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Background: Although previous research studies have defined several prognostic factors that affect cognitive‐communication performance in patients with all traumatic brain injury (TBI) severity, little is known about what variables are associated with cognitive‐communication impairment in complicated mild TBI (mTBI) specifically. Aims: To determine which demographic and trauma‐related factors are associated with cognitive‐communication performance in the early recovery phase of acute care following a complicated mTBI. Methods & Procedures: Demographic and accident‐related data as well as the scores on cognitive‐communication skill measures in the areas of auditory comprehension (complex ideational material subtest of the Boston Diagnostic Aphasia Examination), verbal reasoning (verbal absurdities subtest of the Detroit Test of Learning Aptitude), confrontation naming (short form of the Boston Naming Test), verbal fluency (semantic category and letter category naming), and conversational discourse (conversational checklist of the Protocole Montréal d'évaluation de la communication) were retrospectively collected from the medical records of 128 patients with complicated mTBI admitted to a tertiary care trauma hospital. Multiple linear regressions analyses were carried out on the variables sex, age, education level, Glasgow Coma Scale (GCS) score, lesion site and bilingualism. Outcomes & Results: Females performed better than males on letter‐category naming, while those more advanced in age performed worse on most cognitive‐communication measures. Patients with higher education achieved better confrontation and letter‐category naming, whereas reading comprehension results were worse with a lower GCS score. Bilingual individuals presented more difficulty in conversational discourse skills than those who spoke only one language. In terms of site of lesion, the presence of a right frontal injury was associated with worse auditory and reading comprehension and an occipital lesion was related to worse confrontation naming. Conclusions & Implications: Cognitive‐communication skills should be evaluated early in all patients with complicated mTBI, but especially in those who are advanced in age, those with fewer years of education and those who present with lower GCS scores, in order to determine rehabilitation needs. The findings of this study will allow acute care clinicians to better understand how various demographic and injury‐related factors affect cognitive‐communication skills after complicated mTBI and to better nuance the interpretation of their evaluation results in order to improve clinical care. Further study is required regarding the influence of lesion location, sex and bilingualism following complicated mTBI. What this paper addsWhat is already known on the subjectIn early acute recovery studies including all severity of TBI, cognitive‐communication performance was poorer in individuals with more advanced age, those with fewer years of education and with more severe TBI. It is not yet known which demographic and injury‐related variables predict cognitive‐communication performance after a complicated mTBI specifically.What this paper adds to existing knowledgeWe confirmed that age, level of education and TBI severity, as measured with the GCS score, were associated with some areas of cognitive‐communication performance for a group of patients in the acute stage of recovery from a complicated mTBI. We also identified that sex, bilingualism and site of lesion were new variables that show an influence on aspects of cognitive‐communication skills in this group of patients.What are the potential or actual clinical implications of this work?The findings of this study on prognostic factors in the case of complicated mTBI will help acute care clinicians to better understand evaluation results knowing the variables that can influence cognitive‐communication performance and to nuance the interpretation of these results with the goal of determining rehabilitation needs and enhancing clinical care. [ABSTRACT FROM AUTHOR]

This paper provides a set of guidelines for occupational therapists practicing "patient activation" and "patient engagement" approaches in the acute care hospital setting. Patient activation and engagement (PAE) has gained attention in the health care setting as the new effective intervention. Occupational therapists create client-centered goals and treatment plans in alignment with PAE approaches in the health care system but barriers continue to exist in practice settings that prevent appropriate implementation of such techniques. This paper presents evidence that an occupational therapist's role should not be limited to the assessment of a client's independence with activities of daily living in acute care hospital settings but should also involve being an active leader for the implementation for PAE interventions. As PAE interventions become widely implemented and create more role opportunities in acute care hospitals, the future of occupational therapy's role cannot be simply left behind on the assessment of activities of daily living. The objectives of this paper are to introduce (a) assessments that measure both patient activation and patient engagement, (b) literature supporting the relationship between patient activation and patient health behaviors, and (c) clinical variables associated with a patient's engagement levels. [ABSTRACT FROM AUTHOR]

