Learning from the covid-19 outbreaks in long-term care facilities: a systematic review.

BACKGROUND: The COVID-19 pandemic has devastatingly affected Long-Term Care Facilities (LTCF), exposing aging people, staff members, and visitors. The world has learned through the pandemic and lessons can be taken to adopt effective measures to deal with COVID-19 outbreaks in LTCF. We aimed to systematically review the available evidence on the effect of measures to minimize the risk of transmission of COVID-19 in LTCs during outbreaks since 2021. METHODS: The search method was guided by the preferred reporting items for systematic reviews (PRISMA) and the reporting guideline synthesis without meta-analysis (SWiM) in systematic reviews. The search was performed in April 2023. Observational and interventional studies from the databases of PubMed, Web of Science, Scopus, Cochrane Systematic Reviews, CINAHL, and Academic Search were systematically reviewed. We included studies conducted in the LTCF with outbreaks that quantitatively assess the effect of non-pharmacological measures on cases of COVID-19. Two review authors independently reviewed titles for inclusion, extracted data, and undertook the risk of bias according to pre-specified criteria. The quality of studies was analyzed using the Joanna Briggs Institute Critical Appraisal. RESULTS: Thirteen studies were included, with 8442 LTCF experiencing COVID-19 outbreaks and 598 thousand participants (residents and staff members). Prevention and control of COVID-19 infection interventions were grouped into three themes: strategic, tactical, and operational measures. The strategic measures reveal the importance of COVID-19 prevention and control as LTCF structural characteristics, namely the LTCF size, new admissions, infection control surveillance, and architectural structure. At the tactical level, the lack of personal and long staff shifts is related to COVID-19's spread. Operational measures with a favorable effect on preventing COVID-19 transmission are sufficient. Personal protective equipment stock, correct mask use, signaling, social distancing, and resident cohorting. CONCLUSIONS: Operational, tactical, and strategic approaches may have a favorable effect on preventing the spread of COVID-19 in LTCFs experiencing outbreaks. Given the heterogeneous nature of the measures, performing a meta-analysis was not possible. Future research should use more robust study designs to explore similar infection control measures in LTCFs during endemic situations with comparable outbreaks. TRIAL REGISTRATION: The protocol of this systematic review was registered in PROSPERO (CRD42020214566).

Nurses' Interventions in Minimizing Adult Patient Vulnerability During Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation: An Integrative Review.

Introduction: People during extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation find themselves in a high degree of physical and psychological vulnerability, which could cause additional problems for their health status. Therefore, this review aims to identify the interventions that shape critical nursing care to minimize patient vulnerability during ECMO as a bridge to lung transplantation. Method: A literature review was performed using CINAHL, MEDLINE, PubMed, Scopus and Web of Science databases with searches conducted in March 2023, with temporal restriction of articles published between 2013 and 2023. After selecting articles involving adults in critical situations on ECMO, their quality was assessed using the critical appraisal tools from the Joanna Briggs Institute. Articles with the pediatric population, reviews, and opinion articles were excluded. A spreadsheet was built for data extraction and a narrative analysis was performed. Results: Three articles were included involving 40 participants in total. Interventions that shape critical nursing care to minimize a person's vulnerability are in the physical domain (basic precautions to prevent infection) and in the psychological domain (trusting relationships, consistent and clear communication, physical presence of nurses and family members and the use of advocacy). The Awake ECMO strategy was identified as beneficial for reducing vulnerability. Conclusion: By recognizing and identifying the person's vulnerability during ECMO as a bridge to lung transplantation, nurses can implement effective interventions to minimize vulnerability in this population, thus contributing to the person's well-being through personalization and individualization of care. Additionally, the results of this review could be useful for developing tools to assess the degree of vulnerability and for implementing person-centered care measures and policies. However, further research is warranted given the scarcity of literature on these topics.

Specialized nursing intervention on critically ill patient in the prevention of intubation-associated pneumonia: an integrative literature review.

Healthcare-associated infections are adverse events that affect people in critical condition, especially when hospitalized in an intensive care unit. The most prevalent is intubation-associated pneumonia (IAP), a nursing-care-sensitive area. This review aims to identify and analyze nursing interventions for preventing IAP. An integrative literature review was done using the Medline, CINAHL, Scopus and PubMed databases. After checking the eligibility of the studies and using Rayyan software, ten final documents were obtained for extraction and analysis. The results obtained suggest that the nursing interventions identified for the prevention of IAP are elevating the headboard to 30º; washing the teeth, mouth and mucous membranes with a toothbrush and then instilling chlorohexidine 0.12%-0.2% every 8/8 hr; monitoring the cuff pressure of the endotracheal tube (ETT) between 20-30 mm Hg; daily assessment of the need for sedation and ventilatory weaning and the use of ETT with drainage of subglottic secretions. The multimodal nursing interventions identified enable health gains to be made in preventing or reducing IAP. This area is sensitive to nursing care, positively impacting the patient, family, and organizations. Future research is suggested into the effectiveness of chlorohexidine compared to other oral hygiene products, as well as studies into the mortality rate associated with IAP, with and without ETT for subglottic aspiration.

