Sexual well-being needs of patients with chronic illness expressed in health care: A scoping review.

AIMS: To systematically identify and summarize the needs of chronically ill people concerning their sexual well-being in peer-reviewed published literature, to enable healthcare professionals to provide support in self-management satisfying the needs. DESIGN: A scoping review was performed according to the framework of (JBI Manual for Evidence Synthesis. JBI Global Wiki, 2020). Findings are reported in line with the PRISMA extension for scoping reviews. REVIEW METHODS: A literature search and thematic analysis were conducted. DATA SOURCES: Full research was carried out in 2022 in the search engine BASE and the following databases: Scopus, MEDLINE, Science Citation Index Expanded, Social Sciences Citation Index and CINAHL. Peer-reviewed articles published after 2011 were included. RESULTS: Fifty articles could be found. Seven categories of needs could be identified. People with chronic diseases want their providers to initiate discussions about sexual concerns and treat them trustfully and respectfully. Most of the patients would like the issue of sexuality to be included in routine care. They perceive their medical specialists and psychologists as preferred providers to talk to about this issue. Nurses are seen as primary contact persons but in a smaller number of studies. CONCLUSION: Although the scoping review included different types of chronic diseases, the needs of chronically ill patients concerning their sexual well-being are not very different. Healthcare professionals, especially nurses, who are often the first point of contact for people with chronic illnesses, should take the initiative for open discussions about sexual issues. That requires a new understanding of the role of nurses, training and further education. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Providing patient education and facilitating an open discussion about sexuality require further training in the new understanding of the role of the nurse and the concept of sexual well-being. IMPACT: What problem did the study address? Chronic diseases have an impact on patients' sexuality. Patients want to be informed about sexual issues, but providers often do not address them. What were the main findings? Patients with a chronic condition expect providers to initiate discussions about sexual well-being, regardless of the type of chronic disease. Where and on whom will the research have an impact? The research will impact healthcare professionals', especially nurses', future educational standards and ultimately patients. REPORTING METHOD: PRISMA extension for scoping reviews. NO PATIENT OR PUBLIC CONTRIBUTION: Not required as it was a literary work (scoping review).

Local confinement and bedridden in the context of boundedness - The development of a conceptual definition based on an integrative review / Ortsfixierung und Bettlägerigkeit im Kontext von Gebundenheit (boundedness) - Die Entwicklung einer konzeptuellen Begriffsdefinition auf Grundlage einer integrativen Übersichtsarbeit

Background: Local confinement and bedridden are important phenomena in nursing care. Nevertheless, conceptual definitions and appropriate nursing diagnoses are missing in the current nursing classification systems. Aim: The aim is to provide the basis for a conceptual definition. To this end, the current state of the German and English usage of the terms local confinement and bedridden are presented. At the same time, definitions of English-language terms, which are internationally widely recognized, are elaborated. Additionally, phenomena associated with local confinement and bedridden are recorded and delimited of each other. Method: The identification of the German and English conceptual usage takes place through an integrative literature review covering the period from 1990 to 2016. Results: There are a variety of English-language terms of location confinement and bedridden. The concepts of homebound, wheelchairbound and bedridden form of local confinement and bedridden most extensively. Instability, immobility is connected as cause and inactivity as a consequence. In contrast to this is bedrest, which is ordered and temporally limited. Conclusions: Local confinement and bedridden are to be viewed through the definition of boundedness. The antecedents (instability, immobility) must be diagnosed to derive adequate interventions to avoid or alleviate the consequences.

[A reflective case report applied to pain management in a complex care situation]. / Eine reflexive Fallarbeit bezogen auf das Schmerzmanagement in einer komplexen Pflegesituation.

