Understanding strategies that foster nurses to act as clinical leaders in hospitals: A realist review.

AIM: To identify strategies that develop clinical nursing leadership competencies among staff nurses, and to explain the contextual elements and mechanisms that underpin the development of clinical nursing leadership competencies. DESIGN: Realist review according to the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES). DATA SOURCES: PubMed, Embase, CINAHL, Web of Science, Wiley Online Library, PsycInfo and ProQuest were searched from January 2000 until October 2022. REVIEW METHODS: Three iterative phases: (1) development of initial programme theory, (2) structured searches for relevant published and grey literature and (3) data synthesis and interpretation by researchers and theory triangulation, and discussions within the research group. RESULTS: Multiple context-mechanism-outcome configurations were extracted from 10 reports that explain how, under what circumstances and why strategies can facilitate (or discourage) staff nurses to act as clinical leaders. Reports were both quantitative and qualitative in design, originating from English-speaking countries only. CONCLUSIONS: A logic model was developed and suggests four contexts and five mechanisms underlying the development of clinical nursing leadership. Growth in clinical nursing leadership was mainly experienced through experiential learning, which was enhanced by a supportive relationship with a coach or mentor, the use of reflective practices and modelling from other leaders. Furthermore, a supportive work environment triggers ownership, confidence and motivation, and thereby growth in clinical nursing leadership competencies. IMPACT: Fostering competencies for clinical leadership among staff nurses requires multifaceted strategies. Strategies are successful if, and only if, they combine learning by doing, by knowing and by observing, and establish a responsive work environment. Hospital policy should ensure that staff nurses have access to reciprocal relationships with role models or a coach. In order to grow as clinical nurse leader, ownership and self-reflection on own leadership behaviour need to be facilitated. NO PATIENT OR PUBLIC CONTRIBUTION: Prospero ID CRD42021292290.

Career development of doctorally prepared nurses.

AIM: To integrate research literature regarding careers, career development and factors influencing the career development of doctorally prepared nurses. DESIGN: An integrative review. DATA SOURCES: Medline, CINAHL and Embase were searched in June 2022 without time restrictions. METHODS: Peer-reviewed empirical publications written in English with different types of study designs were included. Two researchers independently applied eligibility criteria, selected studies and conducted quality appraisals using Joanna Briggs checklists. Data were extracted and analysed using a convergent integrated approach with thematic analysis. Themes were established within three categories based on the research questions: career, career development and factors influencing career development. RESULTS: Twenty-two studies were included. Nine themes were identified. One theme regarding careers describes that doctorally prepared nurses need to prioritize work within different positions. The two themes focusing on career development described the need to determine career goals after the doctorate and further develop competencies. Six themes described factors influencing career development: 'Intrinsic motivation to improve health care and nursing education', 'Available support sources', 'Professional development programmes', 'Work-life balance', 'Organizational infrastructures for career advancement' and 'Competition and hostile treatment among colleagues'. CONCLUSION: Limited knowledge of the careers and career development of doctorally prepared nurses was found. Doctorally prepared nurses need to balance work with various part-time positions. Careers and career development could be supported by the development of structures for career advancement as well as supportive working environments. IMPACT: Doctorally prepared nurses with strong careers are important to health care and nursing as they generate and implement new knowledge into clinical practice and thereby support the improvement of (nursing) care and patient outcomes. This study provides considerations towards strengthening the careers of doctorally prepared nurses. REPORTING METHOD: PRISMA. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Improved professional competencies and leadership in PhD-prepared nurses and doctoral students after participating in the cross-national and web-based Nurse-Lead program.

