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Aim: To describe and explain how the concept of family functioning has been used in the targeted sample of health literature on adult family members with illness. Background: Understanding the influence of illness on family functioning is central to the provision of patient‐ and family‐centred care. There is lack of consistency in utilising family functioning which creates confusion about the concept and can interfere with theory development in nursing science. A clear conceptual definition of attributes of family functioning based on concept analysis could act as a guide in the development of instruments to assess family functioning, the design of family‐based interventions and their application in clinical practice. Design: Concept analysis. Data sources: Academic Search Premier, ProQuest Research Library, Family & Society Studies Worldwide, PsycINFO, SocINDEX, PubMed and CINAHL databases were searched within the last 20 years (1997–Dec. 2016) using the terms “family function*” and “patient.” Studies of paediatric patients and non‐English articles were excluded. Method: Rodgers’ evolutionary perspective. Results: The findings suggest that family functioning in the context of illness is defined as family members' ability to maintain cohesive relationships with one another, fulfil family roles, cope with family problems, adjust to new family routines and procedures and effectively communicate with each other. Conclusion: Further research is needed to inform nurses’ practice when assessing families or providing patient‐ and family‐centred interventions to support family functioning across different sociocultural and political contexts, and further identification and evaluation of antecedents and consequences regarding family functioning from a nursing perspective. Relevance to clinical practice: Having a comprehensive understanding of the attributes, antecedents and consequences of ineffective family functioning can facilitate healthcare providers’ ability to identify strengths and potential targets to improve family functioning among their clients. [ABSTRACT FROM AUTHOR]

Background: Little is known about how children and young people experience and manage the critical illness of a parent and a parent's admission to the intensive care unit (ICU). Objective: The aim of this study was to search and interpret the existing literature describing children's and young people's experiences of a parent's illness trajectory in the ICU. Method: A qualitative meta‐synthesis was conducted based on a systematic literature search of online databases. Findings: Four main themes were identified and synthesised to describe the integrated experiences of children and young people: (a) the parent–child bond, (b) the unfamiliar environment, (c) the impact of the illness and (d) the experience of being overseen as close family members. Conclusion: Experiencing a parent's critical illness and admittance to the ICU is overwhelming. The bond between the parent and child is exposed by the separation from the ill parent. To comprehend and manage the experience, children and young people seek information depending on their individual capacities. They express a need to be close to their ill parent and to be seen and approached as close members of the family. However, children experience being overseen in their needs for support during their parent's ICU illness with the risk of being left in loneliness, sadness and lack of understanding of the parent's illness. Relevance for clinical practice: Children and young people as relatives need to be acknowledged as close members of the family, when facing the illness trajectory of a parent, who is admitted to the ICU. They need to be seen as close family members and to be approached in their needs for support in order to promote their well‐being during a family illness crisis. Early supportive interventions tailored to include children of the intensive care patient are recommended. [ABSTRACT FROM AUTHOR]

Aims and objectives: To undertake a mixed methods thematic literature review that explored how elderly adults approached decision‐making in regard to their health care following discharge. Background: A critical time for appropriate health decisions occurs during hospital discharge planning with nursing staff. However, little is known how the 89% of elderly living at home make decisions regarding their health care. Research into older adults’ management of chronic conditions emerges as an important step to potentially encourage symptom monitoring, prevent missed care and detect deterioration. All should reduce the risk of hospital re‐admission. Design: A mixed methods thematic literature review was undertaken. The structure followed the PRISMA reporting guidelines for systematic reviews recommended by the EQUATOR network. Methods: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus online databases were searched using keywords, inclusion and exclusion criteria. References drawn from relevant publications, identified by experts and published between 1995 and 2017 were also considered. Twenty‐five qualitative, quantitative and mixed methods studies and reviews were critically appraised (CASP 2013) before inclusion in the review. Analysis of each study's findings was undertaken using Braun and Clarke's (2006) steps to identify major themes and sub‐themes. Results: Four main themes associated with health‐related decision‐making in the elderly were identified: “the importance of maintaining independence,” “decision making style,” “management of conditions at home” and “discharge planning.” Conclusion: Health care decision preferences in the elderly emerged as highly complex and influenced by multiple factors. Development of a tool to assess these components has been recommended. Relevance to clinical practice: Nurses play a vital role in exploring and understanding the influence that maintaining independence has with each patient. This understanding provides an initial step toward development of a tool to assist collaboration between patients and healthcare professionals involved in their care. [ABSTRACT FROM AUTHOR]

Aims and objective: To critically review the evidence relating to the management of agitation within the Adult Critical Care Unit environment and identify any risks and benefits of current management strategies. Background: Admission to an Adult Critical Care Unit can be traumatic and potentially life altering for the patient. Patient agitation is common in Adult Critical Care Units and is associated with the potential for harm. Despite inherent safety risks, there is a paucity of evidence‐based guidance underpinning the care of agitation in patients with critical illness. Study Design: Integrative review and narrative synthesis. Methods: A systematic procedure for searching and selecting the literature was followed and applied to databases including CINAHL, British Nursing Index, Cochrane Library, ProQuest, Ovid including EMBASE and MEDLINE. Selected manuscripts were analysed using a structured narrative review approach. Results: A total of 208 papers were identified and following a systematic deselection process 24 original articles were included in the review. It was identified that agitation in the setting of Adult Critical Care Unit is associated with high‐risk events such as unplanned removal of life‐supporting devices. There were consistent links to sepsis, previous high alcohol intake and certain medications, which may increase the development of agitation. Prompt assessment and early liberation from mechanical ventilation was a major contributing factor in the reduction in agitation. Administration of antideliriogenic mediation may reduce the need for physical restraint. There was repeated uncertainty about the role of physical restraint in developing agitation and its effective management. Conclusions: Our review has shown that there is a dearth of research focusing on care of agitated patients in the Adult Critical Care Unit, despite this being a high‐risk group. There are dilemmas for clinical teams about the effectiveness of applying physical and/or pharmacological restraint. The review has highlighted that the risk of self‐extubation increases with the presence of agitation, reinforcing the need for constant clinical observation and vigilance. Relevance to clinical practice: The importance of ensuring patients are re‐orientated regularly and signs of agitation assessed and acted upon promptly is reiterated. Early identification of specific patient profiles such as those with previous high alcohol or psychoactive drug habit may enable more proactive management in agitation management rather than reactive. The prompt liberation from the restriction of ventilation and encouragement of family or loved ones involvement in care need to be considered. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine international studies that specifically focus on transition to practice for graduate registered nurses in rural and remote areas. Background: Supportive graduate nursing programmes are essential for enabling nursing graduates’ transition to practice and reducing attrition rates. Literature examining support measures for nursing graduates within metropolitan areas is abundant. However, there is a paucity of evidence on effective graduate programmes for rural and remote‐based nursing graduates. Design: A systematic approach was used to identify robust research within appropriate electronic databases. Method: Eligible articles were critically reviewed using the Mixed Method Appraisal Tool critical appraisal tool. Eligible articles were thematically analysed using the Braun and Clark approach. Results: Eight articles met the selection criteria for inclusion. Findings revealed that while most graduate nurses survived the transition process, they often felt overwhelmed and abandoned with intense feelings of frustration. Many suffered transition shock and did not feel ready for the role. Socialisation of graduates to the clinical environment was lacking. Support offered in many graduate programmes was ad hoc and unstructured. Senior staff were inadequately supported in their roles as preceptors to assist with the transition. Critical support measures recommended included both debrief sessions and regular one‐on‐one support. Conclusions: Graduate programmes need to be structured yet flexible to accommodate the needs of rural and remote nurse graduates. Graduates need to be transitioned into practice with decremental support processes for both workloads and education. Preceptors require education on how to mentor before they can provide the appropriate support for graduates. Without these measures in place, a decrease in transition shock may not be possible. Relevance to clinical practice: Graduate programmes need to be structured yet flexible, including assistance with both clinical skills and socialisation. Senior staff require education before they can adequately support new graduates. [ABSTRACT FROM AUTHOR]

