Effects of a nurse-led transitional burns rehabilitation programme (4Cs-TBuRP) for adult burn survivors: protocol for a randomised controlled trial.

BACKGROUND: Transitioning from the burn unit to the home/community can be chaotic with limited professional support. Some adult burn survivors may face varied concerns leading to poor outcomes in the early post-discharge period with limited access to professional help. Based on these, a nurse-led transitional burns rehabilitation programme has been developed and the current trial aims to ascertain its effects as well as explore the implementation process. METHODS: A single-centre, double-arm randomised controlled trial with a process evaluation phase will be utilised for this study. All adult burn survivors aged ≥ 18 years with burn size ≥ 10% total burn surface area at the site during the study period will be screened for eligibility at least 72 h to discharge. A sample size of 150 will be block randomised to treatment (receiving the nurse-led transitional care programme and routine post-discharge service) and control groups (receiving routine post-discharge service). The nurse-led transitional care programme comprises of predischarge and follow-up phases with the delivery of bundle of holistic interventions lasting for 8 weeks. There are three timelines for data collection: baseline, immediate post intervention, and 4 weeks post-intervention. DISCUSSION: The findings from this study can potentially inform the development and organisation of post-discharge care and affirm the need for ongoing comprehensive home-based care for burn survivors and their families TRIAL REGISTRATION: ClinicalTrials.gov NCT04517721 . Registered on 20 August 2020.

Effects of music intervention on physiological stress response and anxiety level of mechanically ventilated patients in China: a randomised controlled trial.

AIM: To examine the effects of music intervention on the physiological stress response and the anxiety level among mechanically ventilated patients in intensive care unit. BACKGROUND: Despite the fact that previous studies have found music interventions to be effective in stress and anxiety reduction, effects of music on the Chinese population are inconclusive and warranted systematic study to evaluate its effect fully for a different Asian culture. DESIGN: A randomised placebo-controlled trial. METHODS: A total of 137 patients receiving mechanical ventilation were randomly assigned to either music listening group, headphone group or control group. Outcome measures included the Chinese version of Spielberger State-Trait Anxiety Scale and physiological parameters (heart rate, respiratory rate, saturation of oxygen and blood pressure). RESULTS: Comparison of mean differences (pretest score-posttest score) showed significant differences in heart rate, respiratory rate, systolic blood pressure and diastolic blood pressure as well as the Chinese version of Spielberger State-Trait Anxiety Scale, but not in SaO(2) among the three groups (ranging from p < 0.001 to p = 0.007), of which greater mean differences were found in music listening group. A significant reduction in physiological stress response (heart rate and respiratory rate) over time was found in music listening group (p < 0.001 for both variables) and a significant increase in heart rate and respiratory rate over time in control group (p < 0.001 and p = 0.032), with no significant change over time in headphone group. Within group pretest-posttest comparison of the Chinese version of Spielberger State-Trait Anxiety Scale demonstrated a significant reduction in anxiety for the music listening group (p < 0.001) and headphone group (p < 0.001) but not the control group. CONCLUSIONS: Our findings confirm that short-term therapeutic effects of music listening results in substantial reduction in physiological stress responses arising from anxiety in mechanically ventilated patients. RELEVANCE TO CLINICAL PRACTICE: Music as a non-pharmacological nursing intervention can be used as complementary adjunct in the care of patients with low-energy states who tire easily, such as those requiring mechanical ventilator support.

A review of the psychosocial issues for nurses in male genitalia-related care.

