Palliative Care for Older Adults Hospitalized for Stroke From the Informal Caregivers' Perspectives: A Qualitative Study.

BACKGROUND: International guidelines have promoted palliative care (PC) for stroke survivors, but definition and implementation have been less than ideal. This practice gap is more prominent in China, where discussion of death remains taboo. AIM: The aim of this study was to explore the perspectives of PC among caregivers of hospitalized patients with stroke. DESIGN AND SETTING: A descriptive qualitative study design was used. Seventeen in-depth interviews with bedside caregivers in a first-rank tertiary hospital (general hospital with bed capacity exceeding 500) in China were analyzed thematically. RESULTS: "Promoting comfort" stands at the core of PC and was operationalized by "meeting physical care needs," "ensuring communication," "providing psychoemotional care," "providing cognitive stimulation," and "avoiding discussion on death and dying." Caregivers who took care of older adults for a long time have described the use of "cognitive stimulation" to promote patients' positive emotional and cognitive reactions. All interviewees avoided mentioning "death" to protect patients' feelings, because they believed discussion of death was hurtful. CONCLUSIONS: The high care demand for patients with stroke is a defining feature of stroke PC and should be recognized in addition to its prognosis estimation to promote this concept. The healthcare system should integrate PC as part of the regular service for patients with severe stroke to shift the focus of care from survival to promotion of comfort. A discussion of the dying process requires sensitivity and should be approached in a discussion of advanced PC planning, which views death as a meaningful transition.

Experience of coronary heart disease patients with a nurse-led eHealth cardiac rehabilitation: Qualitative process evaluation of a randomized controlled trial.

BACKGROUND: A previous randomized controlled trial (NeCR) has indicated the effectiveness of nurse-led eHealth cardiac rehabilitation (CR) on modifying the behaviors of patients with coronary heart disease. However, limited qualitative studies explore the experiences of using eHealth CR that led to such benefits. OBJECTIVE: The study aimed to explore the experiences of patients who participated in the NeCR program. METHODS: A descriptive qualitative study was employed among 20 intervention group patients who used the eHealth CR website and ranked differently (0-35th percentile, >35th percentile, and > 70% percentile) in the improvement of health-promoting behaviors. RESULTS: Five themes emerged: the NeCR program has promoted behavior change and mitigated emotional distress post-CHD. Patients described how the NeCR influenced cognitive determinants (knowledge and skill acquisition, having a roadmap, self-monitoring, and self-evaluation and resolution) and offered social support (professional counseling and peer interaction via multimedia chat) toward such change. Patients also appreciated the high affordability, accessibility, reliability of the NeCR, and expressed psychological, contextual, and technical barriers. CONCLUSIONS: Providing eHealth CR during patient discharge is warranted as an affordable, accessible, and reliable alternative to obtain health benefits. Extensive behavior change techniques, actionable CR guidance, and increased awareness are widely perceived enablers. Offering professional support and moderation is critical for early post-discharge consultation and for introducing direct peer interaction to reassure patients.

Learning compassionate care: Experiences of nursing students.

Compassion is a core value of the nursing profession which enables nurses to empathize with and help alleviate patient suffering. Literature increasingly reports a lack of compassion in patient care by students and junior nurses; empirical knowledge regarding experiences of compassionate care among nursing students remains understudied. Student experiences in the clinical setting may influence their development of compassion competencies. This study explored the experiences of baccalaureate nursing students in gaining competencies to deliver compassionate care during their clinical practice year. A descriptive qualitative study using semi-structured in-depth interviews was conducted. Thematic analysis was employed, generating six themes. The first three themes depict positive aspects of compassion development, including 'gaining patient acceptance,' 'motivation for professional growth,' and 'establishing an emotional bond with patients.' On the other hand, the other three themes capture the barriers to compassionate care, 'distrust,' 'fear of harm due to violence,' and 'heavy workload.' The positive and negative experiences shared by students indicate that hospital and nursing administrators need to foster a positive practice environment and nursing instructors should become role models to encourage compassionate care.

Systematic review of interventions to improve nurses' work environments.

AIMS: To evaluate the current evidence that examined the effects of nurses' work environment interventions on nurse, patient, and hospital outcomes; and the key intervention characteristics. DESIGN: Quantitative systematic review without meta-analysis. DATA SOURCES: Nine databases (British Nursing Index, CINAHL, EMBASE, Global Health, Global Health Archives, MEDLINE, Ovid Nursing, PubMed, and Web of Science) were searched following Systematic review Without Meta-analysis guideline to elicit studies that examined effects of interventions aimed at improving nurses' work environments among peer-reviewed publications from inception to April 2019. METHODS: Database search used the following keywords: nurs*, patient, hospital, healthcare intervention, organizational improvement, nurs*adj4 outcome, patient adj4 outcome*, hospital adj4 outcome*, and their MeSH terms. The Cochrane's Risk of Bias in Non-Randomized Studies of Intervention (ROBINS-I) was used for quality appraisal. Donabedian model of Quality of Care was used as the framework to categorize interventions components focusing on structure and process aspects of the nurse work environments. RESULTS: The interventions included the use of accreditation process, educational strategies, and participatory approach. By defining the interventions which demonstrated positive effects on the nurse, patient, and hospital outcomes as effective, it appears that they are more consistently characterized as focusing on process improvement, adopting participatory approach, with greater involvement of frontline and nurse executives and at unit-level implementation. CONCLUSION: Although the heterogeneity in the design of the review studies precludes making conclusive insights on the best evidence to improve nurses' work environments, the review informs the major research gaps in the topic area and the ways to design better interventions to enhance the outcomes. IMPACT: The study provides insights on intervention components and strategies that can contribute to healthy nurse work environments. By adapting unit-level process improvements that actively involve frontline and nurse executives, nurse leaders may provide a more directed approach towards achieving favourable outcomes.