Air quality self-management in asthmatic patients with COPD: An integrative review for developing nursing interventions to prevent exacerbations.

Objectives: Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) patients experience a lower quality of life, frequent exacerbations, and worse pulmonary function. Environmental management is essential in a complex chronic condition, as pollutant exposure can worsen symptoms and increase morbidity and mortality. We aimed to identify evidence that informs nursing interventions in promoting self-management of air quality in asthmatic people with COPD. Methods: We conducted an integrative review in March of 2023. We searched the databases CINAHL, MEDLINE, Academic Search Complete, Cochrane Database of Systematic Reviews (CDSR), Scopus, Web of Science, Joanna Briggs Institute (JBI) Evidence-Based Practice Database, and Google Scholar. We included articles whose participants were adults with asthma, COPD, or both; the intervention was air quality management and the outcome of any exacerbations. We excluded editorials, letters, commentaries, opinion papers, position papers, study protocols, conference abstracts, and reviews. Data extraction and synthesis were performed, categorizing interventions according to nursing actions. Methodological quality assessment was conducted using the JBI Critical Appraisal Checklist tools. The review protocol was registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/5Y4KW). Results: We included five articles from different countries. The interventions promoting air quality self-management for individuals with asthma and COPD included vigilance interventions (health professional regular visits, assessment of symptoms), monitoring interventions (measurement of indoor and outdoor trigger factors), and educational interventions (air quality alerts, allergen avoidance). Policy interventions such as smoke-free policies and comprehensive strategies to improve air quality were also identified. These areas of focus represent critical components of nurses' interventions and can integrate the fundamental patterns of knowing in nursing. Although the studies reveal heterogeneous interventions and the methodological quality is variable, these interventions showed potential for preventing exacerbations, reducing emergency department visits, and minimizing hospitalizations. Conclusions: The study emphasizes the need for a comprehensive approach involving nurses in multidisciplinary teams to air quality self-management. They can use these results to inform their interventions and ways of knowing, benefiting individuals with asthma and COPD. Further research is needed to expand the evidence base and refine these interventions.

Nurses' Experiences of Care in Portuguese Nursing Homes during the COVID-19 Pandemic: A Focus Group Study.

The COVID-19 pandemic has had a considerable influence on long-term care facilities, exposing the shortcomings of nursing homes in implementing recommendations by health authorities. It also emphasizes the need for a nursing management model customized to the vulnerable status of residents, organizational demands, and occupational nursing requirements. We aimed to characterize the perspectives of nurses who have experienced COVID-19 in nursing homes regarding measures implemented to avoid or manage outbreaks in that environment. An interview was conducted with a focus group following the consolidated Criteria for Reporting Qualitative research guidelines. Data analysis was performed using WebQDA software following a thematic category orientation. Eight Portuguese nurses working in nursing homes from the country's central area participated in this study. We identified three major significant areas for long-term care respiratory outbreak management: strategic (policy, staffing, and resources); tactical (training, organization, engagement, and supervision); and operational planning (vigilance, prevention of disease spread, and family involvement). From the participants' view, the management of COVID-19 in nursing homes must be highly supportive and responsive, offering resources to control risks, supporting residents' care, and ensuring the safety and well-being of residents and staff members. Saturation was not reached; thus, further research is needed in this area.

Effectiveness of preoperative breathing exercise interventions in patients undergoing cardiac surgery: A systematic review.

Postoperative pulmonary complications are a common cause of morbidity and mortality in patients undergoing cardiac surgery, leading to an increase in length of hospital stay and healthcare costs. This systematic literature review aims to determine whether patients undergoing cardiac surgery who undergo preoperative breathing exercise training have better postoperative outcomes such as respiratory parameters, postoperative pulmonary complications, and length of hospital stay. Systematic searches were performed in the CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Clinical Answers, Cochrane Database of Systematic Reviews, MEDLINE and MedicLatina databases. Studies were included if they examined adult patients scheduled for elective cardiac surgery, who underwent a preoperative breathing exercise training aimed at improving breathing parameters, preventing postoperative pulmonary complications, and reducing hospital length of stay. This systematic review was based on Cochrane and Prisma statement recommendations in the design, literature search, analysis, and reporting of the review. The search yielded 608 records. Eleven studies met the inclusion criteria. Ten studies were randomized controlled trials and one was an observational cohort study. Data from 1240 participants was retrieved from these studies and meta-analysis was performed whenever possible. A preoperative breathing intervention on patients undergoing cardiac surgery may help improve respiratory performance after surgery, reduce postoperative pulmonary complications and hospital length of stay. However, more trials are needed to support and strengthen the evidence.

