Improving healthcare transition for young people with cancer: factors fundamental to the quality improvement journey.

BACKGROUND: Young people receiving cancer treatment in the South Thames Children's, Teenagers' and Young Adults' Cancer Operational Delivery Network usually receive care across two or more NHS trusts, meaning transition into adult services can be challenging. AIM: To develop a planned, co-ordinated approach to transition across the network that meets National Institute for Health and Care Excellence guidance recommendations for transition and the cancer service specifications. METHODS: A 2-year, nurse-led quality improvement (QI) project, using the principles of experience-based co-design. OUTCOMES: The QI project resulted in the development of six key principles of practice; refining and testing of a benchmarking tool; initiatives to facilitate first transition conversations; and the launch of an information hub. CONCLUSION: Robust QI processes, cross-network collaboration and wide stakeholder involvement required significant resource, but enabled deeper understanding of existing pathways and processes, facilitated the establishment of meaningful objectives, and enabled the testing of interventions to ensure the project outcomes met the needs of all stakeholders.

Assessment and examination of the respiratory system.

This article aims to outline the fundamental principles of consultations with and clinical assessments of patients with symptoms that may be indicative of respiratory system pathology. The article explores how to perform a respiratory system-focused patient history and physical examination. An evaluation of clinical 'red flags' to reduce the risk of omitting serious illness is also considered, alongside the exploration of features of respiratory pathology and evidence-based clinical decision-making tools that may be used to support clinical diagnosis.

Precision Health Symptom Science in Oncology Nursing.

Precision health is an emerging approach to predicting, preventing, treating, and managing disease. A goal of precision health symptom science research is the reliable prediction of patients' symptom burden to optimize robu.

My Magical Day in the Trauma ICU.

Healing is a difficult concept to describe, quantify, or replicate. It is a complex mixture of personal contributions from the professional providing care, including competence, compassion, and empathy, that conjoins with the needs, sensitivities, and receptivity of the one who is receiving the care. Although it may be difficult to predict all the elements that come together to initiate sustained healing, as well as the long-term impact, it is important to observe the moments that make a difference. For those who study the nature of healing, a patient's reflections can surface the kinds of elements that are present when healing is sustained. [J Contin Educ Nurs. 2024;55(7):326-327.].

The psychometric properties of the Turkish version of the Ostomy Self-Care Index and the Caregiver Contribution to Self-Care in Ostomy Patient Index.

BACKGROUND: Living with an ostomy is a chronic condition, and self-care in such cases improves patient outcomes. PURPOSE: To adapt and test the psychometric properties of the Turkish version of the Ostomy Self-Care Index (T-OSCI) and the Turkish version of the Caregiver Contribution to Self-Care in Ostomy Patient Index (T-CC-OSCI). METHODS: A psychometric study was conducted on a convenience sample of 202 adult patients with an ostomy and their 165 caregivers. Translation and back translation, face and content validity, construct validation, and reliability assessment of the T-OSCI and the T-CC-OSCI were performed. Exploratory factor analysis was used to evaluate the construct validity. Reliability was established using Cronbach α coefficients, ceiling and floor effects, and the Hotelling T2 test, Wilcoxon signed rank test, and intraclass correlation coefficient. RESULTS: Content validity values were in the range of 0.85 to 1 for both the T-OSCI and the T-CC-OSCI. Exploratory factor analysis demonstrated generally acceptable factor loadings. The overall index revealed a high level of internal consistency (T-OSCI = 0.968, T-CC-OSCI = 0.862). No statistically significant difference was found between test-retest measurements. There was no indication of either ceiling or floor effects, or response bias. CONCLUSION: The T-OSCI and the T-CC-OSCI are valid and reliable indexes to measure the self-care of patients with an ostomy and their caregivers. These indexes may allow health care professionals to evaluate self-care in research and clinical settings, identify educational needs, and collaborate in developing and supporting appropriate self-care initiatives for patients with an ostomy and their caregivers.

The effect of web-based training given to nurses on the prevention of pressure injury in patients hospitalized in the anesthesiology and reanimation intensive care unit: quasi-experimental pre-test post-test research.

