Osteomyelitis, diabetic foot ulcers and the role of the community nurse.

Community nurses face numerous challenges in both diagnosing and effectively treating their patients. The diabetic patient has complex needs requiring a holistic approach. With a reported increase in diabetic patients, and a possible decline in some routine screening following Covid-19 pandemic, complications in diabetic patients are likely to rise. It is estimated that 25% of diabetic patients will develop a diabetic foot ulcer (DFU), with a reported 43% of DFU already infected at first presentation to a health professional. NICE categorise the level of infection in DFU based on standardised assessments such as SINBAD. A high categorised DFU has the possibility of osteomyelitis. It is imperative that osteomyelitis is treated immediately to achieve positive outcomes, benefitting the patients' health and wellbeing in addition to reducing the financial implications to the NHS.

Factors associated with spiritual care competencies in Taiwan's clinical nurses: A descriptive correlational study.

AIMS AND OBJECTIVES: To determine factors associated with nurses' spiritual care competencies. BACKGROUND: Holistic nursing care includes biopsychosocial and spiritual care. However, nurses are limited by a lack of knowledge, time constraints and apprehension of assessing spiritual issues, which leaves them unable to assess and meet patients' spiritual needs. Thus, when patients experience spiritual distress, clinical nurses lose the opportunity to support spiritual growth and self-actualisation. In Taiwan, spiritual care, religion and culture are unique compared to those in other countries. Overall, factors associated with Taiwanese nurses' spiritual care competencies lack comprehensive exploration. METHODS: This study adopted a descriptive correlational design using cross-sectional survey (see Appendix S1). Cluster sampling was used to select clinical nurses from fourteen units of a medical centre and a regional hospital. Data were collected from January-June 2018 with a 97.03% response rate. Clinical nurses completed a background questionnaire, spiritual care practice questionnaire, spirituality and spiritual care-related scales. Data were analysed using descriptive and linear regression. This report followed the STROBE checklist. RESULTS: Spiritual care competence ranged from 44-123 (mean 84.67 ± 12.88; range 27-135). The majority of clinical nurses rated their spiritual care competence as moderate (64-98). The significant factors associated with nurses' spiritual care competence were education, religion, interest in spiritual care, having role models, past life events, barriers to providing spiritual care of the spiritual care practice score, and spiritual attitude and involvement score. The overall model was significant (p < .001) and accounted for 55.0% of variance (adjusted R2  = .488). CONCLUSIONS: Most clinical nurses have moderate spiritual care competence. Objective factors identified affect clinical nurses' spiritual care competencies. RELEVANCE TO CLINICAL PRACTICE: To improve nurses' spiritual care competencies, objective factors that affect clinical nurses' spiritual care competencies must be emphasised. Multiple strategies for enhancing nurses' own spiritual well-being can be provided via employee health promotion projects and activities, and promoting nurses' spirituality and spiritual care competencies can be explored in clinical settings through bedside teaching, situational simulation, objective structured clinical examinations and self-reflection.

Mindfulness-Based Stress Reduction for Health Care Staff: Expanding Holistic Nursing Paradigms to the Whole System.

Mindfulness-based stress reduction (MBSR) is a well-known mindfulness meditation program for patients that also may benefit health care providers and clinic staff themselves. An abbreviated MBSR program adapted into 6 weekly 75-minute sessions held during staff lunch breaks provided a feasible and acceptable staff training approach within the workplace setting.

Evaluating the feasibility of a nurse-led self-management support intervention for kidney transplant recipients: a pilot study.

BACKGROUND: To support effective self-management after kidney transplantation, a holistic nurse-led self-management support intervention was developed using the Intervention Mapping approach. The primary aim was to evaluate the feasibility, acceptability and fidelity of the intervention for kidney transplant recipients and professionals. The secondary aim was to explore preliminary effects on outcomes. METHODS: A pilot study was conducted in 2015-2017 to evaluate the intervention. Nurse Practitioners (NP) guided recipients in assessing 14 life areas using the Self-Management Web. Participants were supported in developing self-regulation skills which can be applied to self-management of the illness. Strategies included goal setting, action planning, and promotion of motivation and self-efficacy. Adult recipients from an outpatient clinic of a Dutch University Hospital who underwent their transplant at least 1 month ago, were invited to participate. NPs, nephrologists and recipients were interviewed to assess feasibility, fidelity and implementation experience. Consultations were videoed and analysed to assess fidelity. To assess the preliminary effects, the intervention group completed baseline (T0) and follow-up (T1) questionnaires on self-management behavior, self-efficacy, quality of life and quality of care. A historical control group of kidney transplant recipients completed the same questionnaires at T1. RESULTS: Twenty-seven recipients agreed to participate in the intervention group, of which 24 completed the intervention and 16 completed baseline and follow-up surveys. The control group consisted of 33 recipients. Professionals and recipients appraised the open, holistic focus of the intervention as a welcome addition to standard care and felt that this helped to build a relationship of trust. Recipients also felt they became more competent in problem-solving skills. The within-group analysis showed no significant increase in patients' self-management skills. The between-groups analysis showed significantly higher medication adherence among the intervention group (P = 0.03; G = 0.81). The within-groups analysis showed a significantly higher perceived quality of care (P = 0.02) in the intervention group. CONCLUSION: This holistic nurse-led self-management support intervention was found to be feasible and acceptable by professionals and recipients alike. This pilot had a small sample therefore further research is needed into the potential effects on self-management behavior and well-being of transplant recipients. ISRCTN Trial Registry: ISRCTN15057632 (registered retrospectively on 20-07-2018).