Background: A high percentage of the critically ill polytrauma patients develop acute kidney injury (AKI) secondary to trauma and are therefore prone to high morbidity and mortality rates. One of the main objectives in these cases is the fast detection of the condition and continuous rigorous monitoring of the patients. Currently the panel of biomarkers available for monitoring and for the prognosis of AKI is limited. Numerous studies have proven the importance of microRNAs in this field. In this actualization paper we wish to summarize the most relevant micro-RNAs that can be used as biomarkers for patients with AKI. Methods: For this paper, we looked into the studies available in scientific databases such as PubMed and Scopus. For the analysis we used the following key words: "miRNAs biomarker", "acute kidney injury AKI", "genetic expression in AKI", and "epigenetic microRNAs biomarkers in AKI". Results: Numerous studies have shown high specificity for certain microRNA species in the case of patients with AKI. Moreover, they have reported a series of microRNAs that present high specificity and that have a strong expression in fluids that can be sampled through non-invasive methods, such as urine and saliva. Conclusions: The expression of microRNAs can be successfully used in the future as a non-invasive method for the evaluation and monitoring of AKI patients. [ABSTRACT FROM AUTHOR]

The association between high rates of readmission and detrimental outcomes for an organization's finances and a patient's health outcome has caused it to be a leading cause of concern for healthcare organizations. Research suggests that lack of patient engagement has a significant impact on rates of readmission. Various studies prove that enhancing factors that influence patient engagement successfully decreases readmission rates. Multiple hospitals have reached success in reducing readmission rates by implementing plans to improve these factors. This paper analyzes the factors that influence patient engagement and aims to recognize solutions that are known to be effective so that an approach can be developed to improve readmission rates in an acute care setting. Effective solutions were identified to be advertising health information technology systems such as patient portal, communication via telephonically or printed infographic sheets, and use of the teach back method. [ABSTRACT FROM AUTHOR]

Postoperative delirium (POD) is common, especially among older adults, and can significantly impact health and rehabilitation outcomes. Research evidence suggests that a multicomponent intervention is most effective for delirium prevention. Given that this intervention includes diverse components, interdisciplinary collaboration among members of the healthcare team is essential. This paper presents how occupational therapists, as part of the interdisciplinary acute care team, contribute to preventing POD and embed their unique value, skills, and strengths in each component of the collaborative intervention. This paper also argues that POD preventive care should be standard practice for occupational therapy in the acute care setting. [ABSTRACT FROM AUTHOR]

Background and/or rationale: "Specialling" is a common nursing practice in hospitals which entails the allocation of extra staff to be with an older person who is confused to maintain safety. Despite ongoing use, this practice has little evidence of effectiveness. To facilitate further investigation, a concept analysis of "specialling" was undertaken. Aims: The aim of this paper was to report on a concept analysis on the practice of "specialling" pertaining to older people who have cognitive impairment when in hospital. Methods: This study used Rodgers evolutionary approach to concept analysis to clarify the attributes, antecedents and consequences of the concept to determine a definition of "specialling." Web of Science (Core Collection and Web of Science Medline), CINAHL and SCOPUS databases were searched to identify relevant literature. Due to the scarcity of papers, the search was broadened to include all sources that could add understanding. Findings: A total of (n = 43) sources were identified. The attributes were themed to 5 categories: Labels and descriptions; the "Special" role; Patient safety; Patient care; and Communication. The antecedents to 2 themes: Patient characteristics; and Organisational risk. The consequences of "specialling" were diverse with 6 themes: the "Special" role; the Older persons experience; Costly; "Special" use and nursing beliefs; Safety outcomes; and Opportunities. Discussion: The process of concept analysis provided a means to identify knowledge gaps and practice challenges. The definition determined from this analysis has provided a reflective opportunity for clinicians and researchers to consider when implementing care initiatives to support older people in hospital. Important is the lack of person‐centred approaches and the opportunities in developing nurse leadership through empowerment. The findings from this analysis will inform a PhD study. Implications for practice: Nurses have an opportunity to lead care improvements by ensuring person‐centred approaches in the care of older people with cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Patient feedback in the English NHS is now widespread and digital methods are increasingly used. Adoption of digital methods depends on socio-technical and contextual factors, alongside human agency and lived experience. Moreover, the introduction of these methods may be perceived as disruptive of organisational and clinical routines. The focus of this paper is on the implementation of a particular digital feedback intervention that was co-designed with health professionals and patients (the DEPEND study).Methods: The digital feedback intervention was conceptualised as a complex intervention and thus the study focused on the contexts within which it operated, and how the different participants made sense of the intervention and engaged with it (or not). Four health care sites were studied: an acute setting, a mental health setting, and two general practices. Qualitative data was collected through interviews and focus groups with professionals, patients and carers. In total 51 staff, 24 patients and 8 carers were included. Forty-two observations of the use of the digital feedback system were carried out in the four settings. Data analysis was based on modified grounded theory and Normalisation Process Theory (NPT) formed the conceptual framework.Results: Digital feedback made sense to health care staff as it was seen as attractive, fast to complete and easier to analyse. Patients had a range of views depending on their familiarity with the digital world. Patients mentioned barriers such as kiosk not being visible, privacy, lack of digital know-how, technical hitches with the touchscreen. Collective action in maintaining participation again differed between sites because of workload pressure, perceptions of roles and responsibilities; and in the mental health site major organisational change was taking place. For mental health service users, their relationship with staff and their own health status determined their digital use.Conclusion: The potential of digital feedback was recognised but implementation should take local contexts, different patient groups and organisational leadership into account. Patient involvement in change and adaptation of the intervention was important in enhancing the embedding of digital methods in routine feedback. NPT allowed for a in-depth understanding of actions and interactions of both staff and patients. [ABSTRACT FROM AUTHOR]

