Factors Associated With Depression and Anxiety for Community-Dwelling Patients With Heart Failure: A Retrospective Cohort Study.

BACKGROUND: Depression and anxiety are common comorbidities in heart failure (HF) and are associated with adverse outcomes including unplanned hospitalization. However, there is insufficient evidence on the factors associated with depression and anxiety for community patients with HF to inform optimal assessment and treatment in this population. AIM: The aim of this study was to examine the prevalence of and factors associated with depression and anxiety in community-dwelling patients with HF. METHODS: A retrospective cohort study of 302 adult patients given a diagnosis of HF referred to United Kingdom's largest specialist cardiac rehabilitation center, from June 2013 to November 2020. Main study outcomes were symptoms of depression using Patient Health Questionnaire-9 and anxiety using the General Anxiety Disorder 7-item scale. Explanatory variables included demographic and clinical characteristics and functional status from the Dartmouth COOP questionnaire: quality of life, pain, level of social activity and daily activities, and being bothered by emotional problems (feelings). Logistic regressions were performed to evaluate the association between demographic and clinical characteristics and depression and anxiety. RESULTS: Of the sample, 26.2% reported depression and 20.2% had anxiety. Higher depression and anxiety were associated with difficulty in performing daily activities (95% confidence interval, 1.11-6.46 and 1.13-8.09, respectively) and being bothered by feelings (95% confidence interval, 4.06-21.77 and 4.25-22.46, respectively). Depression was associated with limitations in social activity (95% confidence interval, 1.06-6.34) and anxiety with distressing pain (95% confidence interval, 1.38-7.23). CONCLUSION: Findings indicate the importance of psychosocial interventions for patients with HF to minimize and manage depression and anxiety. Patients with HF may benefit from interventions targeted to maintain independence, promote participation in social activities, and optimally manage pain.

Patient satisfaction with medication consultations and medicines information provided by nurses working autonomously in sexual health services: A questionnaire study.

AIM: To compare the satisfaction of patients managed by independent nurse prescribers with that of patients managed by nurses using PGDs with respect to experience of the consultation and information received about the medication. DESIGN: Survey. METHODS: Patients receiving medications from nurses in five urban sexual health services in the United Kingdom completed validated questionnaires immediately after the consultation, September 2015-August 2016. Scores of independent nurse prescribers and nurses using patient group directions were compared about consultation experience (5 items) Satisfaction with Information about Medicines (SIMS 16 items scale). RESULTS: Of 808 patients receiving medications, 393 (48.6%) received questionnaires and 380 were returned (independent nurse prescribers 180 of 198, 90.9%; patient group directions 173 of 195, 88.7%). Patients in both groups reported high levels of satisfaction. About the consultation experience, patients found nurses friendly/ approachable (>99%), instilling confidence and trust (>99%) and explaining reasons for medications clearly (97%). Satisfaction with medication information: Of 348 (92%) respondents completing SIMS, the overall mean score was 13.4 of maximum 16 (no difference between groups, t-test, p = .63). CONCLUSIONS: Patients were highly satisfied with nurse consultations and information around medications regardless of whether they were managed by independent nurse prescribers or nurses using patient group directions. IMPACT: Findings provide evidence in support of autonomous provision of medications by nurses in sexual health clinics.

Independent nurse medication provision: A mixed method study assessing impact on patients' experience, processes, and costs in sexual health clinics.

BACKGROUND: Local services in the United Kingdom National Health Service enable autonomous provision of medication by nurses, supporting individual nurses to gain prescribing qualifications or by introducing local patient group directions. AIM: To compare nurse prescribing and patient group directions about clinic processes, patients' experiences, and costs from the perspectives of providers, nurses, and patients. DESIGN: Mixed methods, comparative case study in five urban sexual health services in the United Kingdom. METHODS: Data were collected from nurse prescribers, patient group direction users and their patients July 2015 to December 2016. Nurse questionnaires explored training (funding and methods). Nurses recorded consultation durations and support from other professionals in clinical diaries. Patient notes were reviewed to explore medication provision, appropriateness and safety; errors were judged by an expert panel. Patients completed satisfaction questionnaires about consultations and information about medications. RESULTS: Twenty-eight nurse prescribers and 67 patient group directions users took part; records of 1682 consultations were reviewed, with 1357 medications prescribed and 98.5% therapeutically appropriate. Most medication decisions were deemed safe (96.0% nurse prescribers, 98.7% patient group directions, Fisher's Exact Test p = .55). Errors were predominantly minor (55.6% nurse prescribers, 62.4% patient group directions) and related to documentation omissions (78.0%); no patients were harmed. Consultation durations and unplanned re-consultations were similar for both groups. Nurse prescribers sought assistance from colleagues less frequently (chi-squared = 46.748, df = 1, p < .001) but spent longer discussing cases. Nurse prescribing training required more resources from providers and nurses, compared with patient group directions. Nurse prescribers were on higher salary bands. Patient satisfaction was high in both groups (>96%). CONCLUSIONS: Nurse medication provision by both nurse prescribers and patient group direction users is safe and associated with high patient satisfaction; effects on clinic processes and costs are similar. Undertaking the prescribing qualification involves independent study but may bring longer-term career progression to nurses.

