The elements of end-of-life care provision in paediatric intensive care units: a systematic integrative review.

BACKGROUND: Deaths in paediatric intensive care units (PICUs) are not uncommon. End-of-life care in PICUs is generally considered more challenging than other settings since it is framed within a context where care is focused on curative or life-sustaining treatments for children who are seriously ill. This review aimed to identify and synthesise literature related to the essential elements in the provision of end-of-life care in the PICU from the perspectives of both healthcare professionals (HCPs) and families. METHODS: A systematic integrative review was conducted by searching EMBASE, CINAHL, MEDLINE, Nursing and Allied Health Database, PsycINFO, Scopus, Web of Science, and Google Scholar databases. Grey literature was searched via Electronic Theses Online Service (EthOS), OpenGrey, Grey literature report. Additionally, hand searches were performed by checking the reference lists of all included papers. Inclusion and exclusion criteria were used to screen retrieved papers by two reviewers independently. The findings were analysed using a constant comparative method. RESULTS: Twenty-one studies met the inclusion criteria. Three elements in end-of-life care provision for children in the PICUs were identified: 1) Assessment of entering the end-of-life stage; 2) Discussion with parents and decision making; 3) End of life care processes, including care provided during the dying phase, care provided at the time of death, and care provided after death. CONCLUSION: The focus of end-of-life care in PICUs varies depending on HCPs' and families' preferences, at different stages such as during the dying phase, at the time of death, and after the child died. Tailoring end-of-life care to families' beliefs and rituals was acknowledged as important by PICU HCPs. This review also emphasises the importance of HCPs collaborating to provide the optimum end-of-life care in the PICU and involving a palliative care team in end-of-life care.

Effect of integrated English hybrid learning for undergraduate nursing students on students' self-perceived communication competence and communication apprehension: A quasi-experiment study.

Aim: To demonstrate the self-perceived communication competence and communication apprehension of nursing students before and after taking English for Nursing courses. Background: Despite the growing demand for English as a foreign language courses for nursing students in Indonesia, relatively little research has been conducted to investigate whether these courses meet students' specific learning needs to increase communication competency. Design: Quasi-experiment. Methods: A total of 173 undergraduate nursing students participated and had access to the mixed-methods learning system of integrated English hybrid learning from August through December 2021. The learning methods involved lectures, tutorials, and project-based learning on multiple platforms, such as LiVE Unpad, WhatsApp, and Zoom. Communication competence and apprehension in the English Language were assessed using the Self-Perceived Communication Competence and Communication Apprehension questionnaires via Google Form, and were analyzed using the paired t-test and ANOVA. Results: The findings suggest that English for Nursing courses significantly increased self-perceived communication competence and communication apprehension among nursing students (p < 0.001 for both). A variance test revealed favorability for self-perceived communication apprehension in groups that enjoyed learning English and for communication apprehension in groups that read English texts frequently and rarely. Conclusions: Integrated English hybrid learning for undergraduate nursing students effectively increased their self-perceived communication competence and communication apprehension in undergraduate nursing students. However, this approach cannot be applied to all nursing education levels. A combination of the current and new approaches, as suggested by educators and policymakers, should make it applicable to the desired level of nursing education.

Problems Facing Healthcare Providers When Caring for COVID-19 Patients: An Integrative Review.

The COVID-19 outbreak is a world health problem that affects millions of people. The pandemic is also causing burdens and challenges to health-care providers. Therefore, this study aimed to examine and help understand health-care providers' problems when caring for COVID-19 patients. An integrative review following Whittemore and Kanfl's approach was used along with a systematic search for emerging online databases and grey literature conducted from January to August 2021. The quality of papers was analyzed and a report was presented following PRISMA guidelines. A total of 18 articles that were predominantly descriptive with five themes, including mental health problems in the early stage of COVID-19 outbreak, working stress, physical and psychological impacts of disease, and the lack of support were analyzed. The results showed the pandemic's significant psychological impact on health-care providers directly caring for COVID-19 patients. Emotional, facilities and family support are needed to maintain the health-care providers' well-being.

Impact of Point of Care Quality Improvement Training and Coaching on Quality Perceptions of Health Care Workers: Implication for Quality Policy.

Background: The quality of infant healthcare service is one of the essential factors in preventing infant mortality. The purpose of the study was to analyze the quality performance in primary healthcare centers (PHC) and hospitals before and after the point of care quality improvement (POCQI) training for Infant Healthcare Services (IHS). Methods: This is a mixed-method study design with convergence triangulation strategy, conducted at six public PHCs and four hospitals in two districts of West Java Province, Indonesia. One hundred health care workers (HCWs) were involved for quantitative study at baseline and end of intervention. An additional 40 patients participated as informants for qualitative study. Quantitative data analysis was performed by Rasch modeling and independent t-test for all variables, followed by content analysis for qualitative data. Results: There were significant changes in the variables of POCQI skill (mean diff: 5.14, p=0.001), quality improvement (QI) understanding (mean diff: 1.2; p=0.001), and QI engagement (mean diff: 1.7; p=0.001) in the PHC group. Although there was an increase in process and outcome variables, the changes were not significant. There was a significant change in all variables in the hospital group which were outcome (mean diff: 2.32 (p=0.19); POCQI skill (mean diff: 2.80, p=0.001); process (mean diff: 1.48, p= 0.01); QI understanding (mean diff: 1.01; p=0.01), and QI engagement (mean diff: 1.52; p=0.03). Patient perception in the qualitative study showed that PHCs and Hospitals' services improved. Moreover, health care workers found they have a better understanding of service quality and created quality changes and improved POCQI steps. Conclusion: Implementation of POCQI in PHC and hospitals improved the performance of the quality of his, therefore assuring that POCQI is an appropriate approach and tool to be adopted in the policy for strengthening the health system.