Spiritual interventions: Improving the lives of colorectal cancer survivors-A systematic literature review.

AIM: To systematically review the types of spiritual interventions available for colorectal cancer survivors and determine if they improve their lives. DESIGN: Systematic review. DATA SOURCE: A thorough literature search was conducted in July 2023 using PRIMO, PubMed/Medline, Cochrane, CINAHL, Scopus, and EMBASE. REVIEW METHODS: As an extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist, the Synthesis Without Meta-Analysis reporting guideline was employed. A narrative synthesis was used to analyse the data. RESULTS: Thirty-five articles were analysed for this study. The findings suggest that psychoeducational intervention, cognitive behavioural therapy intervention, mindfulness intervention, social intervention, and spiritual counselling improved CRC survivor's coping skills, boosted self-esteem, lessened anxiety, instilled hope, enhanced daily functioning, improved survival rates, improved neurological functional status and quality of life (QoL). CONCLUSION: There is proof that spiritual interventions help CRC patients and improve their QoL. It has been discovered that spiritual intervention is helpful in the diagnosis, management, and treatment of CRC conditions. IMPACT: CRC survivors may have impairments in their physical ability and daily functioning as a result of many symptoms, such as pain, bowel dysfunction, and exhaustion. Furthermore, individuals may encounter difficulties in several aspects of their psychological, emotional, social, and role functioning due to the presence of dread symptoms. Therefore, these study will help CRC survivors To implement spiritual interventions in the management of their long-term care. To cultivate problem-solving abilities, foster self-assurance, and enhance self-awareness. To alleviate symptoms, enhance everyday functioning, and improve QoL. NO INDUCEMENT: No financial incentives were used to compensate patients or members of the public for this review.

Influence of perceived benefits, barriers and activities of family engagement in care on family nursing practice: A cross-sectional correlational study.

AIMS: To describe nurses' perceptions of family nursing practice and to explore the influence of their perceptions of the benefits, barriers and activities of family engagement in care on family nursing practice. DESIGN: A cross-sectional correlational study. METHODS: In total, 460 nurses from two tertiary hospitals in the central region of Uganda participated. Quantitative and qualitative data were collected between August 2020 and January 2021 using the Family Nursing Practice Scale. Analyses included descriptive statistics, t-test, Pearson correlation, analysis of variance and ordinal logistics regression. Quantitative content analysis was carried out on the textual data. RESULTS: Nurses who perceived that family engagement in care improves patient and family outcomes were more likely to rate family nursing practice highly. Perceived barriers to family engagement in care particularly time constraints, work overload and family-related conflicts have a negative and significant influence on family nursing practice. Nurse characteristics such as education, usual shift pattern and personal experience of having a family member in hospital are significantly associated with family nursing practice; nurses who work morning shifts were likely to report higher family nursing practice. CONCLUSION: The study reveals that several parameters (perceived barriers, perceived benefits and nurse characteristics) influence nursing practice with families. Thus, bearing in mind the diversity of healthcare contexts, the findings show that multiple interacting factors are important for advancing family nursing interventions and practice. IMPACT: Probabilistic factor-specific predictions of nursing practice with families are provided in this study - this addresses a gap in the evidence regarding the elements that should be optimized when designing well-informed policies and interventions to advance family nursing practice. A comparison of results in the literature with the present study's findings suggests a need to broaden the scope and context perspective in future research and broaden the understanding of how nurses´ perceptions influence family engagement in care. REPORTING METHOD: The study adheres to the STROBE reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: Family members/caregivers were involved in the design of the study particularly in assessment of validation of the tools used in the study.

Polychoric Correlation With Ordinal Data in Nursing Research.