BACKGROUND: Doctor of Philosophy (PhD)-prepared nurses are expected to exercise leadership in their various roles. Therefore, European nurse scholars developed a cross-national web-based Nursing Leadership and Mentoring Educational (Nurse-Lead) program. PURPOSE: To evaluate changes in leadership practices, professional and research competencies as well as career development of PhD-prepared nurses and doctoral nursing students after participation in the Nurse-Lead program. METHODS: A pre-post-test evaluation was conducted. Surveys addressed leadership, professional and research competencies, and career development. Quantitative data were analyzed with descriptive statistics and paired sample t-tests. Content analysis was used for qualitative data. DISCUSSION: The 30 participants showed significant improvements in all leadership practices, professional competencies, and most research competencies. Participants reported increased confidence in decision-making, taking on new responsibilities, and becoming more visible within research teams. CONCLUSION: Web-based, international leadership and mentoring programs are promising tools for the leadership and professional development of PhD-prepared nurses and doctoral nursing students.

Relatives' experiences of the transition from intensive care to home for acutely admitted intensive care patients-A qualitative study.

BACKGROUND: Acute admission to an intensive care unit (ICU) can negatively affect quality of life for patients and their relatives. Relatives play an important caregiving role after the patient's admission. More knowledge and understanding of their needs are necessary as the patient transitions home. AIM: This study aims to explore relatives' experiences of acutely admitted ICU patients' transition from the ICU to a general ward and then home. STUDY DESIGN: A qualitative study with a phenomenological approach was conducted. Interviews were in-depth and featured open-ended questions. The interviews took place after the patients transitioned from ICU to home and were conducted online by videoconference. Data were analysed using Colaizzi's seven-step method. RESULTS: Twelve relatives of acutely admitted ICU patients were interviewed. Five main themes emerged: (1) mixed feelings, (2) sense of not being involved, (3) limited information provision, (4) lack of acknowledgement as a caregiver, and (5) an uncertain future perspective. Relatives experience major uncertainties during transitions and prefer to be actively involved in care and care decisions. CONCLUSIONS: This study indicates that relatives of ICU patients experience a lack of guidance during the transitions from the ICU to a general ward and to home, or a follow-up facility. More focus is needed on the themes of mixed feelings, the sense of not being involved, limited information provision, lack of acknowledgement as a caregiver, and an uncertain future perspective. This increased focus might improve the guidance during these transitions. RELEVANCE TO CLINICAL PRACTICE: The insights from this study may help to improve the care of patients and their relatives during the transitions.

Nurses' motivations to leave the nursing profession: A qualitative meta-aggregation.

AIM: To systematically provide an overview of the qualitative evidence available on the motivations for nurses to leave the nursing profession. DESIGN: A qualitative systematic review using the meta-aggregation design of the Joanna Briggs Institute. DATA SOURCES: Qualitative studies in English, dating from 2010 until January 2023, were obtained from CINAHL, PsycINFO and PubMed. REVIEW METHODS: Studies were selected using predetermined inclusion and exclusion criteria. Quality assessment was done using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. The assessment of confidence in the review findings was done according to the ConQual approach. RESULTS: Nine papers that investigated nurses' motivations to leave the profession were included. We developed four synthesized findings from 11 synthesized categories and 31 categories to reflect nurses' motivations to leave the profession, including (1) challenging work environment, (2) emotional distress, (3) disappointment about nursing reality, and (4) culture of hierarchy and discrimination. CONCLUSION: This review provides an in-depth and meaningful understanding of motivations for nurses to leave the profession. Among others, poor working conditions, a lack of opportunities for career development, a lack of support from managers, work-related stress, a discrepancy between nursing education and practice and bullying behaviour were motivations to leave the profession, which calls for targeted action to retain nurses in the profession. IMPACT: Findings of this study shine a light on reasons why nurses leave the profession, providing evidence to support nurse managers and policymakers to develop retention strategies to move out of current crisis into recovery of sustainable global healthcare. PATIENT OR PUBLIC CONTRIBUTION: There was no direct patient or caregiver contribution to this study because this study originated from the process of a Master study. However, two of the authors are still involved in clinical nursing practice and provided the necessary link between research and practice.