Nursing students' learning from involvement in research projects: an integrative literature review.

OBJECTIVE: To identify the learning outcomes and skills obtained of undergraduate nursing students involved in research projects. METHODS: This was an integrative literature review, based on a research protocol in the CINAHL Complete databases; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Cochrane Methodology Register; MedicLatina; MEDLINE, Scopus and JBI, including primary and secondary studies, published between 2015 and 2020. RESULTS: A total of five heterogeneous articles were included, which were categorized using Kirkpatrick's (adapted) model. Seventeen learning outcomes acquired through participation in research projects were identified, from the learning of new knowledge and skills to the development of new attitudes and behaviors. FINAL CONSIDERATIONS: The involvement of nursing students in research projects is important to their professional development. Future investment in research on this topic can help cement the potential of this type of student involvement.

Nursing students' learning from involvement in research projects: an integrative literature review / Aprendizajes de estudiantes de enfermería involucrados en proyectos de investigación: revisión integrativa de la literature / Aprendizagens de estudantes de enfermagem envolvidos em projetos de investigação: revisão integrativa da literatura

ABSTRACT Objective: To identify the learning outcomes and skills obtained of undergraduate nursing students involved in research projects. Methods: This was an integrative literature review, based on a research protocol in the CINAHL Complete databases; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Cochrane Methodology Register; MedicLatina; MEDLINE, Scopus and JBI, including primary and secondary studies, published between 2015 and 2020. Results: A total of five heterogeneous articles were included, which were categorized using Kirkpatrick's (adapted) model. Seventeen learning outcomes acquired through participation in research projects were identified, from the learning of new knowledge and skills to the development of new attitudes and behaviors. Final considerations: The involvement of nursing students in research projects is important to their professional development. Future investment in research on this topic can help cement the potential of this type of student involvement.

RESUMEN Objetivo: Identificar aprendizajes y competencias desarrollados por estudiantes de Licenciatura en Enfermería involucrados en proyectos de investigación. Métodos: Revisión integrativa de la literatura, partiendo de un protocolo de investigación en las bases de datos CINAHL Complete; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Cochrane Methodology Register; MedicLatina; MEDLINE; Scopus y JBI, habiéndose incluido estudios primarios y secundarios publicados entre 2015 y 2020. Resultados: Se incluyeron cinco artículos heterogéneos, categorizados según el Modelo de Kirkpatrick (adaptado). Se identificaron diecisiete resultados de aprendizajes adquiridos por la participación en proyectos de investigación, desde el aprendizaje de nuevos conocimientos y competencias al desarrollo de nuevas actitudes y conductas. Consideraciones Finales: La participación de estudiantes de Licenciatura en Enfermería en proyectos de investigación se inscribe como de suma importancia para su desarrollo profesional. La inversión futura en investigación sobre esta temática podrá contribuir a cimentar el potencial de esta participación.

RESUMO Objetivo: Identificar aprendizagens e competências desenvolvidas pelos estudantes da Licenciatura em Enfermagem envolvidos em projetos de investigação. Métodos: Revisão integrativa da literatura, a partir de um protocolo de pesquisa nas bases de dados CINAHL Complete; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Cochrane Methodology Register; MedicLatina; MEDLINE, Scopus e JBI, tendo sido incluídos estudos primários e secundários publicados entre 2015 e 2020. Resultados: Foi incluído um total de cinco artigos, heterogêneos, que foram categorizados, por meio do Modelo de Kirkpatrick's (adaptado). Identificaram-se dezessete resultados de aprendizagem adquiridos com a participação em projetos de investigação, desde a aprendizagem de novos conhecimentos e competências até o desenvolvimento de novas atitudes e comportamentos. Considerações Finais: O envolvimento dos estudantes da licenciatura em Enfermagem em projetos de investigação afigura-se extremamente importante para o seu desenvolvimento profissional. O investimento futuro na investigação sobre essa temática poderá contribuir para alicerçar as potencialidades desse envolvimento.