Search

IntroductionDeaths from drug overdoses are rising dramatically in the United States. Treatment for opioid use disorders may include behavioral treatments as well as medications for opioid use disorders (MOUD). Buprenorphine can be prescribed by physicians, nurse practitioners (NPs), other advanced practice registered nurses (APRNs), and physician assistants (PAs) and required a training and a federal waiver until recently. The number of NP MOUD prescribers grew steadily over the past decade, but research has identified state-level scope of practice regulations as a barrier to NP MOUD prescribing. This article explores the contributions of, and remaining barriers faced by NP and other APRN MOUD prescribers. We describe qualitative findings from a study of NPs and other key stakeholders involved in MOUD treatment in four states with two differing levels of regulatory structure.MethodsIn this qualitative study, we conducted site visits and semi-structured interviews with NPs and other APRNs, physicians, clinic managers, and regulators in four states including New Mexico and West Virginia (full practice authority for NPs), and Ohio and Michigan (which require physician supervision). Interview notes were entered into a qualitative software package and coded and reviewed by two members of the research team. Data were grouped into key themes.ResultsA total of 76 participants participated in individual or small group interviews in the four states. We found key themes and several subthemes that describe NP practice in MOUD. Participants described key contributions of NP engagement in MOUD, including increasing access, serving rural areas, the unique role of psychiatric NPs, and the value of the nursing model of care in working with people with substance use disorders (SUD). Participants also identified barriers including scope of practice regulations, other regulatory barriers, stigma, and lack of supportive services to address psychosocial needs.ConclusionsThe waiver requirements were eliminated at the end of 2022 in federal budget legislation. Other barriers for NP and other APRN prescribers remain and should be addressed in practice, and in state and federal regulations. Research needs to explore the impact of the waiver elimination on MOUD prescribing and access to services.

Increased engagement of nurse practitioners (NPs) has been recommended as a way to address care delivery challenges in settings that struggle to attract physicians, such as primary care and rural areas. Nursing homes also face such physician shortages. We evaluated the role of state scope of practice regulations on NP practice in nursing homes in 2012-2019. Using linear probability models, we estimated the proportion of NP-delivered visits to patients in nursing homes as a function of state scope of practice regulations. Control variables included county demographic, socioeconomic, and health care workforce characteristics; state fixed effects; and year indicators. The proportion of nursing home visits conducted by NPs increased from 24% in 2012 to 42% in 2019. Expanded scope of practice regulation was associated with a greater proportion and total volume of nursing home visits conducted by NPs in counties with at least 1 NP visit. These relationships were concentrated among short-stay patients in urban counties. Removing scope of practice restrictions on NPs may address clinician shortages in nursing homes in urban areas where NPs already practice in nursing homes. However, improving access to advanced clinician care for long-term care residents and for patients in rural locations may require additional interventions and resources.

Background: This study aims to establish a consensus-based standard protocol for transanal irrigation (TAI) in patients with low anterior resection syndrome (LARS) and functional constipation. Methods: The Delphi method was utilized to reach a consensus among clinicians and nurses expert in the field of colorectal surgery and gastroenterology. To address various uncertainties concerning technical aspects, difficulties, and prescription of TAI, two questionnaires were developed and analyzed in two rounds. A binary approach was employed, setting a consensus threshold of 75% agreement. Results: In the first round, nurses achieved consensus on all statements, while clinicians required a second round to reach consensus, particularly regarding prescription and technical aspects. Clinicians reached consensus on prescribing TAI as a second-line treatment for LARS and functional constipation, following the failure of conservative measures such as dietary and lifestyle interventions. Timing considerations for patients with LARS encompass avoiding TAI within 1 month of stoma closure and waiting a minimum of 3 months. For functional constipation, TAI is recommended for slow transit constipation, emphasizing its preference over surgical options. Consensus was also reached on the choice of catheter for patients with LARS, training requirements for patients and caregivers, preparation of the patient's intestine before TAI, and recommended irrigations. Conclusions: This consensus study successfully developed a standardized TAI protocol for LARS and functional constipation. It provides comprehensive guidelines for prescription and technical aspects, addressing the challenges encountered by healthcare professionals. The protocol aims to enhance patient care, improve treatment outcomes, and contribute to the advancement of TAI. [ABSTRACT FROM AUTHOR]

ABSTRACT Rationale Aims and Objectives Methods Results Conclusion Awareness of their standing relative to best practices motivates primary healthcare (PHC) teams to improve their practices. However, gathering the data necessary to create such a portrait is a challenge. An effective way to support the improvement of the practices of PHC teams is to simplify the availability of data portraying aspects of their practices that might need improvement. Timely access is one of the foremost challenges of PHC. Yet, very few tools supporting reflections on the implementation of best practices to improve access are available to PHC teams.To develop an online reflective tool that evaluates the state of a PHC team member's advanced access practice and formulates customized recommendations for improvement.This sequential multimethod study was informed by a literature review and an expert panel composed of researchers, patients, provincial and local decision‐makers, and PHC clinical and administrative staff in the province of Quebec, Canada. Consensus was reached on the content of the questionnaire and the prioritization of the recommendations.No reflective tool on advanced access practices was found in the literature review. Grey literature was used to create an initial version of the questionnaire. This version was revised and enriched through consultation phases with the expert panel. Then, five iterations of the tool were tested with 169 PHC team members, which led to the conception of two distinct versions: one for clinical staff and one for administrative agents responsible for appointment booking. The final versions of the reflective tool are available online in both English and French.This reflective tool provides a portrait of PHC team members' advanced access practices as well as an automated report that contains personalized and prioritized recommendations for improvement. Further developments are necessary for its optimal use among PHC professionals other than physicians and nurse practitioners. [ABSTRACT FROM AUTHOR]

Background: Persons (henceforth, women) who have hypertensive disorders of pregnancy (HDP) are at risk of premature cardiovascular disease (CVD). While largely preventable through lifestyle management, many women and clinicians are unaware of the risk. Based on prior research, we developed a question prompt tool (QPT) on preventing and managing CVD after HDP. The purpose of this study was to refine QPT design. Methods: We recruited Canadian women who had HDP and clinicians who might care for them using multiple strategies, conducted telephone interviews with consenting participants, and used qualitative description and inductive content analysis to derive themes. Results: We interviewed 21 women who varied in HDP type, CVD status, years since HDP pregnancy, age, geography and ethno-cultural group; and 21 clinicians who varied in specialty (midwife, nurse practitioner, family physician, internist, obstetrician, cardiologist), geography and years in practice. Participating women and clinicians agreed on needed improvements: more instructions, lay and gender-neutral language, links to additional information, more space for answers, graphic appeal, and both print and electronic format. Both groups identified similar barriers: clinicians lack time/willingness, and low language/health literacy and access to technology among women; enablers: translated, credible source/endorser, culturally relevant, organized by health trajectory stages; and likely benefits: raise awareness, empower women, encourage them to adopt healthy lifestyle. Women desired exposure to the QPT before or during pregnancy, while clinicians recommended waiting until postpartum to avoid overwhelming women. Similarly, most women said the QPT should be available through multiple avenues to empower them for health self-advocacy, while clinicians thought they should introduce the QPT to women, and decide when and which questions to address. To mitigate reluctance, clinicians recommended self-directed educational materials accompany the QPT. Conclusions: We will use this information to refine QPT design and plan for future evaluation. If found to be effective and widely disseminated, the QPT could improve awareness and communication about this issue, and may reduce CVD risk in many women who have hypertensive pregnancies. Ongoing research is needed to more fully understand how QPTs support patient-clinician communication, and how to alert and prime both patients and clinicians to use QPTs. [ABSTRACT FROM AUTHOR]

