Preliminary Analysis of Fall Concern Among Family Caregivers of Older Adults Discharged From the Hospital: A Psychometric Evaluation of the Carers' Fall Concern Instrument.

PURPOSE: To provide a preliminary descriptive analysis of the change in fall concern among family caregiver-care recipient dyads during hospitalization and after discharge as part of a prospective study exploring the psychometric properties of the Carers' Fall Concern Instrument. METHOD: Using a prospective cohort design, an interviewer-administered survey was completed by dyads at 48 hours before discharge and 1 week and 30 days after discharge. RESULTS: Of family caregivers, 76.9% thought their care recipient was at risk of falling and 61.5% were afraid of them falling. However, only 34.6% of older adults thought that they were at risk of falling and only 42.3% were afraid of falling. Family caregivers reported significantly less concern about falls after their care recipients were discharged. CONCLUSION: This study provided greater insight into caregiver-care recipient dyads' fall concern during their transition from hospital to home that may guide post-discharge fall prevention education on falls. [Journal of Gerontological Nursing, 50(5), 14-18.].

Patient perspectives of diabetes care in primary care networks in Singapore: a mixed-methods study.

BACKGROUND: Type 2 diabetes (T2D) remains an important chronic condition worldwide requiring integrated patient-centred care as advocated by the Chronic Care Model (CCM). The Primary Care Networks (PCNs) in Singapore organise general practitioners (GPs) with nurses and care coordinators to deliver team-based care for patients with chronic conditions. This study examined the quality of care in the PCNs as defined by the CCM from the patients' perspective. METHODS: This study followed a cross-sectional convergent mixed-method design with T2D patients across three PCN types (GP-led, Group, and Cluster). The Patient Assessment of Chronic Illness Care (PACIC, range 1-5) was completed by a convenience sample of 343 patients. Multivariate linear regression was performed to estimate the associations between patient and service characteristics and PACIC summary score. Twenty-four participants were purposively recruited for interviews on the experienced care until thematic saturation was reached. Quantitative and qualitative data were collected concurrently and independently. Integration occurred during study design and data analysis using the CCM as guidance. Quantitative and qualitative results were compared side-by-side in a joint comparison table to develop key concepts supported by themes, subthemes, and patients' quotes. RESULTS: The PACIC mean summary score of 3.21 for 343 patients evidenced that some have received CCM consistent care in the PCNs. Being younger and spending more time with the GP were associated with higher PACIC summary scores. PACIC summary scores did not differ across PCN types. The 24 patients interviewed in the qualitative study reported receiving team-based care, nurse services, good continuity of care, as well as patient-centred care, convenient access, and affordable care. Key concepts showed that integrated care consistent with the CCM was sometimes received by patients in the PCNs. Patient activation, delivery system design/decision support, goal setting/tailoring, and problem-solving/contextual counselling were sometimes received by patients, while follow-up/coordination was generally not received. CONCLUSIONS: Patients with T2D from the Singapore Primary Care Networks received integrated care consistent with the Chronic Care Model, particularly in patient activation, delivery system design/decision support, goal setting/tailoring, and problem-solving/contextual counselling. Follow-up/coordination needed improvement to ensure higher quality of diabetes care.

Enhancing professional competency in clinical procedures using head-mounted display virtual reality - a mixed method study.

BACKGROUND: The maintenance of nursing professional competency is essential to ensure patients' health outcomes. With the current shortage of nursing workforce, a novel approach is necessary to refresh clinical skills and update practice. OBJECTIVE: This study aims to examine the effectiveness of using head-mounted display virtual reality to refresh knowledge and skills and explore nurses' perceptions towards using this technology for refresher training. DESIGN: A pre-test post-test mixed-method experimental design was employed. RESULTS: Participants (n = 88) were registered nurses with a diploma in nursing. The intravenous therapy and subcutaneous injection procedures were implemented using head-mounted display virtual reality. The study showed significant improvement in knowledge for the procedures, cognitive absorption, online readiness, self-directed learning, and motivation for learning. In the qualitative focus group discussions, three themes were identified using thematic analyses: enjoyable way to refresh clinical knowledge; learning outside classroom and limitations in maneuver. CONCLUSION: Using head-mounted display virtual reality is promising in refreshing clinical skills for nurses. Training and refresher courses can explore using this novel technology, which may be a viable alternative to ensure professional competence with reduced manpower and resources used by the healthcare institution.

