Causes and Risk Factors of Breast Cancer, What Do We Know for Sure? An Evidence Synthesis of Systematic Reviews and Meta-Analyses.

Breast cancer affected more than 2.3 million women in 2022 and is the most diagnosed cancer among women worldwide. The incidence rates are greater in developed regions and are significantly higher among women with higher education and socioeconomic status. Therefore, it is reasonable to assume that the way women live their lives may impact their risk of being diagnosed with breast cancer. This systematic review aimed to identify what is known about the causes and risk factors of breast cancer, excluding genetic causes. A comprehensive systematic search identified 2387 systematic reviews, 122 were included and six overall themes identified. In our "top list" with the 36 most important findings, a study of breast density had the highest effect size for increasing the risk of breast cancer, and a high sex-hormone-binding globulin level was the most protective factor. Many of the included studies investigating the same topics had conflicting results. The conclusion from this evidence synthesis reveals a lack of consensus of factors associated with the causes and risk of breast cancer. These findings suggest that recommendations about lifestyle and breast cancer should be made with caution.

Surveillance of Infections and Antibiotic Use in 21 Nursing Home Wards during the COVID-19 Pandemic: A Systematic Assessment.

Residents in nursing homes are fragile and at high risk of serious illness or death from healthcare-associated infections. The COVID-19 pandemic posed a significant risk of suffering and mortality for residents of nursing homes. Surveillance of infections is essential for infection prevention and is missing in many countries. The aim of this study is to explore infection rates and antibiotic use in nursing homes during the COVID-19 pandemic. Data collection was conducted from February to September 2021. Each week, healthcare workers at 21 nursing home wards answered a questionnaire on infections, antibiotic use, deaths, and hospital admissions related to infections. A total of 495 infections were reported, and 97.6% were treated with antibiotics. The total infection rate was 5.37 per 1000 bed days, and there were reported 53 hospital admissions and 11 deaths related to or caused by infections. The infection rate and high use of antibiotics found in this study indicated that it is difficult to treat infections in residents in nursing homes and make it difficult to achieve the global goal of reducing infections and antibiotic resistance rates. This emphasizes the need for stricter infection control programs to reduce antibiotic use and patient suffering.

Impact of multimodal interventions targeting behavior change on hand hygiene adherence in nursing homes: An 18-month quasi-experimental study.

BACKGROUND: Nursing home residents are vulnerable and frail, and hand hygiene adherence is often too low to prevent transmission of infections. This study's aim was to investigate whether interventions targeting behavior change can improve hand hygiene adherence in nursing homes. METHODS: Over 18 months, 22 nursing home wards participated in this quasi-experimental study. Three intervention wards were selected based on the mean values of hand hygiene adherence, infections, and antibiotic use. Multimodal interventions targeting behavior change, including education, UV-light boxes, and posters, were implemented. RESULTS: Hand hygiene adherence increased to 60.9% in the intervention wards and decreased to 51.3% in the control wards. The control wards experienced lower adherence in all indications of WHO's "My five moments for hand hygiene." DISCUSSION: Interventions should target proper hand hygiene before patient contact and glove use because health care workers have low adherence in these areas. The findings indicate that the type of intervention is less important than attention to hand hygiene and activating workers' motivation. Using a behavior change approach and continuous reinforcement is important because the effects of interventions diminish over time. CONCLUSIONS: Our findings showed that multimodal interventions targeting behavior change may increase hand hygiene adherence.

Long-term social assistance recipients' experiences with an increased monthly payment: a qualitative pilot study.

