Educational programs and interventions for health care staff to prevent and manage aggressive behaviors in acute hospitals: a systematic review.

OBJECTIVE: The objective of this review was to determine the effect of educational programs that have been implemented in acute health care settings to manage or prevent aggressive behaviors toward staff perpetrated by patients, families, or visitors. INTRODUCTION: Health care staff working within acute-level and tertiary-level hospitals are at high risk of exposure to aggressive behaviors by patients, their family, or visitors. Negative staff and organizational impacts reported in the literature include individual psychological or emotional distress and severe harm, increased absenteeism, high staff turnover, and awarded compensation. Reports of this kind of occupational violence are increasing globally; therefore, strategies to address prevention and management are needed to mitigate the risk of harm to staff and the wider hospital service. Various educational activities have been implemented to address the issue, but the overall effect of these is unclear. INCLUSION CRITERIA: Experimental and quasi-experimental studies were considered for inclusion if they reported on an educational program or intervention for staff working within an acute hospital setting and aimed at managing or preventing occupational violence perpetrated by patients, family, or visitors. Reports of programs implemented to address occupational violence, whether verbal or physical, were included. Studies were excluded if they reported on upward violence or bullying, patients in psychiatric or dementia facilities, or pediatric patients, due to the specific care needs of these cohorts. METHODS: The following databases were searched: PubMed (PubMed Central), CINAHL (EBSCOhost), PsycINFO (EBSCOhost), Embase, ERIC (ProQuest), Cochrane Central Register of Controlled Trials (Cochrane Library), and Scopus. ProQuest Dissertations and Theses was searched for unpublished studies. To obtain a wider perspective of the issue, studies published in Chinese were also searched in WanFang Database, China National Knowledge Infrastructure, and Chongqing VIP. A date filter of 2008-2023 was applied in a deliberate effort to expand from previous work. No language filters were applied. The review was conducted in accordance with JBI methodology for systematic reviews of effectiveness, and reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: The search process retrieved 4681 citations. A total of 32 studies representing 3246 health staff were included in the review. The studies were either before-and-after or pre-test/post-test study designs. Methodological quality of studies varied, with the main issues being absence of CIs within statistical analysis, limited detail on participant selection or attrition/non-response, and underreporting of confounding factors. Educational programs varied in content and duration. Content delivery across the studies also varied, with several didactic, role-play, debriefing, group work, and simulation exercises reported. While studies reported some improvement in self-reported confidence levels, results were mixed for other outcomes. Determining overall effect of included studies was challenging due to heterogeneity within and across studies with regard to intervention types, populations, measurement tools, and outcomes. CONCLUSIONS: This review is unable to determine which workplace educational programs had an effect on staff outcomes or on the number of occupational violence incidents. In the future, educators and researchers could use the findings of this review to guide the design of educational programs and employ measures that are comparable to their settings. REVIEW REGISTRATION: PROSPERO CRD42020190538. SUPPLEMENTAL DIGITAL CONTENT: A Chinese-language version of the abstract of this review is available [ http://links.lww.com/SRX/A33 ].

Exploring approaches to contemporary clinical incident analysis methods within acute care settings: a scoping review protocol.

OBJECTIVE: This review will explore the literature on contemporary incident analysis methods used in acute hospital settings, identifying types and characteristics of these methods and how they are used to minimize, prevent, or learn from errors and improve patient safety. INTRODUCTION: Safety is a major focus in health care; however, despite best efforts, errors and incidents still occur, leading to harm or potential harm to patients, families, carers, staff, or the organization. Incident analysis methods aim to reduce risk of harm. Traditional methods have been criticized for failing to consider the complexity of health care and the dynamic nature of acute care settings. Alternative methodologies are being sought to achieve higher levels of patient safety and care quality care in hospitals. Learning from errors and communicating with those involved in incidents are key requirements in contemporary incident analysis. INCLUSION CRITERIA: This review will consider empirical research published since 2013, reporting on the use of clinical incident analysis methods within acute care settings. The review will explore ways in which consumers or stakeholders (eg, clinicians or other hospital workers, patients, families, carers, visitors) have been included in these analysis methods and how data have been used to support changes in the service or organization. METHODS: Following JBI methods and PRISMA-ScR reporting guidance, we will search PubMed, CINAHL (EBSCOhost), Embase, Scopus, the Cochrane Library, Web of Science, and ProQuest Dissertations and Theses. Studies will be reviewed independently, with results presented in tables, figures, and narrative summaries according to the concepts of interest.