BACKGROUND: The knowledge, attitudes, and behaviors of intensive care nurses concerning the prevention of pressure injury (PI) may be positively affected by education. PURPOSE: To evaluate the effect of web-based training given to nurses on their knowledge of, attitudes about, and behaviors in the prevention of PI. METHODS: This study was conducted between May 2019 and December 2019 with a pre-test and post-test design. The study sample consisted of 22 nurses and 80 patients. A link to the educational video prepared for the prevention of PIs was sent to the nurses' mobile phones. RESULTS: The training had a significant positive effect on nurses' level of knowledge of and attitudes toward PI prevention (P < .001 and P = .042, respectively). In group 1, comprising 40 patients who received treatment before nurses' training, 2.5% of patients had stage 1 PI on day 1 and 7.5% had stage 1 PI on day 7, and 2.5% had stage 4 PI on day 7. In group 2, comprising 40 patients who received treatment after nurses' training, 2.5% of patients had stage 1 PI on day 1 and 2.5% had stage 1 PI on day 7. CONCLUSION: Nurses' knowledge of and attitudes and behaviors toward PI prevention were improved following the web-based training, and the stage and rate of PI were lower in patients who received care after nurses received the training.

Investigation of nursing students' knowledge levels and attitudes in incontinence-associated dermatitis management through game-based learning: a mixed methods study.

PURPOSE: This study aimed to assess nursing students' knowledge levels and attitudes towards the etiology, risk factors, and preventive measures of incontinence-associated dermatitis (IAD) using an escape room game. DESIGN: A mixed-method study. SUBJECTS AND SETTING: The sample size of the study was 32 students. METHODS: Quantitative data obtained with the Knowledge, Attitude and Practice of Nurses in Managing Incontinence-Associated Dermatitis Questionnaire (KAP-IAD-Q) and qualitative data obtained through FGDs following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist were analyzed using a thematic approach. RESULTS: The average age of the participants was 22.63 ± 0.90, 87.5% of them were female (n=28), and 50% were third (n=16) and fourth-year students (n=16). KAP-IAD-Q total posttest score (88.06+7.00) was found to be high. Data obtained from the FGDs were categorized under 3 main themes: main focus areas during participation in the IAD-themed escape room game; advantages and disadvantages of teamwork in IAD management; and the game's contribution to a better understanding and classification of IAD. CONCLUSIONS: The use of the escape room game facilitated high, fast, and efficient learning of IAD knowledge and attitudes. It revealed challenges in collaborative decision-making, accurate diagnosis, distinguishing from other wounds, and attitude development in the management of IAD.

Function-Focused Care for Cognitive Impairment Training Among Formal Caregivers in Long-Term Care Facilities in Taiwan: A Cluster Randomized Controlled Trial.

PURPOSE: To examine behavior changes among formal caregivers in Taiwanese long-term care facilities (LTCFs) after receiving training in function-focused care for cognitive impairment (FFC-CI). METHOD: The current study was a clustered randomized controlled trial. Formal caregivers (i.e., RNs and nursing assistants) (N = 98) from four LTCFs were randomly assigned to experimental or control groups. Training was based on four components of FFC-CI. Data were collected four times within 9 months using five observational outcome measurements: Self-Efficacy for Restorative Care (SERCS), Outcome Expectations for Restorative Care Scale (OERCS), Restorative Care Knowledge Scale (RCKS), Restorative Care Behavior Checklist (RCBC), and Job Attitude Scale (JAS). RESULTS: Statistically significant changes were noted in each activity of restorative care behavior among the four observational measurements. Results also indicated that job satisfaction was a statistically significant main effect for the experimental group; however, SERCS, OERCS, and RCKS scores were not statistically significant. CONCLUSION: To eliminate gaps between translating research outcomes to clinical practice, this study applied a theory-based caring model for caregivers to improve knowledge and skills in caring for older adults with dementia. Caregivers who received training in FFC-CI not only had higher job satisfaction but could also provide specific FFC activities for residents during their daily care. [Journal of Gerontological Nursing, 50(7), 42-50.].

Workplace Resilience and Stress Among Certified Nursing Assistants in Long-Term Care Institutions During the COVID-19 Pandemic.

PURPOSE: To explore the relationship among resilience, stress, and demographic factors in certified nursing assistants (CNAs) who worked in long-term care institutions during the coronavirus disease 2019 pandemic. METHOD: A cross-sectional correlation-based research design was used. Data were collected using a demographic questionnaire, Connor-Davidson Resilience Scale, and Occupational Stress Scale. CNAs from 21 long-term care institutions in Taiwan were recruited. RESULTS: This study included 118 female and 26 male CNAs (response rate = 80%). Mean age was 46.8 years. A moderately negative correlation was found between workplace resilience and stress. Overall, being a woman and parent were found to be significantly correlated with CNAs' resilience. Furthermore, resilience and shift work were important predictors of stress. CONCLUSION: We suggest that leadership and management pay more attention to CNAs' basic demographic background information. Furthermore, timely, relevant strategies can be provided to enhance resilience and reduce workplace stress. [Journal of Gerontological Nursing, 50(7), 19-26.].

