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.

Prevalence of HIV and HCV among injecting drug users in three selected WHO-EMRO countries: a meta-analysis.

BACKGROUND: HIV and Hepatitis C Virus (HCV) infections are responsible for a significant burden of mortality and morbidity, particularly in developing countries. This study sought to determine the prevalence of HIV and Hepatitis C among injecting drug users in Afghanistan, Iran, and Pakistan. METHODS: This review conforms to the Preferred Reporting Guidelines for Systematic Reviews and Meta-Analysis (PRISMA) statement. Databases including PubMed, Scopus, Web of Science/Knowledge, SID.ir, and MAGIRAN were searched. Studies that were published from 2003 up to 2018 were considered for analysis. Studies were screened for inclusion in duplicate, and also, that data were narratively synthesized. RESULTS: We report on data from 79 articles. The total number of participants in studies that assessed the prevalence of HIV among injecting drug users included 68,926 participants, while those from studies that assessed HCV prevalence were 23,016 participants. Overall HIV and HCV prevalence among injecting drug users in the three selected countries were 9.1% (95% CI 6.9-12.0%) and 48.3% (95% CI 43.9-52.7%), respectively. Iran had the highest HIV prevalence of 11.0% among injectable drug users (95% CI 8.4-14.2%), while Afghanistan had the lowest HIV prevalence of 3.1% (95% CI 1.5-6.3%) among three selected countries. In Pakistan, the prevalence of HIV was 8.6% (95% CI 4.8-15.0%). Regarding HCV prevalence, Pakistan had the highest while Afghanistan had the lowest, 54.4% (95% CI 33.5-73.9%) and 37.3% (95% CI 35.2-39.4%), respectively. HCV prevalence in Iran was 47.7% (95% CI 43.4-52.0%). CONCLUSION: Injecting drug users form a special cohort of persons at risk of HIV and Hepatitis C infections. The prevalence of HIV and Hepatitis noted from our findings is significantly high. Awareness of the grave risk of spreading HIV and Hepatitis C associated with sharing needles is recommended among this sub-group of drug users.

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.

Family members' experiences in adult intensive care units: a systematic review.

BACKGROUND: Admission to Intensive Care Units (ICU) exposures family members to a new environment, advanced monitoring systems and aggressive treatments. This is coupled with the critical condition of the patient being admitted in ICU. In such times of stress and crisis, families have varying experiences as they navigate the ICU journey. These happen more or less in chronological phases. AIM: This review sought to describe the experiences of family members of patients admitted in adult ICUs. DATA SOURCES: Four electronic databases (PubMed, Embase, Scopus and Web of Science) were searched, using keywords and free-text words. METHODS: Curation of the review question involved problem identification, a scoping search, developing a search strategy, evaluation, data analysis, and reporting. Freehand search in reference lists of eligible articles was also done to obtain potentially eligible articles published in English language between 2007 and 2018. Studies were included if they reported on family members' experiences in adult ICUs. This review conforms to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). RESULTS: Upon completion of the screening process, 28 studies were included. Most studies were conducted in the United States while no study was identified from Africa. We report on 717 family members. Family members' experience of the ICU journey falls into three main themes: (i) Floating, (ii) Probing and (iii) Continuity or Closure. CONCLUSION: As healthcare technology advances, the ICU environment consequently needs to evolve. As such, healthcare providers will need to adjust their practice, support and consider the patients' family as the other part of the patient and members of the care team in order to meet their expectations. Further research highlighting family members' experience of the ICU journey in Africa is needed.

Barriers Associated With Evidence-Based Practice Among Nurses in Low- and Middle-Income Countries: A Systematic Review.

BACKGROUND: Evidence-based practice (EBP) is both a goal and an approach that requires a combination of clinical experience with the most credible recent research evidence when making decisions in healthcare practice. The approach has been widely embraced; however, an evidence-to-practice gap still exists. AIM: To assess barriers to EBP among nurses in low- and middle-income countries. METHODS: This review conforms to the PRISMA statement. Databases PubMed, Scopus, EMBASE, and Web of Science/Knowledge were searched using a combination of keywords that included "barriers," "evidence-based practice," and "nurses." The references of the selected articles were also hand-searched to obtain additional relevant articles. Studies published in peer-reviewed journals in English between 2000 and 2018 were included in the review. RESULTS: Sixteen articles were included in the analysis, with a total number of 8,409 participants. Both qualitative and quantitative studies were included in the review. Three main themes emerged from eight categories found. The three main themes were institutional-related barriers, interdisciplinary barriers, and nurse-related barriers. The theme of institutional-related barriers emerged from four categories, which included scant resources, limited access to information, inadequate staffing, and lack of institutional support. The theme of interdisciplinary barriers emerged from subcategories that included lack of communication between academic and clinical practice environments, inconsistency between education and practice in the nursing discipline, lack of teamwork, and the public's negative image about the nursing profession. Finally, the theme of nurse-related barriers emerged from categories including perceived limitations in the scope of nurses' practice, time, knowledge of EBP, and individual-related barriers. LINKING EVIDENCE TO ACTION: These findings may guide the design of future interventions aimed at fostering EBP. Implementing EBP in practice should be systematic and requires institutional will and interdisciplinary and individual commitment. It should be a collective goal and a win-win situation for nurses, clinicians, and healthcare organizations.