Objective: Leg ulcers are common, distressing and painful for patients, and are a significant financial burden to healthcare providers. Compression therapy is the mainstay of treatment for venous leg ulceration. Several studies have evaluated leg ulcer management and compression therapy in the community. However, little is known about the prevalence of leg ulceration and use of compression therapy in acute hospitals. The aim of this study was to explore the published literature on the use of compression therapy for inpatients with leg ulcers in UK National Health Service hospital settings. Method: A literature search was undertaken to identify published papers reporting on inpatient leg ulcer populations and the use of compression therapy in hospitals using the following databases: CINAHL, MEDLINE Complete, Embase and PubMed. Results: The literature review identified 364 articles, of which three met the eligibility criteria. These studies reported on the prevalence of leg ulceration, the number of Doppler assessments conducted for patients and the use of compression therapy. Conclusion: This review confirmed a lack of information on the prevalence of hospital inpatients with leg ulcers, and identified the need to conduct prevalence audits, establish leg ulcer services to streamline inpatient leg ulcer care and provide staff and patient education programmes. [ABSTRACT FROM AUTHOR]

Aims: To explore pre‐registration nursing students' understandings and experience of intentional rounding in education and clinical sectors. Intentional rounding is a patient safety intervention used in clinical settings to regularly check and document patients' welfare and environment throughout the course of a shift. Design: An explanatory sequential mixed methods design using convenience sampling was used for this study, with an underlying pragmatic paradigm. Integration occurred in the design, methods, implementation and reporting phases of the study. Methods: Data were collected between August 2017 and August 2018 using a previously validated Nursing Perceptions of Patient Rounding quantitative online survey followed by individual qualitative interviews using the same cohort. Results: Using the Pillar Integration Process, this paper displays and discusses the final results. The integration and mixing throughout the study generated insights into the perceived benefits of intentional rounding for nursing students and patients but also indicated a theory–practice gap that affects nursing students' confidence in undertaking this intervention. Conclusion: Students find this patient safety intervention helpful, but further clarity in the education surrounding it is required. Impact This study addresses pre‐registration nursing students' understanding and perceptions of intentional rounding. Intentional rounding benefits nursing students as a patient safety strategy and organization tool. Educational opportunities around the topic could be enhanced, reducing the ongoing theory–practice gap. Clinicians, academics and educators who support pre‐registration nursing students in clinical and tertiary education settings can benefit from this work. [ABSTRACT FROM AUTHOR]