Developing a model of neonatal nurse-controlled analgesia: A Delphi study.

AIM: To develop a nurse-led model of analgesia to manage post-operative pain in the surgical neonate. DESIGN: A four-round e-Delphi study was conducted from March to December 2022. METHODS: An e-Delphi method was used seeking a consensus of 70% or greater. Fifty-one experts were invited to join the panel. Members consisted of multi-disciplinary healthcare professionals who work in areas associated with neonatal care. In round 1, 49 statements relative to neonatal pain assessment and management were distributed to the panel. Panel members were asked to rate their level of agreeance on a Likert scale from 1 to 5 (1 = strongly disagree to 5 = strongly agree). Ratings equal to or greater than 4 represented agreement, 3 indicated uncertainty and 2 or less disagreement with the proposed statement. An opportunity for free-text responses after each statement was provided. This iterative process continued for three rounds. In the fourth and final round, the completed model of neonatal nurse-controlled analgesia was presented along with a further opportunity to provide feedback on the final version. RESULTS: Four rounds of statements and voting were required to reach consensus on a model of neonatal nurse-controlled analgesia. The model consists of criteria for use, over-arching guidelines and three separate pathways based on an individual baby's pain assessment scores, need for pain relieving interventions and time-lapsed post-surgical procedure. CONCLUSION: A comprehensive model of neonatal nurse-controlled analgesia, applicable to the Australasian context, was developed in collaboration with a group of neonatal experts. IMPACT: This study provides a multi-modal family-integrated model to manage neonatal post-operative pain. By providing nurses with increased autonomy to assess and manage acute pain, this model has the potential to not only provide a more responsive and individualized approach to alleviate discomfort, but highlights the integral role of parent partnerships in the neonatal intensive care. REPORTING METHOD: This study was reported in line with the Conducting and REporting of DElphi studies (CREDE) guidance on Delphi studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was utilized for this study.

Effectiveness of interventions to reduce sexually transmitted infections and blood-borne viruses in incarcerated adult populations: a systematic review protocol.

OBJECTIVE: This review will identify, synthesize, and make recommendations regarding the effectiveness of interventions to reduce sexually transmitted infections (STIs) and blood-borne viruses (BBVs) in incarcerated adult settings. INTRODUCTION: High-risk sexual behaviors, intravenous drug use, piercing, and tattooing are well documented within incarceration environments. Despite the World Health Organization's Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021 and the Global Health Sector strategies on, respectively, HIV, viral hepatitis, and sexually transmitted infections for the period 2022-2030, STI rates within adult incarceration environments continue to rise. Identifying and implementing best-practice interventions to prevent and manage STIs and BBVs will aid infection reduction in correctional settings. The review results will inform the development of educational programs, health promotion, and policies and procedures to improve health outcomes for incarcerated populations. INCLUSION CRITERIA: This review will consider studies in any language from any adult incarceration facility. Studies set in juvenile facilities or detention centers will be excluded. Any intervention for preventing or reducing STI and/or BBV transmission will be included. METHODS: This review will follow the JBI methodology for systematic reviews of effectiveness. Databases to be searched will include PubMed, CINAHL (EBSCO), Ovid Library, PsycINFO (EBSCO), Cochrane CENTRAL, and Scopus. Two independent reviewers will screen titles and abstracts and assess full-text citations against the inclusion criteria. Methodological quality will be appraised using JBI's standardized critical appraisal instruments. Where possible, studies will be pooled using meta-analysis. Where statistical pooling is not possible, findings will be presented in narrative format. Certainty of evidence will be ascertained using the GRADE approach. REVIEW REGISTRATION: PROSPERO CRD42022325077.

Hypothermia With Paradoxical Symptoms: A Case Series of Cesarean Deliveries With Intrathecal Morphine.

