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Aims and Objectives: To identify symptom clusters and examine their association with health‐related quality of life. Background: Multiple myeloma patients undergoing chemotherapy suffer from disease symptoms and adverse effects during the course of the disease. However, single symptom management has little effect, and symptom management for these patients remains challenging. Symptom clusters open a new perspective and provide important clues for symptom management. Design: A cross‐sectional study. Method: Participants were invited to complete the Chinese version of the Memorial Symptom Assessment Scale and Quality of Life Questionnaire‐core 30. Appropriate indicators were used for descriptive statistics. Principal component analysis was used to identify symptom clusters. Associations between symptom clusters and quality of life were examined with Pearson correlation coefficients, Pearson correlation matrix and multiple linear regression. This study was reported following the STROBE checklist. Results: A total of 177 participants were recruited from seven hospitals in this study. We identified self‐image disorder, psychological, gastrointestinal, neurological, somatic and pain symptom clusters in multiple myeloma patients with chemotherapy. Approximately 97.65% of patients suffer from multiple symptom clusters. The pain, psychological and gastrointestinal symptom clusters have negatively influence on health‐related quality of life. The strongest association was found with the pain symptom cluster. Conclusion: Most of multiple myeloma patients suffer from multiple symptom clusters. When improving the multiple myeloma patients' health‐related quality of life, the clinical staff should prioritise relieving the pain symptom cluster. Relevance to Clinical Practice: When multiple myeloma patients undergoing chemotherapy suffer from multiple symptom clusters, nurses should prioritise relieving the pain symptom cluster to improve their health‐related quality of life. When drawing up and providing interventions, nurses should focus on the correlation among symptoms rather than single symptom. By relieving one symptom in a given cluster, other symptoms within the same symptom cluster may also be relieved. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore what constitutes brilliant aged care. Background: Although many aged care services do not offer the care that older people and carers need and want, some perform better. Rather than focus on problems with aged care, this study examined brilliant aged care—practices that exceeded expectation. Design: The methodology for this study was informed by grounded theory, underpinned by constructionism to socially construct meaning. Methods: This study invited nominations for a Brilliant Award via a survey, and interviews with the nominees via web conference. After receiving survey responses from 10 nominators, interviews were conducted with 12 nominees. Data were analysed using reflexive thematic analysis and documented according to COREQ guidelines to optimise rigour and transparency. Results: According to participants, brilliant aged care involved being relationally attuned to older people, a deep understanding of the older person, recognition of aged care as more than a job, innovative practices and permission to reprioritise. Conclusions: This study suggests that, in aged care, brilliance happens. It emphasises the importance of meaningful connections and relationships in aged care, where thoughtful acts acknowledge an older person's value and humanity as well as creativity and innovation. Relevance to Clinical Practice: For those who manage and deliver aged care, the findings suggest that small practice changes can make a positive difference to older people. Brilliant aged care can involve acts of empathy; enthusiasm for aged care; innovative practices, even those that are small scale; and reprioritising workplace tasks to spend time with older people. For policymakers, this study highlights the need to recognise and raise the profile of the pockets of brilliance within the aged care sector. This might be achieved via awards and other initiatives that serve to celebrate and learn from brilliance in its myriad forms. Patient or Public Contribution: The nominees, who included carers, were invited to participate in workshops with other carers and older people to co‐design a model of brilliant aged care, during which workshop participants discussed and critiqued the findings constructed from the data. [ABSTRACT FROM AUTHOR]

Aim: To explore experiences of cardiac arrest in‐hospital and the impact on life for the patient who suffered the arrest and the family member who witnessed the resuscitation. Background: Guidelines advocate that the family should be offered the option to be present during resuscitation, but little is known about family‐witnessed cardiopulmonary resuscitation in hospital and the impact on the patient and their family. Design: A qualitative design consisting of joint in‐depth interviews with patients and family members. Methods: Family interviews were conducted with seven patients and their eight corresponding family members (aged 19–85 years) 4–10 months after a family‐witnessed in‐hospital cardiac arrest. Data were analysed using interpretative phenomenological analysis. The study followed the guidelines outlined in the consolidated criteria for reporting qualitative research (COREQ) checklist. Results: The participants felt insignificant and abandoned following the in‐hospital cardiac arrest. Surviving patients and their close family members felt excluded, alone and abandoned throughout the care process; relationships, emotions and daily life were affected and gave rise to existential distress. Three themes and eight subordinate themes were identified: (1) the intrusion of death—powerless in the face of the fragility of life, highlights what it is like to suffer a cardiac arrest and to cope with an immediate threat to life; (2) being totally exposed—feeling vulnerable in the care relationship, describes how a lack of care from healthcare staff damaged trust; (3) learning to live again—making sense of an existential threat, pertaining to the family's reactions to a difficult event that impacts relationships but also leads to a greater appreciation of life and a positive view of the future. Conclusion: Surviving and witnessing a cardiac arrest in‐hospital is a critical event for everyone involved. Patients and family members are vulnerable in this situation and need to be seen and heard, both in the hospital and after hospital discharge. Consequently, healthcare staff need to show compassion and attend to the needs of the family, which involves continually assessing how family members are coping during the process, and providing support and information during and after resuscitation. Relevance to clinical practice: It is important to provide support to family members who witness the resuscitation of a loved one in‐hospital. Structured follow‐up care is crucial for cardiac arrest survivors and their families. To promote person‐centred care, nurses need interprofessional training on how to support family members during resuscitation, and follow‐up care focusing on providing resources for multiple challenges faced by survivors (emotional, cognitive, physical) and families (emotional) is needed. Patient or public contribution: In‐hospital cardiac arrest patients and family members were involved when designing the study. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to investigate the role of the family in supporting diabetes self‐management and explore the possible mechanisms between family and diabetes self‐management among rural patients in China. Background: The prevalence of Type 2 diabetes mellitus (T2DM) is growing rapidly in rural areas of China, where healthcare resources remain relatively poor and family members play an important role in chronic disease self‐management. Design: This was a multicentre cross‐sectional study. Methods: A total of 276 adults with T2DM were recruited from nine county hospitals in China. Diabetes self‐management, family support, family function, and family self‐efficacy were evaluated using the mature scales. A theoretical model was built based on the social learning family model and previous studies and then verified using a structural equation model. The STROBE statement was used to standardise the study procedure. Results: Family support and general family factors, including family function and self‐efficacy, were positively correlated with diabetes self‐management. Family support fully mediates the relationship between family function and diabetes self‐management and partially mediates the relationship between family self‐efficacy and diabetes self‐management. The model explained 41% of the variability in diabetes self‐management and had a good model fit. Conclusion: General family factors can explain nearly half of the change in diabetes self‐management in rural areas of China, while family support is a mediator between general family factors and diabetes self‐management. Family self‐efficacy, a potential intervention point of family based diabetes self‐management education, can be improved by building special lessons for family members. Relevance to Clinical Practice: This study emphasises the role of family in diabetes self‐management and proposes suggestions for diabetes self‐management intervention among patients with T2DM in rural areas of China. Patient or Public Contribution: Patients and their family members completed the questionnaire which was used for data collection. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the impact of nursing home leadership and staffing characteristics on staff job satisfaction, health and intention to leave. Background: The number of older people has outpaced growth in the nursing home workforce worldwide. Identifying predictors with the potential to positively impact staff job satisfaction, health and intentions to leave are important. Leadership of the nursing home manager can be one such predictor. Design: Cross‐sectional design. Methods: A sample of 2985 direct care staff in 190 nursing homes in 43 randomly selected municipalities in Sweden completed surveys on leadership, job satisfaction, self‐rated health and intention to leave (response rate 52%). Descriptive statistics and Generalised Estimating Equations were conducted. The STROBE reporting checklist was applied. Results: Nursing home managers' leadership was positively related to job satisfaction, self‐rated health and low intention to leave. Lower staff educational levels were related to poorer health and lower job satisfaction. Conclusions: Nursing home leadership plays a significant role in the job satisfaction, self‐reported health and intention to leave of direct care staff. Low education levels among staff seem to negatively influence staff health and job satisfaction, suggesting that educational initiatives for less‐educated staff could be beneficial for improving staff health and job satisfaction. Relevance to clinical practice: Managers seeking to improve staff job satisfaction can consider how they support, coach and provide feedback. Recognising staff achievement at work can contribute to high job satisfaction. One important implication for managers is to offer continuing education to staff with lower or no education, given the large amount of uneducated direct care workers in aged care and the impact this may have on staff job satisfaction and health. No patient or public contribution: No patient or public contribution was required to outcome measures in this study. Direct care staff and managers contributed with data. [ABSTRACT FROM AUTHOR]

Aim: To describe how women perceived relational autonomy for decision‐making during childbirth pain and illuminate influencing factors. Background: Most women report challenging pain during birth. Circumstances can affect their ability to engage in pain management decisions. Design: We used an interpretative description approach to conduct this study. Method: A purposive sample of ten women who reported pain during childbirth participated in semi‐structured interviews. The study was conducted between July 2019 and November 2020 and reported according to the COREQ checklist. Results: Circumstances during childbirth, such as women's expectations and relationships, influenced their efforts to engage in relational autonomy. Care providers dealt with the unpredictability of childbirth and challenges with pain management using decision‐making practices that could disrupt women's expectations, undermine women's trust, demonstrate disrespect for women and rely on inadequate communication. Women who felt dependent on others were less likely to participate in decision‐making. When care providers' perceptions about pain differed from women's reports of pain, participants became distressed because care providers did not acknowledge their subjective pain experiences. Conclusions: Women regarded their relationships and communication with care providers as foundational to relational autonomy in decision‐making about pain management during childbirth. Relevance to clinical practice: Study findings can support care providers' considerations of the complexity of childbirth pain and factors affecting women's relational autonomy in decision‐making about pain. In particular, the findings highlight the importance of women's expectations and care providers' recognition of women's experiences of pain. Patient or public contribution: Women who shared their stories of childbirth pain contributed to the data collected. The chief nursing officers in the data collection setting facilitated the recruitment and data collection. [ABSTRACT FROM AUTHOR]

