The impact of trauma-informed suicide prevention approaches: A systematic review of evidence across the lifespan.

Trauma is associated with an increased likelihood of experiencing suicidality, indicating the need for and potential value of trauma-informed suicide prevention strategies. The aim of this study is to systematically review published literature regarding trauma-informed approaches for suicide prevention, and the impact on suicide outcomes. Systematic searches were conducted in eight databases (Medline, Embase, PsycInfo, Emcare, Nursing, and JBI in the Ovid platform; as well as ProQuest Psychology Database and The Cochrane Library) in March 2022, with no publication date limit. Four studies met the inclusion criteria: two randomized controlled trials and two quasi-experimental studies. Two studies reported reductions in ideation, intent, and behaviour among youth and a cultural minority group. Few studies directly reporting suicide outcomes were identified, all were quantitative, and heterogeneity prevents generalizability across population groups. Currently, there is limited evidence focusing specifically on trauma-informed suicide prevention across the lifespan. Additional research, incorporating lived experience voices, is needed to understand the potential of this approach, as well as how mental health nurses can incorporate these approaches into their practice.

Dedicated Education Unit is a cost-effective clinical education model for undergraduate nursing programs.

OBJECTIVE: To evaluate the cost-effectiveness of clinical education models for undergraduate nursing programs. METHODS: A model-based cost-effectiveness analysis. Settings were universities with undergraduate nursing courses. Participants consisted of the decision tree that guided the structure of the model, filled in with effectiveness results from a hypothetical cohort of undergraduate nursing students. Interventions were Clinical Preceptor or Clinical Facilitator or Clinical Education Unit. Main outcome measure was effectiveness, defined as improvement of clinical education. The projected economic outcomes included incremental costs, incremental effectiveness, and incremental cost-effectiveness ratio. Monte Carlo probabilistic sensitivity analysis was employed to assess uncertainty in the model and robustness of our results. RESULTS: The model based on Clinical Education Unit could be defined as the best, followed by Clinical Facilitator and Clinical Preceptor. The incremental cost of telephone-support intervention was US$ 59,604.40 higher than the second-best performing intervention (Clinical Facilitator), and US$ 32,661.86 higher than the last best performing intervention (Clinical Preceptor). In addition, Clinical Education Unit model showed 7% and 19% more effectiveness than Clinical Facilitator and Clinical Preceptor, respectively. CONCLUSION: Clinical Education Unit represents the best choice to promote better development of skills, knowledge and socialization in undergraduate nursing programs considering its effectiveness and costs.

Healthy eating in pregnancy, education for midwives: A pre-post intervention study.

INTRODUCTION: Midwives have an important role in providing education in healthy eating to pregnant women, which is essential for maternal and foetal health and wellbeing. Importantly, midwives require continual professional development to ensure they provide up-to-date education. METHODS: A pre-post intervention study utilised a purpose-designed questionnaire to collect data at three time points. Forty-four midwives completed the pre education questionnaire, 29 of these midwives attended the education intervention (workshop/webinar) and completed the immediately after questionnaire. Nineteen midwives then completed a questionnaire at 6-8 weeks follow-up. The study aimed to evaluate midwives' knowledge and level of confidence to discuss healthy eating in pregnancy. RESULTS: Education in healthy eating improved midwives' knowledge and level of confidence, which were maintained for six to eight weeks. The mean difference of total scores on knowledge and confidence between pre and immediately after education questionnaires showed a statistically significant improvement in nutrition knowledge (4.93 ± 1.62 vs 7.55 ± 1.55; p<0.001) and confidence level (22.05 ± 6.87 vs 31.48 ± 7.47; p<0.001). In terms of the mode of education, there was a significant increase in total knowledge scores for midwives who attended a workshop compared to a webinar. CONCLUSIONS: Overall, healthy eating education improved midwives' knowledge and confidence immediately after receiving education and also at 6-8 weeks follow-up. This study is unique as it evaluated midwives' knowledge and level of confidence at 6-8 weeks post education. This study concludes that midwives benefited from receiving further knowledge on cultural food choices, eating behaviours, and dental care.

Effectiveness of cognitive behavior therapy for patients with heart failure and depression: A systematic review protocol.