Aims and objectives: To compare the effectiveness of clinical pathway‐directed care to usual care on hospitalisation‐related outcomes in patients with severe traumatic brain injury (STBI). Background: Severe traumatic brain injury is a major cause of disability and mortality in young adults. Clinical pathways endeavour to bring evidence and clinical practice closer together to foster the delivery of best practice and to improve patient outcomes. Design: Quasi‐experimental study. Methods: The study was conducted in a trauma intensive care unit of a large teaching hospital in Egypt. Patients aged 18–60 years with a diagnosis of STBI, a Glasgow Coma Scale score between 3–8 and a nonpenetrating head injury were consecutively assigned to 15 days of care. The outcomes assessed were complications related to hospitalisation, clinical variances, length of intensive care unit (ICU) stay, ICU readmission rate and patient/family satisfaction. Results: Sixty participants completed the study (30 in each arm). Apart from age, there were no significant differences between groups in baseline characteristics. The clinical pathway group demonstrated statistically significantly fewer cases of hospitalisation‐related complications on day 15, and a significantly shorter length of ICU stay, lower ICU readmission rate and a high level of patient/family satisfaction when compared with the usual care group. The effect of the intervention on fever, pressure ulceration, hyperglycaemia and readmission to the ICU was no longer statistically significant after controlling for age. Conclusions: The findings of the current study suggest that the implementation of a clinical pathway for patients with severe TBI may be helpful in improving the patient experience as well as some hospitalisation‐related outcomes. Relevance to clinical practice: The provision of clinical pathway‐directed care in a trauma ICU may offer benefits to the patient, family and institution beyond that provided by usual care. [ABSTRACT FROM AUTHOR]

Aim and objective: To synthesise evidence of registered nurses’ and midwives’ experiences with videoconferencing and identify perceptions of the appropriateness, meaningfulness and feasibility of this technology in professional and clinical practice. Background: Videoconferencing is a form of telehealth that can facilitate access to high‐quality care to improve health outcomes for patients and enable clinicians working in isolation to access education, clinical supervision, peer support and case review. Yet use of videoconferencing has not translated smoothly into routine practice. Understanding the experiences of registered nurses and midwives may provide practitioners, service managers and policymakers with vital information to facilitate use of the technology. Design: A qualitative meta‐synthesis of primary qualitative studies undertaken according to Joanna Briggs Institute methodology. Method: A systematic search of 19 databases was used to identify qualitative studies that reported on registered nurses’ or midwives’ experiences with videoconferencing in clinical or professional practice. Two reviewers independently appraised studies, extracted data and synthesised findings to construct core concepts. Results: Nine studies met the criteria for inclusion. Five key synthesised findings were identified: useful on a continuum; broader range of information; implications for professional practice; barriers to videoconferencing; and technical support, training and encouragement. Conclusions: While videoconferencing offers benefits, it comes with personal, organisational and professional consequences for nurses and midwives. Understanding potential benefits and limitations, training and support required and addressing potential professional implications all influence adoption and ongoing use of videoconferencing. Relevance to clinical practice: Registered nurses and midwives are well placed to drive innovations and efficiencies in practice such as videoconferencing. Nursing and midwifery practice must be reframed to adapt to the virtual environment while retaining valued aspects of professional practice. This includes ensuring professional standards keep pace with the development of knowledge in this area and addressing the findings highlighted in this meta‐synthesis. [ABSTRACT FROM AUTHOR]

Aims and objectives: To review the current literature about nurses’ clinical reasoning practices that support safe medication administration. Background: The literature about medication administration frequently focuses on avoiding medication errors. Nurses’ clinical reasoning used during medication administration to maintain medication safety receives less attention in the literature. As healthcare professionals, nurses work closely with patients, assessing and intervening to promote mediation safety prior to, during and after medication administration. They also provide discharge teaching about using medication safely. Nurses’ clinical reasoning and practices that support medication safety are often invisible when the focus is medication errors avoidance. Design: An integrative literature review was guided by Whittemore and Knafl’s (Journal of Advanced Nursing, 5, 2005 and 546) five-stage review of the 11 articles that met review criteria. This review is modelled after Gaffney et al.’s (Journal of Clinical Nursing, 25, 2016 and 906) integrative review on medical error recovery. Methods: Health databases were accessed and systematically searched for research reporting nurses’ clinical reasoning practices that supported safe medication administration. The level and quality of evidence of the included research articles were assessed using The Johns Hopkins Nursing Evidence-Based Practice Rating Scale©. Results: Nurses have a central role in safe medication administration, including but not limited to risk awareness about the potential for medication errors. Nurses assess patients and their medication and use knowledge and clinical reasoning to administer medication safely. Results indicated nurses’ use of clinical reasoning to maintain safe medication administration was inadequately articulated in 10 of 11 studies reviewed. Conclusion: Nurses are primarily responsible for safe medication administration. Nurses draw from their foundational knowledge of patient conditions and organisational processes and use clinical reasoning that supports safe medication practice. There was minimal evidence clearly articulating nurses’ clinical reasoning used to support medication safety. Relevance to clinical practice: This review focused on finding evidence of nurses’ clinical reasoning that supported safe medication administration. [ABSTRACT FROM AUTHOR]

Aims and objectives To review literature on nurses' coping strategies with patient death. Background Dealing with the loss of a patient was viewed as one of the most demanding and challenging encounters in clinical practice. Those nurses who are not competent in coping with patient death may be inadequate in supporting dying patients and their family members, and minimise the quality of end-of-life care. To get a broader understanding of how nurses cope with patient death and to develop meaningful and effective interventions, a systematic review which would help underpin the multidimensional approaches is needed. Design A systematic review. Methods Exhaustive searching in ten databases: CINAHL Plus, EMBASE, MEDLINE, AMED, Psyc INFO, ProQuest Health & Medical Complete, ProQuest Dissertations & Theses Global, Google Scholar, ETh OS and CareSearch. Meta-aggregation was used to synthesise the findings of the included studies. Results This systematic review aggregated ten categories from the sixteen qualitative studies included, and then two synthesised findings were derived: intrinsic resources and extrinsic resources. The intrinsic resources consisted of setting boundaries, reflection, crying, death beliefs, life and work experience, and daily routines and activity. The extrinsic resources were comprised of talking and being heard, spiritual practices, education and programmes, and debriefing. Conclusion This systematic review synthesised the findings about what resources nurses use when coping with patient death and made recommendations on future directions. Areas which could be developed to improve deficiencies that nurses had when faced with the losses of their patients were identified. Nurses need more support resources, which better assist them in coping with patient death. Relevance to clinical practice The results of this systematic review could provide evidence for nurses' coping strategies when dealing with patient death, and the recommendations could be employed by nurses to cope with the losses of patients. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine factors which contribute to the individual's experience of pain in relation to intrauterine contraception insertion and determine evidence-based nursing strategies to best assess and manage this pain. Background Nurses are increasingly involved in consultations regarding intrauterine contraception. However, concerns regarding painful or difficult insertion may inhibit uptake and discourage nurses from promoting or inserting intrauterine contraception. Design Integrative review. Methods Database searches of CINAHL, PubMed, Wiley Online Library and the Cochrane Collaboration for relevant literature. Eight papers met the inclusion criteria and were analysed using an integrative review process. Results Physical causes and pharmacological interventions for insertion pain have been thoroughly investigated. Absence of previous vaginal delivery and anxiety may increase the likelihood of procedural pain. The literature fails to conclusively determine any universally effective prophylactic analgesia. Cervical anaesthesia may be beneficial in some cases and oral analgesia may relieve postprocedural pain. Distraction in the form of conversation, music or television can be effective in reducing anxiety. Conclusions A combination of physical, psychological and environmental factors contribute to the individual's pain experience. Nurses have the potential to make a significant impact on pain outcomes by demonstrating clinical expertise and creating a trustful environment. Giving reliable information, acknowledging the significance of anxiety and providing reassurance and distraction are effective pain reducing strategies. Research into nonpharmacological approaches is warranted, especially those which reduce anxiety. Relevance to clinical practice Increasing uptake of long-acting reversible contraception is a public health goal. Providing effective pain management strategies to improve patient experience may encourage more nurses to recommend, or enhance their scope of practice to include, intrauterine contraception insertion. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine empirical studies of musical stimulation and music therapy carried out with preterm infants and their parents published from 2010-2015. Background Prematurity constitutes a global health problem that can impact the development of the preterm infant and the well-being of the parents. Music-based interventions may benefit the infant, parents and their relationship. In our review, we distinguished between musical stimulation and music therapy, as we found no previous studies that had made this distinction. Design This is a narrative literature review. Methods A search was undertaken in PubMed, PsycINFO and LILACS using the terms 'music,' 'music therapy,' 'singing,' 'prematurity' and 'preterm.' Thirty studies were included and analysed according to the following categories: (i) aims of the study, (ii) participants, (iii) design, (iv) type of intervention, (v) assessment and measures and (vi) main results. Results The vast majority of the studies focused on the preterm infants and used an experimental design. Few studies carried out family-centred interventions, despite this having been noted as an important factor in effective interventions. Musical stimulation studies used more recorded music, whereas music therapy studies used more individualised interventions with live music. Conclusions Both musical stimulation and music therapy demonstrated significant effects on preterm infants and their parents. However, compared to musical stimulation studies, interventions performed by music therapists provided more individualised care and tended to show greater effects on infants' physiological and behavioural responses. Relevance to clinical practice Our review showed that music therapy interventions may provide individualised, effective and family-centred care. There is a significant need for these types of interventions in the neonatal intensive care unit (NICU). [ABSTRACT FROM AUTHOR]