Transanal irrigation: best practice in the community.

Chronic constipation, which is common and often difficult to treat, has numerous origins, including neurological and other conditions, and adverse reactions to drugs, especially opioids. Chronic functional constipation lacks a clear underlying cause. Increasing evidence suggests that transanal irrigation (TAI) aids faecal evacuation and is well tolerated in many people with bowel dysfunction who do not adequately respond to first-line treatments. Recent papers offer insights that help nurses and other healthcare professionals implement best practice in the community, including discussing any need for assistance before starting TAI, agreeing the most appropriate device with patients and optimising the irrigation protocol. Training, careful follow-up and ongoing supervision improve adherence and success. Further studies are needed, however, and patients who do not respond adequately or are unable to tolerate TAI should be referred to a specialist service.

Incontinence: living with a stigmatised health condition.

This article shares the personal account of the author who is living with double incontinence, and the impact this condition can have on the individual and their carers.

Dementia, comorbidity and multimorbidity.

Many people living with dementia will also have multimorbidity comprising several other intercurrent, long-term and comorbid conditions. This article examines the relationship between such conditions in the context of dementia, giving an overview of the literature, including prevalence and some of the common conditions that can coexist with dementia. The theory and evidence-base will be tied together using a case study approach, to illustrate the complexity of managing comorbid conditions and multimorbidity alongside dementia, and explore some of the approaches that can be used by community nurses to support the overall health of people living with dementia that they work with.

Optimising chronic obstructive pulmonary disease care: an overview for the community nurse.

Chronic obstructive pulmonary disease (COPD) refers to a group of diseases that includes chronic bronchitis and emphysema, which is caused by damage to the airways or other parts of the lung that blocks airflow and eventually makes it difficult for the patient to breathe. As COPD is terminal, the primary goals of treatment are to control symptoms, improve quality of life and reduce exacerbations and mortality. Community nurses can play a vital role in maintaining patients' quality of life and daily functioning, but the ability to access further education in the domain of COPD treatment and allocate dedicated time to patient care is necessary to achieving good outcomes. Francesca Ramadan provides an overview of the mainstays of COPD care, as a foundation for further education.

Using Implementation Science to Improve Short Peripheral Intravenous Catheter Outcomes.

Short peripheral intravenous catheters (short PIVCs) are commonly used in acute care, guided by evidence-based policy with interventions to limit premature failure. Research on how nurses use evidence and change processes to optimize outcomes is needed. The study objective was to use a theory-based implementation science approach to evaluate and improve short PIVC insertion and care processes and reduce removals for adverse outcomes in acute care. This mixed-methods study was conducted with inpatient nursing units (n = 23) at a large urban quaternary medical center. Units identified and implemented one PIVC care intervention that could lower catheter removals for adverse outcomes over 3 months. Data from multiple sources were convergently analyzed to evaluate process and outcomes postintervention. Although overall frequency of PIVC removals for adverse outcomes was unchanged, several units improved their outcomes using implementation strategies. The determinant framework provides a plausible explanation for the study results. While adverse outcome rates remained below published rates, some units had limited success improving outcomes with traditional change strategies. Implementation strategies and readily accessible data can offer nursing units a new approach to effectively deploy, monitor, and maintain interventions to achieve improved outcomes.

Nurses' evidence-based knowledge and self-efficacy in venous access device insertion and management: Development and validation of a questionnaire.

AIM: To develop and psychometrically test an instrument to assess nurses' evidence-based knowledge and self-efficacy regarding insertion and management of venous access devices (short peripheral catheter (SPC), long peripheral catheter/midline (LPC) and PICC) and the management of totally implantable central venous catheter (Port) in adult patients. DESIGN: Multicenter cross-sectional observational study with questionnaire development and psychometric testing (validity and reliability). METHODS: An evidence-based instrument was developed including a 34-item knowledge section and an 81-item self-efficacy section including four device-specific parts. Nineteen experts evaluated content validity. A pilot study was conducted with 86 nurses. Difficulty and discrimination indices were calculated for knowledge items. Confirmatory factor analyses tested the dimensionality of the self-efficacy section according to the development model. Construct validity was tested through known group validity. Reliability was evaluated through Cronbach's alpha coefficient for unidimensional scales and omega coefficients for multidimensional scales. RESULTS: Content validity indices and results from the pilot study were excellent with all the item-content validity indices >0.78 and scale-content validity index ranging from 0.96 to 0.99. The survey was completed by 425 nurses. Difficulty and discrimination indices for knowledge items were acceptable with most items (58.8%) showing desirable difficulty and most items (58.8%) with excellent (35.3%) or good (23.5%) discrimination power, and appropriate to the content. The dimensionality of the model posited for self-efficacy was confirmed with adequate fit indices (e.g., comparative fit index range 0.984-0.996, root mean square error of approximation range 0.054-0.073). Construct validity was determined and reliability was excellent with alpha values ranging from 0.843 to 0.946 and omega coefficients ranging from 0.833 to 0.933. Therefore, a valid and reliable tool based on updated guidelines is made available to evaluate nurses' competencies for venous access insertion and management.