The objective of this review is to determine the effectiveness of cognitive behavior therapy for patients with heart failure and depression, aged ≥18 years, in institutionalized healthcare settings. More specifically, the review aims to identify which cognitive behavior therapy strategy/strategies, including the method of delivery, is the most effective for the management of depression in hospitalized patients with heart failure. The review question is as follows: Is cognitive behavior therapy effective in reducing symptoms of depression in patients with heart failure? This systematic review will be conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of effectiveness evidence. This review only includes randomized controlled trials assessing the effectiveness of cognitive behavior therapy as a treatment for depression in adults (aged ≥18 years) with heart failure, compared with usual care, which might include medications.

Dedicated Education Unit is a cost-effective clinical education model for undergraduate nursing programs / A Unidade de Educação Dedicada é um modelo de educação clínica custo-efetivo para programas de graduação em enfermagem

ABSTRACT Objective To evaluate the cost-effectiveness of clinical education models for undergraduate nursing programs. Methods A model-based cost-effectiveness analysis. Settings were universities with undergraduate nursing courses. Participants consisted of the decision tree that guided the structure of the model, filled in with effectiveness results from a hypothetical cohort of undergraduate nursing students. Interventions were Clinical Preceptor or Clinical Facilitator or Clinical Education Unit. Main outcome measure was effectiveness, defined as improvement of clinical education. The projected economic outcomes included incremental costs, incremental effectiveness, and incremental cost-effectiveness ratio. Monte Carlo probabilistic sensitivity analysis was employed to assess uncertainty in the model and robustness of our results. Results The model based on Clinical Education Unit could be defined as the best, followed by Clinical Facilitator and Clinical Preceptor. The incremental cost of telephone-support intervention was US$ 59,604.40 higher than the second-best performing intervention (Clinical Facilitator), and US$ 32,661.86 higher than the last best performing intervention (Clinical Preceptor). In addition, Clinical Education Unit model showed 7% and 19% more effectiveness than Clinical Facilitator and Clinical Preceptor, respectively. Conclusion Clinical Education Unit represents the best choice to promote better development of skills, knowledge and socialization in undergraduate nursing programs considering its effectiveness and costs.

RESUMO Objetivo Avaliar a relação de custo-efetividade dos modelos de educação clínica para cursos de graduação em enfermagem. Métodos Análise de custo-efetividade baseada em modelo. Os ambientes foram universidades com cursos de graduação em enfermagem. Os participantes consistiram na árvore de decisão, que norteou a estrutura do modelo, preenchida com resultados de efetividade de uma coorte hipotética de estudantes de graduação em enfermagem. As intervenções foram o Preceptor Clínico ou o Facilitador Clínico ou a Unidade de Educação Clínica. A principal medida de resultado foi a efetividade, definida como a melhoria da educação clínica. Os resultados econômicos projetados incluíram custos incrementais, efetividade incremental e custo incremental por efetividade. A análise probabilística de sensibilidade de Monte Carlo foi utilizada para avaliar a incerteza no modelo e a robustez de nossos resultados. Resultados O modelo baseado na Unidade de Educação Clínica foi o melhor, seguido pelo Facilitador Clínico e pelo Preceptor Clínico. O custo incremental da intervenção com suporte por telefone foi US$ 59,604.40 a mais do que o da segunda intervenção de melhor desempenho (Facilitador Clínico) e US$ 32,661.86 a mais do que a última intervenção de melhor desempenho (clínico preceptor). Além disso, o modelo da Unidade de Educação Clínica mostrou 7% e 19% mais efetividade do que Facilitador Clínico e Preceptor Clínico, respectivamente. Conclusão A Unidade de Educação Clínica representa a melhor escolha para promover um desenvolvimento de habilidades otimizado, conhecimentos e socialização nos cursos de graduação em enfermagem, considerando efetividade e custos.

A Healthy Eating Education Program for Midwives to Investigate and Explore Their Knowledge, Understanding, and Confidence to Support Pregnant Women to Eat Healthily: Protocol for a Mixed-Methods Study.