AIMS: Ten long-term social assistance recipients in a Norwegian municipality received a greater-than-average fixed monthly payment for 12 months. This study aimed to explore whether these recipients with reduced administrative requirements and a fixed monthly payment that was greater than the average social assistance experienced reduced poverty, increased feelings of independence, better daily living, and an improved quality of life. METHODS: The study's explorative design included 20 qualitative, in-depth, semi-structured interviews and a longitudinal electronic survey for 12 months. The 10 participants had been selected by the local labour and welfare agency based on stringent criteria and are therefore not representative of social assistance recipients in general. Individual interviews were conducted during autumn 2021 and spring 2022. The interview data were analysed using systematic text condensation, and the survey results are presented using descriptive statistics. RESULTS: The participants included in the project described a reduced experience of poverty. They could buy additional items and set aside money, something they had not been able to do in the past, and meant a great deal to them. They expressed experiencing freedom, gaining a stronger sense of independence, and having lessened feelings of shame. Many of the participants described health issues that were incompatible with working. CONCLUSIONS: Being given this opportunity led to a feeling of increased dignity and greater inclusion in society among this selected group of participants. They appreciated the simplified conditions and reduced requirements for administrative matters. All expressed that spending 8 months without contact with the social welfare office was a liberation.

Changes in Subjective Measures of Cognitive Function in Older Adults From the Initiation Through 12 Months After the Receipt of Chemotherapy.

BACKGROUND: Cognitive impairment has a negative impact on older patients with cancer. OBJECTIVES: The aim of this study was to evaluate for interindividual differences in 2 subjective measures of cognitive function in older patients (n = 112), as well as determine which demographic, clinical, and symptom characteristics, and levels of physical function, were associated with initial levels and with the trajectory of each of these 2 measures. METHODS: Cognitive function was assessed using the cognitive function scale from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the Attentional Function Index at the initiation of chemotherapy and at 1, 3, 6, 9, and 12 months after its initiation. Hierarchical linear modeling was used to assess for interindividual differences in and characteristics associated with initial levels and changes in cognitive function. RESULTS: Characteristics associated with decreases in Quality of Life Questionnaire Core 30 scores at the initiation of chemotherapy were longer time since the cancer diagnosis and higher depression scores. Characteristics associated with poorer Attentional Function Index scores at enrollment were lower levels of education and higher depression scores. No characteristics were associated with worse trajectories of either cognitive function measure. CONCLUSION: Some older patients undergoing chemotherapy experience decrements in cognitive function. IMPLICATIONS FOR PRACTICE: Our findings suggest that clinicians need to assess for depressive symptoms in older patients before the initiation of chemotherapy. Evidence-based interventions (eg, cognitive stimulation, increased physical activity) can be recommended to maintain and increase cognitive function in older oncology patients.

Unpacking the Public Health Triad of Social Inequality in Health, Health Literacy, and Quality of Life-A Scoping Review of Research Characteristics.

Social inequalities in health, health literacy, and quality of life serve as distinct public health indicators, but it remains unclear how and to what extent they are applied and combined in the literature. Thus, the characteristics of the research have yet to be established, and we aim to identify and describe the characteristics of research that intersects social inequality in health, health literacy, and quality of life. We conducted a scoping review with systematic searches in ten databases. Studies applying any design in any population were eligible if social inequality in health, health literacy, and quality of life were combined. Citations were independently screened using Covidence. The search yielded 4111 citations, with 73 eligible reports. The reviewed research was mostly quantitative and aimed at patient populations in a community setting, with a scarcity of reports specifically defining and assessing social inequality in health, health literacy, and quality of life, and with only 2/73 citations providing a definition for all three. The published research combining social inequality in health, health literacy, and quality of life is heterogeneous regarding research designs, populations, contexts, and geography, where social inequality appears as a contextualizing variable.

Characteristics associated with decrements in objective measures of physical function in older patients with cancer during chemotherapy.

PURPOSE: Study purposes were to evaluate for inter-individual variability in the trajectories of three objective measures of physical function (PF) in older patients receiving chemotherapy (n = 112) and determine which characteristics were associated with worse PF. METHODS: Balance, gait speed, and chair-stand test were evaluated at initiation and 1, 3, 6, 9, and 12 months following chemotherapy. Hierarchical linear modeling was used to assess inter-individual variability in the trajectories of the three tests. Demographic, clinical, and symptom characteristics, and levels of cognitive function associated with initial levels and changes over time in each of the tests were determined. RESULTS: Gait speed and chair-stand tests improved over time. Balance declined until month 6, then increased. Characteristics associated with decreases in balance scores at initiation of chemotherapy were lower level of education and lower Karnofsky Performance Status (KPS) score. For initial levels of poorer gait speed, older age, poorer Trail Making Test B (TMTB), and worse Attentional Function Index scores were the associated characteristics. Lower KPS scores, higher body mass index, and poorer TMTB scores were associated with poorer chair-stand times at initiation of chemotherapy. Worse trajectories of chair-stand times were associated with poorer chair-stand time at enrollment. Characteristic associated with lower initial levels and improved trajectories of balance was older age at enrollment. CONCLUSIONS: Determination of characteristics associated with decrements in balance, gait speed, and chair-stand can assist clinicians to identify older oncology patients at risk for decrements in PF. Interventions to maintain and improve PF need to be implemented with higher risk patients.