Lower limb oedema is a common condition in clinical practice, frequently affecting the distal lower limbs. Whereas benign causes such as prolonged sitting or standing are typical, oedema can also indicate serious systemic diseases such as cardiac failure, liver disease, or renal impairment. Identifying the cause is crucial to prevent irreversible skin and tissue changes. This clinical review aims to increase the knowledge of advanced clinical practitioners (ACPs) and generalist practitioners, including practice and community nurses, by providing an overview of how to approach patients with lower limb oedema, encompassing history-taking, examinations, investigations, and management plans. The main focus is on lymphoedema, which can be primary or secondary. Primary lymphoedema results from genetic abnormalities, while secondary lymphoedema arises from acquired defects due to factors such as obesity, infections, neoplasms, and trauma. Effective management includes addressing the underlying cause, ensuring proper skin care, recommending appropriate exercises, and the use of compression garments. Referral to a lymphoedema specialist is recommended for patient education on managing and treating the condition when required. Additionally, the article discusses the importance of regular skin inspections, minor injury management, environmental considerations, and the critical role of compression garments in lymphoedema management. This comprehensive approach aims to enhance patient outcomes and provide a thorough strategy for ACPs and generalist practitioners. [ABSTRACT FROM AUTHOR]

Summary Management of type 2 diabetes includes medications that can unintentionally increase obesity and insulin resistance. This unblinded, single‐centre, randomised controlled trial focused on rural Australian adults with type 2 diabetes (aged 18–75 and body mass index [BMI] >30 kg/m2), measuring the effectiveness of a tailored interdisciplinary obesity care approach compared with usual diabetes care. Led by a nurse practitioner with allied health support (dietitian ± psychologist and physiotherapist), the bariatric treatment involved reducing weight‐gaining medications, a 500‐calories/day deficit, an unsupervised exercise program emphasising movement/strength and psychotherapy, 3‐monthly to 24‐months with support phone calls at weeks 2, 4, 8 and 10. Outcomes from the 224 (113 intervention/111 control) participants were differences in biomedical and physical markers within‐ and between‐groups estimated using multivariate mixed‐effects linear regression between recruitment and 6‐monthly follow‐ups. Greater change occurred in intervention compared with control groups at 12 and 24 months in mean: body weight (−5.9 kg [95% confidence interval, CI: −8.53, −3.23] and −9.0 kg [95% CI: −13.2, −4.77]); BMI (−2.03 kg/m2 [95% CI: −2.92, −1.15] and −3.51 kg/m2 [95% CI: −4.93, −2.08]); and glycated haemoglobin (−0.26% [95% CI: −0.69%, 0.18%] and −0.63% [95% CI: −1.17%, 0.08%]). The control group showed a significant increase in mean leptin level, resulting in a between‐group difference (−27.1 [95% CI: −42.7, −11.5]). Lipids and blood pressure differences were inconclusive, while exploratory analysis showed greater decline in estimated glomerular filtration rate in the control group. The interdisciplinary obesity approach, compared with usual diabetes care, resulted in sustained weight loss and improved diabetes control over 2 years. Trial registration number: ACTRN12622000240741. [ABSTRACT FROM AUTHOR]

The document from the Asia Pacific Journal of Clinical Oncology provides detailed profiles of various professionals working in the field of oncology across Australia. These profiles include information about their roles, qualifications, research interests, and contributions to cancer care. The professionals mentioned work in diverse areas such as nursing, medical oncology, psycho-oncology, and palliative care, showcasing the multidisciplinary approach to cancer care in Australia. Their work focuses on improving patient outcomes, advancing cancer research, and enhancing the quality of care provided to individuals affected by cancer. [Extracted from the article]

Introduction: Despite recommendations for ambulatory withdrawal programs appearing in many contemporary alcohol and other drug treatment guidelines, to date there have been few studies exploring such programs from client and service stakeholder perspectives. The aim of this study was to explore both individual and service stakeholder perceptions of a nurse practitioner‐led ambulatory withdrawal service on the Gold Coast, Queensland, Australia. Methods: Data were obtained from three groups: clinicians with knowledge of the service (n = 6); relatives of clients who had used the service (n = 2); and clients who had used the service (n = 10) using a Qualitative Descriptive design. Saldaña's (Saldaña, The coding manual for qualitative researchers. 2013) structural coding framework was used to analyse and code data into themes, with the study reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (Tong et al. Int J Qual Health Care 2017;19:349–57). Results: Participants noted advantages of the nurse practitioner‐led ambulatory withdrawal service, including rapid availability of admission to the service and a person‐centred approach. Compared with other ambulatory withdrawal options, clients valued the ability to remain in their own environment, however participants suggested greater follow‐up after withdrawal, with the potential of a home visiting service for greater client engagement and treatment retention. Discussion and Conclusions: Findings provide evidence to suggest that nurse practitioner‐led ambulatory withdrawal services are an acceptable option for a proportion of clients who need rapid access to services when they wish to make changes to their alcohol and/or other drug use. Furthermore, they can provide person‐centred care for comorbid physical and mental ill health occurring in addition to psychosocial issues associated with alcohol and/or other drug use. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the feasibility and acceptability of an emotional support programme for newly diagnosed people with multiple sclerosis. Design: Three-arm, mixed methods, randomised controlled trial comparing usual care, versus usual care plus nurse-specialist support, versus usual care plus nurse-specialist support plus peer support. Participants: Community-dwelling adults within two years of diagnosis or undergoing diagnosis. Interventions: PrEliMS involves information provision, emotional support, and strategies and techniques based on psychoeducation, Acceptance and Commitment Therapy principles, supportive listening. One version of the intervention was provided by nurse-specialists alone and the other was provided by nurse-specialists plus peer support. Main measures: The main outcome of interest was the feasibility of proceeding to a definitive trial, exploring recruitment rate, acceptability, completion of outcome measures (perceived stress, mood, self-efficacy, psychological impact, and service use), and signal of efficacy. Results: Of 40 participants randomised (mean age 36.2 years (SD = 14.8); 54% women; 85% with relapsing-remitting MS), 36 and 38 returned 3- and 6-month questionnaires, respectively. Participant interviews suggested the trial was largely feasible, and the intervention acceptable, with some amendments to trial procedures and intervention delivery noted. There were, however, no statistically significant differences between groups at followup for any measures, and effect-size estimates were small. Conclusion: A definitive trial combining nurse-specialist and peer support adjustment to diagnosis intervention is warranted, but more work exploring the delivery and fidelity of the intervention is needed before this is pursued [ABSTRACT FROM AUTHOR]

America is facing a primary care provider shortage. Enhanced primary care RNs (EPC‐RNs), registered nurses working at the top of their practice scope, can be an important part of community‐based primary care provision. Typically, community health nursing education has not included primary care‐based clinical experiences, and there is a clinical site shortage. Teaching students about EPC‐RN roles can be an important domain of community/public health nursing education. Simulation is a creative pedagogical approach to learning about the EPC‐RN role. The purpose of this manuscript is to 1) describe EPC‐RN Telehealth Simulation development; and 2) describe student simulation feedback. Nursing faculty and simulation experts designed five simulations for community health students to teach about the EPC‐RN role, incorporating recommendations from the Quad Council Coalition of Public Health Nursing Organizations community/public health nursing competencies and the National Competencies for Registered Nurses in Primary Care. Retrospective, descriptive quantitative, and qualitative student feedback data (n = 519) was collected through QuestionPro over multiple semesters. Student feedback data demonstrated support of the use of the simulations in community/public health nursing education. The EPC‐RN Telehealth Simulations prepared pre‐licensure nursing students to practice in community‐based primary care settings. Innovative, sustainable experiences such as this can improve community/public health nursing education. [ABSTRACT FROM AUTHOR]

Objective: This study clarified the measures and necessary factors for regularly and effectively conducting case conferences to improve the quality of public health nurses' care for individuals and families. Design: We employed a qualitative descriptive design. Sample: The study fields were three Japanese municipalities that regularly held case conferences for at least a year to improve the quality of public health nurses' care for individuals and families. The first author conducted semi‐structured interviews with three lead public health nurses and two nurses responsible for case conference projects. Measurements: The audio recordings of the interviews were transcribed verbatim and categorized. Interviews were conducted between December 2021 and May 2022. Results: Measures to regularly and effectively conduct case conferences included "creating a system to promote case conferences," "preparations to achieve case conference objectives," and "case conference progress management." Factors included "resources for promoting case conferences in the organization," "public health nurses' attitudes toward care," and "an environment that allows discussions about care." Conclusion: Lead public health nurses can use the results as a reference to implement the identified measures in their organizations. The factors can enable lead public health nurses to evaluate the status of their organization regarding conducting case conferences. [ABSTRACT FROM AUTHOR]