The holistic assessment and care planning in partnership intervention study (HAPPI): A protocol for a feasibility, cluster randomized controlled trial.

AIM: During an initial phase of this research, an e-Delphi survey was conducted to gain consensus among stakeholders on the components of a nurse-led assessment and care planning intervention for older people who live with frailty in primary care. This feasibility randomized controlled trial (fRCT) will test the proposed intervention and its implementation and determine methods for the design of a conclusive randomized controlled trial. METHODS: The fRCT, with embedded qualitative study, aims to recruit 60 participants. Moderately and severely frail older people will be identified using the electronic frailty index (eFI) and the intervention will be delivered by senior community nurses. The control participants will receive usual primary care for frailty. The study is funded by the National Institute of Health Research (NIHR; funding granted in May 2016, ref: ICA-CDRF-2016-02-018) and received NHS and University Research Ethics Committee approval in 2018. DISCUSSION: There is evidence that the delivery of complex interventions for community-dwelling older people can reduce care home and hospital admissions and falls, there is less evidence for the benefit of any specific type or intensity of intervention or the additional benefits of targeting the frail population. This trial will determine feasibility of the intervention, define recruitment and retention parameters and trial logistics, and decide outcome measures. IMPACT: This study aims to address the limitations of current research by using a systematic method of frailty diagnosis and participant identification, trialling implementation of a person-centred intervention, and testing of feasibility parameters. TRIAL REGISTRATION NUMBER: ISRCTN: 74345449.

Holistic nursing competence scale: Turkish translation and psychometric testing.

AIM: This study aimed to culturally adapt and evaluate the reliability and validity of the Holistic Nursing Competence Scale for application in the Turkish context. BACKGROUND: Nurses are expected to assess well-being of individuals by considering physical, social, psychological, cultural and spiritual dimensions to enhance adaptation to diseases. In Turkey, no tools have been developed to date for the evaluation of competencies in holistic nursing in the country. METHODS: The study was conducted with 288 nurses working in two hospitals in Ankara equipped with over 500 beds. A confirmatory factor analysis was performed in order to identify whether the items and the sub-dimensions of the adapted scale complied with the original structure comprising 36 items and five sub-scales, namely 'general aptitude', 'staff education and management', 'ethically oriented practice', 'nursing care in a team' and 'professional development'. Cronbach's alpha value was used as an estimate for reliability analysis. RESULTS: Opinions of 11 experts were obtained for content validation of the scale, and the content validity index was 0.90. The adaptation was observed to be acceptable on the basis of structural equation model fit indices in confirmatory factor analysis. Cronbach's alpha value was estimated to be 0.97 and 0.90, respectively, for the complete scale. CONCLUSION: The study identified the Turkish version of Holistic Nursing Competence Scale as a valid and reliable tool for the evaluation of competence in holistic nursing among nurses. IMPLICATIONS FOR NURSING AND NURSING POLICY: The instrument may now be utilized as a tool of measurement in nursing practice, as well as in education and research, for identifying the level of competence in the holistic nursing practices among the nurses in Turkey.

Comfort over Pain in Pregnancy.

Pregnancy is often a time when chronic pain is exacerbated, or when acute pain appears. Frequently the easiest intervention within reach, for both chronic and acute pain, is a prescription. However, medication cannot correct the cause of the pain; instead it alters the person's experiential perception of the pain. In addition, medication exposes both mother and fetus to risks. To provide simple, evidence-based, holistic/alternative remedies for women who experienced nonemergent pain during pregnancy. Holistic/alternative techniques for increasing comfort were taught to the participants and individualized during three sessions. Levels of pain and comfort were measured before and after the treatment, using the validated General Comfort Questionnaire and Pain Outcomes Profile. Pain scores decreased from an average of 5.8/10 to 3.5/10 (p = .00). Comfort scores increased from an average of 17.5 to 30 (p = .00).

[Problem solving care models for Parkinson's disease]. / Problémamegoldó ápolási-gondozási modell Parkinson-kórban.