Women receiving intrathecal morphine for cesarean delivery may experience hypothermia with paradoxical symptoms of sweating, nausea, and shivering. Despite being relatively rare in comparison to commonly experienced symptoms of perioperative hypothermia, hypothermia with paradoxical symptoms affects early maternal recovery and comfort. The cause is undetermined, and treatment approaches vary. Regular active-warming strategies may not be tolerated because of the paradoxical symptoms of sweating and feeling overheated. This case series aims to explore the phenomenon through the evaluation of health care records of women receiving intrathecal morphine for cesarean delivery at a single, tertiary health care institution in Australia from 2015 to 2018. We also summarize published literature to review treatment approaches used in the care of women experiencing profound heat loss while feeling overheated.

Implementing Dignity Therapy Service into an Acute Cancer Care Setting - A Feasibility Study.

Objective: Dignity therapy is a short-term psychotherapy used to help patients at end of life through addressing distress and enhancing dignity. The objective of this study was to assess the effectiveness and feasibility of introducing dignity therapy into a hospital-based cancer care service. Methods: A feasibility study was undertaken using a randomised controlled trial design. Participants were adult patients receiving systemic treatment for cancer or haematological malignancy with palliative intent, within an Australian ambulatory cancer treatment centre. Outcomes of interest were patient distress levels and feasibility of intervention delivery. Participants completed two self-reported distress scales at recruitment and four weeks following (control group) or one month after intervention delivery (intervention group). Patients receiving the intervention also completed the dignity therapy patient feedback questionnaire. Feasibility was measured by collecting data on time required to implement the intervention with subsequent crude cost estimates calculated. Study procedures are reported according to CONSORT guidance. Results: Fifteen patients were recruited for the study. Participants in the intervention group reported small but significantly different lower distress scores than those in the control group at 4 weeks. The time taken to deliver the intervention ranged from 5.5 to 11 h with subsequent cost dependent on the remuneration of the dignity therapy therapist. Conclusions: Findings support other studies on the benefit to patients from delivering a dignity therapy intervention at end of life. Feasibility is influenced by multidisciplinary team support, resource availability and the designated therapist delivering the intervention. Larger sample sizes are needed to ascertain effect.

Ethical challenges faced by nurses during the COVID-19 pandemic: a scoping review protocol.

OBJECTIVE: The aim of this scoping review is to describe the literature reporting on ethical challenges faced by nurses during the COVID-19 pandemic, including the contextual characteristics of ethical challenges, and the strategies to address these challenges. INTRODUCTION: The COVID-19 pandemic presented many ethical challenges to nurses, ranging from allocating scarce resources, to balancing a duty of care with self-preservation, and implementing visitation restrictions. Internationally, there has been a range of reported issues, but few studies have described strategies to overcome these challenges. INCLUSION CRITERIA: Studies that report on ethical challenges faced by nurses while caring for patients during the COVID-19 pandemic will be included. Studies that report on strategies to address these challenges will also be considered for inclusion. METHODS: This scoping review will be conducted in accordance with the methods outlined by JBI and reported using PRISMA-ScR guidance. The following databases will be searched for eligible studies from November 2019 to present day: PubMed, CINAHL, Ovid, PsycINFO, the Cochrane Library, and Scopus. No language restrictions will be applied. Studies will be reviewed for inclusion by 2 independent reviewers and a data extraction form developed specifically for this review will be used to extract data relevant to the review questions. Results will be analyzed and presented according to the concepts of interest, using tables, figures, images, and supporting narrative synthesis.

Roles and practices of specialist lung cancer nurses: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to map the available literature on the role of specialist lung cancer nurses. INTRODUCTION: The international literature acknowledges the importance of specialist cancer nurses who provide supportive care to patients. Historically, however, there has been a lack of consistent evidence to inform development and implementation of the role. INCLUSION CRITERIA: This review will consider quantitative and qualitative studies of any design or methodology that report on role characteristics or behaviors, practices, or activities, or other aspects of specialist lung cancer nurses in the acute care setting. Systematic reviews, professional body reports, as well as unpublished or published studies and reports will also be considered for inclusion. Textual or opinion papers will be excluded. METHODS: This review will follow the JBI methodology for scoping reviews. Relevant papers from 2006 to 2022, in any language, will be searched for in the following databases and registries: MEDLINE (PubMed), CINAHL (EBSCO), Web of Science, Embase, and the Cochrane Register of Controlled Trials. Websites to be searched will include the World Health Organization, International Council of Nurses, and Agency for Healthcare Research and Quality. ProQuest Dissertations and Theses (ProQuest) and Grey Matters (CADTH) will be searched for unpublished literature. Results will be presented in tabular and narrative format and mapped according to the specified concepts of interest, as well as to the domains of practice for specialist nursing roles.