Aims: To map the pathway and service provision for pregnant women whose newborns require admission into the surgical neonatal intensive care unit at or soon after birth, and to examine the nature of continuity of care (COC) provided and the facilitators and barriers to woman‐ and family‐centred care from the perspective of women/parents and health professionals. Background: Limited research exists on current service and care pathways for families whose babies are diagnosed with congenital abnormality requiring surgery. Design: A mixed method sequential design adhering to EQUATOR guidelines for Good Reporting of a Mixed Methods Study. Methods: Data collection methods included: (1) a workshop with health professionals (n = 15), (2) retrospective maternal record review (n = 20), prospective maternal record review (17), (3) interviews with pregnant women given a prenatal diagnosis of congenital anomaly (n = 17) and (4) interviews with key health professionals (n = 7). Results/Findings: Participants perceived care delivered by state‐based services as problematic prior to admission into the high‐risk midwifery COC model. Once admitted to the high‐risk maternity team women described care 'like a breath of fresh air' with a 'contrast in support', where they felt supported in their decisions. Conclusion: This study highlights provision of COC, in particular relational continuity between health providers and women as essential to achieve optimal outcomes. Relevance to Clinical Practice: Provision of individualised COC offers an opportunity for perinatal services to reduce the negative consequences of pregnancy‐related stress associated with diagnosis of foetal anomaly. Patient or Public Contribution: No patient or public was involved in the design, analysis, preparation or writing of this review. [ABSTRACT FROM AUTHOR]

Background: There is a gap in the literature on identifying and describing effective interventions for the retention of newly graduated registered nurses in hospital settings. To the best of our knowledge, no systematic review has been conducted on this issue. Aim: To identify effective interventions that promote the retention of newly graduated registered nurses in the hospital setting and their components. Design: A systematic review was conducted according to PRISMA 2020 Statement. Methods: Information derived from the PubMed, CINAHL, Scopus, PsycINFO and Cochrane Library databases was reviewed, for the period January 2012–October 2022. Screening, data extraction and quality appraisal were conducted independently by two reviewers. The Joanna Briggs Institute Critical Appraisal tools were used for descriptive, quasi‐experimental and cohort studies. Disagreements between the two reviewers were resolved through discussion. Results: Following the critical appraisal, nine studies were included. The evidence reveals the heterogeneity of programmes developed in the hospital context to promote the retention of newly graduated registered nurses, clarifies the three competencies to be addressed (core, cross‐cutting and specific), their components (programme development framework, duration, content and support components), and shows significant improvements after their implementation. Conclusions: This systematic review identifies that either nurse residency or individualised mentoring programmes, lasting 1 year, and multi‐component, addressing core and specific competencies and including preceptor or mentor components seem to be the most comprehensive and effective in promoting the retention of new nurses in the hospital setting. Relevance to Clinical Practice: The knowledge provided by this review will contribute to developing and implementing more effective and context‐specific strategies directed at retaining newly graduated registered nurses and subsequently enhancing patient safety and healthcare costs. No Patient or Public Contribution: Given the study design and focus. [ABSTRACT FROM AUTHOR]

Aims and Objective: To understand the frequent attendance phenomenon from the perspective of patients and healthcare professionals and how it can be reduced. Background: Frequent attenders (FAs) are characterised by the consumption of a disproportionate number of medical consultations and a high number of visits per year to primary care physicians (PCP). Although FAs constitute about 10% of all primary clinic attendees, they are responsible for ~40–50% of clinic visits, affecting the efficiency, accessibility and quality of health services provided to other patients. Design: Mixed methods (STROBE Statement: Data S1; COREQ checklist: Data S2). Methods: Eighteen FAs were interviewed in a qualitative approach. PCPs and nurses (n = 184) completed a cross‐sectional survey. Results: FAs are driven by their personal, emotional and mental state. FAs viewed clinics as a source for information and resolving medical problems. They perceived PCPs as authoritative and knowledgeable, and nurses as treatment managers and mediators between PCPs and patients. In contrast, FAs evoked more negative emotions than positive ones among medical staff. PCPs and nurses attributed frequent visits to FAs' personal and emotional states. A model based on the findings was constructed to provide a framework for grasping frequent attendance from a sociological perspective and for planning and managing it. Conclusions: The accessibility and availability of health services at primary clinics, and collaboration and trust in medical staff facilitate the frequent attendance phenomenon. Relevance to Clinical Practice: The frequent attendance phenomenon should be proactively prevented, even before patients become FA, using the model constructed, which serves as a foundation for introducing an intervention program to identify and prevent frequent attendance. PCPs and nurses working in primary care clinics should be made aware of the FA phenomenon and should be educated and given tools to deal with it within the clinic. The process should be facilitated by organisational support. Patient or Public Contribution: There was no patient or public contribution to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript. [ABSTRACT FROM AUTHOR]

Aim: To assess the effectiveness of decision aids for genetic counsellees to improve their conflicts in decision‐making and psychological well‐being when considering genetic tests for inherited genetic diseases, and their knowledge about these tests and their genetic risks. Design: Systematic review. Data sources: Six electronic databases (PubMed, MEDLINE, OVID Nursing, APA PsycINFO, EMBASE and CINAHL) were searched from inception to May 2022. Review methods: Only randomised controlled trials that examined the effect of decision aids for information provision centring genetic testing on outcomes including decisional conflicts, informed choice making, knowledge on genetic risks or genetic tests, and psychological outcomes among participants who had undergone genetic counselling were included. Their risk of bias was assessed using the Version 2 of the Cochrane risk of bias tool for randomised trials. Results were presented narratively. The review was conducted according to the PRISMA checklist. Results: Eight included studies examined the effect of booklet‐based, computer‐based, film‐based or web‐based decision aids on individuals considering genetic testing for their increased cancer risks. Despite contrasting findings across studies, they showed that decision aids enable genetic counsellees to feel more informed in decision‐making on genetic tests, although most showed no effect on decisional conflict. Knowledge of genetic counsellees on genetic risks and genetic tests were increased after the use of decision aids. Most studies showed no significant effect on any psychological outcomes assessed. Conclusions: Review findings corroborate the use of decision aids to enhance the effective delivery of genetic counselling, enabling genetic counsellees to gain more knowledge of genetic tests and feel more informed in making decisions to have these tests. Relevance to clinical practice: Decision aids can be used to support nurse‐led genetic counselling for better knowledge acquisition and decision‐making among counsellees. No patient or public contribution: Patient or public contribution is not applicable as this is a systematic review. [ABSTRACT FROM AUTHOR]

Aims and objectives: Explore the parent and child/young person experience of difficult venous access and identify ideas and preferences for changes to clinical practice. Background: Peripheral intravenous catheter insertion is one of the most common invasive procedures in hospitalised paediatric patients. Multiple insertion attempts in paediatric patients are common and associated with pain and distress. Little research has explored the parent and child/young person experience of difficult venous access nor sought to identify their suggestions to improve clinical practice. Design: Qualitative description. Methods: A purposive sampling approach was used to identify children and young people with experience of difficult venous access and their parents. Semi‐structured interviews were conducted, with sample size based on data saturation. Transcripts were analysed using thematic analysis. Results: There were 12 participants, seven parents and five children/young people (five parent/child dyads and two individual parents). Analysis of the data revealed three main themes: (1) Distress—before, during and after (2) Families navigating the system: the challenging journey from general clinician to specialist and (3) Difficult venous access impacts both treatment and life outside the hospital A pre‐determined theme, (4) Recommendations for good clinical practice is also described. Conclusions: Multiple attempts to insert a peripheral intravenous catheter are a source of substantial distress for children/young people, leading to treatment avoidance. Effective interpersonal skills, providing choice and avoiding frightening language are important to minimise distress. Clinicians without specialist training should assess each child's venous access experience and consider immediate referral to a specialist if they have a history of difficult venous access. Cultural change is required so clinicians and healthcare services recognise that repeated cannulation may be a source of psychological distress for children/young people. [ABSTRACT FROM AUTHOR]