Front-line staff perspectives on a caring culture in Chinese hospitals: Validation of a Chinese version of the Culture of Care Barometer.

AIMS: The aim of this study is to examine the psychometric properties of the Chinese version of the Culture of Care Barometer in health care organizations. BACKGROUND: There is a lack of tools to gauge the caring culture in Chinese hospitals. The Culture of Care Barometer is a psychometrically sound measure for caring culture developed in Western settings. METHODS: This study was guided by Sousa and Rojjanasrira's methodological approach. A total of 2365 staff were recruited from two tertiary hospitals. The Barometer was administered with the Hospital Culture Evaluation Index and Minnesota Satisfaction Questionnaire. RESULTS: The content validity index was calculated as 0.99. The goodness-of-fit indices, apart from the model chi-square, which was statistically significant, all exceeded established thresholds for adequate fit. The internal consistency was very satisfactory. Pearson's correlation indicated that the tool has good concurrent and convergent validity. CONCLUSIONS: The Barometer is a reliable and valid instrument to assess front-line staff perspectives on a caring culture in Chinese hospitals. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers can use the Barometer to gauge the caring culture in China. Tailored interventions can be designed to address specific domains, and additional support can be provided to more vulnerable departments or staff groups.

Dietary Habits of Women with Gynecological Cancer before, during and after Treatment: A Long-Term Prospective Cohort Study.

BACKGROUND AND AIM: Over 21,000 new cases of gynecological cancer are diagnosed annually in the United Kingdom. There is evidence of cancer patients altering their eating habits before and during treatment. Some women with gynecological cancer make conscious decisions to change their diet as self-management for their cancer symptoms and to adopt a healthier lifestyle. Little is known about the impact of treatment on dietary habits. This study aimed to identify and describe the dietary habits of women with gynecological cancer before, during and after treatment. METHODS: This was a longitudinal prospective cohort study using seven-day food diaries to collect dietary intake data before treatment and up to two years after gynecological cancer treatment. Nutritics© software was used for analysis of the diaries. A general linear mixed model was used for the statistical analysis, adjusted for multiple comparisons. RESULTS: 15 women with gynecological cancer participated; 69 food diaries were analyzed. There were no statistically significant changes in dietary habits or weight for this cohort during the two-year follow-up, except for caffeine intake which increased at 2 years (p < 0.05). CONCLUSIONS: Despite the importance of maintaining a healthy dietary intake and weight after cancer treatment, participants' diets did not change.

A mixed-methods feasibility study of an intervention to improve men's mental health and wellbeing during their transition to fatherhood.

BACKGROUND: Many health visiting services in England use the Promotional Guide system with mothers and fathers, an intervention to support their transition to parenthood, but there is little known about its use and effectiveness, especially with fathers. The aim of this study was to test the feasibility and acceptability of the Promotional Guide system with first-time fathers and pilot potential outcome measures to assess their mental health and wellbeing. METHODS: A mixed methods prospective observational cohort study. Expectant first-time fathers were recruited from four London (UK) local authority boroughs. Data were collected through online pre and post intervention questionnaires, and semi-structured telephone interviews. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using framework analysis. RESULTS: Eighty-six fathers were interested in participating; 7 did not meet inclusion criteria and 79 were invited to complete the baseline questionnaire. Questionnaires completed by 45 men at both timepoints were included in the final analysis. Mean and standard deviations were calculated for all outcomes, showing a slight deterioration in the scores across all measures in the postnatal period compared to the antenatal. Ten of these men were also interviewed. Six major categories were identified: 1) Experience of health visitor contact, 2) Experience of Promotional Guides, 3) Experience of perinatal health services, 4) Experience of fatherhood, 5) Fathers' mental health and wellbeing, and 6) Experience of the research process. While antenatal and postnatal outcomes were collected from 45 first-time fathers, none had received the intervention in its entirety. This study identified major gaps in the implementation of the Promotional Guide system with fathers. CONCLUSION: This study assessed recruitment of first-time fathers, time to complete recruitment, and retention rates and identified outcome measures that could be used in a future definitive study. While it wasn't possible to examine the potential changes following the use of the Promotional Guide system, the study reported on the changes in the fathers' 'states' in the antenatal and postnatal period. It provided a narrative on whether first-time fathers found it acceptable to be asked about their mental health and wellbeing, highlighted their specific needs during their transition to fatherhood, and how they wanted to be supported. It also identified barriers to implementation of the Promotional Guide system by health visitors, which need to be addressed prior to any future research into this intervention. These findings have a number of implications for researchers, health professionals, health service managers, commissioners, policy makers and parents.