Promoting resilience among adult cancer patients: An integrative review of patient education methods.

PURPOSE: To explore the essential elements of patient education methods for promoting resilience among adult cancer patients. METHODS: The PubMed, Scopus, CINAHL and PsycInfo databases were searched fromJanuary 2010 to April 2021. The outcome of interest was resilience. The integrative review applied the PRISMA statement guidelines. RESULTS: Nine studies were identified, which formed three main patient education strategies that fell under categories: 1. Provision of illness-related information 2. Learning self-management skills 3. Provision of emotional support and the adjustment process. The key elements include promotion of positive factors, easing patients' mental burden, highlighting the importance of illness-related information, developing self-management skills, and emotional support. Interventions prepared patients for the future, enhanced their understanding of illness and recovery process, and comfort in physical and mental aspects of life, and improved their resilience. CONCLUSIONS: Resilience among cancer patients is a process that helps them adjust to live with cancer. The provision of psychosocial support and illness-related information, as well as learning self-management skills, are essential elements of patient education interventions that aim to improve resilience among adult cancer patients.

Evidence base of economic evaluations of workplace-based interventions reducing occupational sitting time: an integrative review.

OBJECTIVE: To review the evidence on the economic evaluations of workplace-based interventions that are designed to reduce prolonged periods of occupational sitting. DESIGN: An integrative review. DATA SOURCES: The search was conducted in 11 databases, including PubMed, Scopus, PsychINFO, NHS-EED, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, Cochrane library, Sportdiscus, Research Paper in Economics (RePeC), the International Health Economic Association (IHEA) and EconLit. The databases were searched for articles published from inception to January 2022. Subsequent citation searches were also conducted in Google Scholar. The items of the Consensus Health Economic Criteria (CHEC) checklist were used for quality appraisal of the included studies. RESULTS: This review included five randomised control trails, including 757 office-based workers in high-income countries. The median quality appraisal score based on the CHEC items was 14 points (a range of 9-18). The mean duration of interventions was 33 weeks (a range of 4-52 weeks). Overall, the studies reported economic benefit when implemented to reduce occupational sitting time but no effect on absenteeism. From the societal perspective, the interventions (eg, the use of a sit-stand desk) were cost-effective. CONCLUSION: The economic impact of workplace interventions implemented to reduce occupational sitting time is evident; however, the existing evidence is limited, which precludes strong conclusions. Cost-effectiveness is not often evaluated in the studies exploring workplace interventions that address occupational sitting time. Workplace interventions are still in the development and testing phase; thus, the challenge for future studies is to include economic evaluation of interventions addressing sedentary behaviour in workplaces. PROSPERO REGISTRATION NUMBER: CRD42021226275.

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.

Technical results from a trial of the FREO2 Low-Pressure Oxygen Storage system, Mbarara Regional Referral Hospital, Uganda.

Increased access to reliable medical oxygen would reduce the global burden of pneumonia. Oxygen concentrators have been shown to be an effective solution, however they have significant drawbacks when used in low-resource environments where pneumonia burden is the heaviest. Low quality grid power can damage oxygen concentrators and blackouts can prevent at-risk patients from receiving continual oxygen therapy. Gaps in prescribed oxygen flow can result in acquired brain injuries, extended hypoxemia and death. The FREO2 Low-Pressure Oxygen Storage (LPOS) system consists of a suite of improvements to a standard oxygen concentrator which address these limitations. This study reports the technical results of a field trial of the system in Mbarara, Uganda. During this trial, oxygen supplied from the LPOS system was distributed to four beds in the paediatric ward of Mbarara Regional Referral Hospital. Over a three-month period, medical-grade oxygen was made available to patients 100% of the time. This period was sufficient to quantify the ability of the LPOS system to deal with blackouts, maintenance, and an unscheduled repair to the LPOS store.

Demographic Profile of Gastric Cancer in Afghanistan.

Gastric cancer is the second commonest cause of death among all cancers and the fifth most common cancer in the world. The number of deaths due to gastric cancer is about 723,000 annually. It is more common in men compared to women. The incidence of gastric cancer has 20-fold variation worldwide. In Asia, it is the third most prevalent cancer after breast and colorectal cancers. The prevalence of gastric cancer in Middle East varies from very high in Iran to low in Israel and very low in Egypt. The purpose of this study was to assess the demographic profile of gastric cancer in Afghanistan. A retrospective analysis of patient's records at the Oncology Department of Jamhoriat Hospital in Kabul, Afghanistan was conducted in a 1 year period. Data of patients diagnosed with gastric cancer was obtained from the registers of the oncology department from March 2018 to February 2019. Variables of interest included age, gender, ethnicity, and place of residence of the patients. Totally, 1324 cancer patients attended to the oncology department in 1 year; of these, 174 patients were diagnosed with gastric cancer. There were significantly more gastric cancer patients among males (69.5%) relative to females. With regard to ethnicity, the Tajeks contributed majority of the cases presenting with gastric cancer. The majority of the patients presenting with gastric cancer were from Kabul province. There were more cases of gastric cancer were in northern provinces. Majority of the cases were contributed by patients above 50 years of age and male gender. This retrospective study aims to provide information about prevalence and demographic characteristics of patient with gastric cancer in Afghanistan. However, there is lack of literature regarding gastric cancer in this war-torn country.

Dysmenorrhoea among students aged 18-45 years attending University in Uganda: A cross-sectional multicenter study of three Universities in Uganda.

AIM: Dysmenorrhoea presents as pain associated with menstruation. It is often an issue discussed privately, yet it continues to affect girls and women with grave impact on their education, social activities and work. This study sought to assess the factors associated with dysmenorrhoea among female students aged 18-45 years in three selected universities in Kampala Capital city, Uganda. DESIGN AND METHODS: The study was a cross-sectional study conducted among 351 female students of three Universities in Kampala, Uganda. Purposive sampling methods were used. A self-administered questionnaire was used for data collection, a 95% confidence interval was considered and analysis was done using SPSS version 20. RESULTS: Respondents (N = 351) fully completed the study out of 383 invited participants. The prevalence of dysmenorrhoea was 75.8%. Associated factors included having children (p < 0.05), daily consumption of sugary foods (p < 0.05) and family history of dysmenorrhoea (p < 0.01). CONCLUSION: As nursing professionals, we believe comfort is a fundamental determinant of health. Therefore, evidence suggesting a high prevalence of dysmenorrhoea as revealed in this study is concerning. We recommend schools to have school clinics and school nurses who could help students during such days of discomfort. Further studies assessing the casual relationships of various correlates to dysmenorrhoea and the impact of dysmenorrhoea specifically on academic life of the students should be conducted.

Barriers to patient and family-centred care in adult intensive care units: A systematic review.

AIM: Despite remarkable theoretical evidence of positive outcomes of patient and family-centred care, it is rarely performed in the intensive care setting. The aim of this review was to assess the barriers to patient and family-centred care among healthcare providers, patients and family members in adult intensive care units. DESIGN: A systematic review of both qualitative and quantitative studies. METHODS: The search strategy sought for published peer-reviewed research papers limited to English language from conception to 2018. The review protocol was registered in the CRD Prospero database (CRD42018086838). Literature search was carried out in four databases: EMBASE, Cochrane Library, PubMed and Scopus where keywords "barriers," "patient and family centered care," "patient-centered care" and "intensive care unit" appeared in any part of the reference. Hand search of reference lists of identified papers was also done to capture all pertinent materials. Each study was assessed by three independent reviewers against the inclusion criteria. Evidence was graded according to sampling quality, quantity and measurement of intended outcomes. Screening of studies and citations resulted in seven studies that were included in the analysis. RESULTS: Barriers to patient and family-centred care broadly fall under four categories; lack of understanding of what is needed to achieve patient and family-centred care, organizational barriers, individual barriers and interdisciplinary barriers.

Knowledge, attitude, and beliefs on epilepsy among adults in Erute South, Lira District, Uganda.

OBJECTIVE: To assess the knowledge, attitudes, and beliefs of adults on epilepsy in Erute South County, Lira District, Uganda. METHODS: A cross-sectional study was conducted in rural Erute South County. Two hundred seventeen of 220 randomly selected adults 18 years or older participated in the study. A standardized self-administered questionnaire (Attitudes towards persons with Epilepsy "ATPE") was used for data collection. Protocol approval was sought from International Health Sciences University, and informed consent was obtained from participants at all times. RESULTS: Two hundred seventeen of 220 invited community members completed the study. Females comprised the majority 51.6%.. Most of the respondents had a low level of knowledge on epilepsy. The mean ATPE scale knowledge score was 4.57 (standard deviation [SD] = 3.24) of a maximum score of 11. The male respondents almost had mean knowledge scores almost equal to their female counterparts (4.23, SD = 2.48; 4.51, SD = 2.54, respectively). Most respondents had negative attitudes toward epilepsy, with a mean ATPE attitude score of 73.2 (SD = 2.11) of a possible maximum score of 126. The mean attitude scores for the male and female respondents were 58.18 (SD = 4.23) and 86.62 (SD = 5.23), respectively. Most respondents had negative beliefs such as attributing epilepsy to supernatural spirits, heredity, and preference of traditional medicine and healers to conventional medicine as a treatment for epilepsy. A significant number of respondents expressed sympathetic feelings toward people living with epilepsy, specifically tolerance and kindness to those living with epilepsy. SIGNIFICANCE: Findings could benefit policymakers, the district health team, researchers, community members, affected families, and people with epilepsy in designing awareness strategies. Knowledge on epilepsy could improve the quality of life and care for people living with epilepsy, through reducing misconceptions and stigmatization in the communities where they live.