Self‐management programmes for people living with chronic obstructive pulmonary disease: a call for a reconceptualisation

Aims and objectives

To synthesise findings from previously published studies on the effectiveness of self‐management programmes for people with chronic obstructive pulmonary disease.

Background

Self‐management is a widely valued concept to address contemporary issues of chronic health problems. Yet, findings of self‐management programmes for people with chronic obstructive pulmonary disease are indecisive.

Design

Literature review of (1) previously published systematic reviews and (2) an integrative literature review.

Method

Synthesis of findings from previously published systematic reviews (n = 4) of the effectiveness of self‐management programmes for people with chronic obstructive pulmonary disease and an integrated review that was performed on papers published between January 2007–June 2012 (n = 9).

Results

Findings demonstrate that there are few studies on the effectiveness of self‐management programmes on people with chronic obstructive pulmonary disease despite more than a decade of research activities. Outcomes of the studies reveal some increase in health‐related quality of life and reduction in use of healthcare resources. The methodological approaches vary, and the sample size is primarily small. Families are not acknowledged. Features of patient‐centredness exist in self‐management programmes, particularly in the more recent articles.

Conclusions

The effectiveness of self‐management programmes for people with chronic obstructive pulmonary disease remains indecisive.

Relevance to clinical practice

A reconceptualisation of self‐management programmes is called for with attention to a family‐centred, holistic and relational care focusing on living with and minimising the handicapping consequences of the health problems in their entirety.     

The contribution of nurses to incident disclosure: A narrative review

Objectives

To explore (a) how nurses feel about disclosing patient safety incidents to patients, (b) the current contribution that nurses make to the process of disclosing patient safety incidents to patients and (c) the barriers that nurses report as inhibiting their involvement in disclosure.

Design

A systematic search process was used to identify and select all relevant material. Heterogeneity in study design of the included articles prohibited a meta-analysis and findings were therefore synthesised in a narrative review.

Data sources

A range of text words, synonyms and subject headings were developed in conjunction with the York Centre for Reviews and Dissemination and used to undertake a systematic search of electronic databases (MEDLINE; EMBASE; CENTRAL; PsycINFO; Health Management and Information Consortium; CINAHL; ASSIA; Science Citation Index; Social Science Citation Index; Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects; Health Technology Assessment Database; Health Systems Evidence; PASCAL; LILACS). Retrieval of studies was restricted to those published after 1980. Further data sources were: websites, grey literature, research in progress databases, hand-searching of relevant journals and author contact.

Review methods

The title and abstract of each citation was independently screened by two reviewers and disagreements resolved by consensus or consultation with a third person. Full text articles retrieved were further screened against the inclusion and exclusion criteria then checked by a second reviewer (YB). Relevant data were extracted and findings were synthesised in a narrative empirical synthesis.

Results

The systematic search and selection process identified 15 publications which included 11 unique studies that emerged from a range of locations. Findings suggest that nurses currently support both physicians and patients through incident disclosure, but may be ill-prepared to disclose incidents independently. Barriers to nurse involvement included a lack of opportunities for education and training, and the multiple and sometimes conflicting roles within nursing.

Conclusions

Numerous potential benefits were identified that may result from nurses having a greater contribution to the disclosure process, but the provision of support and training is essential to overcome the reported barriers faced by nurses internationally.     

Disaster preparedness among nurses: a systematic review of literature

Aim

This review explored peer‐reviewed publications that measure nurses’ preparedness for disaster response.

Background

The increasing frequency of disasters worldwide necessitates nurses to adequately prepare to respond to disasters to mitigate the negative consequences of the event on the affected population. Despite growing initiatives to prepare nurses for any disasters, evidence suggests they are under prepared for disaster response.

Methods

This is a systematic review of scientific articles conducted from 2006 to 2016 on nurses’ preparedness for disasters. SCOPUS, MEDLINE, PubMed, CINAHL and PsychINFO were the primary databases utilized for search of literature. Keywords used in this review were as follows: ‘emergency’, ‘disaster’, ‘disaster preparedness’, ‘disaster competencies’, ‘disaster nursing’, ‘disaster role’ and ‘nurse’. Seventeen (17) articles were selected for this review.