The Contribution of Staffing to Medication Administration Errors: A Text Mining Analysis of Incident Report Data.

PURPOSE: (a) To describe trigger terms that can be used to identify reports of inadequate staffing contributing to medication administration errors, (b) to identify such reports, (c) to compare the degree of harm within incidents with and without those triggers, and (d) to examine the association between the most commonly reported inadequate staffing trigger terms and the incidence of omission errors and "no harm" terms. DESIGN AND SETTING: This was a retrospective study using descriptive statistical analysis, text mining, and manual analysis of free text descriptions of medication administration-related incident reports (N = 72,390) reported to the National Reporting and Learning System for England and Wales in 2016. METHODS: Analysis included identifying terms indicating inadequate staffing (manual analysis), followed by text parsing, filtering, and concept linking (SAS Text Miner tool). IBM SPSS was used to describe the data, compare degree of harm for incidents with and without triggers, and to compare incidence of "omission errors" and "no harm" among the inadequate staffing trigger terms. FINDINGS: The most effective trigger terms for identifying inadequate staffing were "short staffing" (n = 81), "workload" (n = 80), and "extremely busy" (n = 51). There was significant variation in omission errors across inadequate staffing trigger terms (Fisher's exact test = 44.11, p < .001), with those related to "workload" most likely to accompany a report of an omission, followed by terms that mention "staffing" and being "busy." Prevalence of "no harm" did not vary statistically between the trigger terms (Fisher's exact test = 11.45, p = 0.49), but the triggers "workload," "staffing level," "busy night," and "busy unit" identified incidents with lower levels of "no harm" than for incidents overall. CONCLUSIONS: Inadequate staffing levels, workload, and working in haste may increase the risk for omissions and other types of error, as well as for patient harm. CLINICAL RELEVANCE: This work lays the groundwork for creating automated text-analytical systems that could analyze incident reports in real time and flag or monitor staffing levels and related medication administration errors.

Factors contributing to reported medication administration incidents in patients' homes - A text mining analysis.

AIMS: To describe the characteristics of medication administration (MA) incidents reported to have occurred in patients' own homes (reporters' profession, incident types, contributing factors, patient consequence, and most common medications involved) and to identify the connection terms related to the most common contributing factors based on free text descriptions. DESIGN: A retrospective study using descriptive statistical analysis and text mining. METHODS: Medication administration incidents (N = 19,725) reported to have occurred in patients' homes between 2013-2018 in one district in Finland were analysed, describing the data by the reporters' occupation, incident type, contributing factors, and patient consequence. SAS® Text Miner was used to analyse free text descriptions of the MA incidents to understand contributing factors, using concept linking. RESULTS: Most MA incidents were reported by practical (lower level) nurses (77.8%, N = 15,349). The most common category of harm was 'mild harm' (40.1%, N = 7,915) and the most common error type was omissions of drug doses (47.4%, N = 9,343). The medications most commonly described were Marevan [warfarin] (N = 2,668), insulin (N = 811), Furesis [furosemide] (N = 590), antibiotic (N = 446), and Panadol [paracetamol] (N = 416). The contributing factors most commonly reported were 'communication and flow of information' (25.5%, N = 5,038), 'patient and relatives' (22.6%, N = 4,451), 'practices' (9.9%, N = 1,959), 'education and training' (4.8%, N = 949), and 'work environment and resources' (3.0%, N = 598). CONCLUSION: There is need for effective communication and clear responsibilities between home care patients and their relatives and health providers, about MA and its challenges in home environments. Knowledge and skills relating to safe MA are also essential. IMPACT: These findings about MA incidents that have occurred in patients' homes and have been reported by home care professionals demonstrate the need for medication safety improvement in home care.