Patient outcomes are improved when healthcare professionals work collaboratively. In order for future professionals to have these entry-level skills, students from different disciplines must work together in scenarios simulating patient care. This paper provides an overview of a large-scale, acute care simulation involving students of different disciplines, including nursing and pharmacy. A survey using the validated Student Perceptions of Interprofessional Clinical Education Revised (SPICE-R2) tool was administered to students participating in the simulation prior to and within 1 week of the simulation. There were between-group statistically significant differences on two items on the pre-simulation survey and two items on the post-simulation survey. Student participants reported more positive perceptions after the simulation on every item except for "During their education, health professional students should be involved in teamwork with students from other health professions to understand their perspective roles". The authors concluded that an interprofessional acute care simulation allowed students in both professions to recognize the value of a team approach to patient care. [ABSTRACT FROM AUTHOR]

Seeking to answer the question of what it is that nurses do, scholars researching nursing have worked with theoretical approaches ranging from the more abstract to the concrete: from philosophizing the nature of nursing to emphasizing the interpersonal nature of nursing practice to exploring processes of clinical decision‐making. In this paper, we engage with Bourdieu's theory of practice as an alternative approach that helps to understand the finer points of nurses' everyday practices of nursing as being grounded in an ontology of practice. We first outline the foundations of Bourdieu's thinking as he established both a relational philosophy of science and an embodied philosophy of action to develop the theory of practice around notions of habitus, capital and field. Then, using the inter‐relationships of these key elements of the theory of practice as a 'toolkit to think with', we explore an instance of nursing in practice in an acute care setting and show how, in taking account of social context, the dialectics between the elements reveal the social interactions that are accomplished in the doing. Moving to the relationships of these three elements with Bourdieu's further notions of illusio, symbolic power and symbolic violence, we uncover an ontology of nursing practices in the everyday. We conclude by summarising what this ontology of practice has to offer investigations into practices of nursing in any social context. [ABSTRACT FROM AUTHOR]

Families of persons with acquired brain injuries need to be supported from the early phase of hospitalization. To date, no known early family intervention is available for this population. Using the Medical Research Council Framework, we developed a new intervention based on the Calgary Assessment and Intervention Models that includes the family preferences, clinician's expertise, and the contextual resources. This paper aims to describe the complete development process including a scoping review, an assessment of families and clinicians' needs, an evaluation of the contextual resources, and an adaptation of the theoretical framework. Using a systemic perspective, we tailored the new intervention to involve the stakeholder's preferences. The result is an early family intervention named SAFIR©, led by a clinical nurse specialist, including five core components and structured around three phases and a follow-up. The next steps will be focused on assessment of the clinical feasibility of this new intervention. [ABSTRACT FROM AUTHOR]

Objectives:: The study describes the implementation and adaptation of a brief intervention model as routine clinical practice in an acute care service.Methods:: An action research process informed the evaluation and design of the intervention.Results:: The model's theoretical framework enhanced clinical practice and benefited consumers, though it was too rigid to be implemented in an acute care setting, so was adapted to suit this environment.Conclusions:: This paper highlights the value in realigning practice with fundamental engagement principles to improve practice outcomes. [ABSTRACT FROM AUTHOR]

Background Nosocomial infection remains the most common complication of hospitalisation. Despite infection control efforts, nosocomial methicillin resistant Staphylococcus aureus (MRSA) transmission continues to rise. Various isolation practices are used to minimise MRSA transmission in acute care. However, the effectiveness of these practices has seldom been evaluated. Objectives This review sought to evaluate the efficacy of isolation practices in minimising MRSA transmission in the acute hospital setting and explore staff, visitor and patient compliance with isolation practices. This review updates a review published in 2002. Search strategy A systematic search for relevant published or unpublished English language literature was undertaken using electronic databases, the reference lists of retrieved papers and the Internet. This extended the search published in the original review. Databases searched included: Medline, CINAHL, EMBASE, Cochrane Library and Joanna Briggs Institute Evidence Library. Selection criteria All English language research reports published between 1990 and August 2005 that focused on the role of isolation practices on the nosocomial transmission of MRSA in adult, paediatric or neonatal acute care settings were eligible for inclusion in the review. Studies that evaluated multiple infection control strategies or control of MRSA outbreaks were excluded. The main outcome of interest was the incidence of new cases of MRSA. The secondary outcome was staff, visitor and patient compliance with the isolation practices. Data collection and analysis Two reviewers assessed each paper against the inclusion criteria and a validated quality scale. Data extraction was undertaken using a tool designed specifically for this review. Statistical comparisons of findings were not possible, so findings are presented in a narrative form. Results Seven studies met the inclusion criteria. Given the small number of included studies and variable methodological quality, care must be taken when interpreting the review findings. There is some evidence that cessation of single room isolation and cohorting of MRSA patients does not increase nosocomial MRSA transmission when hand-washing compliance and standard precautions are maintained. Indeed, there is some evidence that reduced MRSA transmission can be achieved by improving compliance with contact precautions alone. The low level of hand hygiene compliance reported in the literature suggests that staff compliance with isolation practices is a significant factor in evaluating any infection-controlled intervention in the clinical setting. While staff compliance data are conflicting, regular audit and feedback of performance may improve compliance. Implications for clinical practice The heterogeneous nature of the topic and methodological weaknesses of included studies impairs the ability to aggregate data and develop specific practice recommendations. While this review presents evidence to suggest that ceasing single room or cohort isolation does not lead to increased MRSA transmission, these studies maintained high levels of hand hygiene or standard precautions. Additionally, the role of extraneous factors, such as environmental reservoirs, specific MRSA strains and patient mix, is unclear. None of the included studies measured financial, social or psychological factors associated with isolation practices. There is an urgent need for well-designed research with significant sample sizes to develop an evidence base upon which to underpin future clinical practice. [ABSTRACT FROM AUTHOR]