Findings

Factors that increase preparedness for disaster response include previous disaster response experience and disaster‐related training. However, it is widely reported that nurses are insufficiently prepared and do not feel confident responding effectively to disasters.

Conclusion

The findings of this review contribute to a growing body of knowledge regarding disaster preparedness in nurses and have implications for academia, hospital administration and nursing educators. The findings of this review provide evidence that could be used by nurse educators and nurse administrators to better prepare nurses for disaster response.

Implications for nursing and health policy

The findings from this review place an emphasis on hospitals to implement policies to address lack of preparedness among their employees. Furthermore, this review highlights the benefit of further research and provision of well‐grounded disaster exercises that mimic actual events to enhance the preparedness of the nursing workforce.     

Nurses’ preparedness for infectious disease outbreaks: A literature review and narrative synthesis of qualitative evidence

Aims and objectives

To explore the core components that constitute nurses’ preparedness in an epidemic event.

Background

Healthcare service providers have worked to augment efforts to protect the public from the impact of epidemic events. While constituting the major healthcare taskforce, nurses are frequently tasked with fronting the response to an infectious disease outbreak. Given the crucial role of nurses in the management of prevailing epidemics, the constituents of their preparedness in epidemic events should be identified.

Design

A systematic search was undertaken to identify eligible studies from the literature. A narrative synthesis approach was employed to extract and synthesise findings of the reviewed qualitative studies.

Methods

Seven qualitative studies on nurses’ experience and perceptions of epidemic events were examined for scientific quality using the Critical Appraisal Skills Programme Qualitative Checklist. Findings of these studies were synthesised adopting a narrative synthesis approach.

Results

Three interplaying themes were identified as follows: (i) personal resources, (ii) workplace resources and (iii) situational influences. The findings suggest that an effective epidemic outbreak response would require further effort to reinforce the interplay between individual nurses, healthcare institutions and the governments.

Conclusions

The practical interplay among individual nurses, healthcare institutions and the governments is crucial in establishing an effective epidemic response. Further research on the understanding of the dynamic process of preparedness development is recommended to set future directions in research.

Relevance to clinical practice

This study offers important insights for devising future strategies in enhancing nurses’ preparedness and response to an epidemic event. These include recommendations on providing education and training to nurses regarding infectious diseases, fostering institutional assistance and support in an outbreak and revising government policies and planning.     

Models for predicting turnover of residential aged care nurses: A structural equation modelling analysis of secondary data

Background

Nurse turnover in the residential aged care industry is a pressing issue. Researchers have shown ongoing interest in exploring how the factors that are amendable to change in aged care policy, regulation and funding and in organizational procedures (e.g. job demands, coping resources and psychological health of nurses) impact on turnover. However, the findings are mixed.

Objective

This study tested two theoretical models of turnover to examine the structural relationships among job demands, coping resources, psychological health and turnover of residential aged care nurses. Although many previous studies operationalized turnover as intention to leave, the present study investigated actual turnover by following up with the same individuals over time, and thus provided more accurate predictive models of turnover behaviour.

Design and methods

The sample, 239 Australian residential aged care nurses, came from the Nurses and Midwives e-cohort Study. Job demands, coping resources, and psychological health were measured using standardized instruments. Structural equation modelling was used to test the measurement and structural models.

Results

Controlling for a number of workforce and individual characteristics, coping resources (measured by job control, supervisor support, and co-worker support) were negatively and directly associated with turnover. Additionally, the findings supported the Job Demand-Control-Support model in that higher coping resources and lower job demands (indicated by psychological demands, physical demands, and effort) were related to better psychological health (measured by vitality, social functioning, role emotional, and mental health), and higher job demands were related to lower coping resources.

Conclusions

Findings suggest that aged care policy makers and service providers might consider increasing coping resources available to nurses and minimizing job demands of care work to reduce turnover and improve nurses’ psychological health. Moreover, findings from this Australian study may provide valuable practical and policy implications for other developed countries.     