Aims and objectives. We aimed to investigate whether e-health is equal to or better than usual face-to-face care with regard to outcomes on health, quality of life, patient satisfaction and costs. Therefore, we systematically reviewed the literature on e-health in chronically ill patients compared with or as an addition to usual care. Background. Interactive websites on internet are increasingly used to inform and treat patients. This type of contact between patients and health care providers, which is called e-health, is easily accessible and particularly interesting for chronically ill patients. Design. A systematic review. Methods. We searched the databases PubMed, CINAHL, the Cochrane Database of systematic reviews, DARE and CENTRAL for articles published between January 2000-July 2009. Results. The search strategy yielded in total 695 possibly relevant references, which resulted in 12 RCTs after application of the in- and exclusion criteria. Most of the studies were well designed according to the Cochrane criteria for RCTs. The studies are divided into e-health vs. usual care and e-health as addition to usual care. e-Health consisted of monitoring, treatment instructions, self-management training and general information and communication between patient and caregiver. Most of the studies showed small to moderate positive effects on health outcomes. Cost-effectiveness, quality of life and patient satisfaction were rarely investigated in the included studies. Conclusions. e-Health interventions for chronically ill patients, offered instead of usual care or in addition to usual care, lead to small to moderate positive effects on primary health outcomes. However, the evidence was not fully convincing, because of the limited number of studies available and the methodological limitations. Further research is needed to confirm the cost-effectiveness of e-health interventions for patients with chronic diseases. Relevance to clinical practice. e-Health is a promising tool for treatment and self-management training of chronically ill patients. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this paper is to examine high-level evidence in early intervention in psychosis and scope the potential role of the mental health nurse-practitioner in the treatment of management of early psychosis. Background. Psychosis imposes complex symptoms that impact on the individual and their social network, often resulting in long-term disability. As specialised early intervention in psychosis is emerging, the nurse-practitioner role in mental health is also gaining momentum. The background literature highlights several critical synergies between nurse-practitioners' scope of practice and needs of patients with early psychosis. Design. Literature review. Method. Electronic databases including Cochrane Library, CINAHL, Medline, TRIP and EMBASE. Searching was limited to articles published between 1988-2009. Eligible studies were limited to systematic reviews and randomised controlled trials. Results. Two systematic reviews and five randomised controlled trials met the inclusion criteria. No studies were located which specifically addressed the nurse-practitioner role in early psychosis. Conclusions. Specific interventions require further research but there is emerging evidence that specialised intervention for people in the early phase of psychotic illness is achievable and possibly essential. It is within the scope of practice of mental health nurse-practitioners to ensure patient and carer education and support, adherence to medication and other treatments, promotion of social inclusion and social connectedness. Relevance to clinical practice. Mental health nurse-practitioners have the potential to provide specialist support to meet the needs of this complex group. Central to this is an ability to build an evidence-base around the treatment and management of people with early psychosis and deliver effective education and leadership across clinical, inter-professional and organisational domains. The paper concludes by positing a set of recommendations for nurse-practitioners in the field of early psychosis in the Australian mental health setting. [ABSTRACT FROM AUTHOR]

Aim and objective. This systematic review describes mentoring of nursing students in clinical placements. Background. Mentoring in nursing has been widely investigated, but mentoring among students has remained vague. There is no universal agreement on student mentoring in nursing placements; therefore, mentoring approaches vary. A unified description of student mentoring is needed to ensure the quality of placement learning in nursing organisations. Design. Systematic review. Method. The data were collected from nursing research articles over 20 years (1986-2006). The articles ( n = 23) were analysed using inductive content analysis. Results. Mentoring of nursing students in clinical placements was described according to two themes: (1) facilitating nursing students' learning by creating supportive learning environments and enabling students' individual learning processes, (2) strengthening students' professionalism by empowering the development of their professional attributes and identities and enhancing attainment of students' professional competence in nursing. Discussion. This description of student mentoring in nursing clinical placements integrates environmental, collegial, pedagogical and clinical attributes. To ensure effective student mentoring, an individual mutual relationship is important, but also essential is organisation and management to provide adequate resources and systematic preparation for mentors. Conclusions. The description of student mentoring needs to be systematically reviewed to reflect changes in nursing and education and compared within related concepts to achieve and maintain a workable description. A clear and systematic strategy for student mentoring in nursing organisations could be one opportunity to enhance recruitment of nursing students to the workforce. Relevance to clinical practice. A unified description of student mentoring will help improve the quality of placement learning opportunities and support for students, also for exchange students. A clear description of student mentoring enables the development of systematic provisions for mentoring of nursing students in placements and adequate mentor preparation programmes for nurses. [ABSTRACT FROM AUTHOR]

Aim and objectives. To provide an overview of vertigo and its management and identify its impact on individuals to offer strategies for managing the condition. Background. Dizziness and vertigo are symptoms common to many pathologies/dysfunctions ranging from the benign to the potentially serious; many are poorly understood. Although rarely life-threatening, vertigo is debilitating and significantly affects quality of life; it may be as disabling as paralysis or loss of a limb. Although 40-80% of cases remain unexplained, referral for specific investigation is rare. Design. A narrative literature review including descriptive, theoretical and empirical material reliant on the keywords 'dizziness' and 'vertigo' and the phrase 'vestibular disorders'. This provided diverse information that was used to address the research questions. Results. Vertigo is a widespread and potentially distressing symptom that may arise at any age and be acute or chronic. For most, it resolves spontaneously; for others, dizziness persists, causing significant distress. Its management is challenging, especially when the underlying cause is unclear. Pharmacological interventions, physiotherapy, psychotherapy or, rarely, surgery can be used in its management. Few nursing studies are available, suggesting that nursing knowledge may be limited. Relevance to clinical practice. Although nurses may frequently encounter patients with vertigo, there are few relevant nursing studies in this area; few consider appropriate nursing interventions or approaches to patient care. The information provided reveals that understanding the full impact of the condition and identification of patients' needs are essential to effective care. Some strategies to help affected patients are outlined. Conclusions. Vertigo, a widespread, often intractable condition, affects significant numbers of people; diagnosis and management can be challenging. Treatment, care and support must be selected on an individual basis taking individuals into account. The primary goals are to maintain physical status, psychosocial interaction and quality of life. [ABSTRACT FROM AUTHOR]

Aim. This paper provides a review of the literature related to adult siblings of learning-disabled people. Background. Siblings of learning-disabled people are often looked upon as next of kin when older parents die; however, there is little research regarding sibling views and wishes. Design. A literature review of published peer-reviewed empirical research was undertaken. Method. Electronic databases and citation tracking were used to collate data using key terms such as adult siblings and learning disability. Relevant articles were analysed, compared and contrasted. Results. Six key themes emerged suggesting a varied impact of learning disability upon sibling lives in areas that include life choices, relationships, identity and future plans. Some siblings report a positive impact upon life, others state their lives are comparable with other adults who do not have a learning-disabled sibling and others still report a negative impact. Sibling roles and relationships are varied. Evidence suggests that sibling roles, relationships and experience are affected by life stage. Parents often have a primary care role for the disabled person, whilst siblings perform a more distant role; however, sibling involvement often rises when parents are no longer able to provide previous levels of support. Conclusion. Many factors appear to affect the sibling experience and uptake of roles including gender, life stage and circumstances, level of disability, health status and relationships between family members. Siblings are concerned about the future, particularly when parents are no longer able to provide support, and many appear to have expectations of future responsibilities regarding their disabled sibling. Relevance to practice. As siblings of people who have a learning disability are often expected by society to provide support, it is important that health and social care practitioners are aware of issues that may impact on this relationship. [ABSTRACT FROM AUTHOR]

Aim. To review the evidence on nurses' health systematically. Background. Nurses are one of the most important resources of a health system. They are subjected to biological, socio-economic, cultural and health system factors that determine their health. Although mental and physical health problems seem to prevail among nurses, literature is often contradictory. The literature on health styles, health behaviours and self perceived health of nurses is also unclear. Design. Systematic review of experimental and observational studies on nurses' health. Methods. Forty-three databases searched. 2692 references identified as of potential interest; 187 studies included. Only the results from studies on physical health are presented. No meta-analysis was possible. The Scottish Intercollegiate Guidelines Network system was used to rate evidence. Results. Nurses were at greater risk of musculoskeletal injuries and more prone to blood-borne pathogens infections than other health care workers. They were at greater risk of breast cancer than other female health care workers. Nurses in hospitals were more at risk of tuberculosis. They did not have excess risk of cancer in general, Hodgkin's disease, stomach, colon, rectum, pancreatic, ovary, kidney, brain or thyroid cancer or of lymphosarcoma. They have a higher prevalence of occupational allergies than clerical workers. Discussion. Nurses suffer more from musculoskeletal disorders which is consistent with the nature of nursing work. They are at greater risk of acquiring tuberculosis, particularly if they work in pulmonary, medicine or Human Immunodeficiency Virus wards which might be due to repeated contact with infected patients. Nurses are also more prone to blood-borne pathogens infections which might be explained by exposure while working. The proneness to occupational allergies can be explained by exposure to a series of chemical agents. Relevance to clinical practice. Without sound knowledge on nurses' health and it is not possible to develop specific occupational health programmes. [ABSTRACT FROM AUTHOR]

The article discusses the results of a literature review on the effectiveness of silver-alloy urinary catheters in decreasing the incidence of catheter-associated urinary tract infections (UTI) in adult patients. The authors mention that eight out of 11 papers reviewed showed a favorable pattern towards the effectiveness of silver-alloy urinary catheters compared with silicone or latex catheters in reducing catheter-associated UTI. They discuss the criteria used in the selection of literature.