The effects of forest bathing on psychological well-being: A systematic review and meta-analysis.

Globally, around half (55%) of the population live in fast-paced urban settings where many people find it challenging to manage their stress and respond to crises with a positive mindset. This resulted in prolonged distress where anxiety and fatigue caused physical and mental health concerns. Nature walks involving immersive exposure in the forest, and green spaces have been posited to offer physiological and psychological benefits. Therefore, in this systematic review, we evaluated the effects of forest bathing on psychological and physiological outcomes. We searched four English and five non-English databases (Chinese and Korean) for peer-reviewed studies published between January 2000 and March 2021. This review adhered to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement 2020. The primary outcomes explored in this review were mainly psychological, including anxiety, depression, mood and quality of life. The secondary outcomes were physiological outcomes such as blood pressure and heart rate. We conducted a meta-analysis on each outcome using the random-effects model. Heterogeneity was assessed by the I2 statistic. Thirty-six articles (21 in English, 3 in Chinese and 12 in Korean) with 3554 participants were included in this review. Our meta-analysis suggested that forest bathing can significantly reduce symptoms of depression and anxiety. However, we did not observe as many benefits in physiological outcomes. Against the background of the negative effects of urbanization on mental well-being, this review highlighted the potential therapeutic role of forests in the contemporary world, lending further evidence-based support for forest conservation.

A meta-synthesis on the older adults' perspective of advance care planning.

AIM: To synthesise the evidence regarding older adults' perception of advance care planning in preparation for end-of-life care. BACKGROUND: Advance care planning involves continuous communication of end-of-life care goals involving an individual's medical treatment preferences. However, its uptake among older adults remains low. DESIGN: The meta-synthesis was conducted according to the Enhancing Transparency in Reporting the Synthesis of Qualitative research (ENTREQ) guidelines and thematic synthesis was employed to synthesise the qualitative findings in an inductive manner. DATA SOURCE: A search was completed on six electronic databases (PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, Scopus), for publications from 1 January 2000 to 4 December 2021. REVIEW METHOD: The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation and Confidence (GRADE-CERQual) in the Evidence from Reviews of Qualitative research. Two independent reviewers conducted this process, and disagreements were resolved through discussions. RESULTS: Fourteen studies were analysed. Four major themes and eleven subthemes emerged from the thematic synthesis: (1) psychosocial preparedness, (2) medical preparedness, (3) psychological barriers towards advance care planning and (4) extrinsic barriers towards advance care planning. DISCUSSION: These themes consolidated older adults' views of advance care planning and how engagement in this planning affected their end-of-life preparedness. CONCLUSION: This review suggested psychological and extrinsic factors were barriers to the uptake of advance care planning and provided directions for future research to achieve a holistic understanding of the impact of advance care planning on end-of-life preparedness. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals could maintain close communication with older adults and families periodically to evaluate their readiness to discuss advance care planning to improve their preparedness. Healthcare professionals could also provide psychological support during the discussion of clinical decision-making to enhance readiness and confidence among older adults and their families.

Effectiveness of the chronic care model for adults with type 2 diabetes in primary care: a systematic review and meta-analysis.