PROBLEM: This case report deals with the unsatisfying pain management of a 44 year old patient with cardiac arrest and subsequent cardiopulmonary resuscitation. The patient has (1) a reduced consciousness, (2) is isolated due to an infection with multi-resistant germs, (3) has a tracheotomy and (4) contractures of the muscles in fingers and hands. During nursing care he shows facial expressions and body postures that indicate pain which is insufficiently addressed. METHOD: The case was processed according to the model of reflexive case report by Johns (1995) and interpreted by theoretical expertise and the change of the perspective. Therefore the following questions were answered: Which factors made the nurse who brought the case to the case deliberation feeling dissatisfied with the pain management? RESULTS: Insufficient pain management due to a lack of knowledge, no assessment of the state of consciousness, pain and isolation probably led to unnecessary burden of the patient, next of kin and nurses. Training, systematic pain management and multi-disciplinary case conferences might facilitate dealing with comparable complex situations of caring in the future. DISCUSSION: The present case report shows that pain can only be treated successfully if pain-triggering factors are recognized, systematically assessed and treated. An adequate external assessment of the pain situation is especially important when dealing with patients who suffer from disorders of consciousness. In complex cases, in which multiple factors influence the pain situation, interdisciplinary case conferences may help to improve the quality of pain management.

Informed consent, vulnerability and the risks of group-specific attribution.

People in extraordinary situations are vulnerable. As research participants, they are additionally threatened by abuse or exploitation and the possibility of harm through research. To protect people against these threats, informed consent as an instrument of self-determination has been introduced. Self-determination requires autonomous persons, who voluntarily make decisions based on their values and morals. However, in nursing research, this requirement cannot always be met. Advanced age, chronic illness, co-morbidity and frailty are reasons for dependencies. These in turn lead to limited abilities or opportunities for decision-making and self-determination. Exclusion of vulnerable people from research projects would disadvantage them by not covering their needs, which would violate the ethical principles of justice and beneficence. Commonly, vulnerability is attributed to social groups. The consequence for individuals, attributed as belonging to such a vulnerable group, is that the principles of respect for autonomy, justice and beneficence are subordinated to the principle of non-maleficence, understood as avoiding the risk to cause more harm than good. In addition, group-specific attribution could lead to stigmatizing because labelling a person as deviation from a norm violates integrity. For clinical nursing research, the question arises how the protection of vulnerable people could be granted without compromising ethical principles. The concept of relational ethics provides a possible approach. It defines vulnerability as the relation between a person's health status and the extent to which this person is dependent on the researcher and the research context. Vulnerability is not attributed solely to a person but to a situation, meaning the person is viewed in context. By combining vulnerability as a context-related and situational concept with existing approaches of informed consent, the different ethical principles can be balanced and preserved at every step of the research process.

Mind the gaps in ethical regulations of nursing research.

The introduction of and the commitment to evidence-based nursing in all care settings have led to a rapid increase of intervention and outcome-based research programs. Yet, the topics of nursing research are not only affected by interventions and outcomes but also affected by the concept of caring derived from humanistic philosophy. Considering this twofold orientation of nursing science, nuanced ethical regulations for nursing research programs are called for. In addition to the different research approaches, further arguments for ethical regulations are as follows: first, the different degrees of contextualization and the variety of participation models regarding the target groups; second, the capacities and opportunities of participants; and third, the caring relationship between nurses and research subjects. To capture these special features of nursing science, four approaches to fill the gaps in existing ethical regulations for nursing research are proposed: (a) process orientation, (b) community orientation, (c) context orientation, and (d) relation orientation.

Being wheelchair-bound and being bedridden: Two concept analyses.

AIM: Analysis of the concepts and development of a conceptual definition of being wheelchair-bound and being bedridden. DESIGN: Concept analysis. METHODS: Walker and Avant´s concept analysis method was used. A thematic analysis guided the determination of the attributes, antecedents and consequences. RESULTS: Being wheelchair-bound and being bedridden are defined as permanent states in which people are bound to an object. Being passively bound to a wheelchair and being bedridden both mean an increasing restriction of the life-space. Being passive wheelchair-bound often represents a preliminary stage to being bedridden. Both concepts have six attributes: in need of help, powerlessness, life-space confinement, mobility limitation, endurance and weakness. They differ in the main feature maintaining an independent sitting position. Physical immobility and physiological instability are antecedents with the following influencing factors: illness, complexity, burden, endogenous/exogenous booster. The consequences are the progression of inactivity and all related physical and psycho-social problems.