Tuberculosis is a major health problem internationally and brings with it a range of physical, economic and social consequences. There is a stigma associated with having tuberculosis because the disease is commonly viewed as a 'dirty disease'. This stigma can have a negative impact on an individual and may delay the person seeking treatment. The aim of this review was to explore the stigma and impact of having tuberculosis or having a family member with tuberculosis. Literature review. A comprehensive search of the electronic databases was undertaken. Inclusion criteria for the review were studies that investigated people with tuberculosis or their families, focused on the stigma or impact of tuberculosis and reported descriptions of the experience. Data were synthesised using a thematic analysis. The literature search identified thirty studies. Three themes emerged from the synthesis: shame, isolation and fear. The shame related to tuberculosis being viewed as a bad disease, a dirty disease. Isolation involved both the withdrawal from social contact and the shunning of contact by other people. Fear was a consequence of the many difficulties that accompany tuberculosis. These factors operated at three levels, on the individual level, the family level and the societal level. The stigma that accompanies tuberculosis can have a negative impact on the individual and family and may result in their withdrawal from society because of shame and fear. The review highlights the need for education to provide practical strategies for individuals and families and to educate communities where tuberculosis is endemic. The review highlights the widespread ignorance of tuberculosis and need for education of the individual, family and community. This education should provide practical strategies to help people cope with tuberculosis. It also suggests that ensuring confidentiality should be an important component of management strategies. [ABSTRACT FROM AUTHOR]

The aim of this study was to review dementia nursing competencies. The objectives were to explain the relevancy of dementia competencies across care settings and levels of practice. Dementia is strongly associated with increasing age and as the world population ages there is an imperative to ensure the healthcare workforce is fully equipped to meet the needs of people with dementia and their carers. A literature review study addressed the research aim and objectives. Literature sources were (i) academic databases, (ii) the internet and (iii) snowballing. Search terms were 'dementia', 'care standards', 'training and education' and 'competency'. The sample consisted of 59 reviewed publications. A synthesis of the findings generated 10 dementia competencies: (i) Understanding Dementia; (ii) Recognising Dementia; (iii) Effective Communication; (iv) Assisting with Daily Living Activities; (v) Promoting a Positive Environment; (vi) Ethical and Person-Centred Care; (vii) Therapeutic Work (Interventions); (viii) Responding the needs of Family Carers; (ix) Preventative Work and Health Promotion and (x) Special Needs Groups. There were also five levels of practice: (i) Novice; (ii) Beginner; (iii) Competent; (iv) Proficient and (v) Expert and no care setting specific competencies were generated. Government initiatives demonstrate commitments to dementia, such as Australia's adoption of dementia as a National Health Priority and the UK National Dementia Strategy. Registration boards for the nursing workforce in Japan and the UK included dementia competencies in generalist frameworks to emphasise the importance of dementia as a healthcare issue. This study demonstrated that there is no dementia competency framework relevant across care settings or levels of practice. An empirical study will develop a multi-disciplinary dementia competency framework relevant across care settings and levels of practice to ensure the healthcare workforce can effectively deliver services to people with dementia and their carers. [ABSTRACT FROM AUTHOR]

To review, systematically, factors contributing to outcomes in patients with traumatic brain injury. Traumatic brain injury is a leading cause of death and disability. Several studies have determined the significant predictors of outcomes after traumatic brain injury. The comprehensive identification of these reliable factors for traumatic brain injury is critical to both clinical practice and research. Systematic literature review. Eligible studies that combined at least two variables to predict outcomes in patient with traumatic brain injury were identified via electronic database searches, footnote chasing and contact with clinical experts. Quality of selected studies was assessed in terms of internal and external validity using 15 questions. Two reviewers independently examined titles, abstracts and whether each met the predefined inclusion criteria. A total of 46 studies which met review criteria were finally selected. Most studies satisfied internal validity in terms of validity of research variables and multivariate analysis, but few were validated externally. The following factors were significantly associated with unfavourable outcomes: sociodemographic factors such as older age, male gender, lower level of education; clinical factors such as lower Glasgow Coma Scale score, injury caused by motor vehicle crash, hypotension, hypoxia, increased intracranial pressure, no pupil reaction, hypo- or hyperglycaemia, anaemia, coagulopathy, hypo- or hyperthermia, abnormal level of electrolytes, duration of coma; higher level of computed tomography classification by Marshall category; type of intracerebral lesions. Further studies on integrating the sociodemographic factors, the course of the clinical condition and a unified CT scoring system, are recommended for the evaluation and improvement of the prognosis of traumatic brain injury. A systematic review of factors contributing to outcome for patients with traumatic brain injury will be invaluable in triage criteria, injury prognostication, care and discharge planning, resource use and patient and family counselling. [ABSTRACT FROM AUTHOR]

To examine the psychometric properties of the Hospital Anxiety and Depression Scale in selected research to determine the suitability of this instrument for use in an alcohol-dependent population. Anxiety and depression represent a significant comorbid problem encountered with alcohol dependency. Effective screening for clinically relevant anxiety and depression is crucial for tailoring effective treatment intervention. However, no guidance exists to suggest the most appropriate screening measure in this clinical group. Narrative review. Three criteria were used: factor analysis, test-retest reliability and internal consistency reliability. Factor analysis studies highlighted a mostly bi-dimensional model or a tripartite model, with only a couple of exceptions. Test-retest reliability came from only five studies, and while they all showed significantly positive correlated scores, only one study fulfilled criteria for a good or efficient reliability measure. The last evaluation, internal consistency reliability, faired much better in terms of recommended scores for reliability. Nearly all the studies showed a high level of internal consistency reliability. It is concluded that the Hospital Anxiety and Depression Scale is likely to be a suitable screening tool for use in an alcohol-dependent population. Effective screening for anxiety and depression can significantly enhance treatment efficacy when working with those patients presenting with alcohol dependency. This review suggests that the Hospital Anxiety and Depression Scale may be an appropriate instrument to use in this group based on observation of the tools measurement characteristics. [ABSTRACT FROM AUTHOR]

The aim of this paper is to review the literature on factors that influence the expression of sexuality by older people in care homes. Sexuality is an intrinsic part of what we are, however there is evidence to suggest that the sexual needs of older people are often overlooked, particularly in long-term care settings. Whilst there is information about sexuality and its expression in later life, questions remain as to how this influences and is influenced by the behaviours and experiences of residents and staff in care homes. A systematic search of online databases. Databases using keyword and bibliographical searches in a specified timeframe were undertaken. Research studies ranging from 1996-2009 were selected for inclusion on the basis that they addressed issues relating to expressions of sexuality by older people in care homes. Forty articles were included in the review. The review revealed a dearth of rigorous research on sexuality amongst older people in general and care home residents in particular. Issues identified in the literature were categorised into four broad thematic areas: sexuality and ageing, expression of sexuality in care homes, attitudes of staff and sexuality in dementia. There is a dearth of rigorous research on the factors influencing sexual expression by care home residents. Attitudes of staff in care homes influence their perceptions about the extent to which the expression of sexuality by residents is considered to be problematic. This, in turn influences the emotional and behavioural responses of staff to the resident. There is need for nurses and other care staff to gain a better understanding of and insight into late life sexuality. This involves change at an educational level but also at an organisational and cultural level in long-term care settings. [ABSTRACT FROM AUTHOR]

