Family adaptation in families of individuals with Down syndrome from 12 countries.

Our current understanding of adaptation in families of individuals with Down syndrome (DS) is based primarily on findings from studies focused on participants from a single country. Guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation, the purpose of this cross-country investigation, which is part of a larger, mixed methods study, was twofold: (1) to compare family adaptation in 12 countries, and (2) to examine the relationships between family variables and family adaptation. The focus of this study is data collected in the 12 countries where at least 30 parents completed the survey. Descriptive statistics were generated, and mean family adaptation was modeled in terms of each predictor independently, controlling for an effect on covariates. A parsimonious composite model for mean family adaptation was adaptively generated. While there were cross-country differences, standardized family adaptation mean scores fell within the average range for all 12 countries. Key components of the guiding framework (i.e., family demands, family appraisal, family resources, and family problem-solving communication) were important predictors of family adaptation. More cross-country studies, as well as longitudinal studies, are needed to fully understand how culture and social determinants of health influence family adaptation in families of individuals with DS.

Professional empowerment among Portuguese nursing staff: A correlational study.

AIM: To identify the level of professional empowerment in hospital nurses and describe the relationship between sociodemographic variables and professional empowerment. BACKGROUND: Professional empowerment is positively related to work effectiveness, job satisfaction and organisational and professional commitment. METHOD: Data on professional empowerment were collected by surveying 365 nurses in a Portuguese hospital, with the Portuguese versions of 'Conditions of Work Effectiveness Questionnaire-II' and the 'Psychological Empowerment Instrument'. RESULTS: Overall, psychological empowerment scored 66.2 (standard deviation = 8.9, with 'meaning' scoring highest and 'impact' scoring lowest), whereas structural empowerment scored 18.6 (standard deviation = 3.3, with 'opportunity' and 'informal power' scoring highest and 'resources' scoring lowest). The factor 'age' correlated positively with 'self-determination', 'impact' and 'psychological empowerment', as well as with 'informal power', 'resources' and 'structural empowerment'. Lastly, 'competence' correlated negatively with 'formal power', 'information' and 'structural empowerment'. CONCLUSION: There is a relationship between demographic variables and empowerment, and between structural and psychological empowerment. IMPLICATIONS FOR NURSING MANAGEMENT: Professional empowerment is related to organisational results, so it is important to reinforce and optimize organisational structures. Empowerment can be achieved with access to structures that promote empowerment, particularly resources.

A systematic review of nurse-led weaning protocol for mechanically ventilated adult patients.

OBJECTIVES: The aim of this systematic review is to synthesize the current best evidence for the effectiveness of weaning protocols led by nurses compared with usual physician-led care. BACKGROUND: Protocol-directed weaning has been shown to reduce the duration of mechanical ventilation. Studies have reported that a weaning protocol administered by nurses leads to a reduction in the duration of mechanical ventilation and has a major effect on weaning outcomes. This can have especially positive consequences for critically ill patients. STUDY DESIGN: Systematic review with meta-analysis. SEARCH STRATEGY: The databases CINAHL, PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched from as far back as the database allowed until January 2016. INCLUSION AND EXCLUSION CRITERIA: Searches were performed to identify the best available evidence including quantitative studies of nurse-led weaning protocols for mechanically ventilated adult patients. We excluded all studies of weaning protocols implemented by non-nurses and non-invasive mechanical ventilation and studies that addressed patient populations younger than 18 years of age. RESULTS: The database searches resulted in retrieving 369 articles. Three eligible studies with a total of 532 patients were included in the final review. Pooled data showed a statistically significant difference in favour of the nurse-led weaning protocol for reducing the duration of mechanical ventilation (mean differences = -1.69 days, 95% confidence interval = -3.23 to 0.16), intensive care unit length of stay (mean differences = -2.04 days, 95% confidence interval = -2.57 to -1.52, I2 = 18%, and p = 0.00001); and hospital length of stay (mean differences = -2.9 days, 95% confidence interval = -4.24 to -1.56, I2 = 0%, and p = 0.00001). CONCLUSION: There is evidence that the use of nurse-led weaning protocols for mechanically ventilated adult patients has a positive impact on weaning outcomes and patient safety. RELEVANCE TO CLINICAL PRACTICE: This review provides evidence supporting intensive care unit nurses' crucial role and abilities to lead weaning from mechanical ventilation.