Engaging in Action Research with Nurses: Overcoming Challenges and Gaining Positive Insights into End-of-Life Care.

The aim of this study was to qualitatively describe, from a practitioner's perspective, the process by which nurses struggle to support a patient with end-of-life cancer with frequent nurse calls and gain positive insights through two methodologies: AR and the case study method. The participants were four ward nurses who supported a patient receiving end-of-life cancer in his 80s. The participants engaged in monthly group work and practical training sessions, which included facilitators, to reflect on and develop care plans. Based on these activities, care was provided to the patient. After the intervention period, the patient's course and practice was documented and analysed qualitatively. The intervention significantly improved the nurses' ability to support inpatients with many needs through careful observation, enhancement, and practical skill improvement. This process resulted in a better understanding of patient needs, proactive skill development, enhanced team performance, and an innovative care-delivery system that resonated throughout the ward. This study demonstrated a successful strategy for nurses to improve support for high-need inpatients, emphasising the importance of attentive care, proactive skill improvement, and a team-based approach to healthcare innovation.

Serum Cholinesterase Levels to Predict All-Cause Mortality in a Community-Based Study: The Takahata Study.

INTRODUCTION: Serum albumin (Alb) levels have been found to be independent predictors of all-cause mortality in a community-based population, but whether this is the case for serum cholinesterase (ChE) levels is uncertain. This study aimed to determine whether serum ChE levels are independent predictors of all-cause mortality in a community-based population. METHODS: A total of 3,504 subjects (mean age 62.5 years) from Takahata, Japan, participated and were followed up for 13.5 years (median 13.2 years). Based on baseline serum Alb and ChE levels, subjects were stratified by interquartile range as low, middle, and high. The correlation between serum Alb and ChE levels was examined by calculating correlation coefficients. The association between each group and all-cause mortality was examined by Kaplan-Meier and Cox proportional hazards analyses. RESULTS: During follow-up, 568 subjects died. There was a positive correlation between serum Alb and ChE levels (r = 0.30). Kaplan-Meier analysis showed that all-cause mortality in the low group was significantly higher for both serum Alb and ChE levels (log-rank p < 0.01). Adjusted Cox proportional hazards analysis showed that the serum Alb level was not an independent predictor of all-cause mortality (hazard ratio [HR] 1.18, 95% confidence interval [CI], 0.95-1.46 for all-cause mortality in the low group compared to the middle group), whereas the serum ChE level was an independent predictor of all-cause mortality (HR 1.30, 95% CI, 1.06-1.59 for all-cause mortality in the low group compared to the middle group). CONCLUSION: The serum ChE level is an independent predictor of all-cause mortality in the general community-based population.