Midwives experiences of interventions to improve breast expression following preterm birth: A qualitative study.

OBJECTIVE: Preterm birth impacts approximately 10% of women globally. Midwives are often the first point of care after the birth of a preterm infant providing mothers with information and support for breast expression. However, despite guidelines that suggest expression within the first hour of birth, most first expressions occur much later. This study aimed to seek an understanding of midwives' experiences with the first expression for mothers of preterm infants, including the barriers and facilitators that midwives may face. DESIGN: A qualitative design using semi-structured interviews via focus groups. Thematic analysis was used to identify relevant themes and sub-themes. PARTICIPANTS: Participants included midwives providing care to women in preterm labour and birth at a tertiary maternity hospital in Australia (N=12). All participating midwives cared for mothers of preterm infants between 28 and 35 weeks' gestation up to six hours following birth. FINDINGS: Two major themes resulted from the data, including the changing expectations of infant feeding and the responsibility versus expectation to support a woman to express in the first hour of birth with other competing clinical and organisational tasks. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Whilst individual philosophies on the benefits of human milk were positive, expressing in the birth suite was dictated by essential clinical tasks and by the institutions value placed on expressing in the first hour. Clear objectives to undertake expressing within the first hour or within the birth suite stay, need to be included in policy and supported by management and team leaders, to increase early expressing rates.

A Comparison of the Timing of Hand Expressing of Human Milk With Breast Massage to Standard Care for Mothers of Preterm Infants: An Exploratory Pilot Using a Randomized Controlled Design.

BACKGROUND: Globally, 10% of all births are preterm. Access to human milk via manual breast expression is required to reduce the incidence of adverse outcomes related to prematurity. However, there is little evidence to recommend optimum timing to commence breast expression in mothers of preterm infants or the most effective method. RESEARCH AIMS: (1) To test feasibility of recruitment and compliance to the protocol and (2) to determine influence of using hand expressing and breast massage on milk production, engorgement, mastitis, and breastfeeding status at 3 months. METHODS: This study was an exploratory parallel two-group, pilot randomized controlled trial. Mothers of preterm infants at a metropolitan maternity hospital in Queensland Australia (N = 31) were randomized to receive either hand expressing and breast massage within the 1st hr of birth or standard care, hand expressing within 6 hr of birth, to determine the influence on milk production, engorgement, mastitis, and breastfeeding status at 3 months. RESULTS: Feasibility targets were not met; however, valuable learning from this trial uncovered barriers facing midwives in the birth suite to commencing expressing in the 1st hr of birth. There was no difference in occurrence of secondary outcomes, although trends support future study. CONCLUSIONS: Overall, unpredictability of preterm birth influenced our ability to recruit participants. Important directions for future study design would benefit from incorporating expressing times up to 6 hr with a replicable breast massage.

Use of Patient-Reported Data within the Acute Healthcare Context: A Scoping Review.

Patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs) and patient satisfaction surveys provide important information on how care can be improved. However, data collection does not always translate to changes in practice or service delivery. This scoping review aimed to collect, map and report on the use of collected patient-reported data used within acute healthcare contexts for improvement to care or processes. Using JBI methods, an extensive search was undertaken of multiple health databases and trial registries for published and unpublished studies. The concepts of interest included the types and characteristics of published patient experience and PROMs research, with a specific focus on the ways in which data have been applied to clinical practice. Barriers and facilitators to the use of collected data were also explored. From 4057 records, 86 papers were included. Most research was undertaken in North America, Canada or the UK. The Hospital Consumer Assessment of Healthcare Providers and Systems tool (HCAHPS) was used most frequently for measuring patient satisfaction. Where reported, data were applied to improve patient-centred care and utilization of health resources. Gaps in the use of patient data within hospital services are noticeable. Engaging management and improving staff capability are needed to overcome barriers to implementation.

Effectiveness of social activity interventions for improving sleep among older people: a systematic review protocol.