Aims: To examine the effectiveness of targeted nursing interventions on mobilization, nutrition and cognitive engagement to reduce functional and hospital‐associated decline (HAD) in older patients. Design: Systematic review of experimental studies using randomized and quasi‐experimental designs. Data sources: We searched electronic databases CINAHL, MEDLINE, EMBASE, Cochrane library, google scholar and BMJ quality reports from January 2009 to February 2020. Review methods: We reviewed intervention studies that targeted ward nursing teams to increase mobilization, nutrition or cognitive engagement of older adults. Inclusion criteria included older patients, acute care (medical, surgical and older adult wards) and reporting patient level outcomes. Quality appraisal included the Joanna Briggs Critical Appraisal Checklist for Quasi‐Experimental Studies. Results: From 1729 papers, 18 studies using quasi‐experimental and pre‐post designs were selected. Study heterogeneity necessitated a narrative synthesis. The quality of evidence was low to moderate. All studies used multicomponent strategies, and 10 studies used evidence translation frameworks to align interventions to local barriers. Overall, 74% (n = 14) of studies reported a significant improvement in the stated primary outcome. Eight studies reported a significant increase in mobilization (e.g., sitting in a chair or walking), and four reported improved functional outcomes. Five studies improved nutrition outcomes (e.g., protein or energy intake), and three studies reported a significant reduction in delirium. Conclusion: Acknowledging methodological limitations, the evidence indicates that nursing teams using evidence‐translation frameworks can improve mobilization, nutrition and cognitive engagement in acute care settings. Future research requires higher‐quality pragmatic trial designs, standardized outcomes, staff co‐designed interventions, evidence‐translation frameworks and patient engagement to make more confident inference about effectiveness. Impact: Nursing teams with the support of hospital management have to address ward and system barriers to prioritize fundamental care to improve patient outcomes. There is sufficient evidence on multicomponent interventions and implementation strategies to inform nurse‐led quality improvement. [ABSTRACT FROM AUTHOR]

As health care transitions to value‐based care, it is more critical than ever to emphasize and quantify the impact on patient outcomes made by inpatient/acute care pharmacists and pharmacist extenders as members of the interprofessional care team. Thus, the American College of Clinical Pharmacy (ACCP) took to task the development of quality measures that were broadly applicable to the diverse inpatient/acute care landscape and important for standardizing practice, measuring impact, contextualizing benefit within the health care landscape, and allowing benchmarking within and between institutions. A framework was established by the writing committee of this paper in order to develop quality measures in a methodical manner. The resulting process led the writing committee to devise 31 foundational quality measures to be used in efforts to champion the pharmacist's role in achieving the quadruple aims in health care. Application and evaluation of quality measure performance as well as limitations and future implications of the measures are addressed to further highlight the evolving role of the inpatient/acute care pharmacist and pharmacist extender. [ABSTRACT FROM AUTHOR]