Objective: This study aims to examine the relationship between human papillomavirus (HPV) testing attitudes and beliefs, knowledge, and vaccination attitudes. Design: This study was a cross‐sectional design. Sample: This study was conducted between March 15, 2024, and June 2, 2024, through social media platforms such as Facebook, Instagram, Twitter, and Telegram, by sharing on forum pages, and involved 674 women who volunteered to participate. Measurements: The research data were collected using the "health belief model scale regarding HPV infection and vaccination (HBMS‐HPVV)" and the "HPV Testing Attitudes and Beliefs Scale (HTABS)," which were developed by the researchers through a literature review. Results: The average age of the women participating in the study was 46.59 ± 11.15 years; 81.5% were married, 57.6% had no knowledge about cervical cancer, and 62.2% had no knowledge about the HPV vaccine, a protective vaccine against cervical cancer. The average scores for the subdimensions of severity, barriers, benefits, and susceptibility of the HBMS‐HPVV were 3.19 ± 0.60, 2.96 ± 1.22, 2.29 ± 1.40, and 3.92 ± 0.49, respectively. The average scores for the subdimensions of personal barriers, social norms, confidence, and worries of the HTABS were 31.14 ± 19.27, 7.57 ± 4.47, 30.03 ± 7.18, and 11.91 ± 2.52, respectively. A statistically significant positive relationship was found between all HBMS‐HPVV subdimensions and the HTABS subdimensions (p < 0.001). Conclusion: The study found that as the perceived severity increases, the perceived benefits, susceptibility, and confidence increase, while the perceived barriers, personal barriers, social norms, and worries decrease. Based on these results, it is recommended that women's health nurses provide education and seminars to raise awareness about cervical cancer, early screening and diagnosis programs, and the HPV vaccine. [ABSTRACT FROM AUTHOR]

Introduction: Surgical care practitioners (SCPs) are non-medical workers involved in various aspects of the management of surgical patients. The role includes assisting and performing surgical procedures. More than 60,000 laparoscopic cholecystectomies (LC) are performed annually in the UK. With ever-increasing pressure on waiting lists, it is important to look at fully utilising the skills of our entire workforce. We report what we believe is the first published series of LC performed by an SCP. Methods: A retrospective review of a prospectively collected database was performed. The primary outcome was any complication requiring intervention. Secondary outcomes were minor complications, operative time, length of stay, conversion and readmission. Results: In total, 170 patients were operated on. Indications were biliary colic in 127 (74.7%), cholecystitis in 30 (17.6%) and pancreatitis in 13 (7.6%). Mean operating time was 65min (range 35–152min). Fifty-three operations were assisted by a consultant, 110 by a specialist or associate specialist grade (SAS) doctor and 7 by a core trainee (CT2). Some 139 (81.7%) patients were discharged on the day of surgery and 24 (14.1%) stayed one night in hospital. There were no major complications. Five patients required readmission, three with pain and two with port site infections. There were no conversions or transfusions required. Conclusions: There is a paucity of published data on surgical outcomes of procedures performed by SCPs. With a structured, supervised approach, SCPs could be trained to take on more complex procedures and further strengthen the surgical workforce. This study demonstrates that elective LC can be safely performed by an appropriately trained and supervised SCP. [ABSTRACT FROM AUTHOR]

Background: The care processes of cardiac surgery patients are difficult, complex and stressful. Nurses, who have an important role in the care of these patients, may experience burnout or poor quality of work life may be affected because of difficult care processes, and professional difficulties. Aim: This study analysed burnout and quality of work life in cardiac surgery nurses. Study Design: This cross‐sectional study was conducted with 68 nurses in the clinic and intensive care unit of a university hospital's cardiovascular surgery department. Clinical nurses care for inpatients in this department, while intensive care nurses care for patients in the intensive care unit. The 'Sociodemographic and Descriptive Characteristics of Nurses Form', 'Maslach Burnout Inventory' and 'Nursing Work Quality of Life Scale' were used to collect the data. Results: The mean score of emotional exhaustion sub‐dimension of Maslach Burnout Inventory was 15.25 ± 5.08 (min: 7, max: 27), the mean score of the personal accomplishment sub‐dimension was 17.48 ± 4.90 (min: 8, max: 27), and the mean score of depersonalization sub‐dimension was 5.60 ± 2.70 (min: 0, max: 13). The mean scores of the emotional exhaustion sub‐dimension (t: −2.380, p:.020, risk ratio [RR]: 1.67, confidence interval [CI]: [14.21, 18.82]) and the personal accomplishment sub‐dimension (t: −2.604, p:.011, RR: 1.00, CI: [16.08, 19.92]) were higher in intensive care nurses. The mean total score of the nursing quality of work life scale was 107.20 ± 14.60 (min: 72, max: 149). A negative statistically significant relationship was found between the mean scores of emotional exhaustion (r: −0.243, p:.045) and depersonalization sub‐dimension (r: −0.325, p:.007) of the Maslach Burnout Scale and the mean total score of the nursing quality of work life scale. Conclusion: In this study, it can be said that cardiac surgery nurses had moderate levels of emotional burnout, personal accomplishment and quality of work life, and low levels of depersonalization. At the same time, it can be seen that intensive care nurses have higher levels of emotional burnout. The increased emotional burnout and depersonalization in nurses decreased the quality of work life. Relevance to Clinical Practice: This study provided an understanding of burnout and quality of work life of cardiac surgery nurses. Strategies can be developed to reduce burnout and improve the quality of the work life of cardiac surgery nurses. Particular attention should be paid to intensive care nurses who experience more burnout on several sub‐dimensions. This may be a good approach to improving the quality of patient care. [ABSTRACT FROM AUTHOR]

This survey, which was distributed to nursing schools across the US, explores nursing students' perceptions of interactions with nurses during clinical experiences. This article discusses the findings, which support the importance of fostering more positive relationships among clinical nurses and nursing students, provide important implications for nurses and nurse leaders, and guide future research. [ABSTRACT FROM AUTHOR]

Aim: To explore the feasibility of development and implementation of an educational intervention addressing sexual and gender minority healthcare issues; examine recruitment processes and instrument appropriateness. Design: Non‐randomized feasibility study. Methods: The educational intervention was developed and implemented in family nurse practitioner courses with data collection from August through December 2022. Clinical preparedness, attitudinal awareness and basic knowledge were measured using the lesbian, gay, bisexual and transgender Development of Clinical Skills Scale. Results: Development and implementation of the intervention was feasible but will require amendment before progressing to the pilot study. Clinical preparedness and basic knowledge increased post‐intervention, but attitudinal awareness did not improve. Recruitment did not achieve the desired sample size. Instrument internal consistency reliability was confirmed. Conclusion: Feasibility was established but will require amendment prior to the pilot study. Implications for the Profession and/or Patient Care: To prepare nurses and nurse practitioners to care for sexual and gender minority patients. Impact: This study addressed the feasibility of developing and implementing a sexual and gender minority healthcare education using an e‐Learning platform. Findings confirm that the intervention was feasible but will require amendment. The intervention increased knowledge and clinical preparedness in caring for this population, but recruitment was challenging. This research will impact nurses, nurse practitioners and nurse educators. Reporting Method: The authors adhered to the relevant EQUATOR guidelines. The Consolidated Standards of Reporting Trials guideline extension for reporting randomized and feasibility guidelines were used. Public Contribution: Sexual and gender minority community members contributed to the intervention development. What Does this Paper Contribute to the Wider Global Clinical Community?: The feasibility of using interactive e‐learning educational resources to provide sexual and gender minority healthcare curriculum.Evidence to support the use of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale to measure learning outcomes. Trial Registration: This study was not prospectively registered because it was an educational intervention involving graduate student nurses and did not assess clinical outcomes of patients. [ABSTRACT FROM AUTHOR]