OBJECTIVE: The objective of this review is to evaluate the effectiveness of social activity interventions for improving sleep among older people. INTRODUCTION: Sleep is one of the most important functions for humans because it assists in maintaining health. Sleep disturbance is common in older people. Social activity has shown to be associated with better sleep in the older population; however, the effectiveness of these interventions is unclear. INCLUSION CRITERIA: This review will consider studies that include people aged 60 years or older. Any type of social activity intervention will be included. Outcomes will include both objective (eg, sleep time) and subjective sleep measures (eg, subjective sleep satisfaction). This review will consider both experimental and quasi-experimental study designs. METHODS: MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and Ichushi web will be searched for eligible studies. Sources of unpublished studies and gray literature to be searched include OpenGrey and ProQuest Dissertations and Theses. Studies published in any language will be considered. No date filter will be applied. Titles and abstracts will be screened by two independent reviewers who will then assess the full text of selected citations against the inclusion criteria. Eligible studies will be critically appraised by the reviewers using the JBI critical appraisal instruments. Where possible, studies will be pooled using meta-analysis. Where statistical pooling is not possible, the findings will be presented in narrative form. The degree of certainty of the evidence on sleep outcomes will be assessed using the GRADE approach. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPEPO CRD42022315454.

JBI series paper 4: the role of collaborative evidence networks in promoting and supporting evidence-based health care globally: reflections from 25 years across 38 countries.

Evidence-based health care (EBHC) is a worldwide movement with hundreds of organizations and thousands of individuals working to ensure that health care practice, policy, and decision-making are informed by rigorous research evidence, to improve health outcomes. The success of this global agenda, however, depends on individuals and organizations working together within a functioning evidence ecosystem. Collaborative evidence networks are a key mechanism to facilitate the synthesis, transfer, and implementation of evidence into health care policy and practice. Using the network functions approach as a framework for review, this paper explores the strategic functions and form of the JBI Collaboration to illustrate the role of a collaborative evidence network in promoting and supporting EBHC globally. It illustrates how the functions of a collaborative evidence network enable the development, exchange, and dissemination of knowledge, the building of social capital, mobilization of resources, and amplification and advocacy of members work and ideas, which increase the capacity and effectiveness of members in achieving their unified purpose. Effective and sustainable collaborative evidence networks have innovative ways of relating and mobilizing energy for action and combine formal and informal structures and relationships to successfully work together to address complex global health issues and drive the EBHC agenda forward.

Challenges and Feasibility of Co-Design Methods for Improving Parent Information in Maternity Care.

This study explored the feasibility of using experience-based co-design methods (EBCD), based on participatory action principles, to improve service delivery regarding parent information needs within a metropolitan postnatal maternity unit. Data were collected from January 2018 to March 2019 from parents and staff using surveys, video interviews, a focus group and ward observations of episodes where parents were provided information. Participants included postnatal mothers who had recently given birth, their partners and hospital staff. Survey results (n = 31) were positive regarding content and satisfaction with information delivery. Data from the staff focus group (seven participants) and in-depth video interviews with mothers (n = 4) identified common themes, including challenges to information delivery due to time pressures, the value of breastfeeding advice and environmental influences. Overall, parents were satisfied with the information delivered; however, inconsistencies were present, with time pressures and other environmental factors reported as influencing the process. Staff and parents both identified the amount of content being delivered in such a short time frame as a major challenge and tailoring information was difficult due to individual experiences and circumstances. Additional resources or alternative methods are suggested for conducting future studies to capture patient experience within a similar busy hospital setting.

Evaluating behavioral economic interventions for promoting cancer screening uptake and adherence in targeted populations: a systematic review protocol.