The provision of acute healthcare within patients own home (i.e. hospital in the home) is an important method of providing individualised patient-centred care that reduces the need for acute hospital admissions and enables early hospital discharge for appropriate patient groups. The Hospital in the Home (HitH) model of care ensures that this approach maximises patient safety and limits potential risk for patients. As HitH services have seen record numbers of patient referrals in the past 2 years, there is now a greater need to measure and understand the acuity and dependency levels of the caseload. Through an expert clinician development process at one NHS trust, aspects of procedural complexity, interdisciplinary working, risk stratification and comorbidities were used to quantify acuity and dependency. This paper uses a case study approach to present a new method of measuring this important concept. [ABSTRACT FROM AUTHOR]

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Background: Multifunction surveillance alerting systems have been found to be beneficial for the operating room and labor and delivery. This paper describes a similar system developed for in-hospital acute care environments, AlertWatch Acute Care (AWAC). Results: A decision support surveillance system has been developed which extracts comprehensive electronic health record (EHR) data including live data from physiologic monitors and ventilators and incorporates them into an integrated organ icon-based patient display. Live data retrieved from the hospitals network are processed by presenting scrolling median values to reduce artifacts. A total of 48 possible alerts are generated covering a broad range of critical patient care concerns. Notification is achieved by paging or texting the appropriated member of the critical care team. Alerts range from simple out of range values to more complex programing of impending Ventilator Associated Events, SOFA, qSOFA, SIRS scores and process of care reminders for the management of glucose and sepsis. As with similar systems developed for the operating room and labor and delivery, there are green, yellow, and red configurable ranges for all parameters. A census view allows surveillance of an entire unit with flashing or text to voice alerting and enables detailed information by windowing into an individual patient view including live physiologic waveforms. The system runs via web interface on desktop as well as mobile devices, with iOS native app available, for ease of communication from any location. The goal is to improve safety and adherence to standard management protocols. Conclusions: AWAC is designed to provide a high level surveillance view for multi-bed hospital units with varying acuity from standard floor patients to complex ICU care. Alerts are generated by algorithms running in the background and automatically notify the selected member of the patients care team. Its value has been demonstrated for low acuity patients, further study is required to determine its effectiveness in high acuity patients. [ABSTRACT FROM AUTHOR]

Introduction: The Australian Gold Coast Integrated Care programme trialled a model of care targeting those with chronic and complex conditions at highest risk of hospitalisation with the goal of producing the best patient outcomes at no additional cost to the healthcare system. This paper reports the economic findings of the trial. Methods: A pragmatic non-randomised controlled study assessed differences between patients enrolled in the programme (intervention group) and patients who received usual care (control group), in health service utilisation, including Medicare Benefits Schedule and Pharmaceutical Benefits Scheme claims, patient-reported outcome measures, including health-related quality of life, mortality risk, and cost. Results: A total of 1,549 intervention participants were enrolled and matched on the basis of patient level data to 3,042 controls. We found no difference in quality of life between groups, but a greater decrease in capability, social support and satisfaction with care scores and higher hospital service use for the intervention group, leading to a greater cost to the healthcare system of AUD$6,400 per person per year. In addition, the per person per year cost of being in the GCIC programme was AUD$8,700 equating to total healthcare expenditures of AUD$15,100 more for the intervention group than the control group. Conclusion: The GCIC programme did not show value for money, incurring additional costs to the health system and demonstrating no significant improvements in healthrelated quality of life. Because patient recruitment was gradual throughout the trial, we had only one year of complete data for analysis which may be too short a period to determine the true cost-consequences of the program. [ABSTRACT FROM AUTHOR]