The impact of educational concerns and satisfaction on baccalaureate nursing students' distress and quality of life during the Covid-19 pandemic; a cross-sectional study.

BACKGROUND: High levels of psychological distress and poor overall quality of life (QOL) have been identified among nursing students during the COVID-19 pandemic. The pandemic necessitated improvised reconstructions of educational curriculums and restrictions in clinical placement and training at campuses, possibly reducing educational quality. OBJECTIVES: We explored whether baccalaureate nursing students' concerns and satisfaction with the educational curriculum, focusing on the conduct of clinical training, were associated with perceived psychological distress and overall QOL. METHODS: Baccalaureate nursing students (N=6088) from five Norwegian universities were invited to an internet-based, cross-sectional survey during the second wave of the pandemic. The survey included COVID-19 specific questions on health, education and clinical training, the Fear of COVID-19 scale (FCV-19S), The Hopkins Symptom Checklist (SCL-5) and overall QOL. Data from national surveys on satisfaction with the educational curriculum, before and during the pandemic were used for comparison. RESULTS: In total, 2605 (43%) students responded, of whom 1591 (61%) had been engaged in clinical training during the pandemic. Overall, 53% were either satisfied or fully satisfied with their educational curriculum, with the level of satisfaction being significantly lower than pre-pandemic reference values. Also, 79% were concerned or highly concerned about the educational quality. In multiple regression analyses for all students, lower levels of satisfaction and higher levels of quality concerns were associated with worse SCL-5 scores. Furthermore, satisfaction with the educational curriculum was positively associated with overall QOL. For students engaged in clinical training, only concerns about infecting others were additionally associated with psychological distress. None of the items related to clinical training were associated with overall QOL. CONCLUSION: Nursing students' educational satisfaction and quality concerns may significantly impact perceived psychological distress and overall QOL during a pandemic. However, with necessary adaptations implemented, concerns regarding the conduct of clinical training account for little of these associations.

Students' observations of hand hygiene adherence in 20 nursing home wards, during the COVID-19 pandemic.

BACKGROUND: Healthcare-associated infections are a major threat to patient safety, particularly vulnerable elderly living in nursing homes, who have an increased risk of infections and mortality. Although good hand hygiene is the most effective preventive measure against infections, few studies of hand hygiene adherence have been conducted in nursing homes. The aim of this study is to investigate hand hygiene adherence in nursing homes with students as observers using a validated observation tool. In addition, to examine when healthcare workers perform hand hygiene and when they do not. METHODS: This observational study used the World Health Organization's observation tool for studying hand hygiene indication and adherence: "My five moments for hand hygiene." For 1 week each in February and March 2021, 105 first-year nursing students conducted 7316 hand hygiene observations at 20 nursing home wards in one large municipality in Norway. RESULTS: The overall adherence rate found in this study was 58.3%. Hand hygiene adherence decreased from 65.8% in February to 51.4% in March. The adherence varied largely between the different wards, from 26.4 to 83.1%, and by occupation status, indications of hand hygiene, and use of gloves. Nursing students were found to have the greatest adherence, followed by nurses. The use of gloves reduced adherence. Healthcare workers to a larger degree conduct hand hygiene after contact with patients than before approaching them. CONCLUSIONS: Hand hygiene adherence is too low to protect all residents against healthcare-associated infections, and the findings from this study indicate that there are many factors that influence hand hygiene adherence, eg., education, occupation status and glove use Increasing healthcare workers' knowledge and skills of hand hygiene is needed to reduce healthcare-associated infections and reminders of the importance of hand hygiene adherence must be an ongoing activity. Interventions to improve hand hygiene adherence in healthcare workers is needed to reduce infections and antibiotic use in nursing homes.