Purpose To explore the perceptions and current practices of radiologist assistants' peer-review process. Methods A 49-question, anonymous, online questionnaire was emailed to 133 radiologist assistants in the American Registry of Radiologic Technologists database. Descriptive statistics were used for data analyses. Results The survey response rate was 42.1% (56/133). Most respondents (62.5%) participated in peer review. Direct in-person observation (21.4%) was the most common process used for radiologist assistants. Radiologists (62.5%) and radiologist assistants (51.8%) were considered peers to perform peer review. Although respondents indicated individual feedback was given by letters or emails (16.1%), they preferred face-to-face or phone call discussions (39.3%). Most respondents (65.5%) did not have peer-review meetings for educational purposes. Most respondents (92.5%) agreed that participating in peer review would be beneficial to their professional and educational development (90%) and that learning from peer review would be worth their time (95%). Discussion Health care providers and organizations use peer review to identify practice variations, optimum care delivery, effective communication, and deficiencies in professionalism by comparing the peers' views on performance against accepted standards. In radiology, diagnostic and interventional radiologists routinely perform peer review, but no information exists on processes for radiology-specific advanced practice providers, particularly radiologist assistants. Conclusion Radiologist assistants were receptive to participating in peer review and saw it as beneficial for educational and professional development. Knowledge of current processes and perceptions allows for radiologist assistant--specific peerreview development. [ABSTRACT FROM AUTHOR]

The document "Global Statement Defining Interventional Radiology—Have We Reached the Tipping Point?" discusses the evolution and current state of interventional radiology (IR) worldwide. It highlights the consensus statement developed by various IR societies, emphasizing the clinical evaluation, image-guided therapies, training, certification, research, and professionalism in IR practice. The document underscores the need for global collaboration to advance common strategic goals and promote IR as a distinct subspecialty or primary specialty in medicine. The authors call for continued efforts to prioritize patient care and image-guided therapy in IR practice. [Extracted from the article]

Background: New care models are needed for the increasing elderly, chronically ill, and multimorbid population, especially in primary healthcare. Rural regions are particularly affected where bottlenecks in provision of care and a shortage of health professionals are emerging. To address these challenges, nurse practitioners have been implemented in Swiss general practices to improve primary healthcare of chronically ill people. Aim: We aimed to explore Swiss primary healthcare delivery for chronically ill people in general practices with and without nurse practitioners and identify similarities and differences in these general practices. Methods: We conducted multiple case studies. Data were collected using interviews, observations, patient records, and questionnaires. We described the similarities and differences by drawing on Wagner's Chronic Care Model and applied deductive thematic cross-case analysis. We included five general practices located in rural areas in Switzerland, with nurse practitioners in two general practices. A total of 34 patients and 26 health professionals were included. The Enhancing the QUAlity and Transparency Of health Research (EQUATOR) reporting standards for organizational case studies were used. Results: Similarities were that chronically ill patients valued to be perceived as a whole person; guidelines for multimorbidity and reimbursement of relevant services such as coordination were limited. Differences in general practices with nurse practitioners were unclear role allocation, criteria for patient referral were missing and interprofessional teams were in an extended process of change. Nurse practitioners provided a bridge between the general practices and local home healthcare organizations, thereby, strengthening interface management and obtaining a more comprehensive nursing perspective. Conclusion: This study highlights that new models of care can better respond to patients' needs as additional nursing skills are available. Interprofessional teams undergo substantial changes in the new care model requiring a revision of existing structures. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your awareness of the communication and information needs of older people with cancer • To recognise that many older people with cancer want to be involved in decision-making about treatment • To acknowledge the benefits of a clinical nurse specialist acting as the main contact within the team. Older people with cancer often have a varying range of specific but fluctuating physical, psychological, emotional, social, economic and spiritual needs. To be able to participate in decision-making, they need optimal communication with healthcare professionals and accurate information from them. A systematic review of the literature explored the communication and information needs of older people with cancer. It appeared that these needs are not always addressed and that older people’s priorities are not always recognised. Barriers to addressing older people’s information and communication needs included personality traits and age-related functional decline, the effects of cancer on the person, a lack of time on the part of healthcare professionals and the absence of a main contact within the healthcare team. To meet the communication and information needs of older people with cancer it is crucial to adopt a person-centred approach. [ABSTRACT FROM AUTHOR]

Certification exams are often the least understood aspect of certification processes. This article delves into the development of certification exams, highlighting their crucial role in assessing the knowledge and skills required for effective job performance. It explores how exams are meticulously crafted to align with specific job tasks, knowledge areas, and skill sets within various nursing specialties. Through collaborative efforts between practicing nurses and exam developers, these exams are designed to uphold validity, reliability, and fairness standards. Ultimately, certification exams are pivotal in evaluating nurses' competencies in vital aspects of clinical practice, facilitated by ongoing partnerships between nurses and certifying bodies. [J Contin Educ Nurs. 2024;55(11):513–516.] [ABSTRACT FROM AUTHOR]

Background: Although psychological contract breach is linked to various significant organizational consequences, few studies have explored the antecedents of this important concept within the nursing field. This study aimed to investigate the correlation between perceived organizational justice and psychological contract breach among clinical nurses. Methods: This descriptive cross-sectional study included 328 inpatient ward nurses from six teaching hospitals in Tehran, Iran. Clinical nurses were selected through multistage random sampling. Data were collected using a demographic questionnaire, the Niehoff and Moorman (1993) Organizational Justice Questionnaire, and the Robinson and Morrison (2000) Psychological Contract Breach Questionnaire.Data analysis was performed in SPSS version 21 using descriptive statistics, Pearson's correlation coefficient, and multiple linear regression analysis. Results: The findings revealed that procedural justice (P < 0.001; β=-0.20) and interactional justice (P < 0.001; β=-0.47) explained 41% of the variance in psychological contract breach among nursing staff. Conclusions: The results identified interactional and procedural justice as the most significant dimensions of organizational justice in explaining nurses' perceived psychological contract breach. Therefore, healthcare managers should prioritize fair decision-making processes and interactions with nurses to mitigate ' perceived the psychological contract breach. [ABSTRACT FROM AUTHOR]

Background: Where available, Parkinson's Nurse Specialists (PNS) provide a range of care, support, guidance, and advocacy for people with Parkinson's (PwP), and, where appropriate, their care partners (CP). Parkinson's is a complex and progressive condition. Consequently, evaluating health outcomes is not a reliable method to understand the value and impact of PNS. Previous research has identified PNS can improve the subjective well-being of PwP in the community, also that barriers to care include heavy caseloads and a lack of time. Yet little is known about the value of the role of the PNS, particularly about the impact of pharmacological management and review. This research aims to close this research gap by providing explanatory theories of the impact and value of PNS to PwP, their CP, and other professionals. Methods: A social constructivist grounded theory approach was used. Semi-structured interviews were conducted with three groups, PNS, PwP, and CP. Interviews were analysed using NVivo for coding and categorising and Word for memo-writing. Data was analysed inductively and iteratively to identify contexts, social processes, actions, and behaviours, before final emergent theories were identified. Results: 46 semi-structured interviews (PNS 18, PwP 19, CP 9) led to four data categories and 13 sub-categories that delineated PNS value. (1) Expert Counsel; provision of emotional support, education, and lifestyle guidance; CP inclusion; provision from diagnosis; and across all stages of Parkinson's. (2) Conduit of Care; signposting, referral, and connection to PwP, CP, others; PNS barriers and facilitators; (3) Team/Partnership; continuity and partnership, 'working together'; (4) Pharmacological Support, PNS prescribing; concordance; speed of treatment. Where PNS were accessible they could offer personalised support and partnership, so providing person-centred care that improves health and well-being. Conclusion: Where a PNS is accessible due to service availability and manageable caseloads, to provide person-centred care, they deliver several benefits to PwP and CP which improve health and perceived well-being. Where PNS are not available, PwP and CP often struggle to manage their Parkinson's with negative impacts on health and well-being. [ABSTRACT FROM AUTHOR]

