Effects of mindfulness-based interventions on reducing psychological distress among nurses: A systematic review and meta-analysis of randomized controlled trials.

PURPOSE: Nurses increasingly use mindfulness as an effective mental health intervention to reduce psychological distress. The effectiveness of mindfulness-based interventions remains inconclusive, which may lead to implementation of interventions in an inefficient or ineffective manner. This study aimed to examine the effects of mindfulness-based interventions on reducing stress, anxiety, and depression among nurses. DESIGN: Systematic review and meta-analysis. METHODS: Randomized controlled trials (RCTs) were searched using six databases published through May 20, 2023, which evaluated the effects of mindfulness-based interventions on reducing psychological distress among nurses. To assess the quality of methodology included in the RCTs, version 2 of the Cochrane risk-of-bias instrument for RCTs with five domains was used. Standardized mean difference (SMD) with 95% confidence interval (CI) were calculated using the random-effects model in the meta-analyses. Publication bias was assessed using Egger's regression test. Further, the robustness effect size of the pooled analysis was assessed using leave-one-out sensitivity analysis. FINDINGS: A total of 16 RCTs were included in the final analysis. Overall, the modalities appeared to alleviate stress (pooled SMD: -0.50 [95% CI: -0.82 to -0.18]; p < 0.001) and depression (pooled SMD: -0.42 [95% CI: -0.78 to -0.06]; p = 0.02) among nurses. CONCLUSION: Mindfulness-based interventions appear to alleviate stress and depression in nurses. Future research evaluating mindfulness-based interventions among working nurses with more rigorous methodological and larger sample size. CLINICAL RELEVANCE: Support for nurses' mental health must be included while implementing personal and professional development plans.

Efficacy of Robots-Assisted Therapy in Patients With Stroke: A Meta-analysis Update.

BACKGROUND: Robot-assisted therapy (RAT) could address an unmet need to relieve the strain on healthcare providers and intensify treatment in the context of an increasing stroke incidence. A comprehensive meta-analysis could provide firmer data about the topic by considering methodology limitations discovered in previous reviews and providing more rigorous evidence. OBJECTIVE: This meta-analysis study identifies RAT's efficacy for patients with stroke. METHODS: A systematic search of the 7 databases from January 10 to February 1, 2022, located relevant publications. We used the updated Cochrane risk-of-bias checklist for 52 trials to assess the methodologic quality of the included studies. The efficacy of RAT for patients with stroke was estimated using a pooled random-effects model in the Stata 16 software application. RESULTS: The final analysis included 2774 patients with stroke from 52 trials. In those patients, RAT was proven to improve quality of movement (mean difference, 0.15; 95% confidence interval, 0.03-0.28) and to reduce balance disturbances (mean difference, -1.28; 95% confidence interval, -2.48 to -0.09) and pain (standardized mean difference, -0.34; 95% confidence interval, -0.58 to -0.09). CONCLUSIONS: Robot-assisted therapy seems to improve the quality of mobility and reduce balance disturbances and pain for patients with stroke. These findings will help develop advanced rehabilitation robots and could improve health outcomes by facilitating health services for healthcare providers and patients with stroke.

Effects of videoconferencing intervention on stroke survivors: A systematic review and meta-analysis of randomised controlled studies.