Age-related differences in self-report and objective measures of cognitive function in older patients prior to chemotherapy.

AIM: Evaluate for differences in demographic and clinical characteristics and subjective and objective measures of cognitive function (CF) between younger older adults (YOA, 60-69 years) and older adults (OA, ≥70 years). DESIGN: Cross-sectional. METHODS: Older oncology patients (n = 139) completed subjective (Attentional Function Index, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC) CF scale) and objective (Montreal Cognitive Assessment, Trail Making Test (TMT) A & B) measures of CF prior to chemotherapy. Data were analyzed using parametric and nonparametric tests. RESULTS: No differences were found between the two groups for any of the subjective or objective CF measures, except that OA patients had higher TMT B scores. Compared with the general population, OAs had significantly higher EORTC CF scores and YOAs had significantly worse scores for all of the objective tests. Clinically meaningful difference between group differences was found for the TMT B test.

Common and distinct characteristics associated with self-reported functional status in older patients with cancer receiving chemotherapy.

PURPOSE: To evaluate for inter-individual differences in two subjective measures of functional status in older patients (n = 112), as well as to determine which demographic, clinical, and symptom characteristics, and levels of cognitive function, were associated with initial levels and with the trajectory of the two measures. METHODS: Functional status was assessed using self-report measures of physical function (PF) and role function (RF) from the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire at the initiation of chemotherapy and at 1, 3, 6, 9, and 12 months after its initiation. Hierarchical linear modeling was used to assess inter-individual differences in and characteristics associated with initial levels and changes in PF and RF. RESULTS: Characteristics associated with decreases in PF at the initiation of chemotherapy were higher numbers of comorbidities and higher depression, pain, and dyspnea scores. For initial levels of poorer RF, lower Karnofsky Performance Status scores and higher pain and fatigue scores were the associated characteristics. Characteristic associated with worse trajectories of PF was not having had surgery. For RF, worse trajectories were associated with lower cognitive function and higher RF at enrollment. Characteristic associated with both lower initial levels and improved trajectories of PF was having lower performance status at enrollment. CONCLUSIONS: Older patients undergoing chemotherapy experience reduced functional performance. Characteristics associated with decrements in PF and RF need to be assessed and interventions implemented to maintain and increase functional status in older oncology patients.

Symptom experience of older oncology patients with low versus high levels of multimorbidity prior to chemotherapy.

PURPOSE: Evaluate for differences in demographic and clinical characteristics between older oncology patients with low multimorbidity (<2 multimorbidities) and high multimorbidity (≥2 multimorbidities) and evaluate for differences in symptom occurrence, severity, and distress ratings between the two groups. METHODS: Symptoms of older oncology patients (n = 125) were assessed using the Memorial Symptom Assessment Scale prior to chemotherapy administration. Data were analyzed using t-tests for continuous variables and Chi-square or Fisher's exact tests for categorical variables. RESULTS: For the total sample, lack of energy and pain were the two most common symptoms. Compared to the low multimorbidity group, the high multimorbidity group had a higher number of symptoms and significantly higher occurrence rates for feeling nervous, difficulty sleeping, dry mouth, and pain. Compared to the low multimorbidity group, the high multimorbidity group had significantly higher severity ratings for pain, feeling sad, lack of energy, feeling drowsy, and worrying. For distress, the high multimorbidity group reported significantly higher ratings for pain, worrying, feeling sad, feeling nervous, and "I don't look like myself". No differences were found in any demographic or clinical characteristics between the two multimorbidity groups. CONCLUSIONS: Multimorbidity is associated with higher symptom occurrence, severity, and distress in older oncology patients. Our findings suggest that the symptoms with the highest severity ratings were not the most distressing. Clinicians should identify multimorbidities and assess symptoms prior to chemotherapy to identify patients at increased risk and initiate referrals for interventions.

Relationship between teaching modality and COVID-19, well-being, and teaching satisfaction (campus & corona): A cohort study among students in higher education.