Purpose: To compare the accuracy of open-source Artificial Intelligence (AI) Large Language Models (LLM) against human authors to generate a systematic review (SR) on the new pulsed-Thulium:YAG (p-Tm:YAG) laser. Methods: Five manuscripts were compared. The Human-SR on p-Tm:YAG (considered to be the "ground truth") was written by independent certified endourologists with expertise in lasers, accepted in a peer-review pubmed-indexed journal (but not yet available online, and therefore not accessible to the LLMs). The query to the AI LLMs was: "write a systematic review on pulsed-Thulium:YAG laser for lithotripsy" which was submitted to four LLMs (ChatGPT3.5/Vercel/Claude/Mistral-7b). The LLM-SR were uniformed and Human-SR reformatted to fit the general output appearance, to ensure blindness. Nine participants with various levels of endourological expertise (three Clinical Nurse Specialist nurses, Urology Trainees and Consultants) objectively assessed the accuracy of the five SRs using a bespoke 10 "checkpoint" proforma. A subjective assessment was recorded using a composite score including quality (0–10), clarity (0–10) and overall manuscript rank (1–5). Results: The Human-SR was objectively and subjectively more accurate than LLM-SRs (96 ± 7% and 86.8 ± 8.2% respectively; p < 0.001). The LLM-SRs did not significantly differ but ChatGPT3.5 presented greater subjective and objective accuracy scores (62.4 ± 15% and 29 ± 28% respectively; p > 0.05). Quality and clarity assessments were significantly impacted by SR type but not the expertise level (p < 0.001 and > 0.05, respectively). Conclusions: LLM generated data on highly technical topics present a lower accuracy than Key Opinion Leaders. LLMs, especially ChatGPT3.5, with human supervision could improve our practice. [ABSTRACT FROM AUTHOR]

Psychedelics, including ketamine, 3,4-Methyl enedioxy methamphetamine (MDMA), and psilocybin, have gained attention for their potential therapeutic role in mental health treatment. While recreational use is prohibited in Canada, medicinal exemptions can be granted. There are several psychedelic clinics in Ontario, Canada, promoting the use of psychedelics for a variety of medical indications. Our objective was to identify the indications for which psychedelics are being prescribed in Ontario clinics and assess the quality of evidence used to support these claims. Internet searches were conducted using Google and Bing to identify psychedelic clinics in Ontario. Inclusion criteria was as follow: clinics were physically located in Ontario, had a functioning website link, and demonstrated involvement of a licensed physician or nurse practitioner. Identified clinics were evaluated for their claims of effectiveness, the quality of evidence used to support these claims, and statements on psychedelic-related harms. The cited studies were appraised for quality using Oxford Centre for Evidence-Based Medicine Levels of Evidence, "level 5" being the lowest quality and "level 1" being the highest quality. Out of 200 search results, 10 psychedelic clinic websites met our inclusion criteria. These clinics advertised psychedelics for 47 medical conditions, most commonly for depression. Only 2 out of 10 clinics described potential risks associated with psychedelic use. There were 29 studies cited by these websites, majority coming from "level 4" evidence consisting of case-series and case-control studies. Overall, the cited evidence quality was low to moderate. Psychedelic clinics in Ontario promote a wide range of medical indications for psychedelics using primarily low to moderate "level 4" evidence. There is limited information shared on the potential adverse effects of psychedelics. Our study emphasizes the importance of using transparent and high-quality evidence by clinics and clinicians to ensure safe and effective use of psychedelics in mental health treatments. [ABSTRACT FROM AUTHOR]

Background: When nurses feel that the learning processes in their organization are fair and just, they are more likely to feel confident about sharing their knowledge, expressing their concerns, and contributing to the learning process. Conversely, suppose employees perceive a lack of organizational justice. In that case, they may be less likely to speak up and share their valuable input due to concerns about unfair treatment or possible negative consequences. Objective: Nurses' silence and organizational learning may have a connection yet to be thoroughly investigated. We are exploring whether organizational justice mediates this relationship by improving nurses' perception of it and reducing silence among them. Methods: A study was conducted in Ardabil, Iran, to analyze the correlation between organizational learning, organizational justice, and organizational silence among 319 healthcare professionals from five hospitals. The study utilized three assessment tools: the organizational learning questionnaire, the organizational justice scale, and the organizational silence scale. The collected data were analyzed using IBM SPSS Statistics, and a structural equation model (SEM) was developed using the bootstrap method in AMOS 24.0 to test the proposed model. Results: Our study found a strong positive relationship between organizational learning and organizational justice and a significant negative correlation between organizational learning and silence. Also, there was a significant negative relationship between organizational justice and silence. SEM showed that organizational learning indirectly affects organizational silence through organizational justice as a mediator, explaining 72.3% of all variance in organizational silence. Conclusion: Our findings indicated that organizational learning is positively associated with justice but negatively associated with silence. When nurses experience organizational justice, they are less likely to remain silent. Encouraging nurses to share their opinions and concerns reduces silence and improves working conditions, morale, and patient care. Further research is needed to understand the complex interplay between organizational learning, justice, and silence in nursing settings. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Aim Design Method Findings Conclusion Impact Reporting Method Patient or Public Contribution Nurse practitioners (NPs) play a crucial role in healthcare by providing person‐centred and high‐quality care. Their contributions encompass enhanced accessibility to healthcare and reduced hospital admissions and cost‐effectiveness. They usually hold a master's degree in nursing, incorporating expanded clinical skills to manage patients in different settings and address both nursing and medical needs. Despite the global development of the role, its implementation varies, presenting challenges related to role clarity, regulation and acceptance by other healthcare professionals.To explore how nurses who are or have been employed as NPs describe their experiences of transitioning to and working in the NP role in Sweden.A qualitative interview study.This study explores the experiences of 15 NPs in Sweden, using a snowball sampling strategy and semi‐structured interviews. The data were collected through interviews in April and May 2022 and analysed with inductive content analysis.The present study explores the experiences of NPs as they transition from experienced nurses to NPs, emphasising motivations, educational challenges, acceptance and autonomy. Transitioning into the NP role initially brought isolation that evolved into acceptance. They recognised their strength in integrating medical and nursing competencies for holistic care. Leadership was pivotal, with managerial support crucial for the successful implementation of the role. Autonomy‐related challenges, such as prescription rights and dependency on physicians, underscored the need for a protected professional title and national guidelines.This study enriches the evolution of the NP role in Sweden, offering vital insights into the ongoing national‐level dialogues on NP role development in Sweden.The paper's relevance extends globally by providing valuable perspectives on NPs practicalities and fostering international understanding and advancement.Standards for reporting qualitative research.Not applicable. [ABSTRACT FROM AUTHOR]

The article discusses the integration of quality dementia care into existing home care teams, emphasizing the need for comprehensive and holistic care for people living with dementia (plwd) and their caregivers. It highlights the CMS Innovation Center's Guiding an Improved Dementia Experience (GUIDE) Model, which provides Medicare-funded longitudinal dementia care. The commentary also explores home-based dementia programs like COPE, MIND at Home, and COACH, showcasing how interprofessional teams can deliver effective care. The article suggests that embedding quality dementia care within home care teams can support homebound patients in aging in place. [Extracted from the article]

Background: With the surge in China's registered nurse population, defining their rights and responsibilities is crucial for ensuring the quality of medical services. However, challenges such as unresolved medical disputes and unclear duties persist due to the inadequacy and lack of transparency in current nursing laws and policies. This study evaluated nurses' legal awareness, legislative needs, and views on laws and policies affecting their practice, providing insights for future improvements in nursing legislation. Methods: This study employed a descriptive qualitative approach, utilizing purposive sampling to select 16 nurses for in-depth exploration of their experiences. Semi-structured interviews were conducted between December 2023 and March 2024. Data analysis was performed using directed content analysis. Results: A total of 16 nurses with various positions and titles were interviewed. The analysis revealed three main themes and nine sub-themes, focusing on existing issues in the nursing environment, legal training needs, and attitudes towards legislative empowerment. Conclusions: In China, there is a gap in legal knowledge and training among nurses. Enhancing their legal literacy is crucial for elevating their professional status and the quality of their work. Our findings underscore strong support for the enactment of the Nurse Act with a focus on practice conditions, rights protection, and career development. National authorities and experts must expedite this legislation to safeguard the rights of nurses, bolster their professional confidence. [ABSTRACT FROM AUTHOR]

