Nurses' perceived barriers and facilitators to the implementation of nurse prescribing: Delphi study and focus group.

AIM: To obtain consensus on barriers and facilitators to nurse prescribing following its recent introduction in Spain. DESIGN: A three round online Delphi survey and focus group. METHODS: An exploratory method was used with three consecutive rounds of questionnaires based on anonymity and feedback, and a focus group. The study was carried out with primary care, specialized care, socio-health care and manager nurses. RESULTS: On the basis of the Delphi study that was conducted, a list of 15 barriers and 18 facilitators of nurse prescribing was obtained. However, no general consensus was found with respect to the prioritization of these barriers/facilitators. The analysis of the results of the focus group confirmed the information obtained from the Delphi study. The main barriers highlighted were dependence on the figure of the physician, insufficient training in pharmacology, a lack of institutional support and the limited list of products that could be prescribed. The key facilitators were academic knowledge and ongoing training and education, independence in the functions and responsibilities of the nursing profession, adaptation to new roles and autonomy in the case of chronic care processes. CONCLUSION: Nurses were generally positive about the introduction of nurse prescribing. The commitment of nurses to training and their accreditation as prescribers (internal forces) and health policy and nursing management (external forces) play a fundamental role in supporting the basis of nurse prescribing and ensuring that it is developed with the identified support resources, such as staff training and the provision of the materials necessary for its proper implementation, all with the aim of guaranteeing quality healthcare. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Strong models of nurse prescribing are being considered globally to address population needs. The results can help the future implementation of non-medical independent prescribing and provide guidance to the government and society on the interventions that can be used to consolidate it. IMPACT: What problem did the study address? By 2027, the world's population will receive more than 4.5 trillion doses of medicine each year. However, the WHO estimates a projected shortfall of 10 million health workers by 2030. Inadequacies with traditional physician-led care systems mean that new approaches are imperative to maintain patient access to prescription medicines, with NP being a key element in this regard. In Catalonia (Spain), the accreditation process for nurses as prescribers was implemented in 2021. It is therefore of vital importance to question and consult the nurses themselves, the main promoters of the process, to find out their perceptions and thus be able to take them into consideration in the implementation process. What were the main findings? A total of 15 barriers and 17 facilitators were identified. The main perceived barriers are dependence on the figure of the physician, insufficient training in pharmacology during undergraduate studies and a lack of institutional support. The main perceived facilitators are academic knowledge and ongoing education and training, independence in nursing functions and responsibilities, and adaptation to new roles and tasks. Where and on whom will the research have an impact? These results can contribute to improving NP implementation in Spain and serve as a reference for other countries, especially where NP education and training have only recently been instigated or are in the planning process. REPORTING METHOD: Standards for reporting qualitative research: a synthesis of recommendations. SRQR. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

The impact of docosahexaenoic acid on maternal mental health: scoping review / El impacto del ácido docosahexaenoico en la salud mental materna: revisión sistematizada de la literatura

Docosahexaenoic acid (DHA) is a polyunsaturated essential fatty acid from the omega-3 series that appears to be key to perinatal mental health. For this, the aim of this review is to evaluate the effect of DHA on maternal mental health during pregnancy and lactation with respect to depression and anxiety. The present scoping review was carried out following the methodology of Arksey and O’Malley (2005). The selection of studies was carried out in accordance with PRISMA by means of systematic searches in the PubMed, Scopus, PsycINFO and Medline databases. The results classified according to the effectiveness of DHA. In most (n = 9) of the 14 studies finally included, DHA plasma levels with or without other polyunsaturated omega-3 fatty acids were significantly lower in pregnant women with depressive and anxiety symptoms. However, no study reported a beneficial effect of DHA on mental health during the postpartum period. The majority used detection method was the Edinburgh Postpartum Depression Scale (n = 11). The prevalence of depressive symptoms ranged between 5.9 % and 50 %. As a conclusion, although more research is needed in this area, these exploratory results suggest that DHA could play an important role in preventing the pathogenesis of depression and anxiety during gestation.(AU)

El ácido docosahexaenoico (DHA) es un ácido graso esencial poliinsaturado de la serie omega-3 que parece ser clave para la salud mental perinatal. Por ello, el objetivo de esta revisión es evaluar el efecto del DHA sobre la salud mental materna durante el embarazo y la lactancia con respecto a la depresión y la ansiedad. La presente revisión se llevó a cabo siguiendo la metodología de Arksey y O’Malley (2005). La selección de estudios se realizó de acuerdo con PRISMA mediante búsquedas sistemáticas en las bases de datos PubMed, Scopus, PsycINFO y Medline. Los resultados se catalogaron según la eficacia del DHA. En la mayoría (n = 9) de los 14 estudios finalmente incluidos, los niveles plasmáticos de DHA con o sin otros ácidos grasos omega-3 poliinsaturados fueron significativamente más bajos en mujeres embarazadas con síntomas de depresión y ansiedad. Sin embargo, ningún estudio informó un efecto beneficioso del DHA sobre la salud mental durante el periodo posparto. El método de detección más utilizado fue la Escala de Depresión Posparto de Edimburgo (n = 11). La prevalencia de síntomas depresivos osciló entre el 5,9 % y el 50 %. Como conclusión, aunque se necesita más investigación en este ámbito, los resultados exploratorios parecen indicar que el DHA juega un papel importante en la prevención de la patogenia de la depresión y la ansiedad durante el periodo de gestación.(AU)

The impact of docosahexaenoic acid on maternal mental health: scoping review.