BACKGROUND: Mixed evidence exists regarding the effectiveness of the Chronic Care Model (CCM) with patient outcomes. The aim of this review is to examine the effectiveness of CCM interventions on hemoglobin A1c (HbA1c), systolic BP (SBP), diastolic BP (DBP), LDL cholesterol and body mass index (BMI) among primary care adults with type 2 diabetes. METHODS: PubMed, Embase, CINAHL, Cochrane Central Registry of Controlled Trials, Scopus and Web of Science were searched from January 1990 to June 2021 for randomized controlled trials (RCTs) comparing CCM interventions against usual care among adults with type 2 diabetes mellitus in primary care with HbA1c, SBP, DBP, LDL cholesterol and BMI as outcomes. An abbreviated search was performed from 2021 to April 2022. This study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for data extraction and Cochrane risk of bias assessment. Two reviewers independently extracted the data. Meta-analysis was performed using Review Manager software. Heterogeneity was evaluated using χ2 and I2 test statistics. Overall effects were evaluated using Z statistic. RESULTS: A total of 17 studies involving 16485 patients were identified. Most studies had low risks of bias. Meta-analysis of all 17 studies revealed that CCM interventions significantly decreased HbA1c levels compared to usual care, with a mean difference (MD) of -0.21%, 95% CI -0.30, -0.13; Z = 5.07, p<0.00001. Larger effects were experienced among adults with baseline HbA1c ≥8% (MD -0.36%, 95% CI -0.51, -0.21; Z = 5.05, p<0.00001) and when four or more CCM elements were present in the interventions (MD -0.25%, 95% CI -0.35, -0.15; Z = 4.85, p<0.00001). Interventions with CCM decreased SBP (MD -2.93 mmHg, 95% CI -4.46, -1.40, Z = 3.75, p=0.0002) and DBP (MD -1.35 mmHg, 95% CI -2.05, -0.65, Z = 3.79, p=0.0002) compared to usual care but there was no impact on LDL cholesterol levels or BMI. CONCLUSIONS: CCM interventions, compared to usual care, improve glycaemic control among adults with type 2 diabetes in primary care, with greater reductions when the mean baseline HbA1c is ≥8% and with interventions containing four or more CCM elements. SYSTEMATIC REVIEW REGISTRATION: PROSPERO  CRD42021273959.

The impact of restorative green environment on mental health of big cities and the role of mental health professionals.

PURPOSE OF REVIEW: To provide an update on insights into the effectiveness of the green environment and forest on the mental health of city dwellers; and the role of mental health professionals in advocating green restorative therapies. RECENT FINDINGS: The studies reviewed in this paper confirmed the mental health benefits on individuals who engaged in the green environment and forest. Results of studies showed that the participants reported significantly higher positive effects. However, it is difficult to compare studies because of marked differences in methodology and often lack of biological markers. With the recent global concern about climate warming, mental health professionals have a critical role to influence city planners on the importance of the green environment and the forest. In Singapore, the 'Therapeutic Garden' project and 'Therapeutic Rainforest' program are examples of mental health professionals working with government agencies for a 'city in nature'. SUMMARY: The benefits of the green environment and forest are emphasized especially on the psychological well being. In the light of the danger of climate warming, this review highlights the need for city planners to collaborate with mental health professionals to incorporate high-quality green spaces when planning the city of the future. There is an urgent need for better consultation between health agencies and local city government to create an appealing and diverse green environment within the city.

Nursing students' perceptions of online learning and its impact on knowledge level.

BACKGROUND: Online learning in nursing education has been demonstrated to exert positive effects on knowledge, skills, learning attitudes, and confidence in performance. However, a noteworthy caveat has been that such benefits could vary depending on the content of pedagogical materials. AIM: To examine the impact of online-tutorials in place of face-to-face tutorials on knowledge level and understand the perspectives of learners who experience online-tutorials. METHODS: This study adopted a mixed method experiential design in which the perspectives of learners who experience online-tutorials are embedded within the trial. Two cohort of nursing students enrolled for the module on Psychology for Nurses were recruited to evaluate the impact of online-tutorials compared to face-to-face tutorials in terms of knowledge level. Apart from the dissimilar mode of delivery, both cohorts experienced the same teaching structure, content, and assessments. Examination results from these two cohorts were compared upon completion of the course. For the online group, additional one-to-one interviews were conducted to further understand the impacts exerted by online learning on the level of knowledge among them. RESULTS: There was a significant difference between the knowledge level of the two cohorts. Responses elicited during the interviews revealed five themes: lack of motivation; limited teamwork; missed learning opportunities; decreased interactions; and differences between online and face-to-face learning. CONCLUSION: Online-tutorials may be a feasible pedagogical approach but the motivation to learn, teamwork and quality of discussion may be compromised due to the lack of socialization and interactions between students and tutors.