BACKGROUND: Nutrition and healthy eating behaviors during pregnancy are vitally important for the health of a mother and her developing baby. However, some midwives have reported a lack of evidence-based nutrition knowledge for providing information about healthy eating to women during pregnancy. OBJECTIVE: In this study, the aim is to design and evaluate a healthy eating education program to enhance midwives' knowledge, understanding, and confidence to support pregnant women in South Australia to make healthy eating choices. METHODS: This mixed-methods study consists of two phases. The first phase, Phase 1, consists of an education program for midwives, "Healthy Eating in Pregnancy," to be delivered through a workshop or webinar. Each midwife will attend one workshop or webinar, which will be approximately two hours in length. This program will be evaluated through pre-, immediate-, and post-educational questionnaires utilizing a website specifically designed for this study. The participants will be midwives who are members of the Australian College of Midwives and the Australian Nursing and Midwives Federation, and users of social media (eg, Facebook and Twitter) residing and employed in South Australia. Phase 2 will consist of semistructured interviews with a purposive sample of midwives. These interviews will be undertaken to gain an in-depth understanding of midwives' views and how confident they feel educating pregnant women after receiving the healthy eating education. Interviews will be face-to-face or conducted by telephone with midwives who have participated in the healthy eating educational program. RESULTS: A systematic review has previously been undertaken to inform this study protocol. This paper describes and discusses the protocol for this mixed-methods study, which will be completed in April 2019. CONCLUSIONS: The results from the systematic review suggest that there is clear justification to undertake this mixed-methods study to investigate and explore midwives' knowledge, understanding and confidence to support healthy eating in pregnant women. The results and conclusions from the systematic review provided some guidance for the design and development of this study protocol. This mixed-methods study will address a gap in the literature. The results from quantitative and qualitative data sources in this proposed study will help to draw conclusions to address the research topic. REGISTERED REPORT IDENTIFIER: RR1-10.2196/9861.

The effectiveness of clinical education models for undergraduate nursing programs: A systematic review.

Clinical nurse education is a major part of all undergraduate programs preparing nurses for competent professional practice. While research mostly evaluated specific clinical education models, few studies compared different type of models and limited attention has been given to the effect on student learning outcomes. This systematic review aimed to examine the effectiveness of clinical education models for undergraduate nursing programs. This systematic review utilised the Joanna Briggs Institute systematic review approach (JBI, 2014). A web-based literature search was conducted to identify research studies published from 2002 to 2015 using a three-step search strategy. All selected papers were assessed by at least two independent reviewers for inclusion criteria, methodological validity, and data extraction in the review. This systematic review included nine studies including two pre-post-test studies with a control group totalling 1893 participants including 1286 nursing students. The evidence regarding the effectiveness of clinical education models for undergraduate nursing programs is notably weak; however this review found limited evidence that the clinical facilitator model is preferable to the preceptor model and the Clinical Education Unit (CEU) model provided greater engagement and an enhanced learning environment compared with the standard facilitation model.

The effect of "hands on" techniques on obstetric perineal laceration: A structured review of the literature.

OBJECTIVE: The purpose of this structured review was to review current evidence of "hands on" and "hands off" techniques as it relates to rates of perineal laceration in order to provide direction for future research in this important area of midwifery practice. METHOD: A structured literature search using all identified keywords and index terms was undertaken in MEDLINE, EMBASE Joanna Briggs Institute, CINAHL, TRIP, and OVID nursing database. FINDINGS: A total of 24 papers were identified from the initial searches as potentially relevant to the review questions. Of these a total of nine papers were considered relevant for this review. These nine included one systematic review with meta-analysis, four randomised controlled trials (RCTs), one quasi-experimental study and three cohort studies. CONCLUSION: "Hands on" techniques have been traditionally used but not been well defined in the literature, therefore it is currently unclear as to whether or not "hands on" technique can reduce perineal laceration. More studies are required to test the effectiveness of a standardised "hands on" technique and also to determine what part other factors such as maternal position, visualisation and use of water might play in perineal laceration rates.

Cognitive behavioural therapy for older adults with depression: a review.

BACKGROUND: Depression is a major public health concern of global significance. The illness diminishes overall quality of life and has been associated with significant distress and disability in physical, interpersonal, and social role functioning. Over the past few decades, a consensus has evolved that cognitive behavioural therapy (CBT) can be an effective treatment for depression in older adults; however, little attention has been given to its effect on them. AIMS: The purpose of this review was to examine the current use of CBT and its effect on older adults with depression. METHOD: A web-based literature search was performed to identify original research articles published from 2000 to 2013 using a three-step search strategy. RESULTS: Evidence indicates that cognitive behavioural therapies are likely to be efficacious in older people when compared with treatment as usual. This is consistent with the findings of several systematic reviews and meta-analyses undertaken across a wider age range. CONCLUSIONS: Given that many older adults with depression are reluctant to accept antidepressant medication or unable to tolerate their side effects, CBT can be used as an option in treating depression in older adults.

Focus groups in nursing research: methodological perspectives.