OBJECTIVE: The objective of this review is to determine the effectiveness of behavioral economic interventions for promoting uptake of and adherence to cancer screening recommended by guidelines. INTRODUCTION: Cancer screening has been found to help reduce incidence of and mortality from advanced cancer. However, adherence to recommended cancer screening services is low in asymptomatic adults with average risk, possibly due to systematic decision biases. The findings of this review will demonstrate whether interventions informed by behavioral economic insights can help improve uptake of and adherence to cancer screening. INCLUSION CRITERIA: This review will consider experimental, quasi-experimental, and analytical observational studies that i) evaluate the effects of behavioral economic interventions in adults eligible for guideline-recommended cancer screening; and ii) report the number/percentage of individuals who used screening services; number/percentage of individuals who completed screening recommended by guidelines; participant self-reported intentions, choice, and satisfaction regarding the use of screening services; detection rates of early-stage cancers; use of early intervention for cancers; and cancer-related mortality. METHODS: A systematic literature search will be performed by one reviewer. After removing duplicates, two reviewers will independently screen and appraise eligible studies according to the JBI methodology for systematic reviews of effectiveness. Five databases will be searched: CINAHL, the Cochrane Library, PsyclNFO, PubMed, and Web of Science. Sources of gray literature and registered clinical trials will also be searched for potential studies. There will be no limits on publication date or language. Data synthesis will be conducted using meta-analysis and narrative synthesis where appropriate. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021258370.

Safety and effectiveness of parent- or nurse-controlled analgesia in neonates: a systematic review.

OBJECTIVE: The aim of this systematic review was to determine the safety and effectiveness of parent- or nurse-controlled analgesia on neonatal patient outcomes. More specifically, the objective was to determine the effect of parent- or nurse-controlled analgesia on neonatal pain scores, analgesic use, and incidence of iatrogenic withdrawal syndrome, as well as any opioid-associated adverse events. INTRODUCTION: Despite recent innovations in neonatology leading to significant improvements in short- and long-term outcomes for newborns requiring intensive care, optimal management of pain and distress remains a challenge for the multidisciplinary treatment team. The inability of neonates to communicate pain easily, inconsistent practice among health professionals, insufficient analgesic prescriptions, and delays in medical reviews all impact effective pain management. Exploring the effect of parent- or nurse-controlled analgesia may identify a modality that negates these concerns and improves the pharmacological management of pain in newborns. INCLUSION CRITERIA: This review considered experimental and observational studies evaluating the safety and effectiveness of parent- or nurse-controlled analgesia that included babies born at 23 weeks' gestation to four weeks post-term. The interventions considered for inclusion were any type of analgesia delivered by an infusion pump that allowed bolus dosing or a continuous analgesic infusion with bolus dosing as required. Studies using algorithms and protocols to guide timing and dosage were eligible for inclusion. Comparators included the standard management of pain for neonates in the newborn intensive care unit. A modification to the a priori protocol was made to include all neonates nursed outside of a neonatal intensive care unit to ensure all studies that examined the use of parent- or nurse-controlled analgesia in the neonatal population were included in the review. METHODS: An extensive search of six major databases was conducted (CINAHL, Cochrane Library, Embase, PubMed, PsycINFO, and Web of Science). Studies published from 1997 to 2020 in English were considered for inclusion in this review. Databases searched for unpublished studies included MedNar and ProQuest Dissertations and Theses. RESULTS: Fourteen studies were included in this review: two randomized controlled trials, six quasi-experimental studies, one case-control study, and five case series. There was considerable heterogeneity in the interventions and study outcome measures within the studies, resulting in an inability to statistically pool results. The small sample sizes and inability to distinguish data specific to neonates in six of the studies resulted in low quality of evidence for the safety and effectiveness of parent- or nurse-controlled analgesia in neonates. However, studies reporting neonatal data demonstrated low pain scores and a trend in reduced opioid consumption when parent- or nurse-controlled analgesia was used. CONCLUSIONS: The use of parent- or nurse-controlled analgesia in the neonatal population has shown some effect in reducing the amount of opioid analgesia required without compromising pain relief or increasing the risk of adverse events. Due to the paucity of evidence available, certainty of the results is compromised; therefore, larger trials exploring the use of parent- or nurse-controlled analgesia in neonates and the development of nurse-led models for analgesia delivery are needed. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42018114382.

Effects of mobile mindfulness on emergency department work stress: A randomised controlled trial.