To provide an inclusive understanding of nurses' responses to suicide and suicidal patients that can benefit nursing practice and guide research. The question was 'What is a critical interpretive synthesis of accumulated nursing research on nurses' responses to suicide and suicidal patients?' Various studies address nurses' responses to suicide and suicidal patients. An understanding of accumulated research-based literature about nurses' responses to suicide and suicidal patients may guide nurses to care for suicidal patients in ways that facilitate suicide prevention and recovery. The design is reflexive and iterative. A Critical Interpretive Synthesis was conducted, which comprised of six phases: formulating the review question, searching the literature, sampling, determining quality, extracting data and conducting an interpretive synthesis. Qualitative content analysis and systematic review of literature was included in these phases. The results report the review question, literature review strategies, purposive sample (26 full-text studies published in peer reviewed journals, 1988-July 2009, conducted mostly in Europe and North American), quality determinants, data extraction into themes and an interpretive synthesis of four key concepts, i.e. critical reflection, attitudes, complex knowledge/professional role responsibilities, desire for support services/resources. This understanding of accumulated research-based literature enhances contextual, conceptual and methodological perspectives. Contextually, gaps exist in international research. Conceptually, the four key concepts can serve as a useful guide for nurses to understand their own and other nurses' responses to caring for suicidal patients in various settings. Methodologically, the Critical Interpretive Synthesis approach moved a small body of knowledge that varied in quality measures beyond an aggregate understanding. Understanding nurses' responses to suicide and suicidal patients may guide nurses to care for suicidal patients in ways that facilitate suicide prevention and recovery, thus addressing the urgent work of suicide prevention in the world. [ABSTRACT FROM AUTHOR]

The purpose of the review was to identify student characteristics and strategies in research studies investigating retention (why students stay) as opposed to attrition (why students leave) nursing and midwifery preregistration programmes. Retention in nursing and midwifery programmes is a serious international problem. Many governments are committed to diversifying both the student population and the health care workforce. This has led to higher education institutes in some countries offering places on nursing and midwifery programmes to students with non-traditional entry qualifications. There are suggestions that the policy of widening access has contributed to the challenges of retention in nursing and midwifery programmes. Integrative literature review. Undertaken using electronic databases and specific search terms, 15 articles were identified and reviewed. The critical appraisal tools produced by were used to evaluate the quality of the data. Findings from the identified research literature were analysed using qualitative content analysis. Two broad themes emerged from the analysis: Programme and Personal. Subthemes were identified in these that give clues as to why students stay: profession, support, student characteristics and family. Personal commitment and good support seem to be essential for students to remain on undergraduate programmes of nursing and midwifery. The term 'support' is rarely explicit and requires to be more clearly defined. Furthermore, studies reviewed fail to indicate clearly how to identify when students are most vulnerable and which interventions are most appropriate in different situations in supporting retaining students on programmes. Nursing and midwifery student retention is a political and professional problem. Collaboration between clinical placement providers, academic institutions, students and their families is required to address the issue. Illumination of factors that help students stay may help us devise interventions that prevent future students leaving. [ABSTRACT FROM AUTHOR]

The aim was to review available literature on research and service evaluation evidence of nurse-led case management services targeting older people with multiple chronic conditions in their own homes. This was anticipated to highlight important issues for nursing practice, healthcare policy, service provision and health service research. Enhanced roles for nurses have developed in response to demands for increased efficiency in the provision of healthcare especially in the area of chronic disease management. It is apparent that the evidence to support nurses providing a case management approach for patients with multimorbid chronic conditions in their home environment is ambiguous. A systematic review of the literature. The review was carried out across multiple sources including search and alert engines, electronic databases, relevant journal websites and grey literature. The inclusion criteria applied concentrated on articles in the English language, case management intervention involving nurses providing care in the patients' own home and older people (aged over 65 years) with multiple chronic illnesses. Of a total of 568 papers identified, eight were of relevance and included in the review. The qualitative data derived from this systematic review suggests that access to case management services had a positive impact on the patient, the carer and the healthcare staff particularly the General Practitioner. In contrast the more robust quantitative data does not demonstrate a significant impact on emergency admissions, bed days, nor costs. Further research is needed to understand how case management can most effectively improve service effectiveness for patients and their carers and reduce cost of care. A new emphasis on comparative effectiveness research is required which has the potential to reshape the whole system of healthcare provision for patients with complex needs. [ABSTRACT FROM AUTHOR]

To review and synthesise, systematically, the research findings regarding motivational interviewing and to inform education, research and practice in relation to cardiovascular health. Motivational interviewing is designed to engage ambivalent or resistant clients in the process of health behaviour change, and it has been widely used in different clinical conditions such as substance abuse, dietary adherence and smoking cessation. Motivational interviewing has also been proposed as a method for improving modifiable coronary heart disease risk factors of patients. Systematic review. Eligible studies published in 1999-2009 were identified from the following databases: CINAHL, Medline, PsycINFO, Cochrane Library, EBSCO, Web of Science, Embase and British Nursing Index. A manual search was conducted of bibliographies of the identified studies and relevant journals. Two researchers independently reviewed the studies. Four meta-analyses, one systematic review and three literature reviews of motivational interviewing and five primary studies of motivational interviewing pertaining to cardiovascular health were identified. Despite a dearth of primary studies in cardiovascular health settings, there appears to be strong evidence that motivational interviewing is an effective approach focusing on eliciting the person's intrinsic motivation for change of behaviour. Motivational interviewing is an effective approach to changing behaviour. It offers promise in improving cardiovascular health status. This review indicates that motivational interviewing is a useful method to help nurses improve health behaviour in people with coronary risk factors. [ABSTRACT FROM AUTHOR]

To synthesise the body of literature on workplace violence in the emergency department and to identify characteristics of intervention studies that are the basis for guiding best practice modelling in the clinical setting. The research question addressed was what are the characteristics and findings of studies since 2004 on workplace violence in the emergency department? Emergency departments are prone to increased incidents of workplace violence. Workplace violence in the health care setting has become a hot topic of policy, political debate and research in recent years. Despite the research that has been carried out in this area, little consensus exists as to what are the best practices for mitigating violence in this setting. Systematic literature review. Search using four online databases, including MEDLINE, CINAHL, PsycINFO and the Dissertations and Theses Full Text Database. Most research focused on the incidence rates of workplace violence in the emergency department and effects on staff. There was a significant lack of intervention studies to provide a framework for guiding evidence-based practice. Themes of under-reporting violence, barriers and attitudes towards reporting, description and characterisation of incidents of violence, predisposing factors and the concept of safety or lack of fear were all major content areas addressed in the literature. Incidence of workplace violence in the emergency department has been well documented in numerous published studies. Emergency department workers are exposed to significant rates of physical and verbal abuse. Under-reporting of workplace violence in the emergency department is common and contributes to the difficulty in accurately tracking violence. Future research must move beyond descriptive studies to include more advanced research methods. Few practice-guiding implications can be gained from this body of research because of the lack of intervention studies. [ABSTRACT FROM AUTHOR]

The purpose of this integrative review of the literature was to find and review international research studies that explored student attrition to determine what is known about the topic and to identify gaps in the research with a view to addressing the situation in the UK. Attrition from nursing programmes is a serious problem in the UK. It is recognised as a complex phenomenon, not attributable to a single cause. Regardless of actual attrition rates and trends, departments of nursing are challenged to perform in a business-like manner. Consequently, every student lost to a programme of study equates to a financial penalty for the department and to the future workforce and community. Integrative review of the literature. Using electronic databases and specific search terms, 18 articles were identified and reviewed. Findings from the identified international research literature were analysed using qualitative content analysis. Four broad themes that accounted for factors of relevance to attrition were identified: Social, Prediction, Programme and Personal. Retention studies are fraught with methodological problems. These include incomplete or inaccurate data and low response rates. Attrition early in programmes may be attributed to a failure to understand the roles of nurses in contemporary societies. This has led to dissatisfaction with programmes and academic failure, as students may underestimate the intellectual demands of their programmes. Attrition later in the programme may be attributed to a combination of personal factors that culminate in a personal crisis. The research literature suggests that stereotyping of nurses is a major factor in attrition. Both professions need to find ways of communicating contemporary roles to wider society. [ABSTRACT FROM AUTHOR]

To determine current evidence about the use of complementary and alternative medicine in the context of highly active antiretroviral therapy. The following objectives included identifying the risks and benefits of using complementary and alternative medicine when living with the human immunodeficiency virus (HIV) and taking such medications. In Canada and the USA, HIV/AIDS service organisations recognise that people affected or infected by HIV are increasingly choosing to use complementary and alternative medicine to cope with this disease. These same organisations advocate for increased access to complementary and alternative medicine and more information about the safe use of complementary and alternative medicine to make informed decisions. Based on the increased integral use of complementary and alternative medicine and conventional medicine in Canada and the USA, the literature review was limited to these two countries. Systematic review. Available full-text abstracts published in English from 2000-2009 were retrieved by electronic searches of selected databases, including the websites of Health Canada and American National Center for Complementary and Alternate Medicine (NCCAM). Forty studies were examined and were categorised by referring to the NCCAM (2007) four types of complementary and alternative medicine. Insufficient evidence exists to support the use of a particular complementary and alternate therapy to enhance the management of HIV disease. Decisions about using complementary and alternative medicine in conjunction with highly active antiretroviral therapy are often poorly informed. Safety risks and potential drug interactions are frequently ignored as people who use highly active antiretroviral therapy prefer to focus on the physical and mental benefits of using selected complementary and alternate therapies to promote their quality of life. As life expectancy increases, from the use of highly active antiretroviral therapy, it is important for health professionals like nurses to be knowledgeable about the prevention, assessment and treatment of HIV symptoms and treatment side effects. Given the increased trend of using complementary and alternative medicine by the general population, it is also important to understand the appropriate use of complementary and alternative medicine for symptom management in HIV/AIDS care. [ABSTRACT FROM AUTHOR]