Infection and wound breakdown in spontaneous second-degree perineal tears: An exploratory mixed methods study.

BACKGROUND: Perineal trauma affects large numbers of women who have a vaginal birth. This study explores the incidence, etiology and women's experiences of wound infection/breakdown associated with spontaneous second degree tears. METHODS: This was an exploratory mixed methods study set in an urban tertiary National Health Service hospital in 2014-2015. The study included a prospective observational study of second-degree tears using electronic patient records. Infection was defined using criteria adapted from Public Health England's Surgical Site Infection Surveillance Service. We also did a case-control study of maternity records to explore factors associated with perineal infection/wound breakdown, and semi-structured interviews with a purposeful sample of women who experienced wound infection/breakdown. RESULTS: Of 2892 vaginal births during the study period, 76.8% sustained perineal trauma, with second-degree tears most commonly recorded (n = 828/28.6%). Sixteen (1.9%) had a documented infection/wound breakdown which were associated with "compromised wound status" (increased severity of wound/poor suturing; P = 0.033) Women complained of a lack of information about their perineum and poor postnatal surveillance by midwives and physicians. Diagnosis and treatment were often delayed by clinicians' reliance on external signs of wound infection. Although the sample size was small, there were no differences in rates of infection between sutured and unsutured second-degree tears. CONCLUSIONS: Although second-degree tears were common after vaginal birth, wound infection/breakdown was relatively uncommon. Women who report feeling unwell or develop pyrexia postnatally should be assessed urgently. A prospective longitudinal study exploring the long-term sequelae of second-degree tears is needed.

Identifying risks areas related to medication administrations - text mining analysis using free-text descriptions of incident reports.

BACKGROUND: Some medications carry increased risk of patient harm when they are given in error. In incident reports, names of the medications that are involved in errors could be found written both in a specific medication field and/or within the free text description of the incident. Analysing only the names of the medications implicated in a specific unstructured medication field does not give information of the associated factors and risk areas, but when analysing unstructured free text descriptions, the information about the medication involved and associated risk factors may be buried within other non-relevant text. Thus, the aim of this study was to extract medication names most commonly used in free text descriptions of medication administration incident reports to identify terms most frequently associated with risk for each of these medications using text mining. METHOD: Free text descriptions of medication administration incidents (n = 72,390) reported in 2016 to the National Reporting and Learning System for England and Wales were analysed using SAS® Text miner. Analysis included text parsing and filtering free text to identify most commonly mentioned medications, followed by concept linking, and clustering to identify terms associated with commonly mentioned medications and the associated risk areas. RESULTS: The following risk areas related to medications were identified: 1. Allergic reactions to antibacterial drugs, 2. Intravenous administration of antibacterial drugs, 3. Fentanyl patches, 4. Checking and documenting of analgesic doses, 5. Checking doses of anticoagulants, 6. Insulin doses and blood glucose, 7. Administration of intravenous infusions. CONCLUSIONS: Interventions to increase medication administration safety should focus on checking patient allergies and medication doses, especially for intravenous and transdermal medications. High-risk medications include insulin, analgesics, antibacterial drugs, anticoagulants, and potassium chloride. Text mining may be useful for analysing large free text datasets and should be developed further.

Text Mining Method for Studying Medication Administration Incidents and Nurse-Staffing Contributing Factors: A Pilot Study.

Incident reporting systems are being implemented globally, thus increasing the profile and prevalence of incidents, but the analysis of free-text descriptions remains largely hidden. The aims of the study were to explore the extent to which incident reports recorded staffing issues as contributors to medication administration incidents. Incident reports related to medication administration (N = 1012) were collected from two hospitals in Finland between January 1, 2013, and December 31, 2014. The SAS Enterprise Miner 13.2 and its Text Miner tool were used to excavate terms and descriptors and to uncover themes and concepts in the free-text descriptions of incidents with (n = 194) and without (n = 818) nurse staffing-related contributing factors. Text mining included (1) text parsing, (2) text filtering, and (3) modeling text clusters and text topics. The term "rush/hurry" was the sixth most common term used in incidents where nurse-staffing was identified as a contributing factor. Nurse-staffing factors, however, were not pronounced in clusters or in text topics of either data set. Text mining offers the opportunity to analyze large free-text mass and holds promise for providing insight into the antecedents of medication administration incidents.

Development of tools to measure dignity for older people in acute hospitals.