Effects of low-to-moderate physical activities on older adults with chronic diseases: A systematic review and meta-analysis.

AIM: Examined the evidence of low-to-moderate-intensity physical activities to assess the effect in managing hypertension, diabetes mellitus and hyperlipidaemia conditions among community-dwelling older adult. BACKGROUND: Physical activity is recommended for the maintenance and improvement of health. However, high-intensity physical activity may adversely impact exercise adherence by older adults. DESIGN: This review was conducted with reference to methods set out in the Cochrane Handbook for Systematic Reviews of Interventions. The PRISMA statement was employed to guide the reporting of the systematic review and meta-analyses. DATA SOURCES: Seven electronic databases were searched to identify relevant articles that were published in English from 1 January 2000 to 31 December 2020. REVIEW METHOD: This review included randomised controlled trials and cluster-randomised controlled trials on interventions of physical activities with low-to-moderate intensities compared against usual care without physical activities. Two reviewers independently extracted data and assessed the risk of bias using the Cochrane Risk of Bias Tool. Meta-analysis was performed using RevMan, with Cochran Q and I2 used for determining heterogeneity. The overall effect was reviewed with z scores. RESULTS: Fifteen randomised controlled trials with 940 total participants were evaluated. Low-to-moderate-intensity physical activity significantly improved systolic blood pressure [Z = 3.59, p = .0003], HbA1C [Z = 2.10, p = .04] and high-density lipoprotein (HDL) levels [Z = 3.83, p = .0001], compared to usual care. A further subgroup analysis found no significant difference in systolic blood pressure level after three sessions a week as well as after three months. There were insufficient papers to evaluate for both HbA1C and HDL levels. CONCLUSION: Regular physical activity ranging from low-to-moderate intensity should be encouraged among older adults with chronic diseases. RELEVANCE FOR CLINICAL PRACTICE: This review suggested that low-to-moderate levels of physical activity could be encouraged among community-dwelling older adults to improve their physical health.

Using infrared imaging and deep learning in fit-checking of respiratory protective devices among healthcare professionals.

AIMS: This study aimed to investigate the application of infrared thermal imaging and adopt deep learning to detect air leakage for determining the fitness of respirators during fit-checks. BACKGROUND: The outbreak of Covid-19 virus constitutes a public health crisis with substantial resultant morbidities and mortalities; has exerted profound impacts. METHODS: This was a prospective observational study, employing a non-probability sampling method on a convenience sample to recruit the participants and followed the Strengthening the Reporting of Observational Studies in Epidemiology statement guidelines. RESULTS: The use of infrared thermal imaging identified air leakage points as a disruption to the facial thermal pattern distribution at (a) front of face; (b) right lateral of the face; (c) left lateral of the face; (d) top of the facemask with the head facing down; and (e) bottom of the facemask with the head facing up. Results also indicated that artificial intelligence tools and the proliferation of deep learning have the potential to detect the location of air leakage locations. CONCLUSION: The use of infrared thermal imaging provides evidence of the feasibility and applicability of infrared thermal imaging techniques in detecting air leakage for individuals wearing respirators. CLINICAL RELEVANCE: The use of infrared thermal technology can serve a potential role in complement fit-checking of respiratory protective devices and offers promising practical utility in determining the fitness of respirators for nurses at the frontline to protect against the air-borne viruses.

A systematic review on the structured handover interventions between nurses in improving patient safety outcomes.