BACKGROUND: Measures in nursing research frequently use Likert scales that yield ordinal data. Confirmatory factor analysis using Pearson correlations commonly applies to such data, although this violates ordinal scale assumptions. OBJECTIVES: The aim of this study was to illustrate the application of polychoric correlations and polychoric confirmatory factor analysis as a valid alternative statistical approach using data on family members' perceived support from nurses as an exemplar. METHODS: A primary analysis of cross-sectional data from a sample of 800 participants using data collected with the Iceland-Family Perceived Support Questionnaire was conducted using polychoric versus Pearson correlations, analysis of variance, and confirmatory factor analysis. RESULTS: A two-factor measurement model was compatible with data from family members in the Ugandan care settings. Two contextual factors (cognitive and emotional support) constituted the family support measurement model. A factor correlation indicated that the two factors reflected distinct but closely related aspects of family support. Polychoric correlation revealed 13.8% (range: 5.5%-25.2%) higher correlations compared to Pearson correlations. Moreover, the polychoric agreed with the data, whereas the Pearson confirmatory factor analysis did not fit based on multiple statistical criteria. Analyses indicated a difference in emotional and cognitive support perception across two family characteristics: education and relationship to the patient. DISCUSSION: A polychoric correlation suggests stronger associations, and consequently, the approach can be more credible with an ordinal Likert scale than Pearson correlations. Hence, polychoric confirmatory factor analysis can address a larger proportion of variance. In nursing research, polychoric confirmatory factor analysis can confidently be utilized when conducting confirmatory factor analysis of ordinal variables in Likert scales. Furthermore, when a Pearson confirmatory factor analysis is used for ordinal Likert scales, the researcher should carefully evaluate the difference between the two approaches and justify their methodological choice. Even though we do not suggest dispensing with Pearson correlations entirely, we recommend using polychoric correlation for ordinal Likert scales.

Interventions improving well-being of adult cancer patients' caregivers: A systematic review.

AIM: The aim of this study was to determine what kind of psychosocial interventions aimed at improving the well-being of adult cancer patient caregivers were developed, and to describe the methodological characteristics and clinical effectiveness of the interventions which could be included in the nursing care plans. DESIGN: Systematic review DATA SOURCES: A systematic search of three databases (PubMed, CINAHL, and PsycINFO) was conducted to identify peer-reviewed papers published between years 2004-2019. REVIEW METHODS: The review was guided by the Joanna Briggs Institute manual for systematic reviews. Data were extracted and appraised by three reviewers using standardized checklists. Narrative synthesis was used to analyse the data. RESULTS: A total of 37 studies underwent analysis. Most of the studies described psychoeducational interventions, designed for patient-caregiver dyads, delivered face-to-face. There was a great variety in caregiver outcomes and measurement tools used. Even though most studies used a randomized controlled design and standardized intervention protocols, many reported problems with recruitment and attrition. Most studies reported that the intervention improved caregiver outcomes, yet the majority of them failed to report effect sizes. CONCLUSION: There are currently a plethora of successful interventions available for cancer patient caregivers which can be included to the nursing care plan. Psychoeducational online interventions which include a social support component may have the best potential in supporting caregivers. It is important to address specific caregiver needs at different cancer stages rather than general needs of caregivers in future interventions. IMPACT: This review suggests that despite a large number of different interventions which can be included in the nursing care plan to improve the support offered to caregivers, some issues should be addressed while designing an intervention study. The emphasis should be placed on reporting effect sizes, focusing on specific caregiver needs and improving recruitment, retention strategies and sustainability of caregiver interventions.

The evidence base of nurse-led family interventions for improving family outcomes in adult critical care settings: A mixed method systematic review.