Aim: To explore the use and implementation of teleconsultations by primary care nurses in the context of the COVID‐19 pandemic. Background: Teleconsultation use increased rapidly during the COVID‐19 pandemic. Its implementation has been documented for physicians and specialists, but knowledge is still limited in nursing practice. Design: A sequential mixed‐methods study. Methods: Phase 1: A cross‐sectional e‐survey with 98 nurses (64 nurse clinicians [NCs] and 34 nurse practitioners [NPs]) was conducted in 2020 in 48 teaching primary care clinics in Quebec (Canada). Phase 2: Semi‐structured interviews with four NCs and six NPs were conducted in 2021 in three primary care clinics. This study adheres to STROBE and COREQ guidelines. Results: During the pandemic, telephone was the principal teleconsultation modality used by NPs and NCs compared to other teleconsultation modalities (text messages, email and video). The only variable associated with a higher likelihood of using teleconsultations was type of professional (NCs). Video consultation was almost absent from the modalities used. The majority of participants reported several facilitators to using teleconsultations in their work (e.g. web platforms and work‐family balance) and for patients (e.g. rapid access). Some barriers to utilisation were identified (e.g. lack of physical resources) for successful integration of teleconsultations at the organisational, technological and systemic levels. Participants also reported positive (e.g. assessment of cognitive deficiency) and negative (e.g. rural population) impacts of using teleconsultations during a pandemic that made the use of teleconsultations complex. Conclusion: This study highlights the potential for nurses to use teleconsultations in primary care practice and suggests concrete solutions to encourage their implementation after the pandemic. Relevance to clinical practice: Findings emphasize the need for updated nursing education, easy‐to‐use technology and the strengthening of policies for the sustainable use of teleconsultations in primary health care. Implications for the profession: This study could promote the sustainable use of teleconsultations in nursing practice. Reporting method: The study adhered to relevant EQUATOR guidelines; the STROBE checklist for cross‐sectional studies and the COREQ guidelines for qualitative studies were used for reporting. Patient or public contribution: No patient or public contribution, as the study focused on the use of teleconsultation among health professionals, specifically primary care nurses. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To determine which factors can be considered protective of ethical conflicts in intensive care unit healthcare professionals during a pandemic. Background: The COVID‐19 pandemic gave rise to new ethical concerns in relation to the management of public health and the limitations on personal freedom. Continued exposure to ethical conflict can have a range of psychological consequences. Design: A qualitative design based on phenomenological approach. Methods: A total of 38 nurses and physicians who were regular staff members of Barcelona and Milan's public tertiary university hospitals and working in intensive care units during the first wave of the COVID‐19 pandemic. Semi‐structured online in‐depth interviews were conducted. A thematic analysis was performed by two independent researchers following the seven steps of Colaizzi's methods. We adhere COREQ guidelines. Results: One theme 'Protective factors of ethical conflict in sanitary crisis' and four subthemes emerged from the data: (1) knowledge of the infectious disease, (2) good communication environment, (3) psychological support and (4) keeping the same work team together. Conclusions: Four elements can be considered protective factors of ethical conflict for healthcare professionals during a sanitary crisis. While some of these factors have already been described, the joint identification of this set of four factors as a single element is, in itself, novel. This should help in ensuring the right mechanisms are in place to face future pandemics and should serve to improve institutional organisation and guarantee safe and high‐quality patient care in times of healthcare crisis. Relevance to Clinical Practice: Future strategies for the prevention of ethical conflict during sanitary crises, pandemics or other catastrophes need to consider a set of four factors as a single element. These factors are the knowledge of the infectious disease, a good communication environment, psychological support and keeping the same work team together into joint consideration. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of the study was to investigate the effect of supporting family members to partner with health professionals on nutrition intakes and decision‐making and to evaluate intervention and study feasibility. Background: Family partnerships can improve outcomes for critically ill patients and family members. Interventions that support families to engage with health professionals require evaluation. Design: A multi‐centre, randomised, parallel group superiority Phase II randomised controlled trial. Methods: In nine intensive care units (ICUs) across three countries, critically ill patients ≥60 years, or those 55–59 years with advanced chronic diseases and expected ICU length of stay >72 h and their family member were enrolled between 9 May 2017 and 31 March 2020. Participants were randomised (1:1:1) to either a decision support or nutrition optimisation family‐centred intervention, or usual care. Primary outcomes included protein and energy intake during ICU and hospital stay (nutrition intervention) and family satisfaction (decision support). Study feasibility was assessed as a composite of consent rate, intervention adherence, contamination and physician awareness of intervention assignment. Results: We randomised 135 patients/family members (consent rate 51.7%). The average rate of randomisation was 0.5 (0.13–1.53) per month. Unavailability (staff/family) was the major contributor to families not being approached for consent. Declined consent was attributed to families feeling overwhelmed (58/126, 46%). Pandemic visitor restrictions contributed to early study cessation. Intervention adherence for the decision support intervention was 76.9%–100.0% and for the nutrition intervention was 44.8%–100.0%. Nutritional adequacy, decisional conflict, satisfaction with decision‐making and overall family satisfaction with ICU were similar for all groups. Conclusions: Active partnerships between family members and health professionals are important but can be challenging to achieve in critical care contexts. We were unable to demonstrate the efficacy of either intervention. Feasibility outcomes suggest further refinement of interventions and study protocol may be warranted. Relevance to Clinical Practice: Interventions to promote family partnerships in critical illness are needed but require a greater understanding of the extent to which families want and are able to engage and the activities in which they have most impact. Reporting Method: This study has been reported following the Consolidated Standards of Reporting Trials (CONSORT) and the Template for Intervention Description and Replication (TIDieR) guidelines. Patient or Public Contribution: Patients and caregivers were engaged in and contributed to the development and subsequent iterations of the two family‐centred interventions use in this study. Clinical Trial Registration Number: Trial registration. Clinicaltrials.gov, ID: NCT02920086. Registered on 30 September 2016. First patient enrolled on 9 May 2017 https://clinicaltrials.gov/ct2/results?cond=&term=NCT02920086&cntry=&state=&city=&dist=. [ABSTRACT FROM AUTHOR]

Aims: To describe and synthesize non‐pharmacological and nonsurgical interventions for male urinary incontinence from the existing literature. Methods: A scoping review was conducted following the methodology suggested by Arksey and O'Malley: (1) identification of the research questions; (2) identification of relevant studies using a three‐step search recommended by JBI: an initial search within PubMed and CINAHL, a comprehensive literature search within PubMed, CINAHL, EMBASE, PsycINFO, Cochrane Library, and literature search of references lists; (3) study selection; (4) data extraction and charting; (5) collation, summarization, and reporting of the results. The PRISMA‐ScR Checklist was used to report. Results: A total of 4602 studies were identified, of which 87 studies were included. Approximately 78% were randomized controlled trials. More than 88% of the participants were men with prostate cancer. Exercising pelvic floor muscles 30 times per day for 12 weeks was the most frequently reported. Parameters of electrical stimulation were typically set up to 50 Hz and 300 μs for frequency and width of pulse, respectively, and lasted for 15 min. Pure pelvic floor muscle training, Pilates, Yoga, whole body vibration, diaphragm/abdominal muscle training, micturition interruption exercise, acupuncture, and auriculotherapy showed positive effects on reducing urinary incontinence. Conclusion: The findings suggested implementing pelvic floor muscle training alone before or after surgery can both prompt the recovery of continence in men after prostate cancer surgery. The decision to use biofeedback or electrical stimulation to enhance the therapeutic effect of pelvic floor muscle training should be approached with caution. More rigorous designed studies are needed to validate the effectiveness of Traditional Chinese Medicine techniques and diverse novel methods. Relevance to clinical practice: Physicians and nurses need to be up to date on the latest evidence‐based non‐pharmacological and nonsurgical interventions in male urinary incontinence and select appropriate interventions based on available medical resources and patient preferences. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To map and synthesise the literature on loneliness at end‐of‐life and identify key knowledge gaps in loneliness research. Background: Declined health conditions, reduced social engagement, loss of social roles, and fear of death may lead to loneliness at end‐of‐life. However, systematic information about loneliness at end‐of‐life is scant. Methods: This scoping review followed the methodology proposed by Arksey and O'Malley. Nine electronic databases were searched from January 2001 to July 2022. Studies about loneliness at end‐of‐life were included. Two review authors independently screened and selected relevant studies and performed the data charting. The PAGER framework was employed to collate, summarise and report the results. The PRISMA‐ScR checklist was included. Results: A total of 23 studies were included in this review (12 qualitative, 10 quantitative, and one mixed‐methods design). There was not reliable data about the prevalence of loneliness among adults at end‐of‐life internationally. Three or 20‐item UCLA loneliness scale was frequently used to measure loneliness. Factors predisposed adults at end‐of‐life to loneliness included passive and active withdrawal from social networks, inability to share emotions and to be understood, and inadequate support on spirituality. Four strategies were identified to alleviate loneliness, yet none have been substantiated in clinical trials. Interventions facilitating spirituality, social interactions and connectedness seem effective in alleviating loneliness. Conclusions: This is the first scoping review on loneliness at end‐of‐life, synthesising evidence from qualitative, quantitative, and mixed‐methods studies. Loneliness among adults at end‐of‐life is under‐investigated and there is a prominent need to address existential loneliness at end‐of‐life. Relevance to clinical practice: All nurses should proactively assess loneliness or perceived social isolation for clients with life‐limiting conditions, regardless of social networks. Collaborative efforts (e.g., medical‐social collaborations) to promote self‐worthiness, social engagement and connectedness with significant others and social networks are needed. Patient or Public Contribution: No patient or public involvement. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aims to explore, describe, and synthesize the personal requirements student nurses are assessed in their clinical placement to be suitable, fit, competent, and safe for the nursing profession. Background: There are different terms and concepts used when describing what nursing students are assessed by regarding personal requirements needed to be eligible to enter the nursing profession. This is regulated and enforced mainly by different standards and guidelines. Design: An integrative review using Whittmore and Knafl's (2005) methodology. Methods: Searches were systematically conducted in CINAHL, Education Source, ERIC, Academic Source Elite, MEDLINE and EMBASE, NORART, SveMed+, and Bibliotek.dk. The PRISMA checklist for systematic reviews was used. Results: Eighteen studies were included in the review. The results present various factors student nurses are assessed by in clinical placements, which were categorized into three themes: attitude and personal characteristics, behavior, and basic knowledge. Assessing students is a complex and subjective endeavor, and decisions are based on a holistic assessment of several different aspects of the student's performance and behavior Conclusions: The personal requirements to be deemed suited for det nursing profession are complex and composed of several different components. Assessments are often based more on assessors' subjective standards and intuition than on the provided guidelines and standards. There is no universal understanding of which characteristics or qualities are considered necessary for a student to be deemed suited for the nursing profession. Relevance to clinical practice: This study points at challenges with the assessment of nursing students today as there are no clear standards or understanding of the requirements needed. [ABSTRACT FROM AUTHOR]

Background: Although gynaecological cancer's negative effects on sexual function are well known, most studies on the subject have not included vulvar cancer patients or a multidimensional perspective on sexual health. Therefore, this review aimed to address this research gap and explored the impact of vulvar cancer on women's sexual health from a multidimensional perspective. Methodology: An integrated review was conducted, as described by Whittemore and Knafl. The PubMed, CINAHL, PsycINFO and Embase databases were searched in March 2021 and updated in August 2022 and March 2023. The data were thematically analysed using NVivo, and the PRISMA‐ScR and ENTREQ guidelines were followed. Findings: The following themes were identified in the 28 reviewed articles: impact of a changed female body, impact on women's sexual identity, consequences for women's sexual relationships and unmet needs and loneliness caused by taboos about sexual health. Discussion: Women's impaired sexual health after vulvar cancer points to a great need to understand and holistically investigate sexual health. In addition, healthcare professionals have an obligation to care for the sexual health issues of patients with vulvar cancer. However, most questionnaires used in the selected studies revealed a narrow understanding of sexual health and focused on sexuality as a genital activity. Conclusion: The sexual health of women with vulvar cancer was tabooed and stigmatised for patients and healthcare professionals. Consequently, women received sparse sexual guidance, felt isolated and had unmet needs. Implications for clinical practice: Healthcare professionals need knowledge and training on how to break taboos and address the sexual needs of vulvar cancer patients. Systematic screenings for sexual health needs should be conducted using a multidimensional perspective. Trial and protocol registration: The protocol was preregistered at the Open Science Framework (www.osf.io), registration DOI: https://doi.org/10.17605/OSF.IO/YDA2Q Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To assess the methodological quality of current clinical practice guidelines related to post‐stroke dysphagia and develop an algorithm using nursing process as a framework for clinical nursing. Background: Dysphagia is a serious complication of stroke. Yet the recommendations related to nursing in guidelines have not been systematically sorted out, so they are difficult for nurses to use to guide clinical nursing practice. Design: Systematic review. Methods: A systematic review of literature was performed using the PRISMA Checklist. A systematic search for relevant guidelines published between 2017 and 2022 was conducted. Appraisal of Guidelines for Research and Evaluation II instrument was used to assess methodological quality. Recommendations related to nursing practice from high‐quality guidelines were summarised and developed into an algorithm to provide reference for the standardised construction of nursing practice scheme. Results: 991 records were initially identified from database searches and other sources. Finally, 10 guidelines were included, of which 5 were rated as high quality. A total of 27 recommendations from the 5 highest‐scoring guidelines were summarised and used to develop an algorithm. Conclusions: This study indicated deficiencies and variability in current available guidelines. Based on five high‐quality guidelines, we developed an algorithm to facilitate nurses' adherence to guidelines and contribute to evidence‐based nursing. In the future, high‐quality guidelines, together with large‐sample and multi‐centre clinical researches are suggested to give more scientific and convincing evidence to nursing of post‐stroke dysphagia. Relevance to Clinical Practice: The findings indicate that nursing process may provide a unified framework for standardised nursing of different diseases. Nursing leaders are recommended to adopt this algorithm in their units. In addition, nursing administrators and educators should promote the application of nursing diagnosis to help nurses foster nursing thinking mode. Patient or Public Contribution: No patient or public involvement in this review. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the perceptions of family‐centred care among nurses and the family members of hospitalised children and investigate the facilitators of and barriers to the implementation of family‐centred care in Malawi. Background: In Malawi, approximately 34% of children have long‐term illnesses that require hospitalisation. Family‐centred care ensures that the delivery of healthcare is grounded in partnerships between healthcare providers, patients and their families, which can improve the psychological well‐being of families. However, there is lack a good understanding of how families and nurses perceive this concept, its facilitators and the barriers. Design: This was an exploratory qualitative study. Data were analysed deductively and inductively using the five‐step qualitative content analysis method. Methods: Twenty‐nine nurses and 31 families were recruited. Data were collected through in‐depth, semi‐structured and face‐to‐face individual interviews. The study was reported using the COREQ checklist. Results: Both nurses and families of hospitalised children recognised the importance of nurse–family partnerships in family‐centred care. Four themes emerged as follows: Perceptions of family‐centred care, elements of family‐centred care, facilitators of family‐centred care and barriers to family‐centred care. Specific information to families and the religious beliefs of families were identified as important facilitator and barrier to family‐centred care, respectively. Conclusion: The implementation of family‐centred care is promising in Malawi, as it is positively perceived by nurses and families, and its implementation is consistent with the Institute for Patient and Family‐Centred Care Framework. Relevance to clinical practice: Our findings present the best practices, gaps and challenges in the context of a low‐income country regrading implementation of family‐centred care. Education programmes on family‐centred care are crucial for sustaining the current gains. [ABSTRACT FROM AUTHOR]