Leadership of PhD-prepared nurses working in hospitals and its influence on career development: A qualitative study.

AIMS AND OBJECTIVES: To explore leadership experiences and the influence of leadership on career development of PhD-prepared nurses working in hospitals. BACKGROUND: The Doctor of Philosophy (PhD) represents the highest level of education for a career in research and scholarship. PhD-prepared nurses have an important role in advancing the nursing discipline by conducting and implementing research finding. Given the rapidly changing health care environment, there is a clear need for PhD-prepared nurses with strong leadership competences. Currently, there is a dearth of studies exploring leadership of PhD-prepared nurses working in hospitals. DESIGN: A descriptive qualitative study. METHOD: A purposive sample with PhD-prepared nurses employed at clinical departments was used. Twelve interviews were conducted with participants from seven hospitals. Perceptions towards leadership, leadership experiences, leadership barriers and the influence of leadership on career development were discussed. Interviews were thematically analysed. Reporting followed the COREQ guidelines. RESULTS: Three themes addressing leadership experiences were found: (1) "Leadership is needed for career development" describes how participants took initiative and received support from colleagues and mentors; (2) "Practicing leadership behaviours" describes leadership behaviours and feelings associated with leadership and (3) "Leadership influenced by the hospital setting" describes the working environment including struggling nursing research cultures and infrastructures with limited positions, managerial support and opportunities for collaboration. CONCLUSION: Although participants showed leadership to advance their careers, barriers related to working environment were found. Stakeholders should invest into opportunities to develop and utilise leadership competences and development of strong nursing research cultures and infrastructures with sustainable career frameworks and positions. RELEVANCE FOR CLINICAL PRACTICE: There is a need for ongoing efforts to build strong leadership competences as well as nursing research cultures and infrastructures with career pathways and suitable positions for PhD-prepared nurses within hospitals to empower them to strengthen nursing.

Developing leadership in postdoctoral nurses: A longitudinal mixed-methods study.

BACKGROUND: Postdoctoral nurses have an important role in advancing nursing by generating knowledge and building networks in research, practice, and education which requires effective leadership. Therefore, the Leadership Mentoring in Nursing Research programme for postdoctoral nurses was developed. PURPOSE: This study was to evaluate expectations, experiences, and perceived influence of the leadership mentoring programme on leadership and professional development, professional identity, and research productivity of postdoctoral nurses. METHODS: A longitudinal mixed-method study with a concurrent triangulation design was used with data collected through semistructured interviews and online surveys. FINDINGS: The leadership mentoring programme was found to be valuable by the participants who described strengthened leadership and professional development and development of professional identities. Participants showed increased research productivity and many moved to new/higher positions. DISCUSSION: The leadership mentoring programme was found to enhance the leadership and professional development of postdoctoral nurses and support them in their academic careers.

Developing ActivABLES for community-dwelling stroke survivors using the Medical Research Council framework for complex interventions.

BACKGROUND: Novel technical solutions are called for to promote home-based exercise among community-dwelling stroke survivors supported by their caregivers. Lack of resources and knowledge about how to accomplish it, has been demonstrated. The objective of this study is to describe in detail the development of ActivABLES, a technical intervention to promote home-based exercise and physical activity engagement of community-dwelling stroke survivors with support from their caregivers. METHODS: The technical development process of ActivABLES was guided by the Medical Research Council (MRC) framework for development and evaluation of complex interventions as well as by principles of human-centred design and co-design. The main steps included: (1) Synthesis of evidence supporting the inclusion of balance exercises, mobility and walking exercises and exercises for the upper arm; (2) Implementation of initial user studies with qualitative data collection from individual interviews with stroke survivors, and focus group interviews with caregivers and health professionals; (3) Preliminary testing of eight prototypes with seven stroke survivors and their caregivers. RESULTS: After the preliminary testing of eight prototypes, four prototypes were not further developed whereas four prototypes were modified further. In addition, two new prototypes were developed, leaving six prototypes for further modification: 1) ActivFOAM for balance exercises, 2) WalkingSTARR to facilitate walking, 3) ActivBALL for hand exercises, 4) ActivSTICKS for upper arm exercises, and 5) ActivLAMP and 6) ActivTREE which both give visual feedback on progress of daily exercise and physical activities. ActivFOAM, ActivBALL and ActivSTICKS are all connected to a tablet where exercise instructions are given. All the exercise prototypes can be connected to ActivLAMP and ActivTREE to give feedback on how much exercise the user has done. Settings can be individualised and recommended daily time and/or repetition can easily be changed as the user progresses to higher activity levels. CONCLUSIONS: The development process of ActivABLES was guided by the principles of human-centred design, with iterative testing of future users, and by the MRC framework of complex intervention, with a repeated process of development and testing. This process resulted in six prototypes which are available for feasibility testing among a small group of community-dwelling stroke survivors.