["If you're no longer able to get out and about " Validity and differentiation of the concepts of being homebound, wheelchair-bound and bedridden: A Delphi study]. / "Nicht mehr raus können!" Validität und Differenzierung der Konzepte Hausgebundenheit, Rollstuhlgebundenheit und Bettlägerigkeit: eine Delphi-Studie.

INTRODUCTION: Being place-bound, including the dimensions of being homebound, wheelchair-bound and bedridden, has multifactorial consequences and carries an increased risk of mortality. The prevalence of being homebound and bedridden is high. Valid concepts are necessary to recognize the dimensions of being place-bound in practice and to act preventively or reductively. In preliminary studies, literature-based concept analyses of being homebound, wheelchair-bound and bedridden were carried out and a conceptual model with the following six characteristics was developed: life-space confinement, in need of help, powerlessness, mobility limitation, endurance, weakness. The aim of this study was to test the concept by differentiating and validating the dimensions of the model with regard to characteristics, antecedents, and risk factors. METHOD: Concept testing was carried out employing the Delphi method based on Fehring's DDV (Differential Diagnostic Validation) model. The CREDES guideline was used for reporting. RESULTS: Apart from the characteristic of endurance in connection with being wheelchair-bound, general approval was achieved for all six characteristics. Mobility limitation and weakness are the main characteristics of differentiation. Antecedents (physiological instability, physical immobility) and risk factors (illness, complexity, stress, endogenous/exogenous booster) were also consented. Regarding the concepts of being wheelchair-bound and bedridden, there was little consensus on the antecedents of physiological instability. The antecedents of physical immobility through hand strength and hand use received no consensus in any of the dimensions. The German terms of the dimensions, originally coined in English, were confirmed: Hausgebundenheit (being homebound) 78.26%, Rollstuhlgebundenheit (being wheelchair-bound) 60%, Bettlägerigkeit (being bedridden) 80%. DISCUSSION: With a few exceptions, a high level of consensus regarding the approval/rejection of the characteristics, antecedents, and risk factors of the dimensions of being homebound and bedridden is shown. This unambiguity is not evident in the dimension of wheelchair-boundness. One possible cause is the ambiguity of the term itself (active/passive/permanent/temporary wheelchair use). The rejection of physical immobility through hand strength/use is to be seen critically since this is essential in independent movement of the wheelchair and when turning/sitting down in bed. The fact that bedridden people, on the one hand, need a wheelchair to move and, on the other hand, cannot maintain a sitting position, must also be questioned. If an upright sitting position can be maintained, this must be promoted to support orthostatic stability, which would correspond to being wheelchair-bound. CONCLUSION: The validity of the dimensions of the model of being place-bound is an essential contribution to evidence-based health care and provides a basis for the development of nursing and interdisciplinary interventions to prevent and reduce being place-bound. Mobility does not only have a major impact on the individual quality of life, but also on the resources of the health care system. Therefore, a valid concept is not only important for science and research, but also for health economy and health policy. However, further studies on validity testing in clinical settings including those affected are necessary.

The burden of boundedness and the implication for nursing: A scoping review.

BACKGROUND: In the COVID-19 pandemic, many people experienced temporal boundedness in different ways (e.g., home, country, persons, and rules). However, being bound is also a permanent experience for chronically ill or handicapped people with sometimes serious consequences. To be able to recognize the phenomenon, a clear definition is necessary. In the literature, though, boundedness shows up as a very multifaceted phenomenon. OBJECTIVES: Exploring and conceptualizing the phenomenon of boundedness taking into account the various forms and the consequences for nursing. METHODS: A scoping review using the framework of Arksey and O'Malley and the PRISMA statement (PRISMA-ScR) to verify the fullness of the review. DATA SOURCES: Online dictionaries and theoretical and empirical publications in CINAHL, Medline via PubMed, PsycINFO, PsycArticles, Scopus, WISO. A total of 34 sources were included. RESULTS: Boundedness as a contextual concept is ambiguous. There are three basic causes: an acquired condition, personal obligations, arranged conditions, two principal courses: enduring and temporary, and seven types of being bound: to one or more person(s), to a place/position, to/in an object, to thoughts/opinions, to activities, to/in substances and to time. Examples of types are bedbound, culture-bound, homebound, time-bound, wheelchair-bound and are particularly relevant for care. The consequences are manifold, physically, as well as mentally, and socially. CONCLUSION: To reduce or avoid the burdens caused by boundedness, the concept must be implemented in nursing education and nursing practice. To this end, nursing research must further specify the types of boundedness in concept analyses and develop suitable interventions.