BACKGROUND: The COVID-19 pandemic has exacerbated the consequences of a patient's admission to critical care settings, causing families to face more psychosocial issues than in previous years. Thus, nurses and other clinicians need to keep abreast of interventions that support the families of critical care patients. OBJECTIVE: To provide evidence of nurse-led family interventions and their family outcomes in adult critical care settings. DESIGN: A mixed method systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. DATA SOURCES: The search included both a screen of relevant databases (PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Library) and the screening of citations in relevant articles. Studies published in the English language between January 2010 and October 2020 were considered. The final database searches were performed on 20 October 2020. METHODS: Screening and eligibility assessment were conducted using the Rayyan software. Studies describing the family outcomes of nurse-led interventions in adult critical care settings through either qualitative or quantitative methods were included, i.e., the mixed method synthesis permitted the inclusion of either qualitative or quantitative findings. Article quality was evaluated by three authors using the Joanna Briggs Institute's critical appraisal tools. FINDINGS: A total of 15 studies - two trials, eight quasi-experimental studies, four qualitative, and one mixed method met the inclusion criteria. The described interventions were organized into five categories: educational/informational; family involvement in care; diary; communication; and bundled interventions. These categories varied in terms of elements, delivery, and family outcomes. Nurse-led interventions that resulted in small to medium improvements in family outcomes included educational interventions with digital storytelling, a bundled approach, informational nursing interventions, and nurse-driven emotional support. The included studies (n = 2) that investigated family rounds in the ICU reported that this approach did not noticeably influence family outcomes. CONCLUSION: The differences in the intervention elements, tools, and outcomes evaluated in this review reflect the diversity of family needs, and that numerous interventions have already been developed to promote family health in critical care settings. The evidence suggests that interdisciplinary nurse-led family interventions can improve family outcomes. Tweetable abstract: Interprofessional nurse-led family interventions draw on diverse approaches and improve family outcomes in adult critical care settings.

Nurses' autonomy in sleep management improves patients' sleep quality: A cross-sectional study.

BACKGROUND: The current literature indicates that intensive care (ICU) patients' sleep quality is generally poor, which is associated with serious physical and psychological consequences. AIMS AND OBJECTIVES: To describe the practices nurses use to provide good-quality sleep to adult ICU patients and assess nurses' perceptions of patients' sleep quality and nurses' professional autonomy in sleep management. DESIGN: A descriptive-correlational, cross-sectional study. METHODS: A total of 232 ICU nurses from four hospitals in Poland were recruited. Data were collected between May and August 2019 using a previously developed questionnaire and analysed using descriptive statistics and non-parametric tests. RESULTS: A total of 119 nurses took part in the study (response rate: 51%). On average, nurses rated patients' sleep quality as moderate (4.44 ± 2.23, scale 0-10). Most of the respondents (95.8%) said they did not use any sleep protocol. Various strategies to improve patients' sleep were used sporadically (2.64 ± 1.55, scale 1-5). The use of sleep quality assessment methods was positively correlated with patients' sleep quality (rho = 0.22, P = .02). Nurses' professional autonomy regarding sleep management was assessed as average (4.34 ± 2.43, scale 0-10) and was correlated with the patients' sleep quality (rho = 0.25, P < .01). Nurses who rated their autonomy in patients' sleep management more highly (rho = 0.29, P < .01) and more often influenced patients' sleep decisions (rho = 0.24, P < .01) used more methods to improve patients' sleep. CONCLUSIONS: Strengthening the professional autonomy of ICU nurses and creating a reliable sleep assessment and improvement tool, which would describe strategies nurses can implement independently could increase sleep quality among ICU patients. RELEVANCE TO CLINICAL PRACTICE: Addressing organizational problems, which hamper the patients' sleep management by ICU nurses could result in using more strategies to provide good-quality sleep to ICU patients. There is a need for clinical guidelines regarding patients' sleep management to help educate and guide nurses how to independently use sleep improvement methods.

Nursing leadership styles and their impact on intensive care unit quality measures: An integrative review.

AIM: To examine the impact of nursing leadership styles on intensive care unit quality measures. BACKGROUND: Evidence on the impact of leadership styles has direct implications for building and strengthening leadership behaviours that foster quality nursing care in intensive care units. EVALUATION: An integrative review approach was adopted. Databases including the Cumulative Index of Nursing and Allied Health Literature, PubMed, Scopus, ProQuest, Google Scholar and the Cochrane Library were searched. KEY ISSUES(S): Out of 253 identified studies, seven were included in the review. Leadership styles in intensive care units include transformational, considerate, exemplary, trusted and absentee leadership. Active nurse leaders who share a common vision, and advocate for their staff are perceived as more effective than those who exhibit absentee characteristics. Structural measures influenced by leadership styles include productivity and morale of nursing staff. Outcome measures such as staff outcomes (intent to stay, job satisfaction), medication errors and periventricular/intraventricular haemorrhage in neonatal intensive care units have a positive relational effect with nursing leadership style. CONCLUSIONS: The findings highlight the link between nursing leadership styles on structural and outcome measures in intensive care units. The current literature lacks studies highlighting the impact of nursing leadership styles on process measures in intensive care units. IMPLICATIONS FOR NURSING MANAGEMENT: Transformational, considerate, exemplary leadership practices, and trusted leadership styles when used by nurse leaders guarantee higher quality of nursing care in intensive care units. Therefore, modern leadership styles need to be supported by health care organisations and education.