Aim: To explore general ward nurses' attitudes and perceptions towards recognising and responding to clinical deterioration in a hospital with automated rapid response system activation. Background: There is growing interest in deploying automated clinical deterioration notification systems to reduce delayed or failed recognition and response to clinical deterioration of ward patients. However, little is known about its impact on ward nurses' perspectives and work patterns. Design: A mixed‐methods study. Methods: Online survey of 168 registered nurses and individual interviews with 10 registered nurses in one acute hospital in Singapore. The study adhered to the STROBE checklist for cross‐sectional studies and the COREQ guidelines for qualitative studies. Results: Many nurses (38.1%) rarely performed patient assessments or observations other than vital signs assessment to assess for early signs of clinical deterioration. About 30% were worried about being criticised for calling the primary team doctors. Four themes emerged from the qualitative analysis: automated rapid response system activation as a safety net, being more cautious with vital signs monitoring, the NEWS2 alone is inadequate, and ward nurses as the 'middleman' between the intensive care unit outreach nurse and primary team doctors. Conclusions: Although nurses value the automated rapid response system activation as a safety net to minimise delays in accessing urgent critical care resources, it does not address the sociocultural barriers inherent in escalation of care. Although the automated system led nurses to be more cautious with vital signs monitoring, it does not encourage them to perform comprehensive patient assessments to detect early signs of deterioration. Relevance to clinical practice: Nurse education on assessing for clinical deterioration should focus on the use of broader patient assessment skills other than vital signs. Sociocultural barriers to escalation of care remain a key issue that needs to be addressed by hospital management. No patient or public contribution: No patients, service users, care‐givers or members of the public were involved in the study. [ABSTRACT FROM AUTHOR]

Aim and objectives: To explore the family's experience being offered memory making during end‐of‐life care in the adult intensive care unit and its use in early bereavement. Background: Family members of individuals who develop a critical illness requiring emergency hospitalisation are unlikely to be prepared for a possible death. This places them at increased risk of poorer bereavement experiences. One potential intervention is memory making, which is an act that provides tangible objects such as a handprint, footprint, lock of hair, or teddy bear, that allows connections with and provides meaningful memories about a person. Families in the adult acute population reportedly have positive reactions regarding the objects, but it is unknown the object's effects on early bereavement experiences. Design: Descriptive qualitative study utilising inductive reflexive thematic analysis. Reporting adheres to the COREQ checklist. Methods: Between May 2019‐December 2020, a purposeful, convenience sample of 21 participants from a tertiary referral, adult intensive care unit in Australia were recruited to explore their experiences being offered memory making during end‐of‐life care and the objects use in early bereavement. Interviews were conducted using a semi‐structured format and occurred at the participants' location of choice. Results: Data analysis generated three themes: guidance during end of life by healthcare professionals that recognises the autonomy of the family; object used as a trigger to access memories; and storage and preservation of the object as an indication of its sentimental value and use in early bereavement Conclusion: Memory making objects such as handprints, locks of hair, or teddy bears received in the adult intensive care unit were valued and utilised during early bereavement by most recipients. Relevance to clinical practice: Findings inform practice evidence gaps regarding the family's experiences of memory making received as a bereavement intervention in the adult acute population. Patient or public contribution: Participants contributed through sharing their first‐hand experiences of receiving memory making in the adult intensive care unit. [ABSTRACT FROM AUTHOR]

Aim: To scope the international literature about registered nurses delegated models of care to unlicenced workers, identify gaps and reflect upon how the evidence relates to nursing in multiple contexts. Design: Scoping review of the peer reviewed literature from the year 2000 onwards, using the PRISMA‐ScR checklist. Methods: The study searched the following databases in February 2022: CINAHL, Medline, ProQuest, and SCOPUS, and included keywords, Boolean operators and subject headings relevant to registered nurses delegating the provision of care to unlicenced workers. Results: A total of 49 articles met the eligibility criteria for this study, and relevant data were extractedThree models of delegation were highlighted within the literature: direct, indirect and a mixture of both. The data highlighted that direct delegation mainly occurred in acute contexts, with delegation decreasing with increasing patient acuity and/or complexity but the threshold of when this would occur was not clear. There was one intervention study that measured patient outcomes which could aid in the determination of what is effective delegation. For studies that did report on it (n = 6), there were few examples of better patient outcomes in cases where care was delegated from registered nurses to unlicenced workers. Conclusions: The scoping review highlighted heterogeneity in practice areas and methods of delegation practice. A key gap in literature is the absence of studies focusing on patient outcomes, with a clear baseline to measure and identify effective delegation practices. Additionally, the legal and logistical implications presented in both direct and indirect delegation practices is not evident in the literature. Implications for the Profession: Decisions related to delegation are often made at the service level and prescribed to those who work within the service, suggesting that models of indirect delegation are in fact not delegation at all, rather a re‐distribution of nurses' work. Relevance to clinical practice: Delegation is a vital component of the scope of practice of registered nurses. This review has highlighted unique differences in delegation by practice context, where the proliferation of unlicensed workers in certain contexts places a vastly different professional and legal burden on the registered nurse. [ABSTRACT FROM AUTHOR]

Objective: To identify the main ventilatory support medical devices related to the occurrence of pressure injuries in hospitalised adults, as well as the most frequent anatomical localisations of these injuries. Methods: The Integrative review was registered at Open Science Framework as per DOI 10.17605/OSF.IO/P3NTZ. Two independent reviewers, in May 2022, searched the databases: PubMed, Embase, Cochrane Database of Systematic Reviews, LILACS and CINAHL; no language or publication year restriction. The review question was: What are the ventilatory support medical devices that cause PIs in hospitalised adults more often? The terms for searching the database were: "adult," "noninvasive ventilation," "artificial respiration." and "pressure injury," and their synonyms. This review followed the PRISMA checklist. Results: The final sample was 21 articles. Oxygen nasal catheters caused up to 40.7% of the pressure injuries by ventilatory support devices identified, all in the ears. Noninvasive mechanical ventilation oronasal masks presented an incidence of pressure injuries of 63.3%. The nasal bridge was the site most affected by this mask. The Set of Holders for Insight® endotracheal tubes was the device that caused the most pressure injuries, with an incidence of 75%, affecting lip commissure. Tracheostomy cannula accounted for 18.2% of the pressure injuries related to ventilatory support devices; all lesions were in the neck. Conclusion: The ventilatory support devices causing pressure injuries and the most affected sites were, respectively, nasal catheters, ears; masks, nasal bridge; endotracheal tubes, lip commissures; tracheostomy cannulas, neck. Relevance for clinical practice: Knowing which respiratory devices cause pressure injuries more often in hospitalised adults and which anatomical localisations are more likely to be affected is fundamental for adopting preventive measures and reducing the occurrence of this problem. No patient or public contribution: No patient or public contribution because of the review. [ABSTRACT FROM AUTHOR]

Background: Videoconferencing has been proposed as an innovative telerehabilitation approach for stroke survivors, demand for which is growing. Aim: To evaluate the efficacy of a videoconferencing intervention for stroke survivors. Design: Systematic review and meta‐analysis. Methods: We conducted a systematic review of the literature in the databases Academic Search Complete, CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, Ovid (and its companion UpToDate), and Web of Science published from January 1, 2002, to May 27, 2021. The methodologic quality of the included studies was evaluated using version 2 of the Cochrane risk‐of‐bias tool. A meta‐analysis using a random‐effects model calculated the pooled standardised mean difference (SMD) for using a videoconferencing intervention with stroke survivors and for the ability of survivors to perform activities of daily living (ADLs) and to maintain balance. The Stata software application (version 16.0: StataCorp LP) was used for the statistical analysis. Results: Nine studies with 603 participants were included in the analysis. Videoconferencing interventions were observed to be effective in improving the ability of stroke survivors to carry out their ADLs (SMD: 0.57; 95% confidence interval [CI]: 0.13 to 1.01) and to recover their balance (SMD: 1.96; 95% CI: 1.27 to 2.66). Conclusions: Stroke survivors were able effectively to improve their ADL and balancing abilities. Further studies could consider the frequency, duration, and standard protocol for videoconferencing interventions. Relevance to Clinical Practice: This study could change the approach to patient support in future clinical practice and might constitute an alternative for improving care for stroke survivors in their homes or in long‐term care facilities. [ABSTRACT FROM AUTHOR]