BACKGROUND: Videoconferencing has been proposed as an innovative telerehabilitation approach for stroke survivors, demand for which is growing. AIM: To evaluate the efficacy of a videoconferencing intervention for stroke survivors. DESIGN: Systematic review and meta-analysis. METHODS: We conducted a systematic review of the literature in the databases Academic Search Complete, CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, Ovid (and its companion UpToDate), and Web of Science published from January 1, 2002, to May 27, 2021. The methodologic quality of the included studies was evaluated using version 2 of the Cochrane risk-of-bias tool. A meta-analysis using a random-effects model calculated the pooled standardised mean difference (SMD) for using a videoconferencing intervention with stroke survivors and for the ability of survivors to perform activities of daily living (ADLs) and to maintain balance. The Stata software application (version 16.0: StataCorp LP) was used for the statistical analysis. RESULTS: Nine studies with 603 participants were included in the analysis. Videoconferencing interventions were observed to be effective in improving the ability of stroke survivors to carry out their ADLs (SMD: 0.57; 95% confidence interval [CI]: 0.13 to 1.01) and to recover their balance (SMD: 1.96; 95% CI: 1.27 to 2.66). CONCLUSIONS: Stroke survivors were able effectively to improve their ADL and balancing abilities. Further studies could consider the frequency, duration, and standard protocol for videoconferencing interventions. RELEVANCE TO CLINICAL PRACTICE: This study could change the approach to patient support in future clinical practice and might constitute an alternative for improving care for stroke survivors in their homes or in long-term care facilities.

Association between medicare annual wellness visits and prevention of falls and fractures in older adults in Texas, USA.

Fall-related injuries contribute to increased frailty, disability, and premature death in older adults (≥65 years). The US Centers for Medicare and Medicaid Services began reimbursing annual wellness visits (AWVs) in 2011. In the present study, we assessed the effect of AWV receipt in 2017 on fall and fracture prevention through December 31, 2018. Using Texas Medicare data for 2014-2018, we identified cohorts of Medicare beneficiaries ≥68 years, matched for the presence/absence of an AWV in 2017 by propensity score, and observed two outcomes: fracture as a primary diagnosis, and fall occurrences. Rates of each outcome were estimated using the Kaplan-Meier method. Of the 2017 beneficiaries, 32.2% received an AWV. For the 742,494 beneficiaries in the matched cohort, conditional Cox proportional hazards models revealed that receiving an AWV in 2017 was associated with reduced risks for future falls (3.9%) and fractures (4%). The effect of the AWV was stronger on fall reduction in rural residents (HR: 0.799; 95% CI: 0.679 to 0.941) and on fracture reduction in beneficiaries with ≥4 morbidities (HR: 0.918; 95% CI: 0.867 to 0.972). Receipt of an AWV in three consecutive years (2015-2017) further lowered the risk of future falls. We conclude that the risks for future falls/fractures are lower in older adults receiving AWVs. Our study underscores the need for expanded public education programs that raise awareness about AWVs and the potential for AWV data to inform fall prevention interventions and other health promotion practices.

Global prevalence of stigmatization and violence against healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis.

PURPOSE: During COVID-19, stigmatization and violence against and between professional healthcare workers worldwide are increasing. Understanding the prevalence of such stigmatization and violence is needed for gaining a complete picture of this issue. Therefore, the purpose of this review was to update estimates of the prevalence of stigmatization and violence against healthcare workers during the pandemic. DESIGN: A systematic review and meta-analysis was conducted. METHODS: This review followed PRISMA guidelines and encompassed these databases: PubMed, Academic Search Complete, CINAHL, Web of Science, MEDLINE Complete, OVID (UpToDate), and Embase (from databases inception to September 15, 2021). We included observational studies and evaluated the quality of the study using the Joanna Briggs Institute methodology. Further, a random effects model was used to synthesis the pooled prevalence of stigmatization and violence in this study. FINDINGS: We identified 14 studies involving 3452 doctors, 5738 nurses, and 2744 allied health workers that reported stigmatization and violence during the pandemic. The pooled prevalence was, for stigmatization, 43% (95% confidence interval [CI]: 21% to 65%) and, for violence, 42% (95% CI: 30% to 54%). CONCLUSIONS: Stigmatization and violence during the COVID-19 pandemic were found to have affected almost half the studied healthcare workers. Healthcare professionals are more prone to be stigmatized by the community and to face workplace violence. CLINICAL RELEVANCE: Health administrators and policymakers should anticipate and promptly address stigmatization and violence against and between healthcare workers, while controlling the spread of COVID-19. Health care systems should give serious attention to the mental health of all health providers.