OBJECTIVES: Higher education institutions all over the world struggled to balance the need for infection control and educational requirements, as they prepared to reopen after the first wave of the COVID-19 pandemic. A particularly difficult choice was whether to offer for in-person or online teaching. Norwegian universities and university colleges opted for a hybrid model when they reopened for the autumn semester, with some students being offered more in-person teaching than others. We seized this opportunity to study the association between different teaching modalities and COVID-19 risk, quality of life (subjective well-being), and teaching satisfaction. STUDY DESIGN: Prospective, observational cohort study. METHODS: We recruited students in higher education institutions in Norway who we surveyed biweekly from September to December in 2020. RESULTS: 26 754 students from 14 higher education institutions provided data to our analyses. We found that two weeks of in-person teaching was negatively associated with COVID-19 risk compared to online teaching, but the difference was very uncertain (-22% relative difference; 95% CI -77%-33%). Quality of life was positively associated with in-person teaching (3%; 95% CI 2%-4%), as was teaching satisfaction (10%; 95% CI 8%-11%). CONCLUSION: The association between COVID-19 infection and teaching modality was highly uncertain. Shifting from in-person to online teaching seems to have a negative impact on the well-being of students in higher education.

Distinctions Between Self-Report and Performance-Based Measures of Physical Function in Older Patients Prior to Chemotherapy.

BACKGROUND: The maintenance of physical function (PF) is an extremely important outcome for elderly people. OBJECTIVE: The aims of this study were to identify differences in the subjective and objective measures of PF between younger older adults (YOAs, 60-69 years of age) and older adults (OA, ≥70 years of age), to compare the PF scores with age-matched samples from the general population, and to evaluate for associations between the subjective and objective measures of PF. METHODS: Patients (n = 139) were assessed using subjective (ie, European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire) and objective (ie, Short Physical Performance Battery [SPPB]) measures prior to chemotherapy (CTX). Data were analyzed using parametric and nonparametric tests. RESULTS: No differences were found between the 2 age groups in any of the subjective or objective measures of PF. Compared with the age-matched general population, both YOAs and OAs had significantly lower scores in both measures of PF. Large effect sizes were found for differences in European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire role function, SPPB balance, and SPPB total scores between the YOA group and the age-matched general population samples. Correlations between the subjective and objective measures were low. CONCLUSIONS: Older patients with cancer have lower PF than their age-matched general population prior to CTX. Longitudinal studies are warranted to evaluate for changes in PF during and following CTX. IMPLICATIONS FOR PRACTICE: Nurses need to perform routine assessments of PF in older oncology patients prior to CTX. Our findings suggest that SPPB gait speed may be a useful screening measure for PF in older patients.

Students' top 10 priorities of research uncertainties on students' sleep: a pragmatic James Lind Alliance approach.

OBJECTIVES: Inspired by the James Lind Alliance (JLA) user involvement approach, the aim of the present study was to identify the top 10 uncertainties for sleep research raised by students in higher education, and to discuss our experiences with adapting the JLA method to a student population. DESIGN: The study design is a pragmatic JLA approach, including a priority setting partnership within the field of sleep, collection of sleep-related research uncertainties as reported by students in higher education, sorting of the uncertainties and a final identification of the top 10 uncertainties through collaborative work between researchers, students, stakeholders and experts in the field. Uncertainties were collected using a one-question online survey: 'as a student, which question(s) do you consider to be important with regards to sleep?'. A variety of approaches were applied to promote the survey to the students, including social media, radio, the university website, stands in university cafeterias and a sleep stunt. NVivo V.12 was used to code and sort the questions. SETTING: A higher education institution in Norway. PARTICIPANTS: 555 students. RESULTS: The data collection provided 608 uncertainties, and the following prioritised top 10: (1) screen time, (2) stress, (3) educational achievements, (4) social relations, (5) mental health, (6) physical activity, (7) indoor environment, (8) substance abuse, (9) shift work and (10) sleep quality. Despite successful data collection, we found sleep to be a broad topic, and defining specific questions throughout the sorting and verification process proved difficult. CONCLUSIONS: We identified the prioritised top 10 research uncertainties as reported by students in higher education, ranking screen time first. However, the process was time and resource consuming. The research uncertainties addressed by the students showed great diversity, characterised by heterogeneity and a lack of specificity, making verification of the uncertainties challenging.