Aim and objectives: The aim of this study was to describe and understand how heterosexual women with Turner Syndrome experience sexuality. Background: Turner Syndrome is a genetic condition that is the result of one of the X chromosomes missing or partially missing, and it affects women of all ages. Turner Syndrome may lead to psychological, relational and sex life disorders. Design: This is a qualitative study, and the COREQ checklist was employed to report on the current study. Methods: The study was conducted in a region of southern Spain. Convenience and snowball sampling were used to recruit 18 women, aged 22–51 years, who had been diagnosed with Turner Syndrome. Participants' experiences were explored through semi‐structured interviews between January and May 2021. Thematic analysis was used for data analysis. Results: Three main themes and eight sub‐themes emerge from the data analysis: (1) Sexuality linked to corporeality, with the sub‐themes: 'Discovering that your body is different', 'Social stigma limits one's sex life' and 'Fear of penetration surpresses sexual desire'. (2) Adapting one's sexuality to Turner Syndrome, with the sub‐themes: 'Feeling like a woman' and 'Suffering from and adapting to comorbidities'. (3) When infertility overshadows sexuality, with the sub‐themes: 'Prolonging childhood by ignoring sexuality', 'Fertility treatment: always a possibility' and 'Lack of specialised professional knowledge'. Conclusion: Heterosexual women with Turner Syndrome suffer from sexual problems, delayed diagnosis and treatment, and lack of information. Unawareness and relational problems may also lead to scarce and late sexual relations, jealousy and a fear of being left. The women with Turner Syndrome refer to little self‐exploration or masturbation as well as a fear of penetration. Relevance to clinical practice: Understanding the experiences of sexuality in heterosexual women with Turner Syndrome is a challenge for clinical nurses, who could provide quality care to these women in contextualised services. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To systematically review interventions and outcomes regarding family participation in essential care in adult intensive care units. Background: Patients and relatives may benefit from family participation in essential care activities. Design: An integrative literature review. Methods: The following databases were systematically searched from inception to January 25, 2021: PubMed, CINAHL, EMBASE, MEDLINE, Cochrane, Web of Science and reference lists of included articles. Studies were included when reporting on family participation in essential care activities in intensive care including interventions and outcomes. Quality of the studies was assessed with the Kmet Standard Quality Assessment Criteria. Interventions were assessed, using the TIDieR framework. Data were extracted and synthesised narratively. Results: A total of 6698 records were screened, and 322 full‐text studies were assessed. Seven studies were included, describing an intervention to support family participation. Four studies had a pretest‐posttest design, two were pilot feasibility studies and one was observational. The quality of the studies was poor to good, with Kmet‐scores: 0.50–0.86 (possible score: 0–1, 1 being the highest). Five studies offered various essential care activities. One study provided sufficient intervention detail. Outcome measures among relatives varied from mental health symptoms to satisfaction, supportiveness, comfort level and experience. Two studies measured patient outcomes: delirium and pressure ulcers. Among ICU healthcare providers, perception, comfort level and experience were assessed. Since outcome measures varied, only narrative synthesis was possible. Family participation is associated with a reduction of anxiety and PTSD symptoms. Conclusion: Intervention descriptions of family participation in essential care activities are generally inadequate and do not allow comparison and replication. Participation of relatives was associated with a significant reduction in mental health symptoms. Other outcome measures varied, therefore, the use of additional outcome measures with validated measurement instruments should be considered. Relevance to clinical practice: The review contributed further insight into interventions aiming at family participation in essential care activities in the intensive care unit and their outcomes. No patient or public contribution: Neither patients nor public were involved. [ABSTRACT FROM AUTHOR]

Background: Diabetes has become a global public health problem. Strengthening the self‐management ability of people with prediabetes plays an important role in preventing the occurrence and development of type 2 diabetes. The aim of this study is to synthesise the self‐management experiences and perceptions of people with prediabetes, which can contribute to the development of self‐management programs. Methods: This review adheres to the ENTREQ Guide. Evidence‐based medicine database (JBI and Cochrane) and original literature database (PubMed, Medline, EMbase, Web of Science, Wanfang, CNKI and VIP) were searched up to 31 May 2022. Both Chinese and English literature of qualitative research on self‐management experiences and perceptions of prediabetic patients were included. The quality of the included studies was evaluated, and the data were synthesised and analysed by thematic synthesis method. Results: A total of 23 primary studies containing 504 participants were included. After repeated reading and coding of the literature, three analytical themes were finally identified: coping with role management, success and failure in medical management, seeking and perceiving support. Conclusion: Role management for people with prediabetes needs more attention. Healthcare providers should identify problems from patients' self‐management experiences and improve professional skills to assist program modifications. Integrating the self‐management program into community activities under the guidance of medical staff and inviting family members and peers to participate can increase involvement and improve the self‐management ability. Relevance to Clinical Practice: These findings describe the different stages and issues in the self‐management process of prediabetic patients. The practice of prediabetes self‐management should incorporate the psychosocial, physical, and financial issues of the patients. As the main provider of health services, nurses should make patients aware of the susceptibility and severity of prediabetes and help them improve their self‐management skills. No Patient or Public Contribution: This is a meta‐synthesis without direct participation of patients. [ABSTRACT FROM AUTHOR]

Background: Patient engagement has emerged as a key focus in the research literature to facilitate patients' recovery. The term is commonly used by researchers, yet without working definitions. This lack of clarity is further complicated by the interchangeable use of a few terms. Objectives: This systematic review aimed at identifying how patient engagement was conceptualised and operationalised in perioperative settings. Methods: MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched for publications in English discussing patient engagement during the perioperative phase. Three reviewers conducted study selection and methodological assessment using Joanna Briggs Institute mixed methods review framework. Reflexive thematic analysis was used to analyse qualitative data and descriptive analysis for quantitative data. Findings: Twenty‐nine studies were included with a total sample of 6289. Study types included qualitative (n = 14) and quantitative (n = 15) with different types of surgery. Sample sizes ranged from n = 7 to n = 1315. Only 38% (n = 11) of included studies offered an explicit definition. Four themes associated with operationalisation included provision of information, which was most studied theme, communication, decision‐making and action‐taking behaviours. All four themes were interconnected and co‐dependent on each other. Conclusions: Patient engagement in perioperative settings is a complex and multifaceted concept. The conceptual void in the literature calls for more theoretically informed and comprehensive approaches to researching surgical patient engagement. Future research should aim to better understand the factors that influence patient engagement, as well as the impact of different forms of engagement on patient outcomes through the whole surgical journey of a patient. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To determine the global prevalence of nursing burnout syndrome and time trends for the last 10 years. Background: The prevalence of burnout syndrome varied greatly in different regions in the last 10 years, so the average prevalence and time trends of nursing burnout syndrome for the last 10 years were not completely clear. Design: A meta‐analysis conducted in the PRISMA guidelines. Methods: CINAHL, Web of Science, and PubMed were searched for trials on the prevalence of nursing burnout syndrome from 2012 to 2022 systematically. Hoy's quality assessment tool was used to evaluate the risk of bias. The global prevalence of nursing burnout syndrome was estimated, and subgroup analysis was used to explore what caused heterogeneity. Time trends for the last 10 years were evaluated by meta‐regression using Stata 11.0. Results: Ninety‐four studies reporting the prevalence of nursing burnout were included. The global prevalence of nursing burnout was 30.0% [95% CI: 26.0%–34.0%]. Subgroup analysis indicated that the specialty (p <.001) and the region (p <.001) and the year (p <.001) were sources of the high heterogeneity. Meta‐regression indicated that it tended to increase gradually for the last 10 years (t = 3.71, p =.006). The trends increased in Europe (t = 4.23, p =.006), Africa (t = 3.75, p =.006) and obstetrics (t = 3.66, p =.015). However, no statistical significance was found in ICU (t = −.14, p =.893), oncology (t = −0.44, p =.691) and emergency department (t = −0.30, p =.783). Conclusions: A significant number of nurses were found to have moderate‐high levels of burnout syndrome for the last 10 years. The meta‐analysis also indicated an increased trend over time. Therefore, more attention to the prevalence of nursing burnout syndrome is urgently required. Relevance to Clinical Practice: High prevalence of nursing burnout may attract more attention from the public. This analysis may serve as an impetus for relevant policy to change nurses' working conditions and reduce the occurrence of burnout. [ABSTRACT FROM AUTHOR]

Aim: This review sought to discover how community nurses globally provide palliative care, with specific focus on how they manage the personal and professional stressors associated with caring for dying clients in the home. Design: An integrative review methodology was used to gain insight into how community palliative care is delivered worldwide. Background: The provision of home palliative care by community nurses gives clients the ability to spend their final days in familiar surroundings. Research has focussed on the provision of palliative care in the inpatient setting, with little known about the community setting. Methods: Data were collected through a literature search, then a critical analysis approach was used to evaluate the strengths of palliative care literature by analysing recurrent themes to stimulate further research on the topic. Data Sources: The following databases were used to conduct the literature search: CINAHL, Medline, Pubmed, Scopus, Ovid. Results: The results highlighted the importance of building a skilled palliative community nursing workforce and the need to offer specialised palliative care training to nurses, particularly around difficult conversations and service coordination. Conclusion: The literature identified the challenges implicit within the community nursing role in delivering palliative care, but it did not identify the factors that enhance the nurses' ability to manage the stressors associated with this role. The input of nurses must be sought to understand the development of resilience. Implications for the profession: Community palliative care nursing requires time spent with clients and family members who are suffering, therefore predisposing nurses to stress. Effort must be made to provide palliative care nurses with support to enhance professional resilience. [ABSTRACT FROM AUTHOR]