Nurses’ perceptions of climate sensitive vector-borne diseases: A scoping review

Objective

Nurses are well positioned to play an integral role in the mitigation of climate change and climate-driven vector-borne diseases, however, they lack awareness and knowledge about their role. The purpose of this scoping review was to map existing literature on nurses’ perceptions, knowledge, attitudes, and experiences with vector-borne diseases, specifically Lyme disease and West Nile virus.

Design

A scoping review was conducted using Joanna Briggs Institute (JBI) scoping review methodology. CINAHL, ProQuest Nursing & Allied Health Premium, MEDLINE, APA PsycINFO, ProQuest Dissertations & Theses, and Web of Science were searched for English-language publications. The PRISMA-ScR was used. After initial screening as per study protocol, a total of 33 items were reviewed independently by four reviewers.

Results

Thirty-three articles, including seven sources from grey literature, met the criteria for this scoping review. Results were mapped according to the five domains of the Guidelines for Undergraduate Nursing Education on Climate-Driven Vector-Borne Diseases.

Conclusions

Findings from the review indicate that nurses play a role in climate-related health effects and should be knowledgeable about vector-borne diseases. However, scant literature exists on nurses’ knowledge, perceptions, attitudes toward vector-borne diseases, and practice readiness, signifying a need for further research on this emerging topic.     

Capacity for care: meta‐ethnography of acute care nurses' experiences of the nurse‐patient relationship

Aims

To synthesize evidence and knowledge from published research about nurses' experiences of nurse‐patient relationships with adult patients in general, acute inpatient hospital settings.

Background

While primary research on nurses' experiences has been reported, it has not been previously synthesized.

Design

Meta‐ethnography.

Data sources

Published literature from Australia, Europe, and North America, written in English between January 1999–October 2009 was identified from databases: CINAHL, Medline, British Nursing Index and PsycINFO.

Review methods

Qualitative studies describing nurses' experiences of the nurse‐patient relationship in acute hospital settings were reviewed and synthesized using the meta‐ethnographic method.

Results

Sixteen primary studies (18 papers) were appraised as high quality and met the inclusion criteria. The findings show that while nurses aspire to develop therapeutic relationships with patients, the organizational setting at a unit level is strongly associated with nurses' capacity to build and sustain these relationships. The organizational conditions of critical care settings appear best suited to forming therapeutic relationships, while nurses working on general wards are more likely to report moral distress resulting from delivering unsatisfactory care. General ward nurses can then withdraw from attempting to emotionally engage with patients.

Conclusion

The findings of this meta‐ethnography draw together the evidence from several qualitative studies and articulate how the organizational setting at a unit level can strongly influence nurses' capacity to build and sustain therapeutic relationships with patients. Service improvements need to focus on how to optimize the organizational conditions that support nurses in their relational work with patients.     

A systematic review of the effectiveness of advanced practice nurses in long‐term care

Aim

To report quantitative evidence of the effectiveness of advanced practice nursing roles, clinical nurse specialists and nurse practitioners, in meeting the healthcare needs of older adults living in long‐term care residential settings.

Background

Although studies have examined the effectiveness of advanced practice nurses in this setting, a systematic review of this evidence has not been conducted.

Design

Quantitative systematic review.

Data sources

Twelve electronic databases were searched (1966–2010); leaders in the field were contacted; and personal files, reference lists, pertinent journals, and websites were searched for prospective studies with a comparison group.

Review methods

Studies that met inclusion criteria were reviewed for quality, using a modified version of the Cochrane Effective Practice and Organisation of Care Review Group risk of bias assessment criteria.

Results

Four prospective studies conducted in the USA and reported in 15 papers were included. Long‐term care settings with advanced practice nurses had lower rates of depression, urinary incontinence, pressure ulcers, restraint use, and aggressive behaviours; more residents who experienced improvements in meeting personal goals; and family members who expressed more satisfaction with medical services.

Conclusion

Advanced practice nurses are associated with improvements in several measures of health status and behaviours of older adults in long‐term care settings and in family satisfaction. Further exploration is needed to determine the effect of advanced practice nurses on health services use; resident satisfaction with care and quality of life; and the skills, quality of care, and job satisfaction of healthcare staff.     