Feasibility of ActivABLES to promote home-based exercise and physical activity of community-dwelling stroke survivors with support from caregivers: A mixed methods study.

BACKGROUND: Technical applications can promote home-based exercise and physical activity of community-dwelling stroke survivors. Caregivers are often able and willing to assist with home-based exercise and physical activity but lack the knowledge and resources to do so. ActivABLES was established to promote home-based exercise and physical activity among community-dwelling stroke survivors, with support from their caregivers. The aim of our study is to investigate the feasibility of ActivABLES in terms of acceptability, demand, implementation and practicality. METHODS: A convergent design of mixed methods research in which quantitative results were combined with personal experiences of a four-week use of ActivABLES by community-dwelling stroke survivors with support from their caregivers. Data collection before, during and after the four-week period included the Berg Balance Scale (BBS), Activities-Specific Balance Confidence Scale (ABC), Timed-Up-and-Go (TUG) and Five Times Sit to Stand Test (5xSST) and data from motion detectors. Semi-structured interviews were conducted with stroke survivors and caregivers after the four-week period. Descriptive statistics were used for quantitative data. Qualitative data was analysed with direct content analysis. Themes were identified related to the domains of feasibility: acceptability, demand, implementation and practicality. Data was integrated by examining any (dis)congruence in the quantitative and qualitative findings. RESULTS: Ten stroke survivors aged 55-79 years participated with their informal caregivers. Functional improvements were shown in BBS (+ 2.5), ABC (+ 0.9), TUG (- 4.2) and 5xSST (- 2.7). More physical activity was detected with motion detectors (stand up/sit down + 2, number of steps + 227, standing + 0.3 h, hours sitting/lying - 0.3 h). The qualitative interviews identified themes for each feasibility domain: (i) acceptability: appreciation, functional improvements, self-initiated activities and expressed potential for future stroke survivors; (2) demand: reported use, interest in further use and need for follow-up; (3) implementation: importance of feedback, variety of exercises and progression of exercises and (4) practicality: need for support and technical problems. The quantitative and qualitative findings converged well with each other and supported the feasibility of ActivABLES. CONCLUSIONS: ActivABLES is feasible and can be a good asset for stroke survivors with slight or moderate disability to use in their homes. Further studies are needed with larger samples.

The Leadership Mentoring in Nursing Research Program for Postdoctoral Nurses: A Development Paper.