Defining compassionate nursing care.

BACKGROUND: Compassion has long been advocated as a fundamental element in nursing practice and education. However, defining and translating compassion into caring practice by nursing students who are new to the clinical practice environment as part of their educational journey remain unclear. OBJECTIVES: The aim of this study was to explore how Chinese baccalaureate nursing students define and characterize compassionate care as they participate in their clinical practice. METHODS: A descriptive qualitative study design was used involving a semi-structured in-depth interview method and qualitative content analysis. Twenty senior year baccalaureate nursing students were interviewed during their clinical practicum experience at four teaching hospitals. ETHICAL CONSIDERATIONS: Permission to conduct the study was received from the Institutional Review Boards and the participating hospitals. RESULTS: Baccalaureate nursing students defined and characterized compassionate care as a union of "empathy" related to a nurse's desire to "alleviate patients' suffering," "address individualized care needs," "use therapeutic communication," and "promote mutual benefits with patients." Students recognized that the "practice environment" was characterized by nurse leaders' interpersonal relations, role modeling by nurses and workloads which influenced the practice of compassionate care by nursing personnel. CONCLUSION: Compassionate care is crucial for patients, nurses, and students in their professional development as well as the development of the nursing profession. In order to provide compassionate care, a positive practice environment promoted by hospital administrators is needed. This also includes having an adequate workforce of nurses who can role model compassionate care to students in their preceptor role while meeting the needs of their patients.

Effect of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients: A systematic review and meta-analysis.

AIMS: To evaluate the effects of eHealth cardiac rehabilitation (CR) on health outcomes of coronary heart disease patients and to identify programme design, which may lead to more effective health benefits. DESIGN: A systematic review and meta-analysis following Cochrane Handbook for Systematic Reviews of Interventions. DATA SOURCES: Medline, EMBASE, CLNAHL, Web of Science, Scopus, PsycINFO, Cochrane Central Register of Controlled Trails, PubMed and CNKI were searched over the period from 1806 to April 2019. REVIEW METHODS: A systematic review and meta-analysis of randomized controlled trials to examine the effect of eHealth CR on health outcomes of coronary heart disease patients. We used RevMan 5.3 for risk of bias assessment and meta-analysis and GRADE software for generating findings. RESULTS: In all, 14 trials with 1,783 participants were included. eHealth CR has significantly promoted duration of physical activity, daily steps, quality of life (QoL) and re-hospitalization. Using comparative analysis of programme design elements, including mode of delivery, intervention content, motivational strategies and social support, between the effective and ineffective eHealth CR, it was found that comprehensive empowerment strategies and follow-up care by tele-monitoring may be the crucial characteristics leading to more favourable treatment effect. CONCLUSION: eHealth CR is effective in engaging patients in active lifestyle, improving QoL and reducing re-hospitalization. Future research needs to test the effects of comprehensive CR programmes by incorporating empowerment strategies and tele-monitoring as active components. IMPACT: eHealth has been increasingly applied to increase accessibility and uptake of CR. Integrative evidence to indicate its effects on health outcomes is lacking. This review identified its positive effects on some behavioural, psychosocial and health service use outcomes. Together with insights about which programme design elements may positively shape the outcomes, this review informs the role and practice of cardiovascular nurses in promoting evidence-based eHealth CR.

A mixed methods study to evaluate the effects of a teamwork enhancement and quality improvement initiative on nurses' work environment.

AIMS: To test the effect of a teamwork enhancement and quality improvement program named 'Nurturing Effective Teams and Continuous Quality Improvement' on nurses' work environments in the hospital setting. DESIGN: Mixed-method study with quasi-experimental controlled trial and focus group interviews. METHODS: Twelve units from two Philippine tertiary government hospitals will be matched and allocated to have 72 nurses receiving the teamwork enhancement and quality improvement program, or no intervention. The program focuses on enhancing the nurse autonomy, leadership and management support, teamwork, and workload management, delivered in two phases: (a) teamwork enhancement training using team strategies and tools to enhance the performance and patient safety; and (b) implementation of quality improvement projects using the model for improvement to identify priority unit issues and change ideas and tested using the Plan-Do-Study-Act cycle. The 6-month implementation includes two trainings and seven mentoring sessions with a quality improvement facilitator. Primary outcome is the nurses' work environment and secondary outcomes are job satisfaction, burnout risk, turnover intention, and perceived quality of care provided measured at the nurse-level using self-administered survey and measured at 0, 3, and 6 months. Focus group interviews will be conducted among 14-16 nurse subjects to explore their experience during the program, while other stakeholders will be interviewed to reflect the program effects. Generalized equation modelling will be used to identify the program effects on the quantitative outcomes and content analysis will be used for qualitative data. DISCUSSION: Establishing measures to improve the nurses' work environments can be used to address poor nurse outcomes in high workload and low-resource settings. IMPACT: A favourable nurse work environment is the cornerstone to sustainable nursing workforce and positive outcomes. This study will provide explicit evidence to inform the effect of a structured evidence-based protocol in improving nurses' work environment given resource-limited context. TRIAL REGISTRATION: China Clinical Trial Registration Center (CciCTR), Registration number ChiCTR1900021754 (March 8, 2019).