Contributing to self-care of a person with chronic obstructive pulmonary disease: A qualitative study of the experiences of family caregivers.

AIM: To explore family caregivers' experiences of contributing to self-care of patients with chronic obstructive pulmonary disease (COPD). DESIGN: A qualitative description study. METHODS: Individual semi-structured interviews were conducted face-to face, by telephone or video calls in a purposive sample of 17 family caregivers of patients with COPD recruited in Italy, and analysed through content analysis. The consolidated criteria for reporting qualitative studies (COREQ) checklist was used for study reporting. RESULTS: Ten subcategories were derived from 106 codes grouped into three main categories: family caregiver contributions to maintaining disease stable and ensuring a normal life for patients; family caregiver contributions to disease monitoring; and family caregiver contributions to coping with disease exacerbations. Family caregivers provided practical and emotional support, and their contribution was essential to improve treatment adherence, to enable the patient to continue living a normal life, and to have access to the healthcare services. Family caregivers were constantly vigilant and monitored patients daily to detect worsening conditions, and they managed exacerbations especially when patients were unable to do it due to their critical conditions. CONCLUSION: This study broadens knowledge of family caregivers' contributions to patients' self-care in COPD, describing the different ways family members provide daily care to patients and the many responsibilities they take on. IMPACT: Family caregivers perform a variety of behaviours when supporting patients with COPD in self-care, especially when patients are more dependent and the disease more severe. Nurses should acknowledge the various contributions provided by family caregivers and develop educational interventions aiming to support them in patient care and improve patient outcomes. PATIENT OR PUBLIC CONTRIBUTION: Researchers shared the draft study report with participants for validation and feedback. This helped to strengthen the study design and results.

Nurse-to-Nurse Collaboration: A Scoping Review.

OBJECTIVE: To map predictors and outcome of collaboration between nurses, outcomes of a good collaboration, and the tools developed to evaluate nurse-nurse collaboration. BACKGROUND: Collaboration between nurses is an intraprofessional relationship between coworkers that is expressed through shared objectives, authority, and a decisional process. Studies on collaboration between nurses are very limited. METHODS: A scoping review was conducted through 4 databases. RESULTS: Eighteen studies were included. Nurses with higher levels of collaboration are more satisfied with their work and report less of an intention to leave their job. Greater collaboration among nurses resulted in a decrease of patient falling, hospital-acquired pressure ulcers, and a better care. Three tools have been developed to evaluate nurse-nurse collaboration: the Nurse-Nurse Collaboration Scale, the Nurse-Nurse Collaboration Behavior Scale, and the Nurse-Nurse Collaboration Between Sector. CONCLUSIONS: Further studies should be conducted to fully understand the issue of collaboration between nurses and the factors connected to it.

Caregivers' experiences of contributing to patients' self-care in Chronic Obstructive Pulmonary Disease: A thematic synthesis of qualitative studies.

AIM: To identify, analyze and synthesize qualitative studies on caregivers' experiences of contributions to the self-care of patients with Chronic Obstructive Pulmonary Disease (COPD). BACKGROUND: COPD patients perform daily self-care behaviours to manage the disease. With aging and disease progression, patients need to rely on the contributions of informal caregivers, usually family members, for disease management. Caregivers' normal or habitual contributions to patients' self-care have not yet been completely investigated. DESIGN: Thematic synthesis of qualitative studies. DATA SOURCES: CINAHL, EMBASE, PubMed, PsycINFO, Web of Science, Scopus, Emcare and OpenGrey databases were searched from inception to September 2020. The search was restricted to English-language papers. REVIEW METHODS: Studies were critically appraised using the Critical Appraisal Skills Programme checklist. The initial line-by-line codes were aggregated into descriptive themes from which analytical themes were derived. RESULTS: Fifteen papers from nine countries, published 2009-2020, were included. Six analytical themes encompassing 22 descriptive themes were identified and grouped in two overarching themes describing caregivers' experiences of contributions to patients' self-care during the stable and exacerbation phases of COPD. In the stable phases, caregivers contribute through maintaining disease stability, promoting healthy behaviours, fostering normal life and helping perform daily activities. During exacerbations, caregivers contribute through assessing, monitoring and managing symptoms in collaboration with patients or autonomously. They contribute by performing actions, motivating patients, organizing care, sensing variations in symptoms, acquiring knowledge and educating patients, making decisions, communicating and collaborating with healthcare providers and patients and advocating for patients. CONCLUSION: This thematic synthesis enlarges knowledge of caregivers' contributions to patients' self-care in COPD, detailing the ways by which caregivers provide care to patients. IMPACT: Contributing daily to the self-care of a family member with COPD is a complex experience. Nurses need to acknowledge the importance of caregivers' contributions to patient disease management and develop effective educational interventions to support them.