PURPOSE: The Dutch Nursing Science Faculties developed the Leadership Mentoring in Nursing Research program, which aims to increase the cadre of nurse scientists, strengthen nursing research within universities, and improve the career development of postdoctoral nurses. The purpose of this article was to describe the development of the leadership and mentoring program to foster its replication and to present a formative program evaluation. DESIGN: The leadership mentoring program was developed using a three-step procedure: a systematic review of the literature on successful leadership programs was conducted; theoretical underpinnings were identified and input; and feedback was solicited from national and international experts and changes made, resulting in the final program, which was executed from February 2016-2018. FINDINGS: A 2-year leadership and mentoring program for postdoctoral nurses working in research was developed and executed. Ten fellows completed the program and worked on their leadership development, developed their own research programs, and established research collaborations. Formative evaluations showed that the fellows highly valued the program sessions. We have learned several key lessons on how to structure, implement, and evaluate the leadership and mentoring program. CONCLUSIONS: Through the leadership and mentoring program, the fellows are immersed in concerted leadership development focusing on the academic leadership role. Formative evaluations showed that the program was valued by the fellows and that several key lessons were learned. CLINICAL RELEVANCE: Through the leadership and mentoring program, 10 postdoctoral nurses strengthened their leadership in research and will further develop their role in healthcare research, clinical practice, and education.

Postdoctoral Nurses' Experiences With Leadership and Career Development: A Qualitative Study.

PURPOSE: The purpose of this study was to explore the experiences and perceptions of Dutch postdoctoral nurses working in research with leadership and career development. METHODS AND DESIGN: A generic explorative qualitative design with semistructured in-depth interviews was used. A criterion sample of 13 postdoctoral nurses working in research in the Netherlands was included. The data were analyzed using thematic analysis. FINDINGS: Three themes were identified: (a) developing leadership and identity as a PhD nurse, (b) becoming a valuable member in the scientific world of academe, and (c) continuous search for progression while balancing worlds and tasks. Postdoctoral nurses experienced their leadership and professional development as a serious and conscious process. Their vision of nursing, health care, and research was an important motive regarding future career choices. Although the scientific world of academe was perceived as honorable, the nurses experienced it as a complex work environment. All the postdoctoral nurses had to deal with the demands and pressures of the scientific world. Coping with the tension between enjoying work and handling high workloads and academic achievements was described as challenging. Searching for balance was important, especially because of the different part-time employment or working activities with various commitments. CONCLUSIONS: This study demonstrates that postdoctoral nurses do show considerable progression in their leadership and career development; however, they experience the scientific working environment as challenging. The findings of this study indicate the need for more academic positions, the strengthening of the infrastructure for nursing research, and the development of supportive leadership and mentoring programs for postdoctoral nurses to provide optimal evidence-based and high-quality care for patients. CLINICAL RELEVANCE: Postdoctoral nurses need to develop strong leadership competencies to strengthen research, education, and evidence-based practice in clinical care to improve patient and healthcare outcomes.

Feasibility of a nurse-led intervention for the early management of depression after stroke in hospital.

AIM: To explore the feasibility of the Post-Stroke Depression toolkit in terms of fidelity and acceptability in daily nursing practice. BACKGROUND: Depression after stroke is common and influences patients' recovery significantly. Although stroke guidelines recommend early depression screening and treatment, depressive symptoms remain unrecognized. To enhance adoption of evidence into the context of the daily practice of stroke treatment, we developed the Post-Stroke Depression toolkit, an evidence-based nurse-led intervention for the early management of depressive symptoms after a stroke for use in the hospital setting. DESIGN: An explanatory mixed-methods before-and-after study design. METHODS: Data were collected continuously from March 2012 - June 2013 during three phases: pre-implementation, the implementation phase (where implementation strategies guided the implementation) and the sustainability phase (executed without the implementation strategies) and involved patient chart audits and surveys and individual and focus group interviews with nurses. RESULTS: A total of 775 patient charts were audited to examine fidelity. Implementation of the Post-Stroke Depression toolkit during the implementation phase resulted in an increase in depression screening (+72.9%) and more patients receiving nursing interventions (+11.1%). During the sustainability phase, screening for depression decreased (-16.3%), while the application of the nursing interventions remained unchanged (+0.6%). The acceptability of the toolkit was judged to be good. CONCLUSIONS: The Post-Stroke Depression toolkit was found to be feasible in terms of fidelity and acceptability, improving structural screening for depressive symptoms as well as the application of nursing interventions in case of a positive screening. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03500250.