OBJECTIVE: High-occupational stress among ED staff has a detrimental impact on both staff wellness and patient care. The objective of the study is to determine whether 4 weeks of smartphone app-guided mindfulness practice reduces stress levels of ED staff. METHODS: This two-arm randomised controlled trial was conducted in two Australian EDs in 2019-2020. Eligible participants were randomly assigned (1:1) to either an App group or a Wait to Treat group to practice daily 10 min app-guided mindfulness for 4 weeks. Online surveys were collected for both groups at three time periods: before (T1), immediately after (T2) and 3 months after cessation (T3). Then the Wait to Treat group received the same intervention, followed by surveys immediately after the intervention (T4) and 3 months later (T5). Primary outcome was measured using the Perceived Stress Scale. Secondary outcomes were measured using the Maslach Burnout Inventory (three subscales: emotional exhaustion, depersonalisation and personal accomplishment), Mindfulness Attention Awareness Scale and Warwick-Edinburgh Mental Well-being Scale. Both intention-to-treat and per-protocol analysis were performed. Repeated measurement data were analysed by the linear mixed model. RESULTS: Of 148 enrolled participants 98 completed all the surveys, but only half (48%) reported continuous use of the app. Based on the results of the intention-to-treat analysis, there was a statistically significant improvement of perceived stress levels (F = 15.70, P < 0.001), all three components of burnout (emotional exhaustion [F = 14.22, P < 0.001], depersonalisation [F = 3.62, P = 0.030], personal accomplishment [F = 7.51, P < 0.001]), mindfulness (F = 8.83, P < 0.001) and wellbeing levels (F = 10.71, P < 0.001) from pre-intervention to 3 months later with small effect sizes. CONCLUSION: Results of the present study demonstrate that brief mindfulness training via innovative digital technology had a small positive effect in improving emergency staff stress, burnout, mindfulness and wellbeing.

Improving care for thalassemia patients in line with best practice standards at a tertiary referral cancer care center.

BACKGROUND: Beta-thalassemia major is a chronic hematological disorder that requires life-long management. This project aimed to improve thalassemia patients' care through the implementation of best practice standards at a tertiary referral cancer care center. METHODS: The current project utilized a clinical audit design. A pre and post-implementation audit was carried out following best practice standards for patients with thalassemia. Chart review of nine thalassemia patients was undertaken pre and post-implementation of staff education, local clinical guidelines, and an annual care plan to manage thalassemia to determine adherence to best practice standards. Data were collected between June 2019 and June 2020 at a specialist outpatient and day treatment unit located in inner Brisbane, Australia. RESULTS: The pre-implementation audit results showed low compliance to the audit criteria, with the exception of nursing staff education. Following the implementation of strategies to align current care with evidence-based recommendations, the post-implementation audit showed improvement across all areas. Overall, implementation strategies were successful in improving patient care for thalassemia patients by 100%. Staff thalassemia education increased from 45 to 92%. CONCLUSION: Implementing an individualized treatment plan and thalassemia-specific nursing documentation as well as developing local clinical guidelines and providing targeted nurse education were effective strategies to improve care for thalassemia patients in line with best practice standards.

Information needs of women undergoing gynaecological risk reduction surgery: Applying patient-reported findings to improve service delivery.

BACKGROUND: Women with genetic mutations including BRCA1, BRCA2 and Lynch syndrome are at increased risk of developing gynaecological cancers with management options including surveillance and/or risk reduction surgery. Little is known about the information women require to inform their decisions around having risk reduction surgery, the implication this surgery has for them and the timing preferences to receive this information. AIMS: To identify the information needs of women who are considering or who have had risk reduction surgery due to having a diagnosed or suspected genetic mutation with subsequent increased risk of developing gynaecological cancer. MATERIALS AND METHODS: A pilot survey was undertaken in a tertiary, metropolitan hospital as part of a service improvement project. Women referred to the gynaecology-oncology service for gynaecological risk reduction surgery between January to December 2018 were invited to participate through completing either online or hard copy versions of a 12-item survey. RESULTS: A response rate of 60% (n = 32) was obtained from women between 27 and 77 years of age. Key information topics included sexuality and intimacy (90.6%; n = 29), the surgery itself (87.5%; n = 28) and surgical menopause (87.5%; n = 28). Over 90% (n = 31) of respondents stated they preferred to receive information about surgery pre-operatively and in written format (81.3%; n = 26). The importance of a multidisciplinary approach was recognised with women wanting information from allied health practitioners such as physiotherapists and social workers. CONCLUSIONS: Findings have enabled a better understanding of the type, timing and content of information desired by women making complex decisions about risk reduction surgery. Results have contributed to developing an information resource which will more adequately assist women to meet their information needs when considering gynaecological risk reduction surgery in our hospital.