BACKGROUND: Dignity is a concept that applies to all patients. Older patients can be particularly vulnerable to experiencing a loss of dignity in hospital. Previous tools developed to measure dignity have been aimed at palliative and end-of-life care. No tools for measuring dignity in acute hospital care have been reported. OBJECTIVES: To develop tools for measuring patient dignity in acute hospitals. SETTING: A large UK acute hospital. We purposively selected 17 wards where at least 50% of patients are 65 years or above. METHODS: Three methods of capturing data related to dignity were developed: an electronic patient dignity survey (possible score range 6-24); a format for nonparticipant observations; and individual face-to-face semi-structured patient and staff interviews (reported elsewhere). RESULTS: A total of 5,693 surveys were completed. Mean score increased from 22.00 pre-intervention to 23.03 after intervention (p < 0.001). Staff-patient interactions (581) were recorded. Overall 41% of interactions (239) were positive, 39% (228) were neutral, and 20% (114) were negative. The positive interactions ranged from 17%-59% between wards. Quality of interaction was highest for allied health professionals (76% positive), lowest for domestic staff (22% positive) and pharmacists (29% positive), and intermediate for doctors, nurses, healthcare assistants and student nurses (40%-48% positive). A positive interaction was more likely with increased length of interaction from 25% (brief)-63% (longer interactions) (F[2, 557] = 28.67, p < 0.001). CONCLUSIONS: We have developed a simple format for a dignity survey and observations. Overall, most patients reported electronically that they received dignified care in hospital. However, observations identified a high percentage of interactions categorised as neutral/basic care, which, while not actively diminishing dignity, will not enhance dignity. There is an opportunity to make these interactions more positive.

Understanding alcohol-related liver disease patients' illness beliefs and views about their medicine.

BACKGROUND: people with alcohol-related liver disease require complex treatment plans that often include the need for medication for the rest of their lives. Between 30% and 50% of all patients do not take their treatment as prescribed, leading to a significantly increased risk of morbidity and mortality. AIM: to consider the factors which influence beliefs held by patients with alcohol-related liver disease about their medication to provide an evidence base to support interventions to reduce medication non-adherence. METHOD: an observational cross-sectional patient survey. RESULTS: statistically significant associations were found between positive attitudes towards medication and the illness representation dimensions of 'illness identity' and 'illness comprehension'. CONCLUSIONS: medication adherence in patients with alcohol-related liver disease is likely to be improved by an intervention that strives to improve the patient's understanding of their illness condition and their perception of their illness symptoms.

Psychological interventions for post-traumatic stress disorder (PTSD) in people with severe mental illness.