Improving the efficacy of rapid response operations in acute care delivery to ensure patient safety and care quality is of significant importance. In this paper, we study the response time performance (RTP) in rapid response operations. Such performance is defined as the probability that an appropriate decision responding to patient deterioration can be made within a desired time period. First, we derive a closed formula to evaluate the RTP by assuming exponential response time, and investigate the system-theoretic properties. Next, we introduce a bottleneck indicator to identify the response whose improvement will lead to the largest improvement in RTP. Then, we extend the study to non-exponential response time scenario. An approximation formula is proposed to evaluate RTP. Finally, a case study at the University of Kentucky Chandler Hospital is introduced to illustrate the applicability of the method. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify barriers and facilitators to engagement of people with dementia and family carers in planning for discharge from hospital. Background: Hospital discharge can be particularly challenging for older people with dementia. To assist in the development of bespoke discharge processes that address the unique needs of older people with dementia, an integrated review of the literature was undertaken. Design and methods: A four‐stage integrative review framework guided the review. Three search strategies were employed: a computerised database search, a hand search of reference lists and forward citation searching. Paired members of the research team reviewed eligible full‐text papers. The methodological quality of each paper was assessed using the Mixed‐Methods Assessment Tool, followed by data extraction and completion of summary tables. Within and across study analysis and synthesis of study findings was undertaken using thematic synthesis. Results: Fifteen papers were included in the review. Most identified barriers to collaborative discharge processes related to distributed responsibility for discharge, risk averse approaches to discharge, limited family carer confidence, and limited validation of assumptions about family competency to manage at home. Facilitators included supported clinician and family carer engagement, and maintaining independence for activities of daily living. Relevance to clinical practice: Reflective analysis of discharge decisions, focused on risk and possible risk aversion, can assist teams to evaluate the quality of their discharge decisions. The use of formal communication strategies such as a patient/family‐held journal of the hospital experience and a structured family meeting early in the hospital admission can enhance family engagement in discharge planning. Prevention of functional and cognitive decline is emerging as critical to improving hospital discharge outcomes. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Empathy is one of the main attributes for establishing the nurse–patient therapeutic relationship. Davis (1983) identified four components on an empathic response: perspective taking, fantasy, empathetic concern and personal distress.It is essential to deepen our knowledge on the influence of the dimensions of empathy for the construction and development of the therapeutic alliance during the different phases of the therapeutic relationship. What the paper adds to existing knowledge?: A significant association exists between the dimensions of empathy and the construction and development of the therapeutic alliance during the different phases of the therapeutic relationship between nurses and patients in mental health units.This study shows that the nurses' perspective on the patient's situation improves the bond, and therefore, this skill is especially useful in the first phase or orientation phase of the therapeutic relationship. However, for the second phase or working phase of the therapeutic relationship, a greater empathic concern among nurses, together with less personal distress, improves collaborative goal setting with patients. What are the implications for practice?: It is important for mental health nurses to be aware of the importance of personal self‐awareness and the emotional management of empathy for the construction and development of therapeutic relationships of quality with patients.Knowledge of the relationship between each of the dimensions of empathy in the different stages of the therapeutic relationship is useful for the design of educational programmes, by including training on empathic strategies. Introduction: Empathy and its dimensions (perspective taking, empathic concern, personal distress and fantasy) are essential for establishing the nurse–patient therapeutic relationship. It is important to know how this influences the construction and development of the therapeutic alliance during the different phases of the therapeutic relationship. Aim: To examine whether the dimensions of empathy influence the nurse–patient therapeutic relationship within mental health units. Method: A cross‐sectional design was used to collect data to measure the therapeutic alliance and the different dimensions of empathy via an online form completed by nurses working at 18 mental health units. Linear regressions were used in the analysis. Results: A total of 198 participants completed the questionnaires. Nurses established a greater therapeutic alliance with patients when they were able to adopt their patient's perspective and experience concern. Discussion: Nurses' perspective taking is an influential factor impacting the nurse–patient bond in the orientation phase, whereas experiencing greater concern and decreased emotional distress were associated with improved therapeutic alliance in the working phase. Implications for practice: These findings may help gain awareness among nurses of the importance of empathy in the nurse–patient relationships, as well as inform educational programmes, by including training in empathic strategies and emotional management. [ABSTRACT FROM AUTHOR]