Copyright of GeSec: Revista de Gestao e Secretariado is the property of Sindicato das Secretarias e Secretarios do Estado de Sao Paulo (SINSESP) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) are both diabetic emergencies that require immediate identification and intervention. Advanced clinical practitioners (ACPs) play a crucial role in the early detection, management and co-ordination of care for patients with these conditions, although some may feel less confident in handling such complex cases. This clinical review explores the role of ACPs in managing DKA and HHS, focusing on their responsibilities in diagnosis, treatment initiation, and communication within multidisciplinary teams. It also examines the epidemiology, pathogenesis, risk factors, and causes of these conditions, alongside diagnostic criteria and management strategies. In addition, the review highlights the importance of minimising risks and preventing recurrence to ultimately enhance patient outcomes. [ABSTRACT FROM AUTHOR]

Advanced clinical practitioners (ACPs) are experienced health professionals educated to master's level. They are accountable for the assessment, diagnosis and treatment of individuals, and are responsible for making complex decisions. The case study presented in this article critically analyses the consultation involving a male patient in his sixties with a 2-day history of abdominal pain, who was referred by his GP to a surgical assessment unit. Analysis was carried out using the Calgary-Cambridge Model. The article discusses history-taking, abdominal examination and differential diagnoses, and presents the process of how the trainee ACP arrived at the diagnosis of appendicitis. [ABSTRACT FROM AUTHOR]

Background: Nurses form the frontline of the healthcare system's response to both epidemics and pandemics, and this was especially the case during the novel coronavirus disease (COVID-19) pandemic. Although the influence of COVID-19 on nursing roles has attracted interest, there is no integrated knowledge of nurses' roles and experiences in primary health care settings during the COVID-19 pandemic. Thus, this study identifies the roles and experiences of nurses in primary health care during the COVID-19 pandemic. Methods: A scoping review study design and the Joanna Briggs Institute methodology were used. The study searched five electronic databases (PubMed, CINAHL, EMBASE, Scopus, and PsychINFO) and included studies published in English from March 2020 to June 2023 that focused on the roles and experiences of nurses (participants) during COVID-19 (concept) in primary health care settings (context). Results: Fourteen articles were selected for review, involving a total of 1,487 nurses as study participants. The various roles undertaken by nurses in primary health care settings were categorized as comprehensive care providers, supporters and empowerers, coordinators and collaborators, information navigators, and change agents. Challenges and strategies are multilevel intrapersonal, interpersonal, organizational, community, and societal issues, but are not mutually exclusive. Conclusions: The pandemic-induced challenges revealed primary health care nurses' vital and indispensable roles and resilience. They also fostered a heightened awareness of technological influence on the progression of primary health care in the current milieu. Policymakers and healthcare organizations need to integrate primary health care nurses' expanding and emerging roles within the scope of practice, ensuring their effective implementation without excessive regulatory constraints. This study emphasizes the importance of developing multilevel interventions to address the support needs of primary health care nurses through a system-based approach. Building a strong infrastructure to support nurses' self-care, offering continuing professional development opportunities, and securing official government recognition will be essential for enhancing the resilience of primary healthcare nurses in preparation for future, potentially devastating pandemics. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions There is very little literature examining the workload and impact of nurse practitioners (NPs) working in emergency departments (ED) in regional and rural Australia. The aim of this paper was to review the ED NPs scope of practice in the ED discharge stream and patient outcomes at Cairns Hospital over a 7‐month period.This retrospective study examined the ED electronic medical record between 14 May 2019 and 31 December 2019. Cases managed by ED NPs, referrals, procedures performed, representations and disposition data were collected. Adverse events were sought from the Qld Health adverse events register (Riskman), the department complaints register and the ED M&M meeting minutes.A total of 1443 patients were treated by NPs, with ages ranging from 0 to 98 years (median 40 years). Australasian Triage Score (ATS) 3 cases made up 30% of the workload. Other than ATS 3 cases, time to being seen was better than the general department. There were very few unexpected representations, complaints or adverse events.This study supports the view that NPs working in a regional emergency department can safely manage a variety of patients outside a fast‐track model, with a wide age range and a variety of triage categories and diagnoses. We believe this has important implications for the provision of emergency care, especially in regional and rural Australia. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim(s) Design Methods Data Sources Results Conclusions Implications for the Profession and Patient Care Impact Reporting Method Patient or Public contribution To provide an introduction to the Good Nursing Care Scale (GNCS) and systematically review the application of the scale in health research.Systematic review.Empirical studies published in English or Finnish in peer‐reviewed journals or as a summary of a PhD thesis where the scale was used for data collection amongst patients were included. Analysis was made by using descriptive statistics, narrative analysis, and evaluation of psychometric properties.PubMed, CINAHL, Cochrane, and Scopus in October 2023.A total of 26 full‐text studies and summaries of PhD theses were included in the review. The GNCS has been developed systematically, and the theoretical structure has remained stable. The studies indicate a high level of patient‐centered quality of nursing care. Validity and reliability evaluation and reporting were systematic in the studies and mainly indicate sufficient level. Variations between countries are not large, supporting the international use of the GNCS.Patient‐centered quality of nursing care is predominantly at high levels. However, systematic evaluation is needed to provide longitudinal data. For that purpose, the GNCS is one potential instrument.Support for the use of existing, tested instruments is encouraged to provide critical ideas for the future needs of nurse practitioners, managers, teachers and researchers.This paper impacts researchers interested in systematic evaluation of the patient‐centered quality of nursing care and for practitioners taking care of patients. For researchers, it introduces a relevant instrument, the GNCS, for analysing the quality or for comparing the quality with other instruments. For practitioners, it produces evidence of the usability of the GNCS.PRISMA guided the systematic review, and the COSMIN guideline was used for quality appraisal of included studies.No Patient or Public contribution. [ABSTRACT FROM AUTHOR]

Background Methods Results Discussion Nocturia (waking from sleep at night to void) and chronic insomnia frequently co‐exist in older adults, contributing synergistically to sleep disturbance. Treatments typically target either nocturia or insomnia rather than simultaneously addressing shared mechanisms for these disorders.We conducted a multisite feasibility study to: (1) test and refine a protocol for recruitment, randomization, and assessment of older adults with co‐existing nocturia and insomnia; and (2) examine preliminary changes in outcome measures to inform a future larger, multisite clinical trial. Participants were men and women aged 60 years and older recruited from outpatient clinics, reporting an average of two or more nocturia episodes per night over the past 4 weeks and meeting diagnostic criteria for chronic insomnia disorder. Participants were randomized to receive either integrated cognitive‐behavioral therapy for insomnia and nocturia or a health education control program involving five weekly visits with a trained nurse practitioner interventionist. Outcomes (e.g., nocturia episodes) were measured 1‐week post‐treatment and 4‐month post‐randomization. Descriptive statistics examined the feasibility of outcomes to guide preparations for a future efficacy trial.Of 245 adults screened, 55% were ineligible and 25% declined to participate. Sixty‐one percent of 49 participants who provided informed consent were randomized. Of the 30 participants randomized (mean age = 70.6 years, 60% White), 14 were assigned to integrated cognitive‐behavioral treatment and 16 to the control group. All randomized participants provided 4‐month follow‐up data. At 4 months, mean nightly nocturia episodes decreased by 0.9 (SD 1.0) in the integrated treatment group and by 0.2 (SD 1.2) in the control group compared with baseline.Findings demonstrate the feasibility of recruiting, randomizing, and collecting outcome data from older adults (predominantly male) assigned to an integrated cognitive‐behavioral therapy for coexisting insomnia and nocturia or a health education control program. [ABSTRACT FROM AUTHOR]

