and required and to date indicates good usability and utility. Child self-reports are essential to inform healthcare delivery, policy, research and theory development from a child and family-centred care lens that honours the United Nations Convention on the Rights of the Child and the best interests of the child.目的: 编制儿童需求调查问卷并对其进行心理学测试,该问卷是一种新的测量儿科病房学龄儿童自述社会心理、生理、情感需求的量表。 设计: 这是一项基于编制可信有效问卷建议进行的量表编制研究。 方法: 从2013年2月到2017年4月,儿童需求调查问卷的编制超过三个阶段,包括项目生成、内容适当性评估、问卷管理、因子分析、内部相容性评估以及结构效度等阶段。来自澳大利亚、新西兰四个地区儿科病房的193名学龄儿童填写了儿童需求调查问卷,随后我们对问卷的心理测量特质进行了评估。 结果: 儿童需求调查问卷在两个国家进行编制和验证,最终产生了一个16项4范畴的量表用于测量学龄儿童自述住院需求的重要性和完成度。样卷的综合克隆巴赫系数为0.93。 结论: 儿童需求调查问卷填补了学龄儿童自述住院需求重要性和完成度等级测量的空白。未来还需要在其他国家和地区的儿科病房测试及验证该问卷。 影响: 16项儿童需求调查问卷是一个有效评估医院提供以及儿童接受的看护质量是否与儿童自述重要需求质量一致并确定可用性、有效性高的量表。儿童自述以儿童和家庭为中心,符合《联合国儿童权利公约》以及儿童的最大利益,为医疗的提供、政策、研究以及理论发展提供了相关信息,因而十分重要。.

The aim of this study was to create a model and verify its fitness for focusing on unlearning of senior clinical nurses who transferred from acute to rehabilitation wards.The processes by which nurses with experience in acute wards acquire expertise in rehabilitation wards, the 'process of unlearning', have not yet been clarified.This research used a cross-sectional study.Content analysis of interview data of 23 senior clinical nurses was used to reveal factors constituting nurses' unlearning and a base model was created. Data were collected between May - September 2016. For its verification, categories extracted through content analysis were used as latent variables and subcategories as observation variables. The model's fit was confirmed through a survey of 5,435 senior clinical nurses from July to September 2017.We extracted six categories-'awareness', 'conflict', 'discard', 'acquisition', 'acceptance' and 'establishment'-and 22 subcategories of the factors constituting unlearning and created a base model. The effective response rate in the survey for verifying the fitness of the base model was 20.2%. The base model generally fulfilled the fitness, but we further studied the model fit with the data and modified it to comprise five categories, excluding 'acceptance', with 16 subcategories. The fitness of the modified model further improved. Through revalidation, we confirmed that the modified model satisfies the goodness of fit.Our findings add to the development of rehabilitation nursing skills of nurses transferred from acute to rehabilitation wards in a Japanese community-based integrated care system.This study revealed the unlearning process of senior clinical nurses. The unlearning process identified in this study contributes to knowledge and skills acquisition specific to nurses specializing in rehabilitation. It will be used for developing a re-education programme for rehabilitation nurses in the future.目的: 本研究的目的是建立一个模型,并验证其在专注于从急症病房转向康复病房的高级临床护士的忘却过程的适用性。 背景: 有急症病房经验的护士在康复病房获取专业知识的过程,即“忘却过程”,尚未得到阐释。 设计: 该调查使用横断面研究。 方法: 通过对23名高级临床护士访谈资料的内容分析,揭示了护士忘却过程的构成因素,建立了护士忘却过程的基本模型。 数据收集与2016年五月至九月之间。为了验证它,内容分析中选取的类别被用作潜在变量,子类别被用作观察变量。2017年七月至九月,通过对5435名高级临床护士的调查,证实了模型的适用性。 结果: 我们选取了构成忘却过程因素的六个类别--“意识”、“冲突”、“抛弃”、“获得”、“接受”和“建立”,以及22个子类别,并建立了一个基本模型。验证基本模型适用性的调查有效应答率为20.2%。基本模型基本上满足了适用性,但我们进一步研究了模型与数据的拟合,并将其修改为包含5个类别(不包括“接受”类别)和16个子类别。改进模型的拟合度进一步提高。通过重新验证,证明了修正后的模型满足拟合优度。 结论: 我们的发现为日本社区综合护理系统中从急症病房转到康复病房的护士的康复护理技能的发展提供了补充。 影响: 本研究揭示了高级临床护士的忘却过程。本研究中发现的忘却过程有助于专业康复护理人员获得知识和技能。它将用于制定针对康复护士的再教育计划。.