Introduction: Docosahexaenoic acid (DHA) is a polyunsaturated essential fatty acid from the omega-3 series that appears to be key to perinatal mental health. For this, the aim of this review is to evaluate the effect of DHA on maternal mental health during pregnancy and lactation with respect to depression and anxiety. The present scoping review was carried out following the methodology of Arksey and O'Malley (2005). The selection of studies was carried out in accordance with PRISMA by means of systematic searches in the PubMed, Scopus, PsycINFO and Medline databases. The results classified according to the effectiveness of DHA. In most (n = 9) of the 14 studies finally included, DHA plasma levels with or without other polyunsaturated omega-3 fatty acids were significantly lower in pregnant women with depressive and anxiety symptoms. However, no study reported a beneficial effect of DHA on mental health during the postpartum period. The majority used detection method was the Edinburgh Postpartum Depression Scale (n = 11). The prevalence of depressive symptoms ranged between 5.9 % and 50 %. As a conclusion, although more research is needed in this area, these exploratory results suggest that DHA could play an important role in preventing the pathogenesis of depression and anxiety during gestation.

Introducción: El ácido docosahexaenoico (DHA) es un ácido graso esencial poliinsaturado de la serie omega-3 que parece ser clave para la salud mental perinatal. Por ello, el objetivo de esta revisión es evaluar el efecto del DHA sobre la salud mental materna durante el embarazo y la lactancia con respecto a la depresión y la ansiedad. La presente revisión se llevó a cabo siguiendo la metodología de Arksey y O'Malley (2005). La selección de estudios se realizó de acuerdo con PRISMA mediante búsquedas sistemáticas en las bases de datos PubMed, Scopus, PsycINFO y Medline. Los resultados se catalogaron según la eficacia del DHA. En la mayoría (n = 9) de los 14 estudios finalmente incluidos, los niveles plasmáticos de DHA con o sin otros ácidos grasos omega-3 poliinsaturados fueron significativamente más bajos en mujeres embarazadas con síntomas de depresión y ansiedad. Sin embargo, ningún estudio informó un efecto beneficioso del DHA sobre la salud mental durante el periodo posparto. El método de detección más utilizado fue la Escala de Depresión Posparto de Edimburgo (n = 11). La prevalencia de síntomas depresivos osciló entre el 5,9 % y el 50 %. Como conclusión, aunque se necesita más investigación en este ámbito, los resultados exploratorios parecen indicar que el DHA juega un papel importante en la prevención de la patogenia de la depresión y la ansiedad durante el periodo de gestación.

Nursing interventions for perinatal bereavement care in neonatal intensive care units: A scoping review.

BACKGROUND: Despite technological advances and specialist training of neonatal teams, perinatal deaths still occur. Such events are traumatic experiences for the parents and increase the risk of pathological grieving. Nursing is one of the main sources of support. However, the important work of nurses in these situations is made more difficult by the lack of recognized strategies that can be implemented to assist parents and family members in the bereavement process. AIM: Identify nursing interventions to help parents of neonates admitted to neonatal intensive care units cope with perinatal loss. METHODS: A scoping review based on the methodological framework established by Arksey and O'Malley was used. A total of 327 relevant studies were identified through a bibliographic search in Pubmed, CINAHL Plus, APA PsycNET and Scopus between 2000 and 2019. The screening process included an initial analysis of the relevance of the abstract and, when required, an extensive review of the full paper. RESULTS: A total of 9 papers were finally selected which responded to the research question. All nine papers are from the USA and have different methodological characteristics. A number of effective interventions were identified, including legacy creation, support groups, family-centred accompaniment and follow-up, parental involvement in pre-mortem care, intergenerational bereavement programmes, and the use of technological and spiritual resources. CONCLUSION: In general, the scant evidence that is available about nursing interventions around perinatal bereavement care underlines the requirement to thoroughly assess the effectiveness of those that have already been designed and implemented. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: This scoping review contributes to the potential implementation of effective interventions to deal with and help parents and family members cope with perinatal bereavement, with nursing staff as the main source of support and leading interventions which have family members in the care team. This review also makes a substantial contribution to the development of a practical and evidence-based clinical guide for nursing, with recommendations that can be adapted to effective quality care criteria. It is additionally intended to encourage visibility in health policies of care and attention to perinatal grief in neonatal intensive care units.

Fluid Intake Recommendation Considering the Physiological Adaptations of Adults Over 65 Years: A Critical Review.

The aim of this critical review was to clarify recommended fluid intake for older people. A literature search of published articles and guidelines on fluid intake recommendations until April 2020 was carried out using PUBMED, Scopus, Cochrane, and Google Scholar. In this review, we focused on people over 65 years old at different care levels. The results show that the mean fluid intake ranges between 311 and 2390 mL/day. However, it is difficult to know whether this corresponds to the real pattern of fluid intake, due to the variability of data collection methods. With respect to the recommendations, most international organizations do not take into consideration the physiology of ageing or the health problems associated with an older population. In conclusions, we recommend to follow the guideline of the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Food Safety Authority (EFSA). ESPEN is the only guideline which takes into account age. It is also based on EFSA recommendations. This authority takes into consideration all fluids consumed (ranging from food to fluids). If it is known that around 20% of all fluids consumed come from food, the result would effectively be that the EFSA recommends the same as the ESPEN guidelines: 1.6 L/day for females and 2.0 L/day for males. The findings could help raise the awareness of professionals in the sector with respect to the required fluid intake of the elderly and, in this way, contribute to avoiding the consequences of dehydration.