Effects of telehealth interventions on performing activities of daily living and maintaining balance in stroke survivors: A systematic review and meta-analysis of randomised controlled studies.

BACKGROUND: Stroke is one of the most common causes of disability worldwide. In recent years, diverse telehealth programmes for stroke survivors have suggested that this mode of rehabilitation could improve stroke survivors' abilities to perform activities of daily living (ADLs) and maintain balance. Although increasingly utilised in clinical and community settings, the effectiveness of telehealth interventions in stroke survivors remains inconclusive. This warrants investigation so that telehealth interventions are evidence-based and are not merely modalities of convenience. AIM: To identify the effects of telehealth interventions on the ability to perform ADLs and maintain balance in stroke survivors. DESIGN: A systematic literature review and meta-analysis were conducted in accordance with PRISMA guidelines. METHODS: A systematic literature search was performed using seven databases for literature dated up to April 25, 2021. The revised Cochrane risk of bias tool for randomised trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth interventions. Stata 16.0 was used for the statistical analyses. RESULTS: A total of 14 studies with 1,367 participants were included in the analysis. Overall, telehealth interventions were effective in improving stroke survivors' abilities to carry out their ADLs (standardised mean difference: .45; 95% confidence interval: .12 to .78); however, no significant effects were found on balance. CONCLUSION: Telehealth interventions are beneficial for improving stroke survivors' performance of their ADLs. Future telehealth intervention trials should focus on identifying essential intervention delivery components that facilitate intervention adoption by clinicians and stroke survivors and sustain the positive effects on stroke survivors' performance of their ADLs in different settings. RELEVANCE TO CLINICAL PRACTICE: It is essential to build flexibility in the telehealth-based intervention delivery protocol to meet individual stroke survivors' needs to motivate and enhance their ADL performance.

Impact of State Nurse Practitioner Regulations on Potentially Inappropriate Medication Prescribing Between Physicians and Nurse Practitioners: A National Study in the United States.

BACKGROUND: The American Geriatrics Society regularly updates the Beers Criteria for Potentially Inappropriate Medication (PIM) to improve prescribing safety. PURPOSE: This study assessed the impact of nurse practitioner (NP) practices on PIM prescribing across states in the United States and compared the change in PIM prescribing rates between 2016 and 2018. METHODS: We used data from a random selection of 20% of Medicare beneficiaries (66 years or older) from 2015 to 2018 to perform multilevel logistic regression. A PIM prescription was classified as initial or refill on the basis of medication history 1 year before a visit. PIM use after an outpatient visit was the primary study outcome. RESULTS: We included 9 000 224 visits in 2016 and 9 310 261 in 2018. The PIM prescription rate was lower in states with full NP practice and lower among NPs than among physicians; these rates for both physicians and NPs decreased from 2016 to 2018. CONCLUSIONS: Changes could be due to individual state practices.

Adopting the Fall Tailoring Interventions for Patient Safety (TIPS) Program to Engage Older Adults in Fall Prevention in a Nursing Home.

BACKGROUND: Falls are the leading cause of injury-related hospitalizations and deaths among older adults globally. LOCAL PROBLEM: About 24% of Canadian nursing home residents fall annually. This quality improvement project evaluated the impact of the Fall Tailoring Interventions for Patient Safety (TIPS) program on preventing falls and fall-related injuries among older adult nursing home residents in a subacute care unit in Canada. METHODS: We used the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines for reporting. The intervention site is a 15-bed subacute care unit within a government-funded nursing home. INTERVENTION: The Fall TIPS program was adapted to a nursing home setting to prevent falls. It provides fall prevention clinical decision support at the bedside. RESULTS: The rates of falls and injuries decreased after implementing the Fall TIPS intervention. CONCLUSION: Engaging nursing home older adult residents in fall prevention is crucial in translating evidence-based fall prevention care into clinical practice.

Do Self-healing and Self-care Mean the Same Thing?