Focus groups have been increasingly used as a data collection method in nursing research. The key feature of focus groups is the active interaction among participants to explore their views and opinions. In this respect, focus groups are distinct from other methods such as Delphi groups, nominal groups, brainstorming, and consensus panels, which seek to determine a consensus between participants. Compared with other data collection methods, it can be concluded that the real strength of focus groups is not simply in exploring what participants have to say, but in providing insights into the sources of complex behaviors and motivations. The aim of this paper is to present an overview of the focus group as a research tool in nursing research, particularly in nursing education.

Effect of educational components and strategies associated with insulin pump therapy: a systematic review.

OBJECTIVES: The objectives of this review were to establish the effectiveness of approaches to the provision of education for adults with type 1 diabetes using or initiating insulin pump therapy (IPT), and identify the best available evidence on the association between intervals and duration of follow up and the stated outcome criteria. INCLUSION CRITERIA: This review considered all studies and papers that involved adults (aged 16 years or over) with type 1 diabetes using IPT as their primary form of therapy who participated in education or training, with no restrictions placed on gender or comorbidities. All forms of education, including resources utilised during education were included in the review. SEARCH STRATEGY: The search strategy sought to find both published and unpublished studies and papers written in the English language. An initial limited search of MEDLINE and CINAHL databases was undertaken to identify optimal search terms. A second search using all identified key words and index terms was then undertaken based on key words specific to each database across all included databases from 1998 to February 2008. Thirdly, the reference lists of all identified reports and articles were searched for additional studies. METHODOLOGICAL QUALITY: Two independent reviewers assessed the methodological quality of retrieved papers using the corresponding checklist from the System for the Unified Management, Assessment and Review of Information (SUMARI) package. RESULTS: A total of 142 studies were identified as potentially relevant to the review question in the first and second steps of the literature search. Based on the title and abstract, 24 papers that were relevant to the review topic were retrieved for evaluation of methodological quality. Following this stage, 20 papers were excluded. Whilst searching the reference lists of the selected studies (n = 4), one paper met the inclusion criteria. Therefore, a total of five descriptive studies were included in the review. The included papers reported a variety of educational methods and different outcome measures. CONCLUSION: In general, it is difficult to draw a strong conclusion regarding the effectiveness of components and strategies associated with IPT because of a lack of high-quality comparative studies, small sample sizes and a variability of reported methods in the included studies. However, included descriptive studies explored a range of issues related to the effectiveness of IPT therapy, and the educative requirements of patients. It is clear that type 1 diabetes patients initiating and utilising IPT need a comprehensive range of advice, education and training. The mixture of group and individual teaching, multidisciplinary teams as educators, educational materials, long-term training with multiple sessions and a variety of educational contents may all be effective for delivering IPT education and training.

Weight loss surgery for obesity.

An evidence-based alternative to conventional treatment.

Interventions to reduce the incidence of falls in older adult patients in acute-care hospitals: a systematic review.

Aim Falls can cause serious physical and emotional injuries to patients leading to poor quality of life and increased length of hospital stay. The aim of this study was to present the best available evidence regarding the effectiveness of risk assessment or other interventions that aimed to minimise the number of falls. Methods A systematic review of randomised controlled trials was undertaken to determine the effectiveness of interventions that were designed to reduce the incidence of falls in older acute-care patients. Only trials published between 1998 and 2008 were considered. Results Only seven studies were included in the review, indicating the evidence on this topic is sparse. There is some evidence to suggest that implementing the following interventions in acute hospitals may be effective in reducing the amount of falls of older adult inpatients: • A multidisciplinary multifactorial intervention program consisting of falls risk alert card, an exercise program, an education program and the use of hip protectors after approximately 45 days • A one-on-one patient education package entailing information on risk factors and preventative strategies for falls as well as goal setting • A targeted fall risk factor reduction intervention that includes a fall risk factor screen, recommended interventions encompassing local advice and a summary of the evidence There is also some evidence to suggest that implementing a multidisciplinary multifactorial intervention that consists of systematic assessment and treatment of fall risk factors, as well as active management of postoperative complications, can reduce the amount of falls in patients following surgery for femoral neck fracture. Conclusion There is some evidence to suggest that certain multifactorial interventions are more effective than others and that increasing patient education or targeting fall risk factors may be of benefit. Further high-quality research is needed in order to ascertain effective fall-prevention strategies in acute-care facilities.