This systematic literature review aimed at addressing two questions: first, what evidence exists regarding intermediate care in the UK; and what interventions have been used to develop interprofessional working in intermediate care in the UK? A systematic review of the literature from 2000-2006 resulted in a total of 104 full-text articles describing research into intermediate care in the UK. The review was the first stage of a large, national project evaluating and developing interprofessional working among health and social care staff, particularly in relation to the intermediate care of older people. Systematic literature review. All the literature was reviewed by one reviewer, and a second review was carried out by a team of reviewers to ensure each article was reviewed twice, independently. One article was reviewed by all the reviewers to ensure inter-rater reliability; finally, all the reviews were amalgamated, which resulted in one summary per article. The main findings drawn from this systematic literature review are that research carried out on intermediate care in the UK has a diverse set of aims, for example economic evaluations, delivery of intermediate care and exploring the views and perceptions of those involved in intermediate care. Although several articles include discussions about the importance of interprofessional working in intermediate care, no article specifically focused on the interprofessional focus of intermediate care, and there was no research about interventions used to develop interprofessional working. Intermediate care as a policy has been interpreted very differently across the four countries of the UK; there is no one preferred or consistent interpretation to its delivery. [ABSTRACT FROM AUTHOR]

This review was designed to evaluate the evidence relating to pain management interventions for patients having bone marrow biopsy. Bone marrow biopsy is an invasive procedure causing considerable pain and anxiety for adult patients, yet there are no guidelines to inform effective nursing care. Although this is an under-researched area, a range of pain interventions have been tested on this patient group, but this evidence has not been synthesised. Structured evidence review. The Cochrane Library and databases Medline, Scopus and Cinahl were searched for original research reports. Reference lists of retrieved papers were hand-searched and researchers in the field were contacted. Retrieved papers were analysed using the CASP framework. A narrative data synthesis considered the strengths and limitations of included studies and findings were collated and interpreted. No systematic reviews of evidence have been undertaken and the search strategy identified twelve research studies eligible for inclusion in the review. Hand-searching did not identify any additional studies, and emails to researchers confirmed this is an under-researched field. Analysis shows three main interventions, intravenous midazolam, premedication with analgesia and/or anxiolysis and the use of Entonox™ are used to manage the pain experience for patients undergoing a bone marrow biopsy. Evidence is inconclusive and provides little guidance for practice. There is an urgent need for research into effective interventions for pain management in bone marrow biopsy and in understanding the patient experience. Nurses have a central role to play in the assessment and management of the pain and anxiety associated with bone marrow biopsy. There is little evidence to guide this aspect of care, but it is important that nurses involved with bone marrow biopsy are aware of the best evidence to facilitate the most effective management of their patients' pain. [ABSTRACT FROM AUTHOR]

This integrative review presents and synthesises previous research investigating practices, perceptions and experiences of bedside staff nurses relative to hospital discharge planning. Preparation for hospital discharge should begin at or prior to admission. Forces in the acute care environment, however, often impede comprehensive discharge planning. Evidence-based redesign of discharge planning processes is a priority for nurses and health care leaders. An integrative review. The review was undertaken using eleven search terms to electronically scan CINAHL, Medline, PsycINFO and Dissertations and Theses databases for the period 1990-2009. Hand searching of reference lists and author searches was also conducted. Sixty English language articles were reviewed; 38 of these 60 publications met the study inclusion criteria. Seven themes were identified across the studies. These themes were intra- and interdisciplinary communication; systems and structures; time; role confusion; care continuity; knowledge; and the invisibility of the staff nurse role in discharge planning. Acute care bedside nurses frequently encounter significant barriers while providing discharge-related care. Although these barriers have been identified consistently in numerous studies spanning nearly two decades, few published reports address interventions designed to overcome identified obstacles and inefficiencies. Additional discharge planning redesign initiatives, which include rigorous evaluation of patient outcomes, are needed. As the direct caregivers with the most consistent presence and knowledge of patients' postdischarge needs, acute care bedside staff nurses play a critical role in preparing patients and families for the transition from hospital to home. Nurses are uniquely positioned to identify barriers and opportunities in discharge planning processes and contribute significantly to evidence-based reform initiatives. Effective and efficient patient-centred discharge planning processes can facilitate the transition from hospital to home and begin to address the adverse events experienced by some patients in the immediate postdischarge period. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review was to establish whether warmed irrigation fluid temperature could decrease the drop of body temperature and incidence of shivering and hypothermia. Irrigation fluid, which is used in large quantities during endoscopic surgeries at room temperature, is considered to be associated with hypothermia and shivering. It remains controversial whether using warmed irrigation fluid to replace room-temperature irrigation fluid will decrease the drop of core body temperature and the occurrence of hypothermia. A comprehensive search (computerised database searches, footnote chasing, citation chasing) was undertaken to identify all the randomised controlled trials that explored temperature of irrigation fluid in endoscopic surgery. An approach involving meta-analysis was used. We searched PubMed, EMBASE, Cochrane Library, SCI, China academic journals full-text databases, Chinese Biomedical Literature Database, Chinese scientific journals databases and Chinese Medical Association Journals for trials that meet the inclusion criteria. Study quality was assessed using standards recommended by Cochrane Library Handbook 5.0.1. Disagreement was resolved by consensus. Thirteen randomised controlled trials including 686 patients were identified. The results showed that room-temperature irrigation fluid caused a greater drop of core body temperature in patients, compared to warmed irrigation fluid ( p < 0·00001; I = 85%). The occurrence of shivering [odds ratio (OR) 5·13, 95% CI: 2·95-10·19, p < 0·00001; I = 0%] and hypothermia (OR 22·01, 95% CI: 2·03-197·08, p = 0·01; I = 64%) in the groups having warmed irrigation fluid were lower than the group of studies having room-temperature fluid. In endoscopic surgeries, irrigation fluid is recommended to be warmed to decrease the drop of core body temperature and the risk of perioperative shivering and hypothermia. Warming irrigating fluid should be considered standard practice in all endoscopic surgeries. [ABSTRACT FROM AUTHOR]

The aim of this integrative literature review was to describe registered nurses' medication competence. The objectives of the literature review were to chart the need for future studies and use the results for instrument development. Nurses play a vital role in different phases of a patient's medication process and thus need adequate competence to fulfil their role. Research on nurses' level of medication competence in different competency areas has been published. However, previous studies have lacked a comprehensive or integrated definition or description of medication competence in nursing. Integrative literature review. The integrative literature review followed five stages: (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis and (5) presentation. Eligible articles were identified via systematic literature search of research and evidence-based - databases. Twenty-one studies met the selection criteria. Eleven competency areas that constitute nurses' medication competence were identified: (1) anatomy and physiology, (2) pharmacology, (3) communication, (4) interdisciplinary collaboration, (5) information seeking, (6) mathematical and medication calculation, (7) medication administration, (8) medication education, (9) assessment and evaluation, (10) documentation and (11) promoting medication safety as part of patient safety. The analysis revealed three major categories which integrate these competency areas: (1) decision making competence, (2) theoretical competence and (3) practical competence. Medication competence requires a solid knowledge base and the ability to apply that knowledge in real-life situations during often complex and dynamic patient medication processes. Decision making competence was found to be an important and integral part of a nurses' theoretical and practical competence. These main competence categories integrated all of the 11 competency areas identified in this review. It is important to determine registered nurses' medication competence in the context of developing nursing education and migration of the nursing workforce. This literature review contributes an integrated perspective on nurses' medication competence and in doing so has clinical relevance for curriculum development and to future research in this area. [ABSTRACT FROM AUTHOR]