Homebound: A concept analysis.

AIM: Analysis of the concept and development of a conceptual definition of homebound. BACKGROUND: Homebound persons have a significantly higher mortality risk as well as physical and psychosocial burden. A clarification of the term is necessary to develop preventive measures. DESIGN: Concept analysis. DATA SOURCES: Scientific literature from electronic databases (CINAHL, Medline via PubMed, PsycINFO, PsycArticles, and Scopus) and definitions from online dictionaries. REVIEW METHODS: Walker and Avant's method was applied to guide the concept analysis. To prevent arbitrary and empty results in determining the attributes, antecedents, and consequences a thematic analysis was carried out. RESULTS: Homebound is defined as an enduring condition in which the life-space is reduced to the home, but moving around in the home is possible (by walking short distances alone or by holding on to furniture, or with the help of a stick, walker, or another person). Homebound has six attributes: in need of help in ADL/IADL and in leaving the life-space, powerlessness, life-space confinement, mobility limitation, endurance, and weakness. Physiological instability and physical immobility are antecedents with wide-ranging influencing factors as illness, complexity, burden, and endogenous/exogenous booster. Homebound has also wide-ranging consequences such as the progression of inactivity, physical, psychosocial, and/or spiritual problems. CONCLUSIONS: The multidimensional concept of homebound modifies the concepts of mobility and immobility. Given the extensive consequences of homebound nurses play a central role in the prevention.

[Transparency and replicability of nursing intervention studies in long-term care: A selective literature review]. / Transparenz und Replizierbarkeit pflegerischer Interventionsstudien im Setting der stationären Langzeitpflege: Eine selektive Literaturübersicht.

BACKGROUND AND OBJECTIVE: The development and evaluation of interventions in long-term care is time-consuming and expensive due to their complexity. To ensure reproducibility and successful implementation, these interventions must be described and published in a comprehensible and qualitative manner. The aim of this study is to analyze intervention studies from the inpatient long-term care setting with regard to their completeness, reporting quality, transparency and thus reproducibility. METHOD: The completeness and the reporting quality of the interventions described in the publications were examined in the context of a selective literature review by means of intervention studies from the long-term care setting (n=22). To this end, the Template for Intervention Description and Replication (TIDieR) checklist and the Criteria for Reporting the Development and Evaluation of Complex Interventions in Healthcare 2 (CReDECI2-DE) list were used. Transparency criteria included study registration and access to study protocols. RESULTS: The TIDieR checklist examination revealed that only three studies contained all the information necessary; the CReDECI2 test provided a complete description for only one study. Frequent shortcomings were observed concerning the information on modifications and titrations for the study participants and the location. Protocols were available for eight studies, 14 studies were registered. CONCLUSIONS: In terms of science, this means that the reproducibility of scientific findings is limited, which is why they cannot provide secure knowledge. As a result, the practical benefit to be derived from published studies that are accessible to decision-makers is limited as well. As far as publishers are concerned they should pay more attention to the completeness, registration and availability of materials.

[Standardised assessment instruments in the light of hermeneutics]. / Standardisierte Assessmentinstrumente im Lichte der Hermeneutik.

The use of standardised assessment instruments as part of evidence based practice is the logic result of its scientific foundation. The aim of this article is to show that the quality of assessments depends not only on the instrument itself but also on how it is applied. It is argued that the use of generalized insights in assessing an individual situation requires a multidimensional approach of interpretation. For this purpose the results of an assessment are defined as a text demanding interpretation based on three hermeneutic circles. Firstly, as a text in the context of the nurse's experience; secondly, as a text in the context of evidence; and thirdly, as a text in the context of the client's Lebenswelt. The main result is that the use of standardized assessment instruments asks for more attention regarding aspects of clients' Lebenswelten both in nursing science and nursing practice. This is particularly important for the comprehension of the meaning of illness and its related phenomena.