Bullying in nursing evaluated by the Negative Acts Questionnaire-Revised: A systematic review and meta-analysis.

AIMS: To report a synthesis of the empirical studies that used the Negative Acts Questionnaire-Revised (NAQ-R) to assess bullying among nurses based on evaluation of the psychometric properties and use and usability of the instrument and identification of the variables associated with bullying. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Four databases were used in the literature search: PubMed, CINAHL, PsycINFO and Scopus. The search was limited to original publications describing results of empirical studies written in English or Polish and published in peer-reviewed journals between 2002 and 2018. REVIEW METHODS: Two reviewers independently assessed eligibility, extracted data and conducted quality assessment. Based on the extracted data, three separate meta-analyses were conducted. RESULTS: Thirty-one articles were included in the review, 13 of which were selected for meta-analysis. In studies where participants reported bullying (N = 19), its prevalence ranged from 17-94%. Variables most often associated with bullying were age, educational level and years of professional experience. Usability of this instrument in different countries was supported by a high reliability in each study. In two meta-analyses, which included 12 studies with mean NAQ-R and item scores, the heterogeneity of data was calculated as high and moderate respectively. CONCLUSION: The good quality of the NAQ-R in determining variables related to bullying is endorsed. Variables related to bullying identified in this review could be used to map out a model of a potential bullying victim for preventative measures. IMPACT: The NAQ-R is a useful and reliable tool for measuring bullying among nurses; however, there remains a strong need to assure that a verified, standardized and updated bullying taxonomy is used in future studies to ensure reliable and comparable data. A model of a potential bullying victim may help nursing directors foster a healthier workplace environment, thereby improving patient outcomes in the long-term.

Preferences of patients' family regarding family-witnessed cardiopulmonary resuscitation: A qualitative perspective of intensive care patients' family members.

OBJECTIVES: To describe preferences of intensive care patients' family members regarding the idea of an inpatient family-witnessed cardiopulmonary resuscitation. RESEARCH METHODOLOGY/DESIGN: A descriptive qualitative design was used in this study. Twelve family members of intensive care patients took part in individual semi-structured interviews. Data were analysed using thematic analysis. SETTING: A population of Finnish and Polish former intensive care adult patients' relatives. FINDINGS: The thematic analysis resulted in two main themes with four subthemes each: (Theme 1) Being more involved and engaged in patient's care in case of cardiopulmonary resuscitation, with subthemes: (a) Having an option to decide, (b) Being in physical proximity to the patient, (c) Feeling like having more control and impact and (d) Having a better idea about the situation. (Theme 2) Being cared for and treated respectfully during possible cardiopulmonary resuscitation, with subthemes: (a) Need for more support and understanding from the staff, (b) Uniqueness of the family - patient relationship, (c) Need for staff to be more humane and less mechanical and (d) Professional and highly qualified staff. CONCLUSION: Results of this study suggest a possible gap in family-centred care delivery in intensive care settings. System changes are necessary in order to increase nurses' awareness of patients' families' preferences, and successfully implement recommended family-witnessed cardiopulmonary resuscitation.

Health care professionals' concerns regarding in-hospital family-witnessed cardiopulmonary resuscitation implementation into clinical practice.

