The Efficacy and Patient Experience of Virtual Reality in Labor: An Integrative Review of Pain and Anxiety Management.

BACKGROUND: Labor pain and anxiety are significant challenges in maternal healthcare, often managed through pharmacological interventions. Virtual Reality (VR), as a non- pharmacological method, has emerged as a potential tool for pain and anxiety relief in labor. This integrative review aims to synthesize evidence from randomized controlled trials (RCTs), qualitative studies, and mixed-methods research to evaluate the effectiveness of VR in labor pain and anxiety management and to understand patient experiences. METHODS: Adhering to the PRISMA guidelines, a structured literature search was conducted across databases, including PsycINFO, CINAHL, and PubMed, yielding 1,227 studies. Following a meticulous screening and selection process by authors, 13 studies (10 RCTs, 2 qualitative, and 1 mixed methods) met the inclusion criteria. Data extraction focused on study design, population characteristics, VR interventions, outcomes measured, and key findings, with a content analysis approach employed for thematic synthesis. RESULTS: The RCTs consistently showed VR's efficacy in reducing labor pain and, to some extent, anxiety. Qualitative studies highlighted VR's role in enhancing patient experiences, offering distraction, relaxation, and improved self-efficacy in pain management. The integration of findings from quantitative and qualitative studies provided a comprehensive understanding of VR's effectiveness and acceptability in labor. Notable themes included the importance of VR's immersive nature and its potential to reduce reliance on pharmacological interventions. CONCLUSION: VR emerges as a promising tool for managing labor pain and anxiety, offering a non-invasive and patient-friendly alternative to traditional pain relief methods. Its implementation in clinical practice could enhance patient satisfaction and overall birthing experiences. However, further research is needed to standardize VR interventions, assess long-term effects, and determine cost-effectiveness. The findings encourage the consideration of VR as part of holistic maternal care, emphasizing the need to integrate patient-centered healthcare technologies.

Integrating Nursing Practice and Policy in Opioid Overdose Prevention: Analysis of the Opioid-Overdose Reduction Continuum of Care Approach Practice Guide.

AIM: To present a comprehensive analysis of the Opioid-Overdose Reduction Continuum of Care Approach (ORCCA) Practice Guide 2023, evaluating its alignment with Russell and Fawcett's conceptual model of nursing and health policy and highlighting the implications for nursing practice and policy. DESIGN: This paper employs a policy analysis framework to evaluate the ORCCA Practice Guide, using Russell and Fawcett's conceptual model as a lens to assess the policy's structure and implementation. METHODS: The analysis is framed by Russell and Fawcett's conceptual model, focusing on the dimensions of efficacy, effectiveness, equity and justice. This framework assesses how well the ORCCA's strategies align with these dimensions in the context of nursing and health policy. RESULTS: Key findings indicate that the ORCCA's strategies are integral to nursing practice, particularly in frontline interventions such as education, naloxone distribution and Medication for Opioid Use Disorder (MOUD) delivery. The integration of these strategies demonstrates a significant impact on the opioid crisis, enhancing the roles nurses play in opioid overdose prevention. CONCLUSION: The ORCCA Practice Guide represents a multifaceted approach to addressing the opioid crisis, with strong alignment to the conceptual model used for analysis. It underscores the essential role of nurses in implementing and refining opioid overdose reduction strategies. IMPLICATIONS: The study highlights the critical need for nursing involvement in policy formation and practice implementation, suggesting that nurses are key to advancing comprehensive opioid overdose prevention measures. IMPACT: This study addresses the problem of opioid overdoses and the need for effective interventions. The main findings show the importance of nurse-driven strategies in opioid crisis management. The research impacts public health policy and practice, particularly influencing how nursing approaches are integrated into overall health strategies for overdose prevention. NO PATIENT OR PUBLIC CONTRIBUTION: No patients, caregivers, or members of the public were involved in conducting this analysis.

Xylazine in the Unregulated Drug Market: An Integrative Review of Its Prevalence, Health Impacts, and Detection and Intervention Challenges in the United States.

Xylazine, a veterinary sedative, has emerged as a concerning element in the landscape of substance use in the United States. This integrative review synthesizes evidence from a systematic examination of 14 selected studies conducted between 2008 and 2023. The primary objective is to comprehensively understand the epidemiology and prevalence of xylazine use, particularly its involvement in drug-related deaths, regional variations, national impact, co-occurrence with opioids, and challenges associated with detection and intervention. The results underscore stark regional disparities in xylazine prevalence. West Virginia and Miami-Dade County have experienced alarming surges in xylazine-involved drug-related deaths. Nationally, its influence extends beyond regional boundaries, predominantly affecting white males in the Northeast. The co-occurrence of xylazine with opioids, especially fentanyl and heroin, significantly amplifies the risks of fatal overdoses. Detecting xylazine presents formidable challenges due to its frequent presence alongside other substances, necessitating enhanced surveillance and more effective detection methods. User perspectives emerge as pivotal, emphasizing the importance of user-informed harm reduction strategies. In conclusion, this review has significant policy implications. Tailored, region-specific strategies are imperative to address the diverse prevalence of xylazine use. A nationwide response is indispensable, prioritizing harm reduction initiatives, enhanced detection methods, and active user engagement. The multifaceted nature of the xylazine issue requires comprehensive approaches to mitigate its profound risks effectively. Policymakers are urged to consider regional disparities and the co-occurrence of xylazine with opioids when crafting targeted interventions. Immediate, user-informed harm reduction is vital to address the evolving landscape of xylazine use in the United States.

Healthcare self-management support of stroke patients after discharge: A conceptual analysis using Rodger's evolutionary approach.

AIM(S): To explore the meaning of healthcare self-management support for post-discharged stroke patients. METHOD: Rodgers' evolutionary approach was used to identify antecedents, attributes, related terms, surrogate terms and consequences. DATA SOURCE: Literature from 2012 to 2022 was searched from MEDLINE, CINAHL, PsycINFO and Google Scholar. RESULTS: Three antecedents preceded healthcare self-management support for post-discharged stroke patients: loss of inpatient support, preparedness for self-management and presence of self-management support. Healthcare self-management support for post-discharged stroke patients was defined by eight attributes: pre-discharge assessment and planning; provision of continuous education and training; collaborative goal-setting; reinforcement and documentation of vital information; coordination of post-discharge care; provision of rehabilitation support and promoting community reintegration; provision of counselling support; and using clear communication, patient empowerment and promoting self-efficacy. The identified consequences of the concept were as follows: improved patient outcomes; improved life quality; decreased healthcare cost; decreased re-admission rate and inpatient care burden; and decreased complication rate. CONCLUSION: Healthcare self-management support for post-discharged stroke patients is an emerging concept that can help to significantly improve stroke patients' health outcomes and life quality. However, its applicability is uncertain considering the workload, time and resources available to healthcare professionals. There is a need for future studies to focus on the feasibility and applicability of this concept in clinical practice and to identify any challenges healthcare providers may have in supporting stroke patients after discharge. IMPACT: This concept analysis brings clarity to the concept of healthcare self-management support of post-discharged stroke patients and distinguishes it from other self-management supports. It provides an opportunity for further studies and a pathway for generalized healthcare self-management support for stroke patients after discharge to improve health outcomes and quality of life. NO PATIENT OR PUBLIC CONTRIBUTION: No patients, service users, caregivers or members of the public were involved in conducting this concept analysis.