This brief essay begins the conversation of whether self-healing and self-care, terms that have been used independently and together, do indeed mean the same thing. To support a holistic approach to nursing and patient-centered care, nursing professionals and educators should be familiar with self-healing processes and self-care acts.

Associations Between Hospital-Level Patient Satisfaction Scores and Hospital-Acquired Pressure Ulcer Occurrences Among Medicare Stroke Patients.

BACKGROUND: Limited research has explored the associations between the US Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings data and hospital-acquired pressure ulcer (HAPU) occurrences. PURPOSE: We examined the associations between the hospital-level patient satisfaction HCAHPS scores with hospital care experience reported by Medicare patients 65 years or older and the occurrence of HAPUs among Medicare patients with stroke. METHODS: A matched case-control design was used. Patients with a history of stroke were identified using the 2011 Medicare fee-for-service patient data. Medicare Beneficiary Summary and Medicare Provider Analysis and Review files processed by the Chronic Conditions Data Warehouse were analyzed. Conditional logistic regression was used. RESULTS: HAPUs occur less frequently among Medicare patients with stroke who received inpatient care at hospitals with higher patient satisfaction HCAHPS scores for nurses' communication skills and quietness at night for the areas around patient rooms. CONCLUSIONS: Using hospital-level patient satisfaction HCAHPS scores to monitor and project HAPU occurrences is recommended.

Exploring the Associations Between Patient Affect, Self-Care Actions, and Emergency Department Use for Community-Dwelling Adults.

BACKGROUND: Nurses and other health care providers need to ensure that patients receive care that addresses their specific needs and wants. PURPOSE: This exploratory study examined the associations between patients' self-reported positive and negative affect, the perceived importance of 57 self-care actions, the desire and ability to perform them, and emergency department use in the past 3 months. METHODS: A secondary analysis from a cross-sectional survey project that surveyed 250 community-dwelling adults living in the southern United States, 2015-2016. Independent t tests and the χ test were used. RESULTS: Positive affect was associated with positive perceptions of self-care actions and having no emergency department visit. Patients with a more negative affect perceived finding and using services that support their health behaviors as being important and expressed a desire to participate in local health screening or wellness events. CONCLUSIONS: Patients' perceptions of their self-care actions could lead to better outcomes.

Do patients' demographic characteristics affect their perceptions of self-care actions to find safe and decent care?

AIM(S): This exploratory study examined the relationship of five patient demographic characteristics (residence in an urban or rural site, gender, age group, marital status, and education level) with the patients' (1) perceived importance of, (2) desire to, (3) ability to perform four patient engagement self-care actions that result in finding safe and decent care. BACKGROUND: Equitable access to health care is essential in a humanized health care system. Healthcare providers must engage patients in discussions about their desires for their care to create person-centered care plans reflecting patient values and wishes. METHODS: This secondary data analysis from a cross-sectional survey project surveyed community-dwelling adults living in the southern United States, 2015-2016. This paper only includes responses of participants aged 65 years and older (N = 123). Data collected in The Patient Action Inventory for Self-Care and demographic questions were used. Chi-square tests and multiple logistic regression analyses were used. RESULTS: As revealed in the Chi-square and logistic regression findings, self-care actions of "finding a doctor or practitioner who meets your needs," "using available information to choose a doctor or practitioner," and "using data to choose a hospital or clinic" showed some associations with whether seniors resided in an urban or rural community, age group, and marital status (P < 0.05). No significant associations between these four self-care actions with gender or education were found. CONCLUSIONS: A community-based solution is warranted to leverage between patient demographic characteristics and their perceived self-care actions by harnessing local factors in collaboration with identified patient needs.

Measuring patient engagement: which healthcare engagement behaviours are important to patients?