Background: Based on the 2018 update of the Surviving Sepsis Campaign, the Committee for Quality Improvement of the NHSs of England recommended the instigation of the elements of the 'Sepsis-6 bundle' within 1 hour to adult patients screened positive for sepsis. This bundle includes a bolus infusion of 30 mL/kg crystalloids in the ED. Besides the UK, both in the USA and Australia, compliance with similar 1-hour targets became an important quality indicator. However, the supporting evidence may neither be contemporaneous nor necessarily valid for emergency medicine settings.Method: A systematic review was designed and registered at PROSPERO to assess available emergency medicine/prehospital evidence published between 2012 and 2020, investigating the clinical benefits associated with a bolus infusion of a minimum 30 mL/kg crystalloids within 1 hour to adult patients screened positive for sepsis. Due to the small number of papers that addressed this volume of fluids in 1 hour, we expanded the search to include studies looking at 1-6 hours.Results: Seven full-text articles were identified, which investigated various aspects of the fluid resuscitation in adult sepsis. However, none answered completely to the original research question aimed to determine either the effect of time-to-crystalloids or the optimal fluid volume of resuscitation. Our findings demonstrated that in the USA/UK/Australia/Canada, adult ED septic patients receive 23-43 mL/kg of crystalloids during the first 6 hours of resuscitation without significant differences either in mortality or in adverse effects.Conclusion: This systematic review did not find high-quality evidence supporting the administration of 30 mL/kg crystalloid bolus to adult septic patients within 1 hour of presentation in the ED. Future research must investigate both the benefits and the potential harms of the recommended intervention. [ABSTRACT FROM AUTHOR]

Behavioural and psychological symptoms of dementia occur in approximately 75% of people with dementia admitted to acute care. Acute care nurses' decision‐making regarding administering 'as needed' (pro re nata or PRN) psychotropic medications to persons with dementia are not well understood. This is an important clinical concern because 'as needed' medications are given at the discretion of the nurse. A comprehensive, systematic search and screen for studies that explored nurses' decision‐making related to administering as needed psychotropic medication to persons with dementia in acute care settings was conducted. No studies that reported nurses' decision‐making related to administration of as needed psychotropic medications to hospitalized persons with dementia were identified. In light of this, we present a discussion based on a narrative review of what is known on this topic from other settings, based on papers found in our original review. We will briefly explore what is needed in future research to address the gap in knowledge about nurse' decision‐making related to administering as needed psychotropic medications. Implications for practice: Research is needed to understand and inform the decision‐making process in the administration of as needed psychotropic medications to hospitalized persons with dementia. [ABSTRACT FROM AUTHOR]

Medication prescribing in paediatrics is complex and compounded by the need to provide age and weight related doses, and errors continue to be problematic. Electronic medication systems (EMS) can reduce errors through dosing calculators and computerised decision support. However, evidence on costs and benefits of these systems is limited, particularly in paediatric hospitals. This paper presents the development of a cost-benefit analysis (CBA) framework to assess the impact of an EMS implementation in a paediatric tertiary hospital. An innovative component of the framework is the incorporation of the impact of the effects of the EMS for both the health system as well as for patients and their wider family networks, allowing a net social benefit assessment. We describe the impact of non-clinical out-of-pocket costs of admission and use discrete choice experiments to measure both medication related harm and the importance of medication safety to families and members of the community. [ABSTRACT FROM AUTHOR]

Background: As in other areas of health delivery, there is a need to ensure that end-of-life care is guided by patient centred research. A systematic review was undertaken to examine the quantity and quality of data-based research aimed at improving the (a) processes and (b) outcomes associated with delivering end-of-life care in hospital settings. Methods: Medline, EMBASE and Cochrane databases were searched between 1995 and 2015 for data-based papers. Eligible papers were classified as descriptive, measurement or intervention studies. Intervention studies were categorised according to whether the primary aim was to improve: (a) end of life processes (i.e. end-of-life documentation and discussions, referrals); or (b) end-of-life outcomes (i.e. perceived quality of life, health status, health care use, costs). Intervention studies were assessed against the Effective Practice and Organisation of Care methodological criteria for research design, and their effectiveness examined. Results: A total of 416 papers met eligibility criteria. The number increased by 13% each year (p < 0.001). Most studies were descriptive (n = 351, 85%), with fewer measurement (n = 17) and intervention studies (n = 48; 10%). Only 18 intervention studies (4%) met EPOC design criteria. Most reported benefits for end-of-life processes including end-of-life discussions and documentation (9/11). Impact on end-of-life outcomes was mixed, with some benefit for psychosocial distress, satisfaction and concordance in care (3/7). Conclusion: More methodologically robust studies are needed to evaluate the impact of interventions on end-of-life processes, including whether changes in processes translate to improved end-of-life outcomes. Interventions which target both the patient and substitute decision maker in an effort to achieve these changes would be beneficial. [ABSTRACT FROM AUTHOR]