AIM: This review aimed to elucidate the effectiveness of structured handovers in improving patient outcomes in the wards. BACKGROUND: Studies have reported that the lack of quality handovers is one of the main causes of adverse effects. EVALUATION: A search over six electronic databases: MEDLINE; CINAHL; Web of Science; EMBASE; Scopus; and CENTRAL via Ovid concluded nine studies and synthesized by two independent reviewers based on the Cochrane Handbook for Systematic Reviews of Interventions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to guide the undertaking of this review and meta-analysis. All studies published up to February 2019 were considered in this review. KEY ISSUES: This review has demonstrated that structured handovers reduced the incidences of patient complications, medication errors and general adverse events. However, the results were not statistically significant. CONCLUSION: Current structured handover formats were effective in reducing problematic handovers such as omission of information, inaccurate information and documentation errors. IMPLICATIONS FOR NURSING MANAGEMENT: Although there is limited high-quality and rigorous research conducted to gain a clearer understanding of the impacts on patient-related outcomes in nursing care, structured handovers remained effective in reducing the number of mistakes in information transfer.

An observational study of temperature and thermal images of surgical wounds for detecting delayed wound healing within four days after surgery.

AIM: To elucidate the infrared thermal patterns and temperature readings of the surfaces of surgical wounds for detecting delayed wound healing within four days after surgery. BACKGROUND: The nursing assessment of surgical wounds within the first four days after surgery is commonly based on visual and physical examination. Surgical wounds with delayed healing may be not detected if they do not exhibit signs such as redness or exudate within four days after surgery. DESIGN: This study was conducted using prospective observational design with reference to the STROBE Statement (see Supporting Information Appendix S1) to examine the temperatures of surgical wounds in their natural settings. METHODS: Based on convenience sampling, 60 participants admitted to the colorectal surgical ward for enterostoma closure from January-November 2013 were recruited. RESULTS: Although both infected and noninfected surgical wounds exhibited a significant increase in wound temperature from Days 1-4, the infected wounds revealed a statistically significantly lower temperature than the noninfected ones. Within the infrared thermal images, the infected wounds presented with partial warming of the skin surrounding and along the incision, suggesting that delayed healing could be identified. CONCLUSION: This study demonstrates that delayed wound healing can be detected within the first four days after surgery for early intervention of prevention and treatment before discharge. RELEVANCE TO CLINICAL PRACTICE: This paper provides evidence-based information for healthcare professionals in assessing surgical wounds for delayed healing within the first four days after surgery. The findings herein enable the early detection of delayed wound healing, based on which early intervention of prevention and treatment may be instituted for affected patients before their discharge.

An exploration of factors influencing inpatient nurses' care behaviour in an acute hospital setting.

OBJECTIVE: To examine factors influencing caring behaviour of nurses in Singapore. DESIGN: Descriptive correlational study using Care Behaviour Inventory (CBI-24) questionnaire to assess nurses' perceptions of their caring behaviours. SETTING: Acute tertiary hospital in Singapore. PARTICIPANTS: A convenience sample of 167 full time registered nurses working in subsidized wards, with more than 1 year of experience in current practising ward were recruited. MAIN OUTCOME MEASURE(S): Nurses' perception of their caring behaviours. RESULTS: Data analysis yielded a mean CBI score of 123.11 out of 144, indicating that nurses had a positive perception of their caring behaviours. Among the 4 CBI subscales, Respectfulness and Connectedness components of CBI were ranked the lowest with a mean score of 4.2 and 4.9, respectively. This indicated that although nurses generally performed adequate caring during patient care, they appeared to be lacking in the expressive aspect of caring. Significant differences (P < 0.05) were found among subgroups of nationality, ethnicity, religion and education level. Nurses' perception of their caring behaviours was positively correlated to their age and total working experience. Linear regression showed that age, religion, education level positively influenced nurses' perception of their caring behaviours. CONCLUSION: Findings from this study raise awareness to the caring behaviours that nurses were lacking in and also offer valuable insights to the potential factors influencing nurses' caring behaviours. This information serves as a foundational knowledge to guide the development of interventions aimed to promote patient-centred care and improve quality of future nursing care.