AIM(S): This study identified patient healthcare engagement behaviours that are important to community-dwelling adult patients living in the southern region of the USA. BACKGROUND: Patient engagement has been identified as a key driver for containing healthcare costs, but the public and healthcare professionals lack a scientific understanding of patient engagement. A valid tool is needed for prompting patients to discuss health activities with their healthcare providers and to obtain support. DESIGN: This exploratory cross-sectional survey study used a quantitative research design. It was conducted in seven senior centres in the southern region of the USA in 2015. METHODS: This project used convenience sampling to recruit subjects. Subjects were community-dwelling adult patients older than 18 years and living in the Upper Cumberland region of Tennessee. Individuals who had taken the survey previously were excluded. The survey tool, Patient Involvement Behaviors in Health Care, was developed by the authors and used for data collection. RESULTS: Ninety-two participants completed or partially completed the survey. The response rate was 74·8%. Among the 51 identified behaviours, 17 were identified as being important by less than 95% of participants; eight of these 17 behaviours were important to less than 90% of participants. CONCLUSIONS: We identified 34 behaviours that at least 95% of the participants indicated were important. Nurses may use this tool to help individual patients identify engagement behaviours that are important to them, to respect their personal preferences and thus improve their engagement in health care.

Facility Characteristics and Risk of Developing Pressure Ulcers in US Nursing Homes.

This research studied 12,507 residents in 1174 nursing homes from the 2004 National Nursing Home Survey. A multinomial logistic regression model was used to predict risk-adjusted probabilities of pressure ulcers with 4 stages. A medical director or a director of nursing on board reduced the odds of ulcers. Facilities offering clusters of beds for rehabilitation and special care programs for hospice care or behavior problems reduced the odds of stage IV ulcers.

Perceived top 10 highly effective interventions to prevent adult inpatient fall injuries by specialty area: a multihospital nurse survey.

PURPOSE: This study identified the perceived top 10 highly effective interventions to prevent fall injuries of adult inpatients based on the perceptions of RN staff by specialty area in acute hospital settings. BACKGROUND: The fall prevention precautions to focus on may vary by patients' medical problems and thus by specialty area. METHODS: This cross-sectional nurse survey was conducted at five U.S. health systems (July 2011-February 2012, 68 study units, 10 specialty areas). 560 staff participants completed the survey, yielding an overall response rate of 25.81%. This work is part of a larger project. Descriptive statistics were used. RESULTS: Each specialty area had its own top 10 effective interventions identified by RNs. The complexity and differences in the top 10 highly effective interventions by the 10 included specialty areas are apparent. For example, only one common intervention (keeping hospital bed brakes locked) appeared in the lists from the medical units and surgical units. CONCLUSION: Addressing the unique needs of the patient population by specialty area is essential. Adopting the perceived top 10 highly effective interventions for preventing injurious falls by specialty area with staff consensus might be more feasible for staff buy-in and compliance in inpatient acute care settings. Since patients' characteristics may change over time and the science in fall prevention is advancing, re-prioritizing effective interventions as needed every 2 years is recommended.

i Engaging user testing: lessons learned from inpatients and health care providers.

This user-testing study assessed the feasibility of the functional prototype of an innovative fall prevention intervention, i Engaging, to engage patients in their own fall prevention care during hospital stays. The i Engaging application as well as its approaches to engage patients in fall prevention care during hospital stays was perceived as being easy to use, effective, and practical. The user-testing study consisted of adults 65 years of age or older and health care providers.

Patient Engagement in Hospital Fall Prevention.

Injurious falls are the most prevalent in-hospital adverse event, and hospitalized patients are at a greater risk of falling than the general population. Patient engagement in hospital fall prevention could be a possible approach to reducing falls and fall-related injuries. To engage patients, bedside nursing staff must first understand the concept of patient centeredness and then incorporate patient centeredness in clinical practice. Clinicians should move from being experts to being enablers. To conceptualize the knowledge gaps identified, a conceptual model was developed to guide future research and quality improvement efforts in hospital settings. This model could be used as a guide to advance nursing leadership in hospital fall prevention via promoting patient engagement (e.g., developing patient-centered fall prevention interventions with patients' input).