Differences in income trajectories according to psychological distress and pain: A longitudinal study among Norwegian social assistance recipients.

Aim: Mental diseases and pain are serious public health problems and are a leading cause of disability worldwide. The aim of this study is to describe how pain and psychological distress separately and in combination are associated with four income trajectories over nine years in a cohort of long-term social assistance recipients (LTRs). Methods: A cohort of 456 LTRs from 14 municipalities in Norway were divided into four groups based on the presence or absence of pain and/or psychological distress. These were surveyed in 2005, and later linked by personal identification numbers to high-quality longitudinal administrative data covering the period 2005-2013. Methods include calculation of income statuses based on main sources of income, and multinomial logistic regression analysis. Results: In the group without pain and psychological distress, earnings from work as main source of income (14.6-38.0%) and disability benefits (2.9-16.1%) increased over the period. In the 'double burden' group the proportions who had social assistance as main income decreased (68.2-21.5%) and the proportions with disability benefits increased over time (5.6-36.6%). Only 27.2% of the total sample had earnings from work as their main income in 2013. Conclusion: LTRs are extra burdened by pain and psychological distress, and this has consequences for their life opportunities and income trajectories. This study indicates that the primary goal of the social assistance system, to make the clients self-sufficient, is hard to achieve. A better co-operation between health services and work-related services is needed.

Family experiences with palliative care for children at home: a systematic literature review.

BACKGROUND: The main goal of pediatric palliative care (PPC) is to improve or maintain the best possible quality of life (QoL) for the child and their family. PPC can be provided in community health centres, within the specialist health care service and/or in the child's home. Home is often the preferred place for families, and recommendations state that, whenever possible, the family home should be the centre of care for the child. The aim of this study is to systematically review the experiences and needs of families with children receiving palliative care at home. METHODS: We conducted a systematic review and searched the peer-reviewed databases CINAHL, Embase, PsycInfo and MEDLINE for articles published between January 2000 and October 2019. We included 23 studies emphasising the experience of family members when their child (0-18 years) received palliative care at home. We used a thematic analysis to identify relevant themes in the literature, and synthesised the findings from the different studies. RESULTS: The review represents the experiences of the families of almost 300 children with life-limiting (LL) and life-threatening (LT) conditions receiving palliative care at home. In general, the children's mothers are interviewed, and seldom the sick children themselves or their siblings. Most families preferred staying at home since it made it easier to maintain a normal family life, was less stressful for the sick child, and meant that siblings could still attend school and be with friends. Families experienced a range of challenges due to the coordination of care, including a lack of support and adequately skilled staff with appropriate experience. Respite care was needed in order to cope with everyday life. Some studies were not specific concerning the place of care, and some relevant papers may have been omitted. CONCLUSIONS: Families receiving PPC need organised, individualised support from a skilled PPC team. Respite care is necessary in order to manage a demanding home-care situation and parents need support for siblings. Privacy to be a family is a need, and many families need financial support. Future studies should focus on PPC at home in the perspectives of sick children and their siblings.

Co-occurrence of decrements in physical and cognitive function is common in older oncology patients receiving chemotherapy.

PURPOSE: Older adults receiving cancer chemotherapy are at increased risk for decrements in physical (PF) and cognitive (CF) function. OBJECTIVES: Study identified subgroups of patients with distinct PF and CF profiles; risk factors associated with subgroup membership; and impact of subgroup membership on quality of life (QOL). METHODS: In 366 older oncology patients, PF and CF were assessed using the Physical Component Summary (PCS) of the SF-12 and Attentional Function Index, respectively. Latent profile analysis was used to identify subgroups of older patients with distinct PF/CF profiles. RESULTS: Three distinct PF/CF profiles were identified (i.e., Very Low PF + Moderate CF (15.6%); Low PF + Low CF (39.3%), Normal PF + Normal CF (45.1%)). Compared to the both Normal class, patients in the other two classes had a lower functional status, a worse comorbidity profile, and were less likely to exercise on a regular basis. Compared to the Both Normal class, patients in the Both Low class were less likely to be married/partnered, more likely to live alone, less likely to be employed, and more likely to report depression and back pain. Compared to the other two classes, patients in the Both Low class had a lower annual household income and were receiving chemotherapy with a worse toxicity profile. CONCLUSION: First study to use a person-centered analytic approach to identify subgroups of older adults with distinct PF/CF profiles. Fifty-five percent of the older adults had statistically significant and clinically meaningful decrements in both PF AND CF that had negative effects on all aspects of QOL.