BACKGROUND: Increasing evidence indicates that individuals who develop severe mental illness (SMI) are also vulnerable to developing post-traumatic stress disorder (PTSD), due to increased risk of exposure to traumatic events and social adversity. The effectiveness of trauma-focused psychological interventions (TFPIs) for PTSD in the general population is well-established. TFPIs involve identifying and changing unhelpful beliefs about traumatic experiences, processing of traumatic memories, and developing new ways of responding to cues associated with trauma. Little is known about the potential feasibility, acceptability and effectiveness of TFPIs for individuals who have a SMI and PTSD. OBJECTIVES: To evaluate the effectiveness of psychological interventions for PTSD symptoms or other symptoms of psychological distress arising from trauma in people with SMI. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Trials Study-Based Register (up until March 10, 2016), screened reference lists of relevant reports and reviews, and contacted trial authors for unpublished and/or specific outcome data. SELECTION CRITERIA: We included all relevant randomised controlled trials (RCTs) which investigated TFPIs for people with SMI and PTSD, and reported useable data. DATA COLLECTION AND ANALYSIS: Three review authors (DS, MF, IN) independently screened the titles and abstracts of all references identified, and read short-listed full text papers. We assessed risk of bias in each case. We calculated the risk ratio (RR) and 95% confidence interval (CI) for binary outcomes, and the mean difference (MD) and 95% CI for continuous data, on an intention-to-treat basis. We assessed quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and created 'Summary of findings' tables. MAIN RESULTS: Four trials involving a total of 300 adults with SMI and PTSD are included. These trials evaluated three active intervention therapies: trauma-focused cognitive behavioural therapy (TF-CBT), eye movement desensitisation and reprocessing (EMDR), and brief psychoeducation for PTSD, all delivered via individual sessions. Our main outcomes of interest were PTSD symptoms, quality of life/well-being, symptoms of co-morbid psychosis, anxiety symptoms, depressive symptoms, adverse events and health economic outcomes. 1. TF-CBT versus usual care/waiting list Three trials provided data for this comparison, however, continuous outcome data available were more often found to be skewed than unskewed, leading to the necessity of conducting analyses separately for the two types of continuous data. Using the unskewed data only, results showed no significant differences between TF-CBT and usual care in reducing clinician-rated PTSD symptoms at short term (1 RCT, n =13, MD 13.15, 95% CI -4.09 to 30.39,low-quality evidence). Limited unskewed data showed equivocal results between groups in terms of general quality of life (1 RCT, n = 39, MD -0.60, 95% CI -4.47 to 3.27, low-quality evidence), symptoms of psychosis (1 RCT, n = 9, MD -6.93, 95% CI -34.17 to 20.31, low-quality evidence), and anxiety (1 RCT, n = 9, MD 12.57, 95% CI -5.54 to 30.68, very low-quality evidence), at medium term. The only available data on depression symptoms were skewed and were equivocal across groups at medium term (2 RCTs, n = 48, MD 3.26, 95% CI -3.66 to 10.18, very low-quality evidence). TF-CBT was not associated with more adverse events (1 RCT, n = 100, RR 0.44, 95% CI 0.09 to 2.31, low-quality evidence) at medium term. No data were available for health economic outcomes. Very limited data for PTSD and other symptoms were available over the long term. 2. EMDR versus waiting listOne trial provided data for this comparison. Favourable effects were found for EMDR in terms of PTSD symptom severity at medium term but data were skewed (1 RCT, n = 83, MD -12.31, 95% CI -22.72 to -1.90, very low-quality evidence). EMDR was not associated with more adverse events (1 RCT, n = 102, RR 0.21, 95% CI 0.02 to 1.85, low-quality evidence). No data were available for quality of life, symptoms of co-morbid psychosis, depression, anxiety and health economics.3. TF-CBT versus EMDROne trial compared TF-CBT with EMDR. PTSD symptom severity, based on skewed data (1 RCT, n = 88, MD -1.69, 95% CI -12.63 to 9.23, very low-quality evidence) was similar between treatment groups. No data were available for the other main outcomes.4. TF-CBT versus psychoeducationOne trial compared TF-CBT with psychoeducation. Results were equivocal for PTSD symptom severity (1 RCT, n = 52, MD 0.23, 95% CI -14.66 to 15.12, low-quality evidence) and general quality of life (1 RCT, n = 49, MD 0.11, 95% CI -0.74 to 0.95, low-quality evidence) by medium term. No data were available for the other outcomes of interest. AUTHORS' CONCLUSIONS: Very few trials have investigated TFPIs for individuals with SMI and PTSD. Results from trials of TF-CBT are limited and inconclusive regarding its effectiveness on PTSD, or on psychotic symptoms or other symptoms of psychological distress. Only one trial evaluated EMDR and provided limited preliminary evidence favouring EMDR compared to waiting list. Comparing TF-CBT head-to-head with EMDR and brief psychoeducation respectively, showed no clear effect for either therapy. Both TF-CBT and EMDR do not appear to cause more (or less) adverse effects, compared to waiting list or usual care; these findings however, are mostly based on low to very low-quality evidence. Further larger scale trials are now needed to provide high-quality evidence to confirm or refute these preliminary findings, and to establish which intervention modalities and techniques are associated with improved outcomes, especially in the long term.

Cross-sectional examination of the association between shift length and hospital nurses job satisfaction and nurse reported quality measures.