BACKGROUND: In-hospital, family-witnessed cardiopulmonary resuscitation of adults has been found to help patients' family members deal with the short- and long-term emotional consequences of resuscitation. Because of its benefits, many national and international nursing and medical organizations officially recommend this practice. Research, however, shows that family-witnessed resuscitation is not widely implemented in clinical practice, and health care professionals generally do not favour this recommendation. AIM: To describe and provide an initial basis for understanding health care professionals' views and perspectives regarding the implementation of an in-hospital, family-witnessed adult resuscitation practice in two European countries. STUDY DESIGN: An inductive qualitative approach was used in this study. METHODS: Finnish (n = 93) and Polish (n = 75) emergency and intensive care nurses and physicians provided written responses to queries regarding their personal observations, concerns and comments about in-hospital, family-witnessed resuscitation of an adult. Data were analysed using inductive thematic analysis. FINDINGS: The study analysis yielded five themes characterizing health care professionals' main concerns regarding family-witnessed resuscitation: (1) family's horror, (2) disturbed workflow (3) no support for the family, (4) staff preparation and (5) situation-based decision. CONCLUSION: Despite existing evidence revealing the positive influence of family-witnessed resuscitation on patients, relatives and cardiopulmonary resuscitation process, Finnish and Polish health care providers cited a number of personal and organizational barriers against this practice. The results of this study begin to examine reasons why family-witnessed resuscitation has not been widely implemented in practice. In order to successfully apply current evidence-based resuscitation guidelines, provider concerns need to be addressed through educational and organizational changes. RELEVANCE TO CLINICAL PRACTICE: This study identified important implementation barriers for allowing families in critical care settings to be present during resuscitation efforts. These results can be further used in developing and adjusting clinical practice policies, protocols and guidelines related to family-witnessed resuscitation.

Factors associated with experiences and attitudes of healthcare professionals towards family-witnessed resuscitation: a cross-sectional study.

AIMS: To examine factors associated with healthcare professionals' experiences and attitudes towards adult family-witnessed resuscitation in the emergency and intensive care units. BACKGROUND: Family-witnessed resuscitation offers the option for patients' families to be present during in-hospital resuscitation. It is important to understand healthcare professionals' views about this practice to determine why, despite its benefits and general recommendation, this practice has not been widely implemented. DESIGN: A descriptive, correlational, cross-sectional survey. METHODS: A total of 390 Finnish and Polish Registered Nurses and physicians from six university hospitals took part in the study. A structured questionnaire that examined nurses' and physicians' experiences and attitudes was used. Data, collected between July-December 2013, were analysed with descriptive statistics, logistic and multiple linear regression analyses. RESULTS: The results indicated that healthcare professionals are not well experienced in family-witnessed resuscitation. The general attitude towards this practice is somewhat negative. Physicians seem more confident about overcoming process-related barriers than nurses. Having previous positive experiences of family-witnessed resuscitation was associated with a more positive attitude towards this practice. Consequently a previous negative experience was associated with more negative attitudes. CONCLUSION: Family-witnessed resuscitation awareness should be increased in daily clinical practice. It is important to find a way to improve experiences and attitudes of healthcare professionals related to this phenomenon. Furthermore, developing local guidelines and multidisciplinary training plans is needed to respond to the needs of patients and their families.

Integrative review: nurses' and physicians' experiences and attitudes towards inpatient-witnessed resuscitation of an adult patient.

AIM: An integrative review of attitudes and experiences of healthcare professionals regarding family-witnessed resuscitation. BACKGROUND: Allowing family members to be present during resuscitation has been a topic of debate in the last years. Increased focus on family centred care led to preparation of official statements concerning this phenomenon. While in some countries witnessed resuscitation is accepted and used, there are many places where it is not respected and remains controversial. DESIGN: Integrative literature review. DATA SOURCES: Databases: CINAHL, PsycINFO and PubMed. REVIEW METHODS: Cooper's five-stage integrative review method has been used. Results were limited to original publications in English, published between 2007-2012, describing nurses' and doctors' experiences and attitudes on inpatient family-witnessed resuscitation of an adult patient. RESULTS: Fifteen articles were included. Healthcare professionals indicated different opinions on family-witnessed resuscitation. Perceptions vary in different cultural settings. There are both positive and negative effects of this practice on the family members and the rescue team. There is a lack of local guidelines. CONCLUSION: Further research with larger sample sizes and different cultural settings would help identify outcomes following the family presence during resuscitation practice. Qualitative research is needed to examine the impact of those outcomes and develop policies and guidelines on cultural variability.