Purpose: To explore and describe the enactment of user involvement and combined care in a Danish clinic that aimed at providing integrated diabetes and mental health care. Design: An ethnographic study. Data Sources and Methods: Data consisted of field notes from 96 hours of participant observations and field notes from 32 informal conversations with healthcare providers, users and relatives as well as 12 semistructured interviews with users. Data were analysed using a thematic analysis. This study reports to the SRQR guidelines. Results: Treatment was not combined as intended if only one healthcare provider handled the consultations. Here, the healthcare providers' focus was often on their own area of expertise—either mental health or diabetes. If more than one healthcare provider handled consultations, the consultations were often divided between them, focussing on one condition at the time. Healthcare providers noted, that learning from peer colleagues was a way to increase the possibility for combined care. Furthermore, combined care was highly dependent on the healthcare providers' ability to involve users' illness experiences in their own care planning. Here, a high level of user involvement increased the levels of combined care during consultations. Conclusion: This study set out to explore and describe user involvement and combined care in a specialised diabetes and mental health outpatient clinic. Combined care is complexed and requires that healthcare providers are well‐equipped to manage the complexity of delivering care for people with both conditions. The degree of combined care was linked with the healthcare providers' ability to involve users and their knowledge on the condition outside there are of expertise. Relevance to Clinical Practice: A peer‐learning environment in combination with clinical guidelines and joint display could support healthcare providers in involving users in own care and when delivering care outside their area of expertise. Public contribution: No patient or public contribution. Due to the COVID‐19 pandemic, the original user council withdraw their consent to participate due to health‐related worries and anxiety concerning the pandemic. The user council consisted of three members diagnosed with diabetes and severe mental illness. They were invited to participate in physical meetings, phone or online meetings. Presenting findings from the study to the study participants were also hindered by the second lockdown. This influenced the possibility for data triangulation. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of women who have had ovarian hyperstimulation syndrome, and healthcare professionals who care for them. Background: Ovarian hyperstimulation syndrome is a side effect of fertility treatment. Little research exists internationally that explores the experiences of women who have had this condition, or the healthcare professionals who manage it. Design: Qualitative study using semi‐structured interviews. Methods: Eighteen interviews with women who had experienced ovarian hyperstimulation syndrome (n = 10) and healthcare professionals (n = 8) in six UK fertility centres. Framework analysis was used. This paper is reported following COREQ guidelines. Results: Women described a range of symptoms and severity, sometimes experiencing worrying physical health problems such as abdominal swelling and shortness of breath. The combination of the symptoms, and their management, on delaying future fertility treatment could cause emotional distress. Healthcare professionals at different centres described variation in practice, which generally involved 'active monitoring' until symptoms became severe, when women would be hospitalised. Women expressed feeling 'left in limbo' while waiting for symptoms to improve or worsen, and described a lack of control during this waiting period. Healthcare professionals felt they provided adequate information about ovarian hyperstimulation syndrome and its management. This, however, did not align with women's perceptions that information, including potential delays to their fertility treatment, was missing. There was similar mismatch between women's and healthcare professionals' views of decision‐making about fertility treatment following ovarian hyperstimulation syndrome, including women's concerns about having to make rushed, unplanned decisions about their fertility treatment when they did not feel adequately informed to do so. Conclusion: Ovarian hyperstimulation syndrome and its management can have a significant physical and emotional impact on women, and influence their fertility treatment. Improvements could be made to the information women receive about this condition, its management and its implications for wider fertility treatment. Implications for the profession and/or patient care: Nurses have the skills and knowledge to support women through the physical and emotional stresses of fertility treatment. Therefore, they are well placed to provide specialist information and support for OHSS and ensure women are fully informed about all aspects of the condition, including how its management might delay fertility treatment. [ABSTRACT FROM AUTHOR]

Aim: The aim of this scoping review was to provide an overview of the literature about the process of obtaining consent from adult patients undergoing planned surgery from the healthcare professionals' perspective and analyse knowledge gaps. Background: The process of obtaining consent for planned elective surgery manifests an individual's fundamental right to decide what happens to their body. The process is often suboptimal and problematic, placing a significant resource burden on health systems globally. Deficiencies in the documentation on consent forms have also been shown to increase the risk of operating room error. Design: Scoping review. Methods: Arksey and O′Malley's (International Journal of Social Research Methodology, 8, 2005 and 19) five‐step scoping review methodology was used. Results: Fifty‐three articles were included; 39 primary and 14 secondary research publications. Three key findings were identified; there is currently low‐level evidence about surgical consent processes to inform clinical practice; junior doctors obtain surgical consent frequently, yet this process was likely undertaken sub‐optimally; and current knowledge gaps include capacity assessment, decision‐making and pre‐procedural consent checks. Conclusion: Planned surgical consent processes are complex, and both surgeons and perioperative nurses are essential during the process. While surgeons have responsibility to obtain consent, perioperative nurses provide a safety net in the surgical consent process checking the surgical consent information is correct and has been understood by the patient. Such actions may influence consent validity and patient safety in the operating room. Knowledge gaps about capacity assessment, decision‐making, pre‐procedural checks and the impact of junior doctors obtaining consent on patient understanding, safety and legal claims are evident. Relevance to clinical practice: This review highlights the importance of the surgical nurse's role in the planned surgical consent process. While the responsibility for obtaining surgical consent lies with the surgeon, the nurse's role verifying consent information is crucial as they act as a safety net and can reduce error in the operating room. No patient or public contribution: The authors declare that no patient or public contribution was made to this review in accordance with the aim to map existing literature from the healthcare professionals' perspective. [ABSTRACT FROM AUTHOR]

Aims: To systematically examine and review relevant qualitative studies exploring the current lifestyle among individuals at high risk of colorectal cancer (CRC), and their awareness of the role of a healthy lifestyle in CRC prevention. Background: The increasing incidence and mortality of CRC have presented a serious threat against the health and life of people. As the major population affected by CRC, the lifestyle of individuals at a high risk of CRC is attracting increasing attention. Design: A qualitative evidence synthesis using the Thomas and Harden method and the PRISMA 2020 checklist provided by the EQUATOR network were used. Data Sources: Literature was retrieved from PubMed, Web of Science, the Cochrane Library, Embase, CINAHL and PsycINFO from the inception to December 2021. Review Methods: Two reviewers independently screened the titles and abstracts and identified the eligible studies. Critical appraisals of each included study were performed. Thematic analysis was used to guide the data synthesis. Results: The data from nine articles were analysed. Three interpretive themes were extracted that formed an overarching synthesis of the experience with healthy lifestyles among high‐risk individuals of CRC. The findings suggested that these individuals with limited awareness of CRC and personal risks lacked sufficient knowledge about the relationship between lifestyle and CRC, and their attitudes and practices towards the role of a healthy lifestyle in CRC prevention were also diversified. Conclusion: Professionals can potentially provide personalised guidance for healthy lifestyles based on knowledge of prevention, the actual background and social support of individuals at high risk of CRC. Impact: Considering that knowledge gaps and health beliefs among these individuals are the premise blocking their adoption of a healthy lifestyle, the findings of this review may make contributions to the design and content of public health policy and prevention programs. No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The objective of this scoping review is to explore the types and mechanisms of Artificial intelligence (AI) techniques for detecting mild cognitive impairment (MCI). Background: Early detection of MCI is crucial because it may progress to Alzheimer's disease. Design: A systematic scoping review. Methods: Five‐step framework of Arksey and O'Malley was used following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping reviews checklist. A total of 11 databases (PubMed, EMBASE, CINAHL, Cochrane Library, Scopus, Web of Science, IEEE Explore, Science.gov, ACM digital library, arXIV and ProQuest) was used to search from inception till 17th December 2021. Grey literature and reference list were searched. Articles screening and data charting were conducted by two independent reviewers. Results: There were a total of 70 articles included from 2011 to 2022 across 16 countries. Four types of AI techniques were found, namely machine learning (ML), deep learning (DL), fuzzy logic (FL) and technique combinations. Herein, ML detects similar pattern within preselected data to classify subjects into non‐MCI or MCI groups. Meanwhile, DL performs classification based on data patterns and data analyses are performed by themselves. Furthermore, FL utilises human‐defined rules to decide the degree to which a person has MCI. A combination of AI techniques enhances the feature preparation phase for ML or DL to perform accurate classification. Conclusion: Although AI‐based MCI detection tool is critical for healthcare decision‐making, clinical utility and risks remain underexplored. Hopefully, this review equips clinicians with background AI knowledge to address these clinical concerns. Hence, future research should explore more techniques and representative datasets to improve AI development. Relevance to clinical practice: Results of this review can increase the knowledge of AI‐based MCI detection tools. Review registration: This study protocol was registered in the Open Science Framework Registries (https://osf.io/45rdt). [ABSTRACT FROM AUTHOR]

Aims and Objectives: To examine the effects of registered nurse staffing levels, work environment and education levels on the residents' quality of life and nurses' job dissatisfaction, burnout and turnover intention. Background: Registered nurse staffing status and work environment are suboptimal in nursing homes worldwide. Nursing home care aims to maximise residents' quality of life. However, evidence on the impact of registered nurse staffing levels, work environment and education levels on the residents' quality of life and nurse outcomes in nursing homes is limited. Design: This is a cross‐sectional observational study. Methods: A total of 513 residents and 117 registered nurses from 39 nursing homes in South Korea participated in surveys. The main measures included registered nurses' staffing levels, work environment, education levels, residents' quality of life, registered nurses' job dissatisfaction, burnout and turnover intention. We analysed data using the generalised estimating equations and reported the study using the STROBE checklist. Results: Overall, the residents' quality‐of‐life score was 13.7 ± 2.6 (out of 17). Residents in nursing homes with a higher number of registered nurses or with work environment evaluated as 'mixed' or 'better' (compared with 'poor') had a higher quality of life. Regarding nurse outcomes, 74.4% of the registered nurses were dissatisfied with their current jobs, 12.0% had burnout and 18.8% had a turnover intention. Registered nurses working in 'mixed' or 'better' work environment were less likely to have job dissatisfaction. Registered nurses' education levels did not have a statistically significant effect on the resident and nurse outcomes. Conclusions: Registered nurse staffing levels and work environment should be considered important for improving residents' quality of life and nurses' job satisfaction. Relevance to Clinical Practice: Regulation and policy reforms are needed to increase the registered nurse staffing levels and to create a good work environment in nursing homes. Patient or Public Contribution: Nursing home residents and registered nurses participated in the surveys of this study. Registered nurses facilitated resident recruitment by identifying and introducing the study to residents who were eligible for study participation. Trial Registration: Not applicable. [ABSTRACT FROM AUTHOR]