BACKGROUND: Twenty-four hour nursing care involves shift work including 12-h shifts. England is unusual in deploying a mix of shift patterns. International evidence on the effects of such shifts is growing. A secondary analysis of data collected in England exploring outcomes with 12-h shifts examined the association between shift length, job satisfaction, scheduling flexibility, care quality, patient safety, and care left undone. METHODS: Data were collected from a questionnaire survey of nurses in a sample of English hospitals, conducted as part of the RN4CAST study, an EU 7th Framework funded study. The sample comprised 31 NHS acute hospital Trusts from 401 wards, in 46 acute hospital sites. Descriptive analysis included frequencies, percentages and mean scores by shift length, working beyond contracted hours and day or night shift. Multi-level regression models established statistical associations between shift length and nurse self-reported measures. RESULTS: Seventy-four percent (1898) of nurses worked a day shift and 26% (670) a night shift. Most Trusts had a mixture of shifts lengths. Self-reported quality of care was higher amongst nurses working ≤8 h (15.9%) compared to those working longer hours (20.0 to 21.1%). The odds of poor quality care were 1.64 times higher for nurses working ≥12 h (OR = 1.64, 95% CI 1.18-2.28, p = 0.003). Mean 'care left undone' scores varied by shift length: 3.85 (≤8 h), 3.72 (8.01-10.00 h), 3.80 (10.01-11.99 h) and were highest amongst those working ≥12 h (4.23) (p < 0.001). The rate of care left undone was 1.13 times higher for nurses working ≥12 h (RR = 1.13, 95% CI 1.06-1.20, p < 0.001). Job dissatisfaction was higher the longer the shift length: 42.9% (≥12 h (OR = 1.51, 95% CI 1.17-1.95, p = .001); 35.1% (≤8 h) 45.0% (8.01-10.00 h), 39.5% (10.01-11.99 h). CONCLUSIONS: Our findings add to the growing international body of evidence reporting that ≥12 shifts are associated with poor ratings of quality of care and higher rates of care left undone. Future research should focus on how 12-h shifts can be optimised to minimise potential risks.

Wellbeing, mental health knowledge and caregiving experiences of siblings of people with psychosis, compared to their peers and parents: an exploratory study.

PURPOSE: The wellbeing and caregiving experiences of family carers supporting people with psychosis has garnered increasing interest. Evidence indicates that the burden of caregiving can adversely impact on parents' wellbeing, few studies have investigated whether this is also the case for siblings, who often take on caregiving responsibilities. This exploratory study investigated the wellbeing, mental health knowledge, and appraisals of caregiving in siblings of individuals with psychosis. METHOD: Using a cross-sectional design, 90 siblings completed three validated questionnaires: Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), Mental Health Knowledge Schedule (MAKS), and Experience of Caregiving Inventory (ECI). Data obtained were compared to general population norms and parent-carers' scores. Multi-variable regression analyses were conducted to examine relationships between questionnaire scores and demographic characteristics including age, sex, birth order, marital status, accommodation and educational level. RESULTS: Siblings, especially sisters, had significantly poorer mental wellbeing, compared to normative scores. Conversely, they had better mental health knowledge. Siblings and parent-carers had comparable high levels of negative appraisals of caregiving experiences, but siblings reported more satisfaction with personal experiences and relationships. Education level was a significant predictor for better mental health knowledge; there were no other relationships between siblings' demographic factors and outcomes. CONCLUSION: Study findings suggest that siblings have overlapping as well as distinct needs, compared to parent-carers. Further research is required to better understand siblings' experiences so as to inform development of targeted interventions that enhance wellbeing and caregiving capacity.

Patients with alcohol-related liver disease--beliefs about their illness and factors that influence their self-management.

AIM: To determine the association between illness belief and self-efficacy to provide the evidence-base to develop a personalized framework to support self-management in patients with alcohol-related liver disease. BACKGROUND: Research in a variety of long-term illnesses suggests patients' illness beliefs are a more influential factor for patient recovery than the severity of the illness. However, research into illness belief and self-efficacy of patients with alcohol-related liver disease is sparse. DESIGN: A cross-sectional survey. METHODS: A cohort of 159 patients with alcohol-related liver disease who attended the Liver Outpatient Clinics at a London Hospital (October 2012-November 2013) completed a set of validated instruments measuring illness beliefs, self-efficacy, emotional states and quality of life. FINDINGS: The mean age of enrolled patients was 52 years, 67% male, 26% live on their own, 61% had no previous history of other chronic illness and average Model for End-Stage Liver Disease and The AUDIT Alcohol Consumption Questions scores were 11·0 and 3·5 respectively. After adjusting for demographic and illness characteristic components, multiple regression analysis shows that the three illness belief components 'Symptoms', 'Understanding' and 'Concerns' made a significant contribution to their confidence to self-manage their liver condition and the 'Symptoms' component makes a signification contribution across to all outcome measures: Anxiety, Depression, Quality of Life and Self-Efficacy. CONCLUSION: Interventions designed to improve these patients' understanding of their illness and strategies to manage their symptoms are likely to improve their self-management, quality of life and reduce anxiety and depression.

A cross-sectional study of 'care left undone' on nursing shifts in hospitals.