INTRODUCTION: Parkinson's disease affects more than 6,3 million people worldwide. Most patients and relatives are left alone to struggle with the symptoms associated with fluctuations in drug levels and the psychotic side effects of the anti-Parkinson's medications. Moreover, quite often even health providers may find difficult to interpret and manage the problems that have been encountered. AIM: The aims of the authors were to analyze systematically the biopsychosocial needs of Parkinson's patients, and to develop a complex, evidence-based Parkinson's-nursing-care model. METHOD: Patients' needs were assessed based on an observational study involving an old patient with Parkinson's disease for more than 28 years. The model has been specified as a multidisciplinary care framework adapted to the special characteristics of Parkinson's disease which transcends the limitations of different standard nursing models. RESULTS: The elaborated model contains a detailed description of cooperative problem solving, which is organized around individual patients along with recommendations for addressing various potential problems that might be encountered. CONCLUSIONS: Implementation of the presented model can improve the life quality of Parkinson's patients and can facilitate the life of affected families provided that these families are well aware about the potential benefits of the novel care delivery system.

Using specialist bandage techniques to improve outcomes.

Chronic oedema is a condition that can become more complex to manage if allowed to progress. With the risk of chronic oedema increasing with age, complex presentations may become more commonplace as projections indicate an ageing population. A full holistic assessment is vital, taking into account venous, lymphatic and arterial elements of a vascular assessment, in order to determine the underlying disease process. Competency-based techniques for the application for below-knee and thigh-length application of inelastic cohesive compression exist and support clinicians in the successful management of chronic oedema. In cases of severe or complex chronic oedema, the specialist clinician can adopt strategies to adapt standard application to achieve volume reduction, shape, and tissue improvement.

Holism and embodiment in nursing: using Goethean science to join 2 perspectives on patient care.

Holism is a central concept in nursing theory, yet recently, embodiment has become prominent in the literature. Epistemological foundations from modern and contemporary philosophy are discussed and their relationship to nursing practice is explored to investigate the concepts of holism and embodiment. Nurses practice holistic care within the patient encounter while patients live an embodied experience. This creates inherent dissonance in the nurse-patient interaction. Goethean science is presented as a way to reconcile this discrepancy, to allow the nurse to better understand the patient's embodiment and, by default, his or her own embodiment. A new perspective of how nursing practice can use Goethean science and an embodied perspective are presented as a means to actualize Carper's fundamental pattern of knowing of personal knowledge within the nurse-patient interaction. With this approach, the nurse is able to examine the phenomenon of the patient with the patient to explore the essential nature that makes the patient who he or she is and what he or she is trying to become. During this exploration, the nurse uses the senses, language, and a critical mind to do what no machine or test could-to see the underlying meaningfulness and internal coherence of the patient. The intuitive revelation would expose nursing interventions simultaneously. Moving beyond the myopic perspective of how to keep "person" central to the nursing metaparadigm, nursing is beginning to see the embodiment of the patient as a means for understanding and providing care for patients. The challenge that remains is for nurses to see their own embodiment and reflect on if or how it is at odds with the necessity of providing holistic care to patients.

Thai Buddhist families' perspective of a peaceful death in ICUs.

AIM: To describe the concept of a peaceful death in intensive care units (ICUs) from the perspective of Thai Buddhist family members. METHODS: This descriptive qualitative study was based on data generated from individual in-depth interviews of nine Thai Buddhist family members from the southern region of Thailand whose loved ones died in adult ICUs. Colaizzi's phenomenological approach was used to analyse the data. Rigour for the study was established by Lincoln and Guga's guidelines for qualitative research studies. FINDINGS: Five core qualities emerged that made-up the concept of a peaceful death as described by Thai Buddhist family members who cared for their loved ones while they were dying in ICUs. These core qualities were 'knowing death was impending, preparing for a peaceful state of mind, not suffering, being with family members and not alone, and family members were not mourning'. CONCLUSION: Thai Buddhist family members described what they meant by a peaceful death. 'This was: preparing for a peaceful state of mind in knowing that one's impending death is not a situation of suffering or being alone, but rather a time of being with family members who are not yet mourning one's death.' The findings support that family members should participate in promoting a peaceful death for their loved ones dying in ICUs. IMPLICATIONS FOR PRACTICE: The five core qualities of a peaceful death reported in this study could be used as a framework for nurses to create nursing practice interventions for quality end-of-life care for Thai Buddhists.

Development of the Holistic Nursing Competence Scale.

This study developed a scale to measure the nursing competence of Japanese registered nurses and to test its psychometric properties. Following the derivation of scale items and pilot testing, the final version of the scale was administered to 331 nurses to establish its internal consistency, as well as its construct and criterion-related validity. Using an exploratory and a confirmatory factor analysis, 36 items with a five-factor structure were retained to form the Holistic Nursing Competence Scale. These factors illustrate nurses' general aptitude and their competencies in staff education and management, ethical practice, the provision of nursing care, and professional development. The Scale has a positive correlation with the length of clinical experience. A Cronbach's alpha coefficient was 0.967. The Scale is a reliable and valid measure, helping both nurses and organizations to correctly evaluate nurses' competence and identify their needs for professional development.