This study examined (a) psychosocial health care needs of people with type 2 diabetes from the perspective of patients and diabetes healthcare providers in primary care, in terms of topics, attention in diabetes care and preferences and (b) factors associated with a positive attitude towards specialized psychosocial health care.Qualitative focus group study.Using purposive sampling, participants were selected from general practices. In 2012-2013, three focus groups were conducted in people with type 2 diabetes (N = 20) and three with healthcare providers (N = 18).Opinions differed considerably on whether there was a need for psychosocial health care. Topics focused mainly on diabetes-specific issues ranging from a need for additional diabetes education to attention and support in regular diabetes care. However, not all healthcare providers felt competent enough to address psychosocial problems. Some participants reported a need for specialized psychosocial help. A positive attitude towards specialized psychosocial health care appeared to be influenced by care setting (e.g., in the primary care practice or 'outside' mental health care), care accessibility, proactive discussion of psychosocial issues with and referral by healthcare providers and previous experiences with psychosocial health care.Although only few participants expressed a need for specialized psychosocial care, attention for psychosocial well-being in regular diabetes care was generally appreciated.People with type 2 diabetes generally felt psychosocial care could be provided as part of regular diabetes care. Suggestions for healthcare providers to meet psychosocial health care needs include training and discussion tools.目的: 本研究从初级保健中的患者和糖尿病医疗保健提供者的角度,从话题、对糖尿病护理的关注和偏好方面,审查了(a)II型糖尿病患者的心理社会医疗保健需求,以及(b)与对专业心理社会医疗保健的积极态度相关因素。 设计: 定性焦点小组研究。 方法: 通过采用有目的抽样,从 全科医生中选取了参与者。 在2012至2013年间,对II型糖尿病患者(20名)和医疗保健提供者(18名)进行了三次分组座谈会。 结果: 关于是否需要心理社会医疗保健,意见分歧很大。话题主要关注糖尿病特有的问题,从需要额外的糖尿病教育到常规糖尿病护理的关注和支持。然而,并不是所有的医疗保健提供者都觉得能够解决心理社会问题。一些参与者报告说需要专门的心理社会帮助。对专门心理社会医疗保健的积极态度似乎受到保健环境(例如,初级保健实践或‘外部’心理健康护理)、保健可及性、与医疗保健提供者积极讨论心理社会问题和通过他们进行转诊以及以往心理社会医疗保健经验的影响。 结论: 尽管只有少数参与者表示需要专门的心理社会护理,但在常规糖尿病护理中对心理社会健康的关注还是得到了普遍认可。 影响: II型糖尿病患者通常认为心理社会护理可以作为常规糖尿病护理的一部分。医疗保健提供者满足心理社会医疗保健需求的建议包括培训工具和讨论工具。.

Aim To synthesize and compare outcomes from controlled trials of interventions to improve heart failure self-care among adults. Background Heart failure self-care interventions are recommended for preventing and detecting exacerbations, improving symptom management and preventing hospitalizations. Little is known about the overall effectiveness of heart failure self-care programmes and which types of interventions show the greatest improvement in outcomes. Design Systematic review and meta-analysis, including moderator analyses. Methods Multiple databases (including MEDLINE/PubMed, CINAHL, PsycINFO, Scopus and Cochrane Central Register of Controlled Trials) will be searched from inception through 2018 along with grey literature searches to identify trials testing interventions to improve self-care outcomes of adults with heart failure. Data will be extracted from eligible studies on sample, methodological and intervention characteristics and data to calculate effect sizes. Data will be analysed using random-effects models. Moderator variables will be analysed with meta-regression and sub-group analyses. Risk for bias will be assessed using the Cochrane Risk for Bias tool and by examining potential sources of bias as moderator variables. Funding for this project began in July 2017. Discussion We will analyse self-care behaviour outcomes and clinical outcomes including hospitalizations, mortality, disease severity and quality of life. This will be the most extensive meta-analysis of heart failure self-care interventions to date. Impact Comparative effectiveness of existing self-care interventions is not yet known. This research will identify the most promising self-care intervention components for designing better interventions and guide targeting of interventions to specific sub-populations. PROSPERO Registration Number: CRD42017075831.