Background: Most medical organizations accept many nursing students each year who gain clinical practice skills under the supervision of clinical nurses. However, there are no assessment tools to measure the contributions nursing students make to the clinical setting during clinical practicum. This study aimed to translate the 'Nursing Student Contributions to Clinical Settings' scale into Chinese and test its reliability and validity from the perspective of Chinese clinical nurses. And to explore whether nurses' personal and professional characteristics are related to nurses' perception of nursing students' contributions to the clinical settings. Methods: The original scale was translated into Chinese following the Brislin translation model. A convenience sample of 935 clinical nurses was selected from January to March 2024 for the survey. The content validity of the scale was assessed by expert consultation and content validity index. Exploratory factor analysis and confirmatory factor analysis were performed to assess the construct validity of the scale. The reliability of the scale was measured using internal consistency, split-half reliability, and test–retest reliability. The measurement quality of the scales was assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments. One-way analysis of variance was used to identify variables related to students' contributions. Results: The content validity index of the scale was 0.983. Exploratory factor analysis supported a one-factor structure, and the cumulative variance contribution was 71.177%. Confirmatory factor analysis showed that the model fit indicators were all within the acceptable range. The McDonald's Omega coefficient and Cronbach's alpha coefficient for the scale were 0.983. Nurses perceive that nursing students' contribution to the clinical settings is influenced by nurses' personal characteristics, professional characteristics, and the hospital environment. Conclusion: The Chinese version of the Nursing Student Contributions to Clinical Settings scale has good reliability and validity and can effectively and reliably measure the contributions of Chinese nursing students to clinical settings. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion To determine whether the use of less‐invasive surfactant administration (LISA) had changed between 2018 and 2024.An online questionnaire was sent to all 191 neonatal units between June 2023 and May 2024. One consultant from each neonatal unit was randomly selected. Follow‐up was done by telephone (middle‐grade doctor grade and above or alternatively to Advanced Neonatal Nurse Practitioners) for the non‐responders.Response rate was 100%from 191 units neonatal units. LISA was used in 134 (70%) neonatal units in 2024 compared to 35 (18.7%) units in 2018 (p < 0.001). The reason why LISA was not performed was lack of experience/training (51%) or not having a standardised practice/guideline (49%). LISA in the delivery suite (DS) had increased from 2% in 2018 to 16% in 2024, and the use of video laryngoscope for LISA is becoming standard of practice. The oxygen requirement criteria for the use of LISA in both the DS and on neonatal unit had reduced to FiO2 of 0.3 or more.The uptake of LISA had increased in the United Kingdom. There is greater use of LISA in the DS. Lack of training and expertise were the major limiting factors for LISA not being performed. [ABSTRACT FROM AUTHOR]

Background:Aim:Methods:Results:Conclusion:A case-management model of care is frequently used in acute-care settings for patients with major traumatic injuries; however, its application to trauma follow-up care after hospital discharge remains unclear.To describe the services provided by the Trauma Connect Clinic (TCC): a NP- led case management model, in trauma follow-up care.An exploratory descriptive study design was used. Data collected included patient and injury characteristics, clinic activities, attendance rates, referral patterns and complications.Three-hundred and twenty-four TCC appointments were scheduled for 194 patients (n = 302) with an attendance rate of 93% (n = 302). Ongoing health issues included pain (n = 22, 37%), thrombotic events (n = 8, 13%) and infection (n = 7, 12%). Clinic activity included 77 referrals to the wider MDT (n = 77), radiology reviews (n = 225) and 39 prescribing events, consisting mainly of analgesia.A case management model can successfully deliver trauma follow-up care and efficiently use limited resources. Key elements involve careful assessment and management of patients’ physical and emotional needs. Evaluation of longer-term outcomes of this model of care in trauma settings is required. [ABSTRACT FROM AUTHOR]

Background: The workplace environment plays a pivotal role in employees' lives as they spend many hours there. Recently, greater attention has been placed on workplace conditions as a key social determinant of health. One way through which workplace conditions may affect health is workplace dignity. This study aimed to describe clinical nurses' workplace dignity. Methods: The study design was descriptive and cross-sectional. Clinical nurses within a tertiary institution were randomly sampled. Data collection included the Workplace Dignity scale which is an 18 item-seven-point Likert scale consisting of dignity and indignity questions (α.98, and 0.95, respectively). Data collection commenced with a pilot followed by a final data collection phase. Ethical considerations were included via informed consent, anonymity, and confidentiality. Data analysis included means, standard deviations, and Pearson correlations. Results: The pilot test yielded a reliability coefficient – α 0.93. Two hundred and thirty-six clinical nurses participated in the study resulting in a response rate of 87.4%. The average mean age of participants was 37.966 ± 0.635 (min 25- max 60) years. Most participants were female (92.8%) with a Bachelor of Science in Nursing Degree (77.5%). The overall mean experience as a registered nurse was 16.038 ± 0.589 years. Nationality responses were divided into Saudi (41.5%) and non-Saudi (58.5%). The construct of general dignity had the highest mean score of 5.52 (SD 1.46), with question 14: "I have dignity at work" having the highest overall mean score of 5.63 (SD 1.4). There was a positive correlation and statistical significance with a 'p < 0.000 i.e. as a nurses' experience as a registered nurse increased, workplace dignity scores increased. Conclusion: The findings of this study indicated that inherent value and general dignity were the highest-scored constructs while indignity and respectful interaction scored the lowest. This study allows for reflection on the importance of workplace dignity, as an impactful and important organizational phenomenon that affects either positively or negatively on employee well-being and performance, hence workplace dignity must be prioritized within work environmental infrastructures. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is prevalent but remains underdiagnosed and undertreated. Recognizing OSA in patients with psychiatric disorders can be challenging due to the conditions' overlapping symptoms. To aid primary care NPs in identifying OSA among patients with psychiatric disorders, this article examines overlapping symptoms and outlines diagnostic reasoning. It also provides an overview of the anatomy and neurotransmitters involved in OSA, as well as OSA-specific screening tools and risk stratification, to promote the condition's identification among this population. [ABSTRACT FROM AUTHOR]

Background: People with stroke and their families face numerous challenges as they leave hospital to return home, often experiencing multifaceted unmet needs and feelings of abandonment. The essential elements of an intervention intended to support transition‐to‐home after stroke are unclear. Objective: The aim of the project was to engage in a co‐design process to identify the key components of a pragmatic intervention to inform a transition‐to‐home support pathway following stroke. Materials and Methods: The study was conducted using a co‐design process engaging multiple stakeholders, including 12 people with stroke, 6 caregivers, 26 healthcare professionals and 6 individuals from stroke organisations in a series of three workshops, facilitated by the primary researcher, a wider team of researchers and an individual with lived experience of stroke. World Café methodology and Liberating Structures facilitation techniques were adapted to meet the aim of the workshops. Data collection involved observations during workshops, followed by summarising of findings and reaching group consensus agreement on outputs. Facilitated consensus on a prioritisation task resulted in the final output. Results: The co‐design group identified 10 key intervention components of a transition‐to‐home support pathway following stroke. These components focussed on enhancing collaboration, streamlining transition processes and facilitating post‐discharge support. While a stroke coordinator was considered a top priority, increased cross‐setting information sharing and community in‐reach, where community‐based healthcare staff extended their services into hospital settings to provide continuity care, were considered most feasible to implement. Conclusion: The co‐design approach, involving a multi‐stakeholder group and strengthened by patient and public involvement, ensured that the identified transition‐to‐home intervention components are meaningful and relevant for people with stroke and their families. Further co‐design workshops are required to refine, and feasibility test the components for generalisability within the wider Irish healthcare setting. Patient or Public Contribution: Individuals who have experienced a stroke actively contributed to shaping the methodological design of this study and the ethics process. They engaged in the analysis of co‐design outputs and provided input for the discussion and recommendations regarding future research. An individual who had experienced a stroke formed part of the research team, co‐facilitating the co‐design workshops and co‐authoring this article. [ABSTRACT FROM AUTHOR]

Background: The extensive research already conducted in numerous non-healthcare disciplines has consistently demonstrated the effectiveness of flow in alleviating work-related stress and boosting employee engagement in the workplace. Despite the potential benefits to nursing of improving flow, no valid instrument is currently available to measure the work-related flow experience of clinical nurses. Purpose: This study was designed to develop the Flow State Scale for Caregiving Tasks (FSS-CT) and to evaluate its psychometric properties in the context of clinical nurses. Methods: This study, guided by the flow theory of Mihaly Csikszentmihalyi (1975), employed a three-phase approach to developing and evaluating the psychometric properties of the FSS-CT. Five hundred thirty-six full-time clinical nurses working in hospitals of various levels in Taiwan were recruited via cluster random sampling to participate in an anonymous online survey. The content validity of the developed scale was established through expert panel verification, criterion-related validity was assessed by correlating the scale with the Work-related Flow Inventory, and construct validity was evaluated via explanatory and confirmatory factor analyses. Scale reliability was determined using Cronbach's α coefficient. Results: The FSS-CT, a 12-item Likert scale comprising four domains, was developed. These domains capture the elements of nurses' work-related flow, including professional confidence, merging of action and awareness, balance between skill and challenge, and autotelic experience. The FSS-CT demonstrated high content validity (content validity index > .90) and satisfactory criterion-related validity (coefficient = .55, p < .001). Furthermore, the scale was found to have excellent internal consistency (Cronbach's α= .91). Factor analyses yielded a four-factor structure accounting for 69.34% of the total variance, indicating a good fit for the final model based on recommended goodness-of-fit indices. Conclusions: The FSS-CT is a viable and dependable instrument for assessing the work-related flow experiences of nurses, with the measured outcomes offering to nursing administrators valuable insights into or directions for personnel development and work allocation initiatives. [ABSTRACT FROM AUTHOR]

The article offers information on the potential of dual-certified nurse practitioners (APRNs) to enhance holistic patient care by bridging mental and physical health services. Topics discussed include the current limitations in integrated healthcare delivery; the mental health crisis and related comorbidities; and recommendations for supporting dual-certified practitioners within primary care settings.