Development and testing of an analytic rubric for a master's course systematic review of the literature: A cross-sectional study.

Background: Conducting grading of systematic reviews in master's level programs of health sciences education is a complex process. Students conduct systematic reviews under the supervision of course faculty in seminar groups where both draft version and definite version of the literature review are graded/assessed. The aim of this study was to develop a systematic review of the literature rubric (SRL-rubric) for the evaluation of systematic reviews in the course of SRL in a master's Program of Health Care Sciences and to investigate students and faculty experiences with and the usability of the SRL-rubric. Methods: The SRL-rubric was developed using a seven-step approach. Usability was investigated with cross-sectional survey. Results: The SRL-rubric included nine categories and five proficiency levels. Fifty-two of 59 students and all six faculty members at Utrecht University Program of Health Care Sciences completed the survey. Students rated the ease of working with the rubric with an average 6.6 (10-point scale). Faculty ratings ranged from 7 to 9. Problems were identified with distinction among cells describing proficiency levels and final grading. Discussion: A structured process focused on the requisite actions to develop the SRL-rubric. It was useful in writing and grading systematic reviews. However, some students indicated that they missed specific feedback and suggestions describing how to improve their weaknesses. Further development and research is needed to enhance grading reliability of SLR-rubric and to establish content validity and maintain consistency with criteria for conducting and reporting reviews.

Psychometric evaluation of the Signs of Depression Scale with a revised scoring mechanism in stroke patients with communicative impairment.

OBJECTIVES: To investigate (1) the diagnostic value of the Signs of Depression Scale (SODS) in a Likert scale format and (2) whether the Likert scale improves the diagnostic value compared with the original dichotomous scale. DESIGN: Cross-sectional multicentre study. SETTING: One general and one university hospital in the Netherlands. SUBJECTS: A total of 116 consecutive hospitalized stroke patients, of whom 53 were patients with communicative impairment. MAIN MEASURES: Depression was diagnosed with the Composite International Diagnostic Interview (CIDI) administered to the patients' relatives. The Barthel Index (BI) was used as an external validator. RESULTS: The correlation between the CIDI and the SODS-Likert or the SODS was small ( rb = 0.18), and the correlation between the Barthel Index and the SODS-Likert ( rs = -0.30) or the SODS ( rs = -0.33) was moderate. For both instruments, the discriminatory power for diagnosing depression when compared with the CIDI was best at a cut-off score of ⩾2. The internal consistency of the SODS-Likert was acceptable (α = 0.69) and slightly higher than that of the SODS (α = 0.57). The inter-rater reliability of the SODS-Likert and the SODS was acceptable (intraclass correlation coefficient (ICC) 0.66 and ICC 0.80, respectively). The clinical utility was rated good. CONCLUSION: The diagnostic value of the SODS did not improve using a Likert scale format. However, the diagnostic value of the original dichotomous SODS is reasonable for the initial mood assessment of stroke patients with communicative impairment.

Implementation and feasibility of the stroke nursing guideline in the care of patients with stroke: a mixed methods study.