AIMS: To determine factors associated with variation in 'care left undone' (also referred to as 'missed care') by Registered Nurses (RNs) in acute hospital wards in Sweden. BACKGROUND: 'Care left undone' has been examined as a factor mediating the relationship between nurse staffing and patient outcomes. The context has not previously been explored to determine what other factors are associated with variation in 'care left undone' by RNs. DESIGN: Cross-sectional survey to explore the association of RN staffing and contextual factors such as time of shift, nursing role and patient acuity/dependency on 'care left undone' was examined using multi-level logistic regression. METHODS: A survey of 10,174 RNs working on general medical and surgical wards in 79 acute care hospitals in Sweden (January-March 2010). RESULTS: Seventy-four per cent of nurses reported some care was left undone on their last shift. The time of shift, patient mix, nurses' role, practice environment and staffing have a significant relationship with care left undone. The odds of care being left undone is halved on shifts where RN care for six patients or fewer compared with shifts where they care for 10 or more. CONCLUSION: The previously observed relationship between RN staffing and care left undone is confirmed. Reports of care left undone are influenced by RN roles. Support worker staffing has little effect. Research is needed to identify how these factors relate to one another and whether care left undone is a predictor of adverse patient outcomes.

Personalised discharge care planning for postmyocardial infarction patients through the use of the Personalised Patient Education Protocol - implementing theory into practice.

AIMS AND OBJECTIVES: This study aims to evaluate the service impact of the integration of an evidence-based instrument - the Personalised Patient Education Protocol - into an existing postmyocardial infarction care pathway. BACKGROUND: Recent research indicates that while better patient health outcomes can be achieved when care planning is personalised, delivery staff feel less satisfied and less confident in its provision. To achieve a shift to personalised care, innovations are needed to enable an effective transition for staff. DESIGN: A service evaluation using a patient survey and nurse interviews. METHOD: A longitudinal patient survey measured changes in patient illness beliefs, cardiac diet and exercise self-efficacy, anxiety, depression and quality of life study of a patient cohort of 74. Paired t-tests analysed the effects before and after the implementation of the Personalised Patient Education Protocol. Cardiac rehabilitation nurses who implemented the Personalised Patient Education Protocol were interviewed and a patient survey identified perceptions of the usefulness of the service innovation. RESULTS: Analysis of change from baseline to three months results showed statistically significant changes in Illness Belief component 'Understanding' and the Dartmouth Quality of Life 'General Health'. The integration of the Personalised Patient Education Protocol into the existing discharge process identified service improvements for cardiac nurse training and care pathway delivery, while patients identified the level and frequency of their use of the protocol following discharge. CONCLUSION: The introduction of the Personalised Patient Education Protocol succeeded in increasing patient engagement, facilitated a more patient-centred service by enabling practitioners to systematically provide personalised patient education, and gave patients a postdischarge structure to better follow-up their illness concerns with health professionals in the community. RELEVANCE TO CLINICAL PRACTICE: Integration of the Personalised Patient Education Protocol into an existing postmyocardial infarction care pathway enabled nurses to systematically respond to individual patients' illness beliefs and expectations.

Evaluation of a Nurse-Led Educational Telephone Intervention to Support Self-Management of Patients With Chronic Obstructive Pulmonary Disease: A Randomized Feasibility Study.

UNLABELLED: This randomized, two armed feasibility study in a UK General Practice Surgery investigated the feasibility of introducing a nurse-led educational telephone intervention for patients with chronic obstructive pulmonary disease (COPD) to reinforce their understanding and use of their self-management plan. METHODS: 73 patients were randomly allocated to a control group which received standard care including a self-management plan or an intervention group which received in addition, two scheduled telephone calls over six weeks from a practice nurse. Calls were tailored to the needs of the patient, but provided education about the use of their plan to manage exacerbations, use of health services and emergency medication. The primary endpoint to be tested was the impact of symptoms assessed by the COPD Assessment Tool (CAT) at baseline and 12 weeks. Secondary endpoints were self-reported exacerbations, emergency visits and service satisfaction. RESULTS: Follow-up CAT data was available for 69 of the 73 randomized patients. CAT scores in the intervention group decreased significantly showing improvement between time 1 and 2 (Time 1 = 15.56 vs 12.44 at Time 2, Mean difference: 3.12, CI 1.52 -4.72, p <0.05) with no significant change in the control group. A significant difference between the CAT scores of the intervention and control groups was found at time 2 adjusting for baseline CAT scores at time 1 (-2.38 (-4.40 to -0.36) p <0.05.) No significant change was found in exacerbations between the groups at time 2. Satisfaction ratings did not vary significantly between the intervention and control groups over time. CONCLUSION: A nurse-led telephone intervention is feasible in primary care and may help to improve patients' health and well-being.