AIM: This literature review aimed to highlight psychosocial issues for nurses in the practice of male genitalia-related care so as to guide the improvement of the teaching and practice of male genitalia-related care. BACKGROUND: Male genitalia-related care is common in hospitals and in the community. In several conditions, e.g. incontinence, postradiotherapy or following operation for cancer of genitalia, bladder, colon or rectum, patients will require male genitalia-related care. Patients who require male genitalia-related care may encounter psychosocial and/or sexual dysfunction. In the holistic approach to men's health, nurses are expected to meet patients' psychosocial and sexual needs, while the literature suggests that nurses' perceptions and attitudes in providing certain male genitalia-related care, e.g. genital hygiene, sexual counselling, are negative. METHOD: Systematic literature review. CONCLUSION: Issues surrounding male genitalia-related care for nurses are complicated and may be related to privacy, intimacy, sexuality, dirty work and emotional discomfort. Age, gender, race and social class could compound these issues. Relevance to clinical practice. Nurses' negative perceptions, responses and attitudes towards male genitalia-related care may exacerbate patients' conditions under which male genitalia-related care is required. Appropriate strategies should be developed to overcome these problems.

Relationship of nurses' spirituality to their understanding and practice of spiritual care.

AIM: This paper reports a study to examine the relationship of nurses' spirituality to their understanding and practice of spiritual care. BACKGROUND: Continued debate surrounds the concept, practice and teaching of spirituality, highlighting the complexity and importance of understanding spirituality and the delivery of spiritual care. Spirituality is defined in this study as the relationship with the self and a dimension beyond the self. METHOD: A convenience sample of 61 nurses from a part-time Bachelor of Science degree programme in nursing in Hong Kong, more than half of whom reported their religious affiliations, completed a newly developed, 27-item five-point Likert scale questionnaire. The data were collected in 2002. Descriptive statistics were calculated. Correlations were used to determine relationships among self, understanding and practices of spiritual care. The Mann-Whitney U and Kruskal-Wallis tests were used to examine differences between demographic variables and spirituality, understanding and practices of spiritual care. Multiple linear regression was used to determine factors contributing to understanding and practices of spiritual care. FINDINGS: A positive statistically significant correlation was found between self and the following three variables: dimension beyond self (r=0.35, P<0.001), understanding of spiritual care (r=0 x 57, P<0 x 001), and practice of spiritual care (r=0 x 26, P<0 x 05). The relative contributions of self to understanding (beta=1 x 06, |t|=10 x 74, P<0.001) and practice of spiritual care (beta=0 x 68, |t| = 3 x 62, P=0 x 001) were statistically significant. There was no statistically significance difference between any of the demographic variables and understanding and practice of spiritual care, except for a negative relationship between religious affiliations and the dimension beyond self (P<0 x 001). CONCLUSION: Through continuously seeking self-awareness and connecting to a dimension beyond the self for inner resource, the contented whole self will be able to provide spiritual care.

Establishing a definition for a nurse-led clinic: structure, process, and outcome.

AIM: This paper reports a study to define a nurse-led clinic by exploring the domains of structure, process and outcome. BACKGROUND: Nurse clinics have been introduced as a measure to support intermediate care after the acute phase of disease. Previous studies have been mainly descriptive, or have only addressed a particular aspect of clinic service. METHODS: This exploratory study was conducted in two phases. In the first phase, nurses from 34 clinics were interviewed. In the second phase, 162 clinic sessions were observed, and 162 patients and 16 physicians were interviewed. The data were collected in 2001-2003. RESULTS: The nurses who ran the clinics were very experienced, and resources were available to support their work. Over 80% of their work was independent or interdependent, involving skills such as adjusting medications, and initiating therapies and diagnostic tests according to protocols. The principal interventions were assessments and evaluations, and health counselling. The nurses rated 'management of symptoms', 'prevention of complications', and 'client satisfaction' as the top three key indicators of their success. All patients studied showed improvement after the nurse clinic consultation, but the best rates were found in wound and continence clinics. Satisfaction scores for both nurses and clients were high. Physicians valued their partnership in care with the nurses, but were concerned about possible legal liability resulting from the advanced roles assumed by these nurses. CONCLUSIONS: A nurse clinic is an effective alternative model of ambulatory healthcare delivery that uses a holistic framework.