BACKGROUND: Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing. Therefore, the Stroke Nursing Guideline (SNG) was developed and implemented. The aim of this study was to determine the implementation and feasibility of the SNG in terms of changes in documentation and use of the guideline in the care of stroke patients on Neurological and Rehabilitation wards, barriers and facilitators, and nurses' and auxiliary nurses' view of the implementation. METHODS: A sequential explorative mixed method design was used including pre-test post-test measures and post intervention focus groups interviews. For the quantitative part retrospective electronic record data of nursing care was collected from 78 patients and prospective measures with Barriers and Facilitators Assessment Instrument (BFAI) and Quality Indicator Tool (QIT) from 33 nursing staff including nurses and auxiliary nurses. In the qualitative part focus groups interviews were conducted with nursing staff on usefulness of the SNG and experiences with implementation. RESULTS: Improved nursing documentation was found for 23 items (N = 37), which was significant for nine items focusing mobility (p = 0.002, p = 0.024, p = 0.012), pain (p = 0.012), patient teaching (p = 0.001, p = 0.000) and discharge planning (p = 0.000, p = 0.002, p = 0.004). Improved guideline use was found for 20 QIT-items (N = 30), with significant improvement on six items focusing on mobility (p = 0.023), depression (p = 0.033, p = 0.025, p = 0.046, p = 0.046), discharge planning (p = 0.012). Facilitating characteristics for change were significantly less for two of four BFAI-subscales, namely Innovation (p = 0.019) and Context (p = 0.001), whereas no change was found for Professional and Patient subscales. The findings of the focus group interviews showed the SNG to be useful, improving and providing consistency in care. The implementation process was found to be successful as essential components of nursing rehabilitation were defined and integrated into daily care. CONCLUSION: Nursing staff found the SNG feasible and implementation successful. The SNG improved nursing care, with increased consistency and more rigorous functional exercises than before. The SNG provides nurses and auxiliary nurses with an important means for evidence based care for patients with stroke. Several challenges of implementing this complex nursing intervention surfaced which mandates ongoing attention.

Identifying depression post-stroke in patients with aphasia: a systematic review of the reliability, validity and feasibility of available instruments.

OBJECTIVE: To identify and critically appraise the evidence for instruments assessing depression in stroke patients with aphasia. METHODS: The PubMed, CINAHL, Web of Science, Psych Info and Cochrane databases were searched from inception until May 2015. RESULTS: Of the 383 titles found in the search, 15 articles met the inclusion criteria and six instruments were identified: The Aphasic Depression Rating Scale, the Clinical Global Impression-Scale, the Stroke Aphasic Depression Questionnaire (four versions), the Signs of Depression Scale, the Visual Analogue Mood Scale (three versions) and the Visual Analogue Self Esteem Scale. Supporting evidence for reliability and validity was limited owing to methodological flaws in the studies influencing the ratings of methodological quality. Feasibility data were available for all instruments. Rating time of the instruments ranged from less than one minute to five minutes, two instruments required extensive training. CONCLUSION: A number of instruments to assess depressive symptoms in patients with aphasia are available. None of the instruments however, were found to be sufficiently investigated and most of the studies identified were of low methodological quality. Given the present evidence, the Stroke Aphasic Depression Questionnaire-10, the Stroke Aphasic Depression Questionnaire-H10 and the Signs of Depression Scale are the most feasible and can be recommended for clinical practice.

Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis.

BACKGROUND: Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence. METHODS: We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression. RESULTS: In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = -0.395, P = 0.001), concerns about ART (SMD = -0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = -0.305, P = 0.001), stigma about HIV (SMD = -0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = -0.196, P = 0.001), daily dosing frequency (SMD = -0.193, P = 0.001), financial constraints (SMD -0.187, P = 0.001) and pill burden (SMD = -0.124, P = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries. CONCLUSIONS: These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects.

Clinimetric properties of the Timed Up and Go Test for patients with stroke: a systematic review.

OBJECTIVE: To systematically review and summarize the clinimetric properties, including reliability, validity, and responsiveness, the procedures used, and the meanings of the scores in the Timed Up and Go Test (TUG). The TUG is a performance test that identifies problems with functional mobility in patients with stroke. METHODS: MEDLINE and the Cochrane Central Register of Controlled Trials were searched from 1991 to January 2013. Studies were included if (1) the participants were adults with stroke; (2) the research design was cross-sectional, descriptive, or longitudinal and examined the clinimetric properties, including reliability, validity, and sensitivity to change, and procedural differences in the TUG; and (3) the study was published in English from 1991 to January 2013. RESULTS: Thirteen studies met the inclusion criteria. Of these, 4 showed the TUG to have good convergent validity, as it had significant correlations with various instruments. Three studies that investigated the test-retest reliability showed the TUG to have excellent intrarater and interrater reliability (intraclass correlation coefficient [ICC] ≯ 0.95). The 3 studies that investigated whether the TUG could predict falls after stroke showed inconclusive results. Three studies showed the TUG to be sensitive to change, and 1 study showed the TUG to be responsive in moderate- and fast-walking patients with stroke. However, there were wide variations in the procedures and instructions used. CONCLUSION: The TUG can be recommended for measuring basic mobility skills after stroke in patients who are able to walk. However, the procedures and instructions should be described more clearly.