Facilitators and Barriers to Implementing the 4Ms Framework of Age-Friendly Health Systems: A Scoping Review.

BACKGROUND: This scoping review explored the evidence in the peer-reviewed published journal literature to identify the facilitators and barriers to implementing the 4Ms Framework of Age-Friendly Health Systems in inpatient and outpatient clinical settings. METHODS: Our search strategy focused on primary and secondary data sources that described the barriers and facilitators of incorporating the 4Ms Framework in clinical settings. We focused on older adults 65 years and older and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-SCR). RESULTS: The evidence analyses of the 19 identified articles revealed six facilitator themes and five barrier themes to implementing the 4Ms Framework of Age-Friendly Health Systems in inpatient and outpatient clinical settings. The most recurring facilitator theme was embedding the 4Ms Framework into routine clinical practice with clinical pathways and designated personnel. The most frequently reported barrier theme was the lack of clinicians' buy-in. CONCLUSIONS: Future research may translate the findings of this scoping review into a facilitator and barrier checklist or a "reality-check" measure to monitor the progress of the journey of embracing the 4Ms Framework in outpatient or inpatient clinical settings. This study was not registered.

Annual Wellness Visits and Early Dementia Diagnosis Among Medicare Beneficiaries.

Importance: Early recognition of cognitive impairment is key to optimal dementia care. No previous research has examined the probability of developing mild cognitive impairment (MCI) or Alzheimer disease and related dementias (ADRD) at 5-year follow-up among older adult Medicare beneficiaries by receipt of an annual wellness visit (AWV). Objective: To assess the association of incident AWV with the first ADRD or MCI diagnosis among older adults with Medicare fee-for-service benefits. Design, Setting, and Participants: This retrospective population-based cohort study used 100% Texas fee-for-service Medicare data from 2015 to 2022. Participants comprised 549 516 community-dwelling Medicare beneficiaries aged 68 years or older in 2018, with complete Medicare fee-for-service Parts A and B and no Medicare Advantage plan enrollment for 2015 to 2018. Exposure: Medicare AWVs. Main Outcomes and Measures: The first MCI or ADRD diagnosis (reported as MCI or ADRD diagnosis, MCI diagnosis, and ADRD diagnosis) from the AWV index date in 2018 through December 31, 2022. Results: In this cohort study of 549 516 Medicare beneficiaries with no diagnosis of MCI or ADRD in 2015 to 2017 (mean [SD] age, 76.7 [6.6] years; 289 932 women [52.8%]), 66 433 (12.1%) had an incident AWV in 2018. Annual wellness visit recipients were more likely than those who did not receive an AWV to be female, to be non-Hispanic White (followed by Hispanic, non-Hispanic Black, and other), to have more education, to reside in a metropolitan area, to have more comorbidities, and to have a primary care professional in the 12 months before the AWV index date. After propensity score matching, AWV receipt was associated with a 21% increase in MCI diagnosis (hazard ratio, 1.21 [95% CI, 1.16-1.27]) and a 4% increase in ADRD diagnosis (hazard ratio, 1.04 [95% CI, 1.02-1.06]). The increase in MCI diagnosis associated with AWV was larger when the AWV was censored or treated as a time-dependent covariate in the follow-up period. Conclusions and Relevance: These findings indicate that AWV recipients had a timelier first MCI diagnosis than those who did not receive an AWV, but first ADRD diagnosis differed little. This study suggests that the Medicare AWV health policy may increase MCI identification, prompting more specialized care.

Frequently observed risk factors for fall-related injuries and effective preventive interventions: a multihospital survey of nurses' perceptions.

There is an urgent need to prioritize the risk factors for injurious falls and effective interventions in nursing practice. Registered nurses perceived that the most frequently observed risk factors were confusion, gait problems, Alzheimer disease, disorientation, and inability to follow safety instructions. The most effective interventions were keeping hospital bed brakes locked, keeping floor surfaces clean/dry, using appropriate footwear for patients, maintaining a call light within reach, and reducing tripping hazards.