The aim is to present the development and implementation of a bereavement follow-up intervention for grieving fathers. The development and implementation process and components of the intervention are presented. There is a lack of research into fathers' grief and bereavement support for them after the death of a child. Promotion of evidence-based nursing requires transparent development and implementation of nursing interventions and models to be able to repeat, evaluate their effectiveness and redevelop them. Phases of action research were used when developing and implementing the intervention. Results of the baseline study of father's grief and social support, the study of current bereavement support and the literature review were combined using triangulation. In this action research, the development of a bereavement follow-up intervention for grieving fathers began with the planning phase that included a baseline study about fathers' grief and social support, a study of current bereavement support systems in Finnish university hospitals and a systematic review of literature on the topic area and collaboration with a panel of experts. The developed bereavement follow-up intervention included three complementary components: support package, peer supporters' contact and health care personnel's contact. Implementation of the intervention included the development of a programme to be used in nursing practice, intervention training for programme implementers and intervention implementation. Developing and implementing an intervention is a complex, demanding and long-term process. The planning required theoretical knowledge as well as understanding the experiences of fathers, nursing practice and collaboration with those who implemented the intervention. New information about the fathers' grief and bereavement follow-up support is described. The model developed is evidence-based and can be applied in nursing care where grieving fathers and families are met. [ABSTRACT FROM AUTHOR]

This literature review aims to define best nursing practice for lower limb ulcer care promoting stabilisation of this physiological consequence of diabetes mellitus and to help provide improved integration of health-within-illness for the patients. According to the Centers of Disease Control, the number of people with diabetes has risen from 20·8 million in 2005 to over 23·6 million in 2007. Research has identified best practice algorithms for care of the diabetic foot, yet none for the ulcerations on the limb from the knee to the ankle. The design of this literature review is to compile research from both nursing and medical communities to develop a best practice for the stabilisation of a lower limb ulcer. A literature search was conducted based on the theoretical framework of stabilisation of a chronic condition. Twenty-nine articles were identified for use in the evaluation of best practice of lower limb ulcerations. Each article was synthesised using a protocol tool. Control of hyperglycaemia, infection control, ulcer debridement, use of dressings and compression therapy to relieve venous congestion were all identified as important factors in the treatment of lower limb ulcerations. This systematic literature review has resulted in a 'best nursing practice algorithm' for the stabilisation and care of lower limb ulcerations regardless of underlying cause. This care algorithm could be used in collaboration with other health care providers to promote stabilisation of lower limb ulcers and improve the overall quality of life of patient cohort. The results of this study yield a suggested 'best practice' algorithm for the stabilisation of a lower limb ulcer - treat and control hyperglycaemia; prevent and/or control infection of the ulcer; routine debridement of the ulcer; using the most appropriate type of dressings for each patient; and the application of compression therapy. This algorithm can also be used for to frame patient teaching regarding appropriate treatments and therapies to promote the patient's self-care and stabilisation of the ulcer. [ABSTRACT FROM AUTHOR]

To investigate the evidence of problem-solving approach interventions on symptom management in cancer care. Symptom-related problems are a common challenge in cancer care. The problem-solving approach is one strategy of cognitive behavioural therapy used to help patients with cancer self-manage their symptoms. However, no systematic review has investigated the effectiveness of this approach. Systematic review. A systematic search for intervention studies using randomised controlled designs, controlled clinical trial and quasi-experimental studies designs was conducted using the following electronic databases: EBSCO host, CINAHL (1991-2008), Medline (1975-2009), Electronic Periodical Services (Chinese) and Electronic Theses and Dissertations System (Taiwan). Seven studies published in English between 1975-2009 were included in this systematic review. All studies were randomly assigned and almost all studies demonstrated the positive effects of a problem-solving approach in reducing symptomatic problems in the target participants. Varying protocols and qualities of methodological design (14% good, 43% fair and 43% poor) were found in this review. This systematic review highlighted the potential of a problem-solving approach in the management of symptom problems in patients with cancer. However, more rigourous studies are needed and a better evaluation of the most effective problem-solving approach protocols is required. Cancer care nurses should explore the use of problem-solving approach interventions in their practice as the evidence base suggests the value of this approach - but caution is needed in regard to the precise structure of the problem-solving approach protocol. [ABSTRACT FROM AUTHOR]

The purpose of our study was to describe the dissemination of research into the clinical nursing literature. The literature provides a means of transferring knowledge from a research study through citations of the work by other authors. This was a citation analysis study to explore the dissemination of research into the clinical nursing literature, beginning with the publication of an original research study and including all of the citations to that article through 2009. The authors searched five academic nursing research journal titles, using CINAHL, for original research reports that had clinical relevance and were published between 1990-1999. The search process yielded a final data set of 28 research articles. For each of the articles, the authors searched three databases, CINAHL, Web of Science and Google Scholar, to determine the citation patterns from the date of publication to August 2009. All of the research studies were cited in articles published in clinical journals although there was a wide range in the number of citations, from 3-80. The 28 research articles had a total of 759 citations; 717 (94·5%) of those citations were in articles published in clinical nursing journals. The median length of time between publication of the original study and the first citation was 1·5 years. Some of the studies were still being cited for 18 years after publication of the original work. All of the original research reports examined in this study were cited in articles in clinical journals, disseminating the research beyond the original work to reach clinicians. Clinical nursing journals keep readers up-to-date and informed about new practices in nursing and serve another important role: they disseminate research that is clinically relevant by publishing original studies and papers that cite research reports. [ABSTRACT FROM AUTHOR]

This paper explores the impact of models of integrated services for pregnant women, children and families and the nature of collaboration between midwives, child and family health nurses and general practitioners. Increasingly, maternity and child health services are establishing integrated service models to meet the needs of pregnant women, children and families particularly those vulnerable to poor outcomes. Little is known about the nature of collaboration between professionals or the impact of service integration across universal health services. Discursive paper. A literature search was conducted using a range of databases and combinations of relevant keywords to identify papers reporting the process, and/or outcomes of collaboration and integrated models of care. There is limited literature describing models of collaboration or reporting outcomes. Several whole-of-government and community-based integrated service models have been trialled with varying success. Effective communication mechanisms and professional relationships and boundaries are key concerns. Liaison positions, multidisciplinary teams and service co-location have been adopted to communicate information, facilitate transition of care from one service or professional to another and to build working relationships. Currently, collaboration between universal health services predominantly reflects initiatives to move services from the level of coexistence to models of cooperation and coordination. Integrated service models are changing the way professionals are working. Collaboration requires knowledge of the roles and responsibilities of colleagues and skill in communicating effectively with a diverse range of professionals to establish care pathways with referral and feedback mechanisms that generate collegial respect and trust. [ABSTRACT FROM AUTHOR]

To conduct a literature review that explores the impact of rapid response systems on reducing major adverse events experienced by deteriorating ward patients. Patients located on hospitals wards are frequently older, have multiple co-morbidities and are often at risk of life-threatening clinical deterioration. Rapid response systems have been developed and implemented to provide appropriate and timely intervention to these patients. A comprehensive review of the literature. This review used the rapid response systems framework recently developed by experts in the area. Medline, CINAHL, Embase and Cochrane databases were searched from January 1995-June 2009. Sixteen papers were selected that most clearly reflected the research aim. Each paper was critically appraised and systematically assessed. Major themes and findings were identified for each of the studies. The effectiveness of rapid response systems in reducing major adverse events in deteriorating ward patients remains inconclusive. Six studies demonstrated that the introduction of a rapid response systems positively impacted on patient outcomes, but three studies demonstrated no positive impact on patient outcomes. Nursing staff appear reluctant to use rapid response systems; the rationale for this is unclear. However, the continued underuse and inactivation may be one reason why research findings evaluating rapid response systems have been inconclusive. The paper illustrates two important gaps in the literature. First, 'ramp-up' systems have not been subjected to formal evaluation. Second, rapid response systems are under-activated and underused by nursing staff. There is an urgent need to explore the reasons for this and to identify interventions to improve the activation of these systems in an effort to promote safe and effective care to the deteriorating ward patient. Rapid response systems are multidimensional models. They are relatively new innovations that have important implications for clinical research and implementation policy. This review contributes to the emerging debate on rapid response systems. [ABSTRACT FROM AUTHOR]

Aims and objectives. To identify the effect of early rehabilitation of patients with post-traumatic amnesia in patients with traumatic brain injury, to review and critically assess evidence related to the timing of intervention and to identify the effect on outcome of a specific neurological rehabilitation in acute care. Background. Up to 70% of patients with traumatic brain injury will experience post-traumatic amnesia. Although duration of post-traumatic amnesia is correlated negatively with outcome for patients with traumatic brain injury, there is limited evidence relating to what influence timing and effect may have on enhancing early rehabilitation patient outcomes. Design. A critical literature review. Methods. Searches for systematic reviews were undertaken in Medline, CINAHL, Cochrane, PSYC INFO and Neurotraume databases. The efficacy of intervention and timing was classified based on a hierarchy of study designs for questions about health care interventions based on soundness of design. Results. Six reviews and 11 original studies were included and comprised the review. Many studies used weak designs and small sample size, thus limiting their ability to control confusing variables and outcomes. Few studies included papers with the information about timing and effect of early post-traumatic amnesia intervention. Only one study showed an effect of a reality orientation programme in acute care. Although there was no significant detail reported on the possibility of reducing the post-traumatic amnesia period, the study showed clinical relevance. Conclusion. This review highlights the limited evidence of the effect of early rehabilitation of patients with post-traumatic amnesia. Future research should be conducted to identify the effectiveness of early intervention. Relevance to clinical practice. Although nurses are treating patients with post-traumatic amnesia without systematic assessment, the limited evidence available does little to direct nurses as to the best approach to start early rehabilitation of post-traumatic amnesia to promote good outcomes. [ABSTRACT FROM AUTHOR]