Living at home with eating difficulties following stroke: a phenomenological study of younger people's experiences.

AIMS AND OBJECTIVES: To explore and describe the experience of eating and eating-related difficulties in stroke survivors living at home. BACKGROUND: The ability to consume food and to take pleasure in eating is an essential part of life. For people with stroke, eating difficulties are frequent. A phenomenological perspective of stroke survivors' experience of eating difficulties exceeding the acute stroke event and in-hospital rehabilitation is missing. DESIGN: A qualitative study founded on the Husslarian descriptive phenomenology. METHODS: Colaizzi's seven phases of data analysis provided a systematic approach to explore 17 in-depth interviews from seven participants and how eating difficulties influenced their daily lives. RESULTS: Eating difficulties revealed themselves in participants' relationship with the outer world in far-reaching disruptions of habits, capacities and actions. Four key themes illuminating the eating difficulties emerged: (1) preserving dignity by not conveying serious problems, (2) staying vigilant to bodily limitations, (3) stepping out of the security zone and (4) moving on without missing out. The findings exposed that eating difficulties might not only lead to serious consequences such as malnutrition but also, and equally importantly, lead to losses in the existential, social and cultural lifeworld. CONCLUSIONS: The experience of eating difficulties entails an ongoing readjustment process, which is strongly influenced by interactions with other people. The findings suggest that individualised long-term support is needed to facilitated the use of helpful strategies to manage eating difficulties. RELEVANCE TO CLINICAL PRACTICE: The long-term losses that people with eating difficulties experience are not reflected in conventional screening tools and interventions. To avoid haphazard identification presupposes professional knowledge of how eating difficulties are woven into daily life. This knowledge may inform innovative nursing strategies reaching beyond immediate rehabilitation. Partnership-based practice may provide an important framework to establish unique needs and to mobilise relevant actions and resources.

In-hospital risk prediction for post-stroke depression: development and validation of the Post-stroke Depression Prediction Scale.

BACKGROUND AND PURPOSE: The timely detection of post-stroke depression is complicated by a decreasing length of hospital stay. Therefore, the Post-stroke Depression Prediction Scale was developed and validated. The Post-stroke Depression Prediction Scale is a clinical prediction model for the early identification of stroke patients at increased risk for post-stroke depression. METHODS: The study included 410 consecutive stroke patients who were able to communicate adequately. Predictors were collected within the first week after stroke. Between 6 to 8 weeks after stroke, major depressive disorder was diagnosed using the Composite International Diagnostic Interview. Multivariable logistic regression models were fitted. A bootstrap-backward selection process resulted in a reduced model. Performance of the model was expressed by discrimination, calibration, and accuracy. RESULTS: The model included a medical history of depression or other psychiatric disorders, hypertension, angina pectoris, and the Barthel Index item dressing. The model had acceptable discrimination, based on an area under the receiver operating characteristic curve of 0.78 (0.72-0.85), and calibration (P value of the U-statistic, 0.96). Transforming the model to an easy-to-use risk-assessment table, the lowest risk category (sum score, <-10) showed a 2% risk of depression, which increased to 82% in the highest category (sum score, >21). CONCLUSIONS: The clinical prediction model enables clinicians to estimate the degree of the depression risk for an individual patient within the first week after stroke.