Interventions to reduce the incidence of falls in older adult patients in acute care hospitals: a systematic review.

BACKGROUND: Falls can have a considerable impact on a patients' well being, they can result in serious physical and emotional injury, poor quality of life and increased length of hospital stay. Most of the current literature recommends a comprehensive approach to fall prevention that addresses a wide variety of risk factors and involves the use of risk assessment. OBJECTIVE: The objective of this review was to present the best available evidence for the effectiveness of interventions designed to reduce the incidence of falls in older adult patients in acute care hospitals. INCLUSION CRITERIA: Only randomised controlled trials (RCTs) assessing the effectiveness of risk assessment or other interventions that aimed to minimise the number of falls were included.Participants were older adult inpatients (defined as aged 65 years or over) in acute care hospitals.This review focused on interventions designed to assess the risk of falling or those used to minimise the risk of falling in older adult hospital patients. These interventions were compared to either standard practice, which included any method or technique already in place at the facility, or no intervention.The primary outcome was the number of patient falls during hospitalisation. SEARCH STRATEGY: A search for published and unpublished literature from 1998 to 2008 published in the English language was conducted using all major electronic databases. A three-step search strategy was developed using MeSH terminology and keywords to ensure that all material relevant to the review was captured. ASSESSMENT OF QUALITY: The methodological quality of included studies was assessed by two reviewers, who appraised each study independently, using standardised Joanna Briggs Institute (JBI) critical appraisal tools DATA COLLECTION AND ANALYSIS: Data was extracted from the studies that were identified as meeting the criteria for methodological quality using the standard JBI data extraction tools. Due to the heterogeneity of populations and interventions, meta-analyses were not possible and results are presented in narrative form. RESULTS AND CONCLUSIONS: Seven studies were included in the review. The evidence on interventions for reducing the number of falls in older adults during their stay in an acute health care facility is sparse. There is some evidence to suggest that certain multifactorial interventions are more effective than others and that increasing patient education or targeting fall risk factors may be of benefit. Further high quality research is needed in order to ascertain effective fall prevention strategies in acute care facilities.There are some evidence to suggest that implementing the following interventions in acute hospitals may be effective in reducing the amount of falls of older adult inpatients:˙ a multidisciplinary multifactorial intervention program consisting of a falls risk alert card, an exercise program, an education program and the use of hip protectors after approximately 45 days˙ a one-on-one patient education package entailing information on risk factors and preventative strategies for falls as well as goal setting˙ a targeted falls risk factor reduction intervention that includes a falls risk factor screen, recommended interventions encompassing local advice and a summary of the evidenceThere is some evidence to suggest that implementing a multidisciplinary multifactorial intervention that consists of systematic assessment and treatment of fall risk factors, as well as active management of postoperative complications can reduce the amount of falls in patients with femoral neck fracture following surgery. IMPLICATIONS FOR RESEARCH: Better designed RCTs that distinguish subgroups of populations (for example people with or without cognitive impairment) and that targets interventions at specific groups is required. Further research that focuses on individual intervention components that are part of larger multifactorial interventions are also warranted.

Health status, trends, and issues in Sri Lanka.

It is widely recognized that better health is a prerequisite for the overall economic and social development of a nation. Sri Lanka, like many other countries experiencing the epidemiological transition, will have to make effective decisions on health-care service management and the development of education and training programs for health-care professionals. This paper provides a comprehensive review of current health service administration, health status, trends and issues, and health financing and resource allocation in Sri Lanka. The review revealed that Sri Lanka has achieved a relatively high health status given a low level of spending on its health-care services; however, Sri Lanka still experiences vital health problems in all stages of the life cycle, mainly related to lifestyle and the epidemiological transition associated with widespread societal and economic crises.

The history of nursing services and education in Sri Lanka and the effects on developing professionalism.

Understanding the evolution of nursing in a country provides perspective on the origins of current successes and dilemmas and enables the development of strategies and plans for future trends in the profession. This article explores the evolution of nursing services and education in Sri Lanka and the effects on developing professionalism in nursing. Internet database searches, personal communication, and published and unpublished literature and reports were reviewed to obtain historical information on nursing services and education in Sri Lanka. The Sri Lankan health system is reviewed, and the establishment of Western medicine in Sri Lanka and its effects on developing institutionalized nursing education is presented, with a focus on the evolution of nursing education. Major challenges for the nursing profession in Sri Lanka are discussed, and some recommendations are shared.