Aims. The aim of this study is to provide an overview of the way that medication work is conceptualised in the literature and introduce a cautionary note into the enthusiasm with which nurses' medication work is currently being reformed. Background. This article is an overview outlining how nurses' medication work is discursively organised and known about authoritatively. There is a great deal of safety and coordination work that nurses undertake in relation to the 'task' of administering medications that remains hidden and misunderstood in the dominant ways that knowledge about medication administration is structured. Technological innovations are eagerly embraced, but we posit that these strategies may be having an impact on nursing work with medications in unknown and potentially deleterious ways. We develop a critical analysis of the discursively limiting frameworks of biomedical science, law, management and safety through which nurses' medication practices are currently framed. This analysis provides insight into the ideologies and power relations that are taken up by nurses. The analytic work presented here informs an institutional ethnographic study that, at the time of this publication, is currently in the first stage of data collection. The study promises to contribute new knowledge about medication work as nurses know it. Design. A discursive paper including a selective critical analysis of the descriptive, theoretical and empirical literature. Methods. Databases were searched using the keywords medication work, medication administration and medication error. Conclusion. The enthusiasm with which technological innovations are being introduced must be tempered with equal attention to the impact that this has on nursing work. Relevance to clinical practice. The way that medication work is conceptualised is constraining and covers over much of what actually happens in everyday nursing practice. Technological innovations change practice, often in unintended or unknown ways. Explicating the actuality of medication work offers an enhanced understanding and allows nurses to appraise critically the ways their work has been transformed. [ABSTRACT FROM AUTHOR]

Aim. To synthesise the evidence available in the literature on the effectiveness of the ultrasound bladder scanner in reducing the risk of urinary tract infection. Background. Acute urinary retention is the inability to empty the bladder notwithstanding it being full and is frequent in the postoperative period. Using the ultrasound bladder scanner for the measurement of urinary residue, nurses are able to evaluate the presence of urinary retention, monitor the volume and the excessive relaxation of the bladder and avoid unnecessary catheterisations. The association between urinary catheterisation and urinary tract infection is well documented in the literature. Design. A meta-analysis was conducted. Method. An extensive review was carried out by two researchers using multiple databases, including all articles published from 1 January 1986-8 February 2008. No restrictions were adopted with regard to language. Studies on (1) documenting hospitalised patients with a need to evaluate bladder urinary volume, (2) comparing the use of the ultrasound bladder scanner vs. the clinical judgment of the nurses in the evaluation of acute urinary retention followed by a decision regarding whether or not to apply a bladder catheter and (3) those documenting the impact on urinary tract infection associated with catheterisation were included. Results. A total of 61 articles were retrieved, of which 58 were excluded because they did not meet the inclusion criteria. The overall effectiveness of the bladder ultrasound scanner in the reduction of urinary tract infection associated with catheterisation was OR 0·27 (IC95% 0·16-0·47; p-value 0·00000294, variance 0·08, weight 12·50). Discussion. The ultrasound bladder scanner helps to define and monitor bladder urinary volume and therefore, to catheterise patients only when necessary. Although there were numerous factors affecting the clinical heterogeneity of the included studies, the reduction in risk of urinary tract infection associated with catheterisation was consistent. Conclusion. The use of the ultrasound bladder scanner for evaluating and monitoring the residue volume in immediate postoperative patients, aged 18 or above, reduces unnecessary catheterisations and therefore the risk of urinary tract infection associated with catheterisation. Relevance to clinical practice. The systematic use of the ultrasound bladder scanner in the peri-operative period could increase the appropriateness of catheterisation and reduce patient discomfort, costs and days of hospitalisation associated with urinary tract infection associated with catheterisation. [ABSTRACT FROM AUTHOR]

Aims and objectives. To review the quality of life questionnaires used to measure the impact of venous ulceration and to evaluate their psychometric properties. Background. Venous leg ulcers have a negative impact on quality of life. Health-related quality of life can be measured using structured questionnaires. Nurses are the primary care providers for patients with venous ulceration and are ideally placed to assess and develop these types of questionnaires. There may also be an opportunity to use such quality of life instruments to measure the impact of nursing interventions in other areas where nurses are the key care providers. Design. Systematic review. Method. Studies were sought that used quality of life instruments to evaluate the impact of venous ulceration. Fourteen electronic bibliographical databases and 11 Internet-based health services research related resources were searched. In addition, grey literature was sought and the reference lists of relevant articles checked. Data were extracted regarding the type of instrument used, sample, number of items and domains and psychometric performance of the instrument. Results. The initial search identified a total of 338 potential citations. After review, a total of 31 studies were included: 17 used generic and 14 used disease-specific instruments. Five different types of generic and seven disease-specific instruments were identified. There was significant heterogeneity between the studies in terms of study design, aetiology of ulceration and times of assessment. The disease-specific instruments showed limitations in relation to their applicability to venous ulcer patients because of flaws in design or validation. Conclusions. The literature on quality of life related to venous ulceration failed to sufficiently distinguish between those with different causes of leg ulceration. There appeared to be problems with the ability of current quality of life instruments to detect changes in quality of life related to ulcer healing. Relevance to clinical practice. There appears to be an opportunity for nurses to develop a health-related quality of life health-related quality of life instruments to evaluate their impact on patient outcomes. Such instruments could potentially allow nursing interventions to be assessed more effectively than the recently proposed nursing metrics. [ABSTRACT FROM AUTHOR]

Aim. This review explores the experiences of international nurses recently recruited to the UK nursing workforce (1995-2007) and the implications for retention. Background. An acute shortage of nurses in the mid 1990s, combined with policy initiatives to increase the number of qualified nurses working in the NHS, resulted in an active campaign to recruit nurses from overseas. Since 1997, approximately 100,000 international nurses have been admitted to the nursing register from more than 50 countries worldwide. Many practice areas are now dependent on overseas nurses as an essential part of their workforce. Design. An integrative review. Method. The review was conducted using a range of electronic databases to capture the experiences of this cohort of migrant nurses. Conclusion. Much literature has been generated over the past decade in relation to the experiences of international nurses recruited during this campaign. Five main themes emerged from the review: motivation for migration, adapting to British nursing, experiences of first world healthcare, feeling devalued and deskilled and vectors of racial discrimination. Although some positive experiences are described, significant numbers of nurses describe not feeling personally or professionally valued by the UK nursing establishment, common emotions expressed are disappointment and unmet expectations. This will have implications for job satisfaction and intention to leave or stay. Relevance to clinical practice. If overseas nurses choose to leave the UK in large numbers, the health services could face a severe staffing shortage. It is important that we listen carefully to their experiences to help identify priorities for policy and practice aimed at improving job satisfaction for migrant nurses and articulating the value that they bring to UK nursing. [ABSTRACT FROM AUTHOR]

Aim and objectives. The aim of this review was to address: (1) How is spinal stability assessed? (2) What is the role of bracing/should braces be used? (3) When is it safe to mobilise the patient? (4) What position should the patient be nursed in? Background. Controversy surrounds the care for patients with metastatic spinal cord compression (MSCC). There is some evidence to indicate that care for patients with MSCC is based on individual clinician preference rather than evidence-based guidelines which has been shown to cause delays and discrepancies in patient treatment. Design. A structured literature review to synthesise the available evidence about the management of MSCC. Methods. The following databases were searched: Medline, EMBASE, Cochrane Systematic Reviews Database, SIGN (Scottish Intercollegiate Guidelines Network), NICE (National Institute for Clinical Excellence), AMED (Allied and Complementary Medicine), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and BNI (British Nursing Index). Publications were selected from the past 10 years. The search yielded a total of 1057 hits, 755 abstracts were screened, and 73 articles were retrieved and examined. Thirty-five articles were included. Results. The findings identified a gap and evidence relating to spinal stability, bracing, patient mobilisation, and positioning is limited and may be inconclusive. It is important for patients with a poor prognosis that their preferences and quality of life are considered. Conclusion. Currently, the evidence base to underpin care is limited, and further research in this area is necessary for patients and healthcare professionals alike. Relevance to clinical practice. Patients who suffer from MSCC suffer numerous physical, psychological and social issues. Because of lack of consensus, the current guidelines to inform clinical decision-making of professional staff are of limited benefit. [ABSTRACT FROM AUTHOR]