Aims: To explore healthcare professionals' perceptions of the feasibility and acceptability of family engagement in early mobilisation for adult critically ill patients. Background: Early mobilisation is beneficial to minimise intensive care unit acquired‐weakness in critically ill patients and family engagement can help with meeting early mobilisation goals, but it is not widely practiced. Understanding healthcare professionals' perceptions of feasibility and acceptability of family engagement in early mobilisation of adult critically ill patients is required to inform future implementation strategies to promote early mobilisation. Design: A descriptive qualitative study. Methods: Face‐to‐face, individual, semi‐structured interviews were conducted between August 2021 and March 2022 with healthcare professionals working in two intensive care units in Australia. The interviews were analysed using the inductive content analysis, and descriptive statistics were used to summarise participant characteristics. The COREQ checklist was followed when reporting this study. Results: Eleven ICU nurses, five physiotherapists and four physicians participated in the interviews. Three main categories were identified: (i) healthcare professionals' readiness, (ii) mediators of engagement and (iii) foundations for successful implementation. Most participants demonstrated a positive attitude towards an implementation of family engagement in early mobilisation for adult critically ill patients; however, capability and capacity of healthcare professionals, family members' willingness, availability and readiness and the care context were considered factors that could influence the successful implementation. Conclusion: From the perspectives of healthcare professionals, family engagement in early mobilisation is feasible and acceptable to enact but implementation is influenced by contextual factors including, healthcare professionals' capability and capacity and family members' willingness, availability and readiness. Collaborative teamwork and preparing family members and healthcare professionals are needed to support this practice. Relevance to Clinical Practice: The findings provide important information to further identify potential strategies of family engagement in early mobilisation and to help and mitigate factors that impede implementation. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the association between patient and caregiver depression and patient self‐care and caregiver contribution to self‐care in the context of ostomy care. Background: Self‐care is essential for ostomy patients and their caregivers. The ostomy self‐care process can be considered a dyadic phenomenon in which the patient and the caregiver interact together and work as a team. The presence of depressive symptoms may limit the patient's ability to perform self‐care and caregivers' abilities to engage in caregiving tasks. Research into the dyadic influence of depression on self‐care behaviours from the perspective of ostomates and their caregivers is still in its infancy. Design: Secondary analysis of a multicentre, cross‐sectional study. The STROBE checklist was used to report the present study. Methods: Patient–caregiver dyads were recruited from eight ostomy outpatient clinics from February 2017 to May 2018. Depression was assessed with the nine‐item Patient Health Questionnaire in both patients and caregivers. Patient self‐care was evaluated with the Ostomy Self‐Care Index, and caregiver contribution to self‐care was assessed with the Caregiver Contribution to Ostomy Self‐Care Index. Both instruments measure the dimensions of maintenance, monitoring and management. The actor–partner interdependence model was performed for the dyadic analysis. Results: In total, 252 patient–caregiver dyads (patients: 69.8% male, mean age 70.05; caregivers: 80.6% female, mean age 58.7) were enrolled. Patient depression was positively associated with caregiver contribution to self‐care maintenance. Caregiver depression was negatively associated with self‐care management. Relevance to Clinical Practice: These findings add a better understanding of the reciprocal influence of dyadic depression on patient and caregiver contributions to self‐care in ostomy contexts was found. Patient and caregiver depression influence patient self‐care and caregiver contribution to self‐care. Therefore, clinicians should assess and treat depression in both members of the dyad to improve self‐care. [ABSTRACT FROM AUTHOR]

Background: Although progress has been made in identifying and responding to acutely deteriorating ward patients, judgements about the level of care required for patients after medical emergency team review are complex, rarely including a formal assessment of illness severity. This challenges staff and resource management practices and patient safety. Objective: This study sought to quantify the illness severity of ward patients after medical emergency team review. Research Design and Setting: This retrospective cohort study examined the clinical records of 1500 randomly sampled adult ward patients following medical emergency team review at a metropolitan tertiary hospital. Outcome measures were the derivation of patient acuity and dependency scores using sequential organ failure assessment and nursing activities score instruments. Findings are reported using the STROBE guideline for cohort studies. No Patient or Public Contribution: No direct patient contact was made during the data collection and analysis phases of the study. Results: Patients were male (52.6%), unplanned (73.9%) medical admissions (57.5%), median age of 67 years. The median sequential organ failure assessment score was 4% and 20% of patients demonstrated multiple organ system failure requiring non typical monitoring and coordination arrangements for at least 24 h. The median nursing activities score was 86% suggestive of a near 1:1 nurse‐to‐patient ratio. More than half of all patients required enhanced levels of assistance with mobilization (58.8%) and hygiene (53.9%) activities. Conclusions: Patients who remain on the ward following medical emergency team review had complex combinations of organ dysfunction, with levels of dependency similar to those found in intensive care units. This has implications for ward and patient safety and continuity of care arrangements. Relevance to Clinical Practice: Profiling illness severity at the conclusion of the medical emergency team review may help determine the need for special resource and staffing arrangements or placement within the ward environment. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To develop a simple and reliable assessment tool for predicting falls in acute care settings. Background: Falling injures patients, lengthens hospital stay and leads to the wastage of financial and medical resources. Although there are many potential predictors for falls, a simple and reliable assessment tool is practically necessary in acute care settings. Design: A retrospective cohort study. Methods: The current study was conducted for participants who were admitted to a teaching hospital in Japan. Fall risk was assessed by the modified Japanese Nursing Association Fall Risk Assessment Tool consisting of 50 variables. To create a more convenient model, variables were first limited to 26 variables and then selected by stepwise logistic regression analysis. Models were derived and validated by dividing the whole dataset into a 7:3 ratio. Sensitivity, specificity, and area under the curve for the receiver‐operating characteristic curve were evaluated. This study was conducted according to the STROBE guideline. Results: Six variables including age > 65 years, impaired extremities, muscle weakness, requiring mobility assistance, unstable gait and psychotropics were chosen in a stepwise selection. A model using these six variables with a cut‐off point of 2 with one point for each item, was developed. Sensitivity and specificity >70% and area under the curve >.78 were observed in the validation dataset. Conclusions: We developed a simple and reliable six‐item model to predict patients at high risk of falling in acute care settings. Relevance to Clinical Practice: The model has also been verified to perform well with non‐random partitioning by time and future research is expected to make it useful in acute care settings and clinical practice. Patient or Public Contribution: Patients participated in the study on an opt‐out basis, contributing to the development of a simple predictive model for fall prevention during hospitalisation that can be shared with medical staff and patients in the future. [ABSTRACT FROM AUTHOR]

Objective: To develop and test the model of association of social connectedness and health‐related quality of life (HRQoL) among patients with cancer undergoing chemotherapy and to describe their social connectedness through photo‐elicitation. Background: Social connectedness has been empirically associated with several well‐being outcomes. However, little is known on the association of social connectedness among patients with cancer undergoing chemotherapy. Methods: Employing a mixed‐methods design following the good reporting of a mixed methods study guideline, the quantitative approach involved 230 consecutively‐selected patients with cancer undergoing chemotherapy who answered a three‐part survey. From these patients, six informants participated in the photo‐elicitation and key informant interview sessions. Gathered data were quantitatively analyzed using structural equation modelling and qualitatively processed using polytextual thematic analysis. Results and Findings: Social connectedness had a positive influence on social well‐being (β =.22, p =.008) and emotional well‐being (β =.20, p =.023); however, it had a negative effect on functional well‐being (β = −.20, p =.007). The overall model revealed good model indices: χ2/df =.82, RMSEA =.01, GFI = 1.00. Qualitative analysis culled from photo‐elicitation uncovered five interconnected themes yielding the Honeycomb model of social connectedness which was composed of correspondence, cohesion, constitution, convergence and corroboration. Conclusion: HRQoL among patients with cancer undergoing chemotherapy is a multi‐factorial health construct affected by social connectedness. The presented model emphasises the importance of social connectedness and paves way for the development of appropriate strategies to promote social connectedness among patients with cancer undergoing chemotherapy. Relevance to Clinical Practice: The findings provide impetus in the modification and development of appropriate practices, policies and strategies in promoting social connectedness. These approaches are geared towards patient–family empowerment and health education techniques to ascertain that assistance from significant others is provided without limiting the patient's autonomy or independence. [ABSTRACT FROM AUTHOR]