Importance: Since 2001, 3.5 million United States service members deployed overseas in support of the post-9/11 Global War on Terror. While healthy and fit upon deployment, veterans have experienced many complex and often unexplainable illnesses and chronic diseases, with more than 520 000 being diagnosed with cancer. With the implementation of the VA MISSION and PACT Acts, post-911 veterans are increasingly being seen in non-VHA healthcare facilities by non-physician providers. Objective: To assess the readiness of registered and advanced practice nurses to provide knowledgeable and competent healthcare for post-9/11 veterans in the civilian healthcare system. Design, setting and participants: A web-based survey was administered by the HunterSeven Foundation (a Veteran-founded non-profit organisation), with 541 nurse respondents. Primary outcomes and measures: Questions were designed to assess military knowledge, comfort level caring for veterans, self-reported proficiency and prior training of participants. Mean differences were compared using a restricted maximum likelihood, fixed-effects model, with incidence between groups estimated as log-binomial relative risks. Results: Meaningful gaps in clinical knowledge of screening for and treatment of medically related conditions were identified. Our assessment also highlighted a sparseness of knowledge for making care recommendations based on apposite resources. Conclusions and relevance: Cognitive biases among healthcare providers in the civilian sector may lead to missed and/or delayed diagnoses, therefore emphasising the need for additional training focused on caring for post-9/11 veterans. [ABSTRACT FROM AUTHOR]

Background: Presurgical blood orders are important for patient safety during surgery, but excess orders can be costly to patients and the healthcare system. We aimed to assess clinician perceptions on the presurgical blood ordering process and perceived barriers to reliable decision‐making. Methods: This descriptive qualitative study was conducted at a single large academic medical center. Semi‐structured interviews were conducted with surgeons, anesthesiologists, nurse anesthetists, nurse practitioners working in preoperative assessment clinics, and transfusion medicine physicians to assess perceptions of current blood ordering processes. Interview responses were analyzed using an inductive open coding approach followed by thematic analysis. Results: Twenty‐three clinicians were interviewed. Clinicians felt that the current blood ordering process was frequently inconsistent. One contributor was a lack of information on surgical transfusion risk, related to lack of experience in ordering clinicians, insufficient communication between stakeholders, high turnover in academic settings, and lack of awareness of the maximum surgical blood ordering schedule. Other contributors included differing opinions about the benefits and harms of over‐ and under‐preparing blood products, leading to variation in transfusion risk thresholds between clinicians, and disagreement about the safety of emergency‐release blood. Conclusion: Several barriers to reliable decision‐making for presurgical blood orders exist. Future efforts to improve ordering consistency may benefit from improved information sharing between stakeholders and education on safe transfusion practices. [ABSTRACT FROM AUTHOR]

Background: Australia's commitment to eliminate hepatitis C by 2030 is underpinned by the mobilisation of the primary care sector. Primary care nurses are well placed to contribute to achieving elimination given their unique access to people with/at risk of hepatitis C and their person-centred approach to care delivery. This study examines the enablers to primary care nurse involvement in elimination efforts. Methods: Primary care nurses involved in the care of people with/at risk of hepatitis C were recruited through two national nursing organisations. Participants provided verbal consent to participate in an electronically recorded, semi-structured interview. Interview data were transcribed verbatim, coded and analysed using a thematic analysis. Results: Sixteen interviews were conducted with nurses working in general practice, community health, alcohol and other drug services, and custodial settings, with the findings framed using a social-ecological model. The study identified individual attributes, such as empathy and advocacy for clients deemed 'too hard for everyone else'. Interpersonal enablers included participants' ability to effectively communicate with clients and colleagues, and using trusted professional relationships to improve client access to care. Public policy that addressed community factors, including stigma and confidentiality, were seen as supportive. Conclusions: This study identified the critical and varied role primary care nurses play in hepatitis C elimination. Effective scale up of hepatitis C care involves recognising the pivotal role of primary care nurses, which will help to create an enabling environment that supports nurses to work to their full scope of practice and enhance their contribution to the elimination response. Hepatitis C elimination in Australia is stalling. Primary care nurses are in regular contact with people with/at risk of hepatitis C and have a unique opportunity to contribute to the elimination effort. This study interviewed primary care nurses to identify the individual and systemic enablers that support these nurses to work to their full scope of practice and contribute to achieving Australia's elimination goal. [ABSTRACT FROM AUTHOR]

Background As cognitive impairment (CI) prevalence rises and primary care screening becomes commonplace, it is critical to understand how to support clinicians. We describe clinician-reported barriers to diagnosing and managing care for patients with CI in a health system with standardized screening. We also explore whether barriers differ by clinician type-physician or advanced-practice clinician (APC). Methods Theory-informed surveys were administered to primary care clinicians in a large integrated health system. The survey assessed barriers, confidence in diagnosing CI and managing CI care, beliefs about the consequences of diagnosing CI, and usability of the electronic health record (EHR) to diagnose and manage CI care; it also included open-ended response items. Descriptive statistics and content analysis were used to describe perceived barriers. Differences by clinician type were compared using chi-square. Results Of the 408 eligible clinicians, 249 started the survey and 247 completed the primary outcomes (61% response rate). Many said they were only a little or not at all confident in diagnosing (70%) and managing care for (60%) CI, with specific gaps in confidence in distinguishing types of dementia and having CI-related conversations with patients or family/care partners. APCs reported lower confidence than physicians. Other barriers were lack of time, low usability of EHR, and lack of family/care partner availability. These did not differ by clinician type. Open-ended responses suggest clinicians would like more support for CI care. Conclusion Low levels of confidence among other barriers suggest an urgent need to develop and implement effective multifaceted strategies to improve CI care. [ABSTRACT FROM AUTHOR]

Purpose: For the first time in France, a randomised controlled trial was conducted to evaluate the impact of a nurse facilitator on family psychological symptoms. We sought to explore the implementation of the intervention, how it was experienced by clinicians, as well as the barriers and facilitators to implementing the change. Methods: We conducted qualitative semi-structured interviews with intensive care unit (ICU) clinicians and facilitators involved in the trial. Interview questions focused on participants' perceptions of the intervention and its outcomes, including the effect of the intervention on patients, families and the health care team, and barriers and facilitators to its implementation. Interviews were conducted by two social science researchers, audio recorded, transcribed, and analyzed using thematic content analysis. Results: Twenty-three clinicians were interviewed from the five participating ICUs. Three themes emerged, capturing clinicians' perspectives on implementing the intervention: (1) improved communication and enhanced care for families and the ICU team, albeit with some associated risks; (2) active listening and support, both for families and ICU clinicians but with certain limitations; (3) barriers to implementation including lack of organizational readiness, exclusion of under-represented groups, and facilitator challenges including role ambiguity and the need for role support. Conclusion: Participants believed the facilitator intervention potentially improved families' experience. However, they also highlighted emotional difficulties and tensions with some members of the participating teams, due to competing territories and ambiguous role definitions. Facilitators' failure to affect decision-making suggests their role in enhancing goal-concordant care was inadequate within the setting. [ABSTRACT FROM AUTHOR]