A systematic integrative review of parents' experience and perception of sleep when they stay overnight in the hospital together with their sick children.

AIMS AND OBJECTIVES: To elucidate knowledge available on parents' experience and perception of sleep when they stay overnight in hospital together with their sick children. BACKGROUND: In Nordic countries, children are entitled to have at least one parent with them during hospitalisation. Parents' sleep, when accommodated at the hospital during the child's admission, may be a challenge. DESIGN: A systematic literature search was conducted in EMBASE, MEDLINE and PsycINFO; period is restricted from 1 January 2007 to 1 April 2019. Studies included were those in which parents were accommodated in hospital with their child, 0-18 years of age, for at least one night. Original peer-reviewed scientific research papers conducting qualitative, quantitative or mixed designs were included. Systematic reviews were not included. This systematic integrative review was registered in PROSPERO and performed according to the PRISMA guidelines. All authors participated in study selection, data extraction and quality assessment of the literature. RESULTS: Fifteen studies were included, and they varied in terms of origin, aims, design, methods used and sample size. Three overall main themes appeared: sleep quality, factors affecting sleep and consequences of sleep loss. Combined psychological factors were found to affect parents' sleep, as well as isolated psychological factors, for example, stress, anxiety, worries and difficult thoughts. Environmental and social factors were also identified, for example, privacy and caring for family. CONCLUSION: Study of this subject is still in its exploratory phase. There is a need for the development of theory of substance in the clarification of the meaning of sleep among parents during difficult times such as children's hospitalisation. RELEVANCE TO CLINICAL PRACTICE: Understanding risk factors associated with sleep and sleep deprivation in parents staying overnight in the hospital with their sick child is important, since lack of sleep may lead to serious stress-related outcomes for the parents.

Students' observations of hand hygiene in nursing homes using the five moments of hand hygiene.

AIMS AND OBJECTIVES: To use nursing students to observe hand hygiene adherence in nursing homes and to explore whether the students' reflections after observing hand hygiene practices gives them a deeper understanding of the subject matter. BACKGROUND: Residents in nursing homes worldwide have low tolerance for healthcare-associated infections that require antibiotics, and hand hygiene is the single most effective action to reduce infections. DESIGN: Observational study using (a) World Health Organization's (WHO) "Five moments for hand hygiene" validated tool to record indications and adherence and (b) an exploratory study of individual reflection notes from students conducted during and after observations. METHODS: From February 12-15, 2018, 26 nursing students in their second semester of a 3-year bachelor programme participated as observers in five wards in four nursing homes in the Oslo metropolitan area. This study was performed according to the STROBE statement. RESULTS: Hand hygiene was performed for 57.2% of the 2,393 indications observed and recorded. Adherence differed significantly by type of personnel and by location. Four thematic categories emerged from the reflection notes: (a) practical awareness and introspection; (b) visualisation and enhancement of understanding of practice learning; (c) incorrect hand hygiene practices; and (d) stimulation to increase essential knowledge. CONCLUSION: Hand hygiene adherence was too low to prevent healthcare-associated infections and to reduce the use of antibiotics. The students' reflection notes indicated more "insight and understanding of the complexity of hand hygiene." We suggest using nursing students in clinical placement as a means of incorporating different interventions as part of their learning skills and become "living reminders" of the importance of hygiene and infection prevention. RELEVANCE FOR CLINICAL PRACTICE: Improving the student's activity about hygiene and infection prevention in clinical placement may help to raise awareness by healthcare workers in nursing homes.