The Experiences of Hospital Admission in a Single Room for Older Persons With Dementia and Their Families: A Scoping Review.

INTRODUCTION: When older persons with dementia are admitted to hospital, they often feel disoriented and confused and their cognitive impairment may worsen, purely due to the sudden change in their environment. As such hospital design is recognised as an important aspect in the care and well-being of older persons with dementia. As the number of persons with dementia is increasing, the experience of admission to a hospital with, for example, single rooms is more relevant than ever. AIM AND METHODS: This scoping review aimed to identify, explore and conceptually map the literature reporting on what older people with dementia and their families experienced during admission to a hospital with single room accommodation. We followed the Joanna Briggs Institute recommendations for undertaking a scoping review. In addition, we used the Preferred Reporting Items for Systematic reviews (PRISMA-ScR) Checklist, which assisted the development and reporting of this scoping review. RESULTS: We included 10 sources within a time frame of 23 years (1998-2021). The sources originate from Europe, Australia and Canada. We identified three conceptual maps: Safety and security, Privacy and dignity and Sensorial stimulation. Our review demonstrates that the themes of the three conceptual maps are experienced as mutually interdependent for the older persons with dementia and their families. CONCLUSION: We conclude that it is not merely the single room design that determines what the older persons with dementia and their families experience as important; the exposure to sensorial stimulation and the presence of well-trained staff taking a dignified patient-centred approach are also crucial for their experience of high-quality nursing care.

Uncertainties experienced by nursing professionals who contracted Covid-19: a priori, everyone is human.

OBJECTIVE: To analyze the uncertainties experienced by nursing professionals who contracted COVID-19. METHODS: This qualitative research was conducted with 20 nursing professionals who fell ill from COVID-19. Data collection was carried out through semi-structured interviews; the data were then organized using thematic analysis and discussed in the context of Merle Mishel's Reconceptualized of Uncertainty in Illness Theory. RESULTS: The antecedents of the disease had a strong influence on how nursing professionals who contracted COVID-19 perceived uncertainty. The media coverage of the increasing number of cases, the collapse of the healthcare system, and the high mortality rate contributed to associating the disease with fear and panic. FINAL CONSIDERATIONS: Viewing it from the perspective of the disease's antecedents, the illness of a nursing professional from COVID-19 underscores that before being professionals, they are human beings just like anyone else, undergoing adversities and facing the possibilities associated with being ill.

COVID-19 pandemic: what factors compromised the mental capacity to work of nursing technicians?

OBJECTIVES: to identify the factors that influenced the mental capacity to work of nursing technicians during the COVID-19 pandemic. METHODS: a cross-sectional study, carried out at two reference hospitals in assisting the population during the COVID-19 pandemic. A total of 237 professionals from Intensive Care Units participated and answered a questionnaire. Multiple linear regression models were used to assess the correlation between mental capacity to work and variables related to risks of contamination, institutional support and health. RESULTS: lack of COVID-19 tests, lack of knowledge of routine, absences in 2021 and mental illness contributed to worse mental capacity to work. Management embracement and physical capacity were considered protective factors. CONCLUSIONS: reduced work capacity in relation to mental demands can affect professional performance and quality of care, with implications for patients and health institutions.

Nursing leadership strategies in addressing COVID-19 in light of John Kotter's framework.

OBJECTIVE: To analyze the leadership strategies of nurses in university hospitals in response to care management changes during the COVID-19 pandemic, informed by John Kotter's insights. METHODS: This multicentric study utilized qualitative and analytical methods. It was conducted through semi-structured interviews with 139 lead nurses from 10 university hospitals in Brazil. Data analysis included Bardin's content analysis and the webQDA software. RESULTS: The primary category identified was "Nursing Leadership Strategies in the Battle Against COVID-19," encompassing five subcategories. This category underscored the importance of strategic vision in nursing leadership for combating COVID-19 within hospital settings, as well as the necessity of working collaboratively with their teams and other healthcare professionals. FINAL CONSIDERATIONS: The results highlight the strategies used by lead nurses in confronting COVID-19, which can be associated with John Kotter's theoretical framework and his model of change.