Interprofessional collaboration between junior doctors and nurses in the general ward setting: A qualitative exploratory study

Aim

To explore the collaboration experiences of junior physicians and nurses in the general ward setting.

Background

Junior physicians and nurses do not always work collaboratively and this could affect the quality of patient care. The understanding of the issues affecting junior physicians and nurses working together is needed to inform strategies to improve interprofessional collaboration.

Methods

Nineteen junior physicians and nurses were interviewed in 2012 and 2013. Interviews were transcribed and analysed using thematic analysis.

Results

Junior physicians and nurses acknowledged the importance of working collaboratively to achieve better patient care, but they are struggling to cope due to heavy clinical workload, organisational constraints and differing power relationships. Nurses have to take on more responsibilities in the decision‐making process of patients’ care to foster effective interprofessional collaboration.

Conclusion

The study calls for educational and organisational strategies to improve interprofessional collaboration between junior physicians and nurses.

Implications for nursing management

Nurse leaders should ensure that ward nurses are given a designated time to participate in ward rounds with physicians and have access to a communication tool that assists them in contributing proactively in the decision‐making process of patient care.     

Experience of Violence from the Clients and Coping Methods Among Intensive Care Unit Nurses Working in a Hospital in South Korea

Purpose

It is difficult to develop a good defense system that can prevent nurses from experiencing physical and verbal violence from patients and families in intensive care units, which are closed spaces. This study aimed to identify intensive care nurses' experience of violence from patients and families and investigate their coping methods, if there are any, in a tertiary hospital in South Korea.

Among nurses,how does education level impact professional values? A systematic review

Background

Professional nursing values have been acknowledged globally as the foundation of daily nursing care practice. Understanding how nurses identify, comprehend and apply their professional nursing values is an important step towards improving nursing practice and patient care quality. Research has demonstrated that nurses' professional values are cultivated during prelicensure academic education.

Aim

The aim of this systematic review was to determine how level of education affects professional nursing values of clinical practising nurses.

Methods

A systematic search of quantitative research published through December 2015 was performed in the following five electronic databases: CINAHL, Cochrane Library, MEDLINE, Web of Science and Religion and Philosophy Collection. The search was not limited to country of origin. The studies were assessed for methodological quality using established criteria.

Results

Of 1501 articles identified through the literature search, only seven studies met the inclusion criteria with the majority being of good to high quality. Most of the studies found registered nurses pursuing a bachelor of science in nursing or higher had a greater awareness and application of professional values than nurses with lower levels of academic or non‐academic education. Nurses with higher education also embraced professional values as fundamental for quality nursing care practice.

Implications for nursing and health policy

Health and academic institutions should support nurses through quality continuing and higher education that reinforces professional values, thus improving the quality of patient care.

Conclusions

The level of nurses' education appears to play an important role in developing both an awareness and an integration of professional values into practice. More research is needed to discover methods that may be used to promote nurses' professional values among nurses already practising clinically.     

The effects of nurse prescribing: A systematic review

Background

In 2008, we conducted a systematic review on the effects of nurse prescribing using studies with a comparative design. In view of the growing number of countries that are introducing nurse prescribing and the fact that several studies into nurse prescribing have been conducted recently, there is a need for an updated review to reassess the available information on the effects of nurse prescribing when compared to physician prescribing.

Objective

To identify, appraise and synthesise the evidence on the effects of nurse prescribing when compared to physician prescribing on the quantity and types of medication prescribed and on patient outcomes.

Design

A systematic review.

Data sources

In addition to the previous review, which covered the literature up to 2005, 11 literature databases and four websites were searched for relevant studies from January 2006 up to January 2012 without limitations as to language or country. Moreover, full-text copies of all studies included in the previous review were reviewed.

Review methods

A three-stage inclusion process, consisting of an initial sifting, checking full-text papers for inclusion criteria and methodological assessment, was performed independently by two reviewers. Data on effects were synthesised using narrative and tabular methods.