Aims To determine the challenges perceived by final-year nursing students in the clinical learning environment. Design Data-based convergent mixed-method systematic review. Methods Three electronic databases (Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature) will be used in the identification stage. The first search will use the search string for each database to identify relevant studies. The articles retrieved will be screened by year of publication, article type and language. Abstracts and full-text of selected studies will be screened for eligibility independently by a minimum of two reviewers. The reference lists will be manually screened to identify additional publications. The quality assessment will be conducted by two reviewers using the Mixed Methods Appraisal Tools. Quantitative and mixed-method studies will be transformed into qualitative. A thematic approach will be used to synthesize and report the data. Ethics approval and funding have been approved in April 2020. Discussion This study will synthesize the types of challenges perceived by final-year undergraduate nursing students in different clinical learning environments across the country. Impact The proposed study findings will help nursing education stakeholders and faculty provide assistance to final-year nursing students in their transition year to become registered nurses.

Aims To develop the Nurse's Communication Ability with Angry Patients Scale (NCAAPS) and evaluate its psychometric properties. Design An instrument development and validation study. Methods The survey was administered to 501 nurses from different emergency departments in China between 2 August 2019 and 3 October 2019. Data from 456 completed questionnaires were analysed to identify the factor structure of the NCAAPS. Results The content validity index was satisfactory. Four factors were included and 71.25% of the total variance was explained by 19 items in NCAAPS. Confirmatory factor analysis supported the four-factor structure. Cronbach's α coefficient was 0.96 for the overall scale and 0.81-0.92 for its subscales. Test-retest reliability was 0.740. Conclusion We consider the NCAAPS to be a useful tool for measuring the ability of nurses to communicate with angry patients. Impact It is anticipated that this new scale will help educators to identify specific areas of deficiency that could be targeted with training to improve the ability of nursing staff to communicate with angry patients.

Aims To determine the fit factor and compliance with American Industrial Hygiene Association (AIHA) and Occupational Safety and Health Administration (OSHA) requirements of surgical masks and filtering respirators in male versus female nurses. Design A case–control gender study performed from 2016 to 2019. Methods A gender and age matched‐paired sample of 74 nurses was recruited and divided into men (n = 37) and women (n = 37). FFP3 filtering respirators and surgical masks fit factors were compared between male and female nurses by Mann–Whitney U tests. These measurements were tested to pass or fail according to the OSHA (≥100) and AIHA (≥50) criteria by Fisher exact tests for a 95% confidence interval. Results Global fit factor mean (standard deviation) was 2.86 (2.73) and 3.55 (6.34) for male and female nurses wearing surgical masks (p = .180), respectively, and nobody passed neither OSHA nor AIHA criteria (p = 1.00). Nevertheless, global fit factor were 30.82 (28.42) and 49.65 (43.04) for male and female nurses wearing FFP3 respirators, respectively, being significantly lower and worse in male nurses (p = .037). According to OSHA criteria, only 2.70% and 13.51% of male and females nurses, respectively, passed with non‐significant difference (p = .199), meanwhile 21.62% and 48.64% of male and female nurses, respectively, passed AIHA criteria showing significant differences (p = .027) wearing FFP3 respirators. Conclusions All male and female nurses wearing surgical masks failed to pass OSHA and AIHA criteria. Global fit factor of the proposed FFP3 filtering respirators was decreased and worse in male than female nurses. Impact Our recommendation is to avoid surgical masks use for protective purposes and use the proposed FFP3 filtering respirators among nurses. Each nurse should be fit tested for its own respirator with special caution in male nurses due to their lower fit factor achieved and most of them failed to pass OSHA and AIHA criteria, especially during COVID‐19 pandemic.