Validity and Reliability of Caregiver Contribution to Self-Care of Chronic Obstructive Pulmonary Disease Inventory and Caregiver Self-Efficacy in Contributing to Self-Care Scale.

The study tested the construct validity and reliability of the Caregiver Contribution to Self-Care of Chronic Obstructive Pulmonary Disease (COPD) Inventory and the Caregiver Self-Efficacy in Contributing to Self-Care of COPD Scale. The two instruments were developed by modifying the Self-Care of COPD Inventory and Self-Care Self-Efficacy Scale in COPD into caregiver versions. The psychometric properties were tested in a convenience sample of 261 informal caregivers of COPD patients recruited in Italy in two cross-sectional studies. Structural validity was tested by confirmatory factor analysis, construct validity by posing several hypotheses, and internal consistency through factor score determinacy and global reliability index for multidimensional scales. In confirmatory factor analysis, the caregiver contribution to self-care maintenance, monitoring and management scales, composing the Caregiver Contribution to Self-Care of COPD Inventory, presented good fit indices. Global reliability indices ranged 0.75-0.88. The caregiver self-efficacy scale presented a comparative fit index of 0.96 and a global reliability index of 0.82. The caregiver contribution to self-care and the caregiver self-efficacy scales correlated moderately among themselves and with the patient versions of the scales, and scores were higher with caregiver-oriented dyadic care types and female caregivers. Our study provides evidence of the two instruments' construct validity and internal consistency.

The Effects of Early Mobilization on Acquired Weakness in Intensive Care Units: A Literature Review.

BACKGROUND: Intensive care unit (ICU)-acquired weakness (ICUAW) is defined as a clinical syndrome of neuromuscular weakness, and a consequence of critical illness, unrelated to any other etiology. It is associated with difficult weaning from the ventilator, prolonged ICU stay, increased mortality, and other important long-term outcomes. Early mobilization is defined as any active exercise in which patients use their muscle strength actively or passively within the first 2 to 5 days of critical illness. Early mobilization can be safely initiated from the first day of admission to the ICU during mechanical ventilation. OBJECTIVES: The purpose of this review is to describe the effects of early mobilization on complications from ICUAW. METHOD: This was a literature review. Inclusion criteria were as follows: observational studies and randomized controlled trials conducted with adult patients (aged ≥18 years) admitted to the ICU were included. Studies selected were published in the last 11 years (2010-2021). RESULTS: Ten articles were included. Early mobilization reduces muscle atrophy, ventilation, length of hospital stay, and ventilator-associated pneumonia and improves patients' responses to inflammation and hyperglycemia. DISCUSSION: Early mobilization appears to have a significant impact on the prevention of ICUAW and appears to be safe and feasible. The results of this review could be useful for improving the provision of efficient and effective tailored care for ICU patients.

The cross-cultural adaptation and validation of the Nurse-Nurse Collaboration Scale in Italy.

BACKGROUND AND AIM: Collaboration between colleagues is an essential element of clinical nursing care because it helps to ensure patient safety. This study aimed to evaluate the psychometric properties of the XXX version of the Nurse-Nurse Collaboration Scale (NNCS). The secondary goal of this study was to assess the degree of collaboration between nurses in Italy. METHODS: First, the cultural adaptation of the NNCS tool was performed. The face and content validity of the tool were assessed through the involvement of nursing experts. To test construct validity, a descriptive cross-sectional study was conducted on a sample of 362 nurses. RESULTS: The Italian version of the NNCS was composed of 23 items distributed across five domains. The five-dimensional model showed an adequate model goodness of fit (RMSEA=0.075, CFI=0.883, SRMR=0.072). The NNCS dimension with the highest average score was Professionalism (M=3.10 ± 0.45), while Conflict Management (M=2.14 ± 0.47) exhibited the lowest score. CONCLUSIONS: The Italian version of the NNCS is a valid and reliable tool. More effort should be made to ensure the proper management of conflicts in healthcare environments.