Aims and Objectives: We aimed to identify correlates of cannabinoid‐based products (CBP) use in patients with multiple sclerosis (MS) in France and Spain. Background: MS is responsible for a wide range of symptoms, including pain. Access to CBP differs according to local legislation. The French context is more restrictive than the Spanish one, and no data regarding cannabis use among MS patients has yet been published. Characterizing MS patients who use CBP constitutes a first step toward identifying persons most likely to benefit from them. Design: An online cross‐sectional survey was submitted to MS patients who were members of a social network for people living with chronic diseases and were living in France or Spain. Methods: Two study outcomes measured therapeutic CBP use and daily therapeutic CBP use. Seemingly unrelated bivariate probit regression models were used to test for associations between the outcomes and patients' characteristics while accounting for country‐related differences. STROBE guidelines were followed in reporting this study. Results: Among 641 study participants (70% from France), the prevalence of CBP use was similar in both countries (23.3% in France vs. 20.1% in Spain). MS‐related disability was associated with both outcomes, with a gradient observed between different degrees of disability. MS‐related pain level was associated with CBP use only. Conclusions: CBP use is common in MS patients from both countries. The more severe the MS, the more participants turned to CBP to alleviate their symptoms. Easier access to CBP should be ensured for MS patients in need of relief, especially from pain. Relevance to clinical practice: This study highlights the characteristics of MS patients using CBP. Such practices should be discussed by healthcare professional with MS patients. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to critically evaluate implementation frameworks, strategies and/or outcomes used to optimise peripheral intravenous catheter (PIVC) care and/or promote guideline adherence. Background: Although a considerable volume of research has investigated the effectiveness of PIVC interventions and treatments to promote performance and prevent harm, how to best implement this evidence into dynamic clinical settings and populations is not well understood. Implementation science is central to translating evidence‐based knowledge to the bedside; however, there is a gap in identifying the best implementation framework, strategies and/or outcomes to optimise PIVC care and/or guideline adherence. Design: A systematic review. Method: The review was conducted using innovative automation tools. Five databases and clinical trial registries were searched on 14 October 2021. Qualitative and quantitative PIVC intervention studies reporting implementation strategies were included in the review. Data were extracted independently by experienced researchers in pairs. The Mixed Method Appraisal tool was used to assess the quality of individual studies. Narrative synthesis was used to present the findings. The systematic review was reported following the PRISMA checklist. Results: Of 2189 references identified, 27 studies were included in the review. Implementation frameworks were used in 30% (n = 8) of studies, with most used during the preparation (n = 7, 26%) and delivery phase (n = 7, 26%) and then evaluation phase (n = 4, 15%). Multifaceted strategies were commonly adopted (n = 24, 89%) to promote PIVC care or study interventions which were clinician (n = 25, 93%) and patient‐targeted (n = 15, 56%). The most commonly reported implementation outcomes were fidelity (n = 13, 48%) and adoption (n = 6, 22%). Most studies were scored as low quality (n = 18, 67%). Conclusion: We call for researchers and clinicians to work together and use implementation science frameworks to guide study design, implementation and evaluation in future PIVC studies, to improve evidence translation and thereby improve patient outcomes. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to assess the perceived caregiver burden among parents of chronically ill children in Jordan. Background: Although there are few studies on the accurate prevalence of chronic diseases among Jordanian children, there are a few on the burden of caregiving, which is important because most children with chronic illness rely on their caregivers to perform their daily tasks. In Jordan, little is known about the caregiver burden associated with caring for children with chronic diseases. Design: A cross‐sectional design was reported in line with the STROBE guidelines. Methods: The Katz Index of Independence was used to determine the children's level of dependence, and the Burden Scale for Family Caregivers was used to measure the caregivers' level of burden. Results: Nearly, 49.3% of caregivers had a very severe burden, 31.2% of children had a severe functional impairment, 19.6% had a moderate impairment, and 49.3% had full functionality. Based on their children's dependency, caregivers' subjective burden varied greatly (p <.001). Fully functional children had a far lower disease burden than severely and moderately disabled children (p <.001). The caregiver burden score differed significantly across chronic disease categories (p <.001). Unemployed caregivers had a far higher subjective burden than working caregivers (p =.009), and single (divorced/widowed) caregivers had higher burdens than married caregivers. Conclusions: Various factors can increase caregiver burden. Therefore, healthcare providers must plan holistic and family‐centred interventions to reduce the caregiving burden. Relevance to Clinical Practice: There is a need to establish support programs to help reduce the level of burden among caregivers of children with chronic diseases. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effects of self‐management interventions targeting individuals with cancer‐related pain on pain intensity, self‐efficacy, quality of life (QoL), pain medication adherence, and pain‐related knowledge and provide recommendations for the content and format of self‐management interventions based on the existing evidence. Design: A systematic review of randomised controlled trials (RCTs) and narrative synthesis. Data Sources: A search of six electronic databases, including Medline, PsycINFO, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus. Review Methods: This systematic review followed the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Studies published from January 2011 to March 2022 in English were retrieved. The Cochrane Risk of Bias Tool was used to assess quality. Data were summarised using narrative synthesis. Results: This systematic review included six RCTs involving 748 patients with cancer‐related pain. The results support the effectiveness of the intervention on QoL and pain‐related knowledge. Mixed results were observed in the effectiveness on pain intensity, self‐efficacy and medication adherence. Overall, the quality of the evidence was low. The content of self‐management interventions varied across studies but with similar formats (face‐to‐face coaching and telephone follow‐up). Conclusion: The existing evidence supports the effectiveness of self‐management interventions on pain‐related knowledge and QoL. Further high‐quality RCTs are needed to determine the most effective interventions. Relevance to Clinical Practice: Self‐management is recommended to improve cancer patients' pain awareness, self‐management behaviour and adaptability. Components for self‐management of cancer pain, including patient attitude and knowledge assessment, nurse coaching and counselling, reinforcement during follow‐up period, and provision of supplementary materials on pain management and medication adherence, could be covered in the intervention. In the future, it is worthwhile exploring an effective intervention using Internet‐based information technology, for example WeChat, to aid the delivery of self‐management intervention. No Patient or Public Contribution: This systematic review does not necessarily involve patients or public members in this work. [ABSTRACT FROM AUTHOR]

Aim: To describe positive and negative spiritual responses to providing COVID‐related nursing care among nurses working in hospitals. Background: The COVID pandemic has intensified and publicised the threats to nurse well‐being. Absent from the recommendations for promoting nurse well‐being is recognition of how nurses' spirituality and/or religiosity is affected by the strain of COVID caring or how it may be affecting their well‐being. Design: Cross‐sectional, descriptive observational, mixed methods study. Methods: Data were collected from 523 registered nurses employed in three Southern California hospitals during March–May, 2022 when these hospitals' COVID case counts were <15%. Using Online survey methods, data were obtained using the Religious/Spiritual Struggles Scale–Short Form, Moral Injury Symptom Scale–Healthcare Professionals, Post‐traumatic Growth Inventory and demographic and work‐related items. STROBE guidelines for cross‐sectional observational studies were observed. Results: The mean for religious/spiritual struggles was 1.98 (range of 1–5, comparable to a little bit). Although roughly half of the sample reported the struggles were not experienced/did not apply, 23%–36.5% reported experiencing these struggles at least somewhat. The most frequent struggle was to find ultimate meaning. The mean observed for moral injury was 6.5 (range of 1–10); applying established criteria indicated it was troubling for at least 50%. The mean for post‐traumatic growth was 4 (on a scale of 0–6); using established criteria, 41% experienced PTG. Quantitative findings were illustrated by the qualitative responses that occasionally expressed spiritual tragedy and transformation concurrently. Conclusion: The professional work of nursing impacts nurses in invisible, spiritual ways that can be tragic and/or transformative. Relevance to Clinical Practice: Interventions to address nurses' mental health challenges must include attention to these invisible struggles. Nurses' mental health challenges must be met in part by addressing how they can surmount spiritual tragedy—and allow spiritual transformation. [ABSTRACT FROM AUTHOR]

Background: Some traditional Chinese medicine (TCM)–based integrated health interventions have been used for depression, but pooled efficacy remains unknown. Aims and Objectives: This study aimed to systematically evaluate the efficacy of TCM‐based integrated health interventions for relieving depression. Design: Systematic review and meta‐analysis. Methods: A comprehensive literature search was conducted on 17 databases from inception up to June 2022. Randomised controlled trials (RCTs) that examined an integrated health intervention based on TCM theory for depression were included. The risk of bias was assessed using the second version of the Cochrane risk‐of‐bias tool for randomised trials, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system. Results: Eighteen RCTs with a total of 1448 depressed participants were included. Health care providers, mainly nurses (14 studies), implemented TCM‐based integrated health interventions. The pooled results showed that TCM‐based integrated health interventions had larger effects on reducing depressive symptoms (15 studies; standardised mean difference = −2.05; 95% CI: −2.74, −1.37; p <.00001) compared with usual care at posttreatment but showed no significant difference contrasted to cognitive behavioural therapy (two studies, p =.31). However, the overall evidence was low. Conclusions: The meta‐analysis results indicated that TCM‐based integrated health interventions were effective in reducing depression. However, the results should be interpreted with caution because of the low quality of the included studies. Future RCTs with rigorous designs should be conducted to provide robust evidence of the efficacy of TCM‐based integrated health interventions in treating depression. Relevance to clinical practice: TCM‐based integrated health interventions might be a potentially effective alternative for depression. Nurses could play an important role in designing and providing TCM‐based integrated nursing interventions for patients with depression. No patient or public contribution: This is a systematic review and meta‐analysis based on data from previous studies. [ABSTRACT FROM AUTHOR]

Aim: To determine the reporting accuracy of pressure injury categorisation by bedside clinicians, compared with nurse experts. Background: Pressure injuries are an enduring complication of hospitalisation. The categorisation of pressure injury affects treatment and management decision‐making and use of resources, and severe hospital‐acquired pressure injury incidence is used to benchmark quality of care. However, it is unclear how accurately pressure injuries are categorised by clinicians in practice. Design: Secondary analysis of hospital pressure injury incident and validation data. Methods: All pressure injuries reported in adults between 2016 and 2019 that were subsequently validated by nurse experts were analysed. Absolute agreement is reported using percentages, with inter‐rater agreement reported using Kappa measure of agreement. The GRRAS reporting guideline was followed. Results: Of 6186 pressure injuries that were analysed, the category was reported correctly in 67.3% (n = 4163), with an overall moderate level of inter‐rater agreement by category (Κ =.567, p <.001). Of those found to be non‐pressure injuries when validated (18.3%, n = 1129), most were reported originally as stage II (41.2%, n = 465) or stage I (30.5%, n = 344), and 13.4% (n = 151) were categorised initially as unstageable. The majority reported initially as stage I, stage II, suspected deep tissue injury or mucosal pressure injury were validated, whereas half of those reported initially as stage III or IV were validated and less than a third of those reported initially as unstageable pressure injuries were validated. Conclusions: This study provides important insight into the accuracy of pressure injury categorisation. Whilst moderate agreement of categorisation was found between reporting clinicians and nurse experts, pressure injury differential diagnosis and categorisation of severe injuries were inadequate. Relevance to Clinical Practice: These results may be used for benchmarking and provide a focal point for future education and practice improvement efforts. Patient or Public Contribution: Neither patients nor the public were directly involved in the project. [ABSTRACT FROM AUTHOR]

Background: Nurses usually provide direct patient care. However, they account for the majority of healthcare workers (HCWs) injured by needles or other sharp objects. Objectives: To assess the prevalence of needle stick injuries (NSI) among nurses worldwide; according to WHO regions, the socioeconomic development index (SDI) of countries, and the developmental status of individual countries, and in the Middle East. Design: Systematic review and meta‐analysis. Methods: We searched PubMed, Scopus, and Web of Science databases. We calculated the pooled NSI prevalence estimates using a random‐effect meta‐analysis with the Comprehensive Meta‐Analysis software. The report of the study was in accordance with the PRISMA 2020 statement. Results: The overall worldwide NSI prevalence pooled from our analysis was 40.97% (95% confidence interval [CI]: 31.29–50.63%, p =.00001). A subgroup analysis of NSI prevalence according to WHO regions revealed the highest prevalence in Southeast Asia (49.9%, 95% CI: [23.4–76.3%]) and the lowest in the United States of America (25.1%, 95% CI: [18.1–32.1%]), respectively. The pooled prevalence in developed and developing countries was 30.5% (95% CI: 27.3–33.8%) and 46.6% (95% CI: 33.7–59.5%), respectively. According to the SDI, NSI prevalence was highest in low‐middle SDI countries (48.9% [95% CI: 30.7–67.2%]). Conclusion: Our results showed a high NSI prevalence among nurses worldwide. Developing countries had a significantly higher NSI prevalence than developed countries, especially low‐middle SDI countries. Relevance to Clinical Practice: This study highlighted the prevalence of NSI risk among nurses practising in clinical settings worldwide. The study findings suggest that continuous training programs should be implemented for nurses to enhance their knowledge, performance and attitude toward NSI prevention in clinical settings. No Patient or Public Contribution: Contributions from patients or the public are irrelevant because the purpose of this study was to examine the global prevalence of NSIs in nurses. [ABSTRACT FROM AUTHOR]