Results

Thirty-five studies met the inclusion criteria. All but five studies had a high risk of bias. Nurses prescribe in comparable ways to physicians. They prescribe for equal numbers of patients and prescribe comparable types and doses of medicines. Studies comparing the total amount of medication prescribed by nurses and doctors show mixed results. There appear to be few differences between nurses and physicians in patient health outcomes: clinical parameters were the same or better for treatment by nurses, perceived quality of care was similar or better and patients treated by nurses were just as satisfied or more satisfied.

Conclusions

The effects of nurse prescribing on medication and patient outcomes seem positive when compared to physician prescribing. However, conclusions must remain tentative due to methodological weaknesses in this body of research. More randomised controlled designs in the field of nurse prescribing are required for definitive conclusions about the effects of nurse prescribing.     

A time to weep and a time to laugh: humour in the nurse–patient relationship in an adult cancer setting

Purpose

The literature highlights the value of humour in health-care settings. Humour impacts on the physiological, psychosocial and cognitive well-being of a person. The diagnosis of cancer is extremely stressful, and treatments are difficult. Patients and nurses may use humour as a coping mechanism to contend with the stresses caused directly or indirectly by cancer. This study investigated the use of humour during interactions between patients and nurses in an adult cancer ward.

Methods

This study used a modified ethnographic methodology that included fieldwork participant observation and informal interviews (n?=?30 h) and formal interviews (n?=?10). In total, 9 nurses and 12 patients participated in participant observation. From these, five nurses and five patients were interviewed. Data were analysed using thematic analysis.

Results

Findings highlighted the importance of humour in the nurse–patient relationship. Patients consciously use humour during nurse–patient interactions in an attempt to help nurses cope with the stress they encounter in clinical practice. Patients perceive having a sense of humour as a positive nurse attribute. Nurses expressed concerns regarding compromising professionalism when using humour and felt the need for guidance from senior staff. Constant assessment and reflection help ensure humour is used appropriately in the adult health-care setting.

Conclusion

The benefits of humour are recognised by both adult cancer patients and nurses. A deeper understanding of patient and nurse perceptions of the use of humour can inform strategies for its therapeutic use in the clinical setting.     

What support can community mental health nurses deliver to carers of people diagnosed with schizophrenia? Findings from a review of the literature

Objectives

The purpose of this review was to determine the nature of support that mental health nurses could deliver to carers of people diagnosed with schizophrenia. The aim was to identify approaches that could be delivered within community practice to reduce burden and increase knowledge, mental health and coping.

Questions addressed

What effect did support have on carer burden and other needs? What were the key elements of effective support? What effective supports could mental health nurses deliver within practice?

Design

This review covers the international scientific literature published between 1980 and 2008.

Data sources

Searches were made of electronic databases relevant to nursing. All papers, published in English, were assessed. Hand searches of review papers and references were also carried out. Sixty-eight studies were included.

Study appraisal and synthesis

Only comparative studies providing a quantitative assessment of carer outcomes were included. Findings were synthesised in narrative format and grouped by intervention type.

Results

Of the 68 emerging studies, 12 (18%) directly included nurses in delivering the intervention and 16 (24%) included nurses as part of a multidisciplinary team. There is fairly robust evidence that education improves carer knowledge of schizophrenia. There is, however, little evidence that it addresses more substantive areas such as burden, coping or mental health. Supportive family education moves beyond information giving by developing coping. As might be expected these approaches can reduce burden. More intensive programmes such as behavioural family therapy aim to address stressful relationships which commonly occur in families of people diagnosed with schizophrenia. These programmes are particularly effective in reducing burden and can also improve mental health. Community support such as intensive outreach is also effective in reducing burden. Finally, there is some evidence that mutual support groups reduce burden and improve coping.

Conclusions

Research on effective support for carers of people diagnosed with schizophrenia is emerging. Although findings were mixed, there was some evidence supporting a range of approaches that mental health nurses could offer to carers. There is, however, still a need for pragmatic studies to determine the extent that these approaches can be delivered within nursing practice.