Multimodal Analgesic Effectiveness on Acute Postoperative Pain Management After Adult Cardiac Surgery: Protocol for a Systematic Review.

BACKGROUND: Many patients report moderate to severe pain in the acute postoperative period. Enhanced recovery protocols recommend multimodal analgesics, but the optimal combination of these is unknown. PURPOSE: The aim of this study was to synthesize the best available evidence about effectiveness of multimodal analgesics on pain after adult cardiac surgery. METHODS: A systematic review to determine the effect of multimodal postoperative analgesics is proposed (International Prospective Register of Systematic Reviews Registration CRD42022355834). Multiple databases including the Cochrane Library, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, American Psychological Association, the Education Resources Information Centre, the Excerpta Medica database, the Medical Literature Analysis and Retrieval System Online, Scopus, Web of Science, and clinical trials databases will be searched. Screening in Covidence and quality assessment will be conducted by 2 authors. A grading of recommendations, assessment, development, and evaluation summary of findings will be presented if meta-analysis is possible.

Strategies to adapt and implement health system guidelines and recommendations: a scoping review.

BACKGROUND: Evidence-based health system guidelines are pivotal tools to help outline the important financial, policy and service components recommended to achieve a sustainable and resilient health system. However, not all guidelines are readily translatable into practice and/or policy without effective and tailored implementation and adaptation techniques. This scoping review mapped the evidence related to the adaptation and implementation of health system guidelines in low- and middle-income countries. METHODS: We conducted a scoping review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was implemented in MEDLINE (Ovid), Embase, CINAHL, LILACS (VHL Regional Portal), and Web of Science databases in late August 2020. We also searched sources of grey literature and reference lists of potentially relevant reviews. All findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS: A total of 41 studies were included in the final set of papers. Common strategies were identified for adapting and implementing health system guidelines, related barriers and enablers, and indicators of success. The most common types of implementation strategies included education, clinical supervision, training and the formation of advisory groups. A paucity of reported information was also identified related to adaptation initiatives. Barriers to and enablers of implementation and adaptation were reported across studies, including the need for financial sustainability. Common approaches to evaluation were identified and included outcomes of interest at both the patient and health system level. CONCLUSIONS: The findings from this review suggest several themes in the literature and identify a need for future research to strengthen the evidence base for improving the implementation and adaptation of health system guidelines in low- and middle-income countries. The findings can serve as a future resource for researchers seeking to evaluate implementation and adaptation of health system guidelines. Our findings also suggest that more effort may be required across research, policy and practice sectors to support the adaptation and implementation of health system guidelines to local contexts and health system arrangements in low- and middle-income countries.

Programmes to support paediatric to adult healthcare transitions for youth with complex care needs and their families: A scoping review.

BACKGROUND: An increasing number of children have complex care needs (CCN) that impact their health and cause limitations in their lives. More of these youth are transitioning from paediatric to adult healthcare due to complex conditions being increasingly associated with survival into adulthood. Typically, the transition process is plagued by barriers, which can lead to adverse health consequences. There is an increased need for transitional care interventions when moving from paediatric to adult healthcare. To date, literature associated with this process for youth with CCN and their families has not been systematically examined. OBJECTIVES: The objective of this scoping review is to map the range of programmes in the literature that support youth with CCN and their families as they transition from paediatric to adult healthcare. METHODS: The review was conducted in accordance with the Joanna Briggs Institute's methodology for scoping reviews. A search, last run in April 2021, located published articles in PubMed, CINAHL, ERIC, PsycINFO and Social Work Abstracts databases. RESULTS: The search yielded 1523 citations, of which 47 articles met the eligibility criteria. A summary of the article characteristics, programme characteristics and programme barriers and enablers is provided. Overall, articles reported on a variety of programmes that focused on supporting youth with various conditions, beginning in the early or late teenage years. Financial support and lack of training for care providers were the most common transition program barriers, whereas a dedicated transition coordinator, collaborative care, transition tools and interpersonal support were the most common enablers. The most common patient-level outcome reported was satisfaction. DISCUSSION: This review consolidates available information about interventions designed to support youth with CCN transitioning from paediatric to adult healthcare. The results will help to inform further research, as well as transition policy and practice advancement.

Patterns of patient coping following hospital discharge from medical and surgical units: A pilot study.

A pilot study was conducted to determine the feasibility of a longitudinal investigation of patients' coping during the early postdischarge period. Recruitment was conducted on a general medical unit and a surgical orthopedic unit. Forty-four participants were recruited with 95% retention. Demographic characteristics plus measures of discharge risk and perceived readiness (expected coping) were collected before discharge. Measures of coping (experienced) and the use of supports and services were collected on the first day postdischarge, the end of the first week, and during weeks 3 and 5. Considerable variability was evident in coping scores, and not all participants exhibited improvement over time. Four patterns of coping were identified: ongoing recovery, initial shock, bumpy road, and progressive decline. Further investigation is required to validate the observed coping patterns. A better understanding of conditions affecting patient coping during the transition from hospital to home will support efforts to reduce unplanned use of acute care services.

Recruitment and Retention Challenges in a Technology-Based Study with Older Adults Discharged from a Geriatric Rehabilitation Unit.

PURPOSE: Technology has the potential to offer support to older adults after being discharged from geriatric rehabilitation. This article highlights recruitment and retention challenges in a study examining an interactive voice response telephone system designed to monitor and support older adults and their informal caregivers following discharge from a geriatric rehabilitation unit. METHODS: A prospective longitudinal study was planned to examine the feasibility of an interactive voice telephone system in facilitating the transition from rehabilitation to home for older adults and their family caregivers. Patient participants were required to make daily calls into the system. Using standardized instruments, data was to be collected at baseline and during home visits. FINDINGS: Older adults and their caregivers may not be willing to learn how to use new technology at the time of hospital discharge. Poor recruitment and retention rates prevented analysis of findings. CONCLUSIONS AND CLINICAL RELEVANCY: The importance of recruitment and retention in any study should never be underestimated. Target users of any intervention need to be included in both the design of the intervention and the study examining its benefit. Identifying the issues associated with introducing technology with a group of older rehabilitation patients should assist others who are interested in exploring the role of technology in facilitating hospital discharge.

The primary prevention of cardiovascular disease: nurse practitioners using behaviour modification strategies.

Cardiovascular disease (CVD) places great financial strain on the health care system and dramatically affects individual quality of life. As primary health care providers, nurse practitioners (NPs) are ideally positioned to advise clients on risk factor and lifestyle modifications that ameliorate the impact of CVD. While the lifestyle targets for CVD prevention are established, the most effective means of achieving these goals remain uncertain. Behaviour modification strategies, including motivational interviewing (MI) and the transtheoretical model (TTM), have been suggested, but neither approach is established as being more efficacious than the other. In this paper, evidence on the effectiveness of the two approaches for modifying smoking, diet, and exercise behaviour are presented, and a recommendation for NP practice is made.

Pedagogical and teaching strategies used to teach writing to pre-licensure students enrolled in health professional programs: a scoping review protocol.

OBJECTIVE: The objective of this review is to map the existing literature on pedagogical approaches and teaching strategies used to teach academic and professional writing to pre-licensure students who are enrolled in health professional programs. INTRODUCTION: Health professional programs are intended to develop competence in both academic and professional writing. Effective academic writing skills prompt critical reflection and engagement with research communities, while professional writing skills are used to document interventions and communicate across health systems. Despite the importance of these 2 forms of writing, there are ongoing concerns that practitioners are entering practice without adequate writing skills. Given these concerns and the importance of writing across health disciplines, there is value in identifying the pedagogical strategies and approaches used in health professional programs to develop writing skills and to transfer such skills from one communicative context to another. INCLUSION CRITERIA: This review will consider research on the pedagogical approaches and teaching strategies used to teach academic and professional writing in pre-licensure health professional programs. METHODS: This review will be conducted in line with the JBI methodology for scoping reviews. The search strategy will aim to locate published literature using MEDLINE (Ovid), Embase, CINAHL with Full-Text (EBSCOhost), ProQuest Nursing & Allied Health (ProQuest), and ERIC (EBSCOhost), along with gray literature (using databases/search engines). Papers published from 2010 onward in English and in French will be included. Extracted data will be reported in tabular format and presented narratively to address each review objective. DETAILS OF THE REVIEW CAN BE FOUND IN OPEN SCIENCE FRAMEWORK: http://osf.io/9raxp.

The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 8: Knowledge Gaps and Status of Existing Research Programs in Canada.

Despite significant progress in medical research and public health efforts, gaps in knowledge of women's heart health remain across epidemiology, presentation, management, outcomes, education, research, and publications. Historically, heart disease was viewed primarily as a condition in men and male individuals, leading to limited understanding of the unique risks and symptoms that women experience. These knowledge gaps are particularly problematic because globally heart disease is the leading cause of death for women. Until recently, sex and gender have not been addressed in cardiovascular research, including in preclinical and clinical research. Recruitment was often limited to male participants and individuals identifying as men, and data analysis according to sex or gender was not conducted, leading to a lack of data on how treatments and interventions might affect female patients and individuals who identify as women differently. This lack of data has led to suboptimal treatment and limitations in our understanding of the underlying mechanisms of heart disease in women, and is directly related to limited awareness and knowledge gaps in professional training and public education. Women are often unaware of their risk factors for heart disease or symptoms they might experience, leading to delays in diagnosis and treatments. Additionally, health care providers might not receive adequate training to diagnose and treat heart disease in women, leading to misdiagnosis or undertreatment. Addressing these knowledge gaps requires a multipronged approach, including education and policy change, built on evidence-based research. In this chapter we review the current state of existing cardiovascular research in Canada with a specific focus on women.

En dépit des avancées importantes de la recherche médicale et des efforts en santé publique, il reste des lacunes dans les connaissances sur la santé cardiaque des femmes sur les plans de l'épidémiologie, du tableau clinique, de la prise en charge, des résultats, de l'éducation, de la recherche et des publications. Du point de vue historique, la cardiopathie a d'abord été perçue comme une maladie qui touchait les hommes et les individus de sexe masculin. De ce fait, la compréhension des risques particuliers et des symptômes qu'éprouvent les femmes est limitée. Ces lacunes dans les connaissances posent particulièrement problème puisqu'à l'échelle mondiale la cardiopathie est la cause principale de décès chez les femmes. Jusqu'à récemment, la recherche en cardiologie, notamment la recherche préclinique et clinique, ne portait pas sur le sexe et le genre. Le recrutement souvent limité aux participants masculins et aux individus dont l'identité de genre correspond au sexe masculin et l'absence d'analyses de données en fonction du sexe ou du genre ont eu pour conséquence un manque de données sur la façon dont les traitements et les interventions nuisent aux patientes féminines et aux individus dont l'identité de genre correspond au sexe féminin, et ce, de façon différente. Cette absence de données a mené à un traitement sous-optimal et à des limites de notre compréhension des mécanismes sous-jacents de la cardiopathie chez les femmes, et est directement reliée à nos connaissances limitées, et à nos lacunes en formation professionnelle et en éducation du public. Le fait que les femmes ne connaissent souvent pas leurs facteurs de risque de maladies du cœur ou les symptômes qu'elles peuvent éprouver entraîne des retards de diagnostic et de traitements. De plus, le fait que les prestataires de soins de santé ne reçoivent pas la formation adéquate pour poser le diagnostic et traiter la cardiopathie chez les femmes les mène à poser un mauvais diagnostic ou à ne pas traiter suffisamment. Pour pallier ces lacunes de connaissances, il faut une approche à plusieurs volets, qui porte notamment sur l'éducation et les changements dans les politiques, et qui repose sur la recherche fondée sur des données probantes. Dans ce chapitre, nous passons en revue l'état actuel de la recherche existante sur les maladies cardiovasculaires au Canada, plus particulièrement chez les femmes.

Bridging the transition from hospital to home: effects of the VITAL telehealth program on recovery for CABG surgery patients and their caregivers.

The purpose of this randomized trial was to determine whether coronary artery bypass graft surgery patients and their caregivers who received telehealth follow-up had greater improvements in anxiety levels from pre-surgery to 3 weeks after discharge than did those who received standard care. Secondary outcomes included changes in depressive symptoms and patients' contacts with physicians. No group differences were noted in changes in patients' anxiety and depressive symptoms, but patients in the telehealth group had fewer physician contacts (p = .04). Female caregivers in the telehealth group had greater decreases in anxiety than those in standard care (p < .001), and caregivers of both genders in the telehealth group had greater decreases in depressive symptoms (p = .03).

Turning knowledge into action at the point-of-care: the collective experience of nurses facilitating the implementation of evidence-based practice.

BACKGROUND: Facilitation is considered a way of enabling clinicians to implement evidence into practice by problem solving and providing support. Practice development is a well-established movement in the United Kingdom that incorporates the use of facilitators, but in Canada, the role is more obtuse. Few investigations have observed the process of facilitation as described by individuals experienced in guideline implementation in North America. AIM: To describe the tacit knowledge regarding facilitation embedded in the experiences of nurses implementing evidence into practice. METHODS: Twenty nurses from across Canada were purposively selected to attend an interactive knowledge translation symposium to examine what has worked and what has not in implementing evidence in practice. This study is an additional in-depth analysis of data collected at the symposium that focuses on facilitation as an intervention to enhance evidence uptake. Critical incident technique was used to elicit examples to examine the nurses' facilitation experiences. Participants shared their experiences with one another and completed initial data analysis and coding collaboratively. The data were further thematically analyzed using the qualitative inductive approach of constant comparison. RESULTS: A number of factors emerged at various levels associated with the successes and failures of participants' efforts to facilitate evidence-based practice. Successful implementation related to: (a) focus on a priority issue, (b) relevant evidence, (c) development of strategic partnerships, (d) the use of multiple strategies to effect change, and (e) facilitator characteristics and approach. Negative factors influencing the process were: (a) poor engagement or ownership, (b) resource deficits, (c) conflict, (d) contextual issues, and (e) lack of evaluation and sustainability. CONCLUSIONS: Factors at the individual, environmental, organizational, and cultural level influence facilitation of evidence-based practice in real situations at the point-of-care. With a greater understanding of factors contributing to successful or unsuccessful facilitation, future research should focus on analyzing facilitation interventions tailored to address barriers and enhance facilitators of evidence uptake.

Nursing students' experiences of a post-licensure practical nurse bridging program: a qualitative systematic review.

OBJECTIVE: The objective of this systematic review was to synthesize qualitative evidence on students' experiences of a post-licensure practical nurse to registered nurse bridging program. INTRODUCTION: A worldwide shortage of registered nurses has prompted governments and educational institutions to develop alternate pathways to nursing licensure. One strategy used to increase the supply of registered nurses is bridging programs. Such programs grant practical nurses academic credit for previous educational and practical experience, which allows them to complete a bachelor of nursing degree in a shorter length of time. Understanding the experience of students enrolled in bridging programs will help identify their specific needs and the educational support needed for them to successfully transition into the registered nurse role. INCLUSION CRITERIA: This review considered qualitative studies that examined the experiences of practical nurses enrolled in bridging programs. METHODS: The literature search was conducted in CINAHL, MEDLINE, Embase, and ERIC. The search for unpublished articles included ProQuest Dissertations & Theses and GreyNet International. Studies published in English were included with no date limits applied to the searches. Papers were screened independently by 2 reviewers against the inclusion criteria. Papers that met the criteria were appraised using the JBI critical appraisal checklist for qualitative research. Key findings were extracted from the included studies using a standardized tool and assigned a level of credibility. The review followed principles of meta-aggregation in line with the JBI approach. The final synthesized findings were graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis. RESULTS: Twenty-four studies, published between 1989 and 2020, were included in the review. A total of 83 findings were extracted and aggregated into 11 categories. From the 11 categories, 4 synthesized findings were developed and are summarized as: i) growth through professional advancement reflects that bridging students report personal growth and professional transformation when they return to school and study to become a registered nurse; ii) need for support indicates that bridging students recognize and appreciate a need to have positive support networks in their lives, mainly with their family, coworkers, and classmates; iii) expecting more reflects that, as adult learners with prior nursing experience, bridging students anticipate receiving more support from the educational institutions and higher levels of clinical expertise and competence amongst faculty than what is provided; and iv) finding balance indicates that bridging students struggle to balance and manage multiple roles and responsibilities in their lives as they return to school to study to become a registered nurse. CONCLUSION: The findings of this review highlight that, as adult learners with prior nursing experience, when post-licensure practical nurses return to study there is often a need to balance multiple roles and responsibilities. It is with the support of family, coworkers, classmates, and faculty that bridging students are able to manage competing personal and academic demands. While many bridging students express disappointment with some of the learning opportunities and/or faculty expertise associated with the nursing program, they ultimately achieve growth through both personal and professional advancement upon completing the program and becoming a registered nurse. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021278408. SUPPLEMENTAL DIGITAL CONTENT: A French-language version of the abstract of this review is available as Supplemental Digital Content [ http://links.lww.com/SRX/A10 ].

Education and training for infection prevention and control provided by long-term care homes to family caregivers: a scoping review protocol.

OBJECTIVE: The objective of this review is to map the infection prevention and control education and training that long-term care homes use with families during a pandemic or infectious outbreak. INTRODUCTION: During the COVID-19 pandemic, restrictions were imposed on visits to long-term care homes to decrease the risk of virus transmission. These restrictions had negative consequences for both residents and families. A scoping review of infection prevention and control education and training used with families will inform family visitation practices and policies during future infectious outbreaks. INCLUSION CRITERIA: This review will examine literature describing infection prevention and control education and training provided to families in long-term care homes. Research and narrative papers, including experimental; quasi-experimental; descriptive observational quantitative and qualitative studies; and reviews, text, policy, and opinion papers, will be considered for inclusion. METHODS: A 3-step approach will be followed, in line with the JBI methodology for scoping reviews. Published literature will be searched for in databases, including CINAHL, Embase, ERIC, MEDLINE, and AgeLine. Published and unpublished papers will be considered from 1990 to the present, in English or French. The World Health Organization, Centers for Disease Control, and the Public Health Agency of Canada websites will be searched for unpublished and gray literature. Two authors will independently review and assess studies for inclusion and extract the data. The findings will be charted in a narrative summary and tables.

Supports and services available to at-risk mothers and their children in maternity residences: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify, categorize, and map the types of supports and services available to at-risk mothers and their children in maternity residences. A secondary objective is to identify and map the measures used to evaluate the efficacy of these supports and services. INTRODUCTION: Pregnant and parenting women and their children experiencing complex challenges related to the social determinants of health, including unstable housing and poverty, are at high-risk for long-term negative health and socioeconomic outcomes. Maternity residences may provide supports and services that improve this population's outcomes, however, there is little understanding of what services are offered and how efficacious they may be. A comprehensive overview of supports and services in maternity residences, as well as identifying the measures used to evaluate the efficacy of the supports and services, will provide the foundation to evaluate these services and outcomes and inform the development of future maternity residential programs. INCLUSION CRITERIA: Studies including pregnant and parenting women and gender-diverse individuals who are housed in, or accessing the services of, maternity residences in politically stable high-income countries due to challenges rooted in the social determinants of health will be considered for inclusion. We define maternity residences as any agency with a residential component offering supports/services to this population. METHODS: This review will be conducted in accordance with JBI methodology for scoping reviews. The data will be analyzed using a quantitative descriptive analysis approach. The data analysis and discussion will informed by the Social Determinants of Health, Reproductive Justice, Harm Reduction, and Health in All Policies frameworks.

Experiences of faculty and staff nurses working with nursing students during clinical placement in residential aged care facilities: a systematic review of qualitative evidence.

OBJECTIVE: The objective of this review was to synthesize evidence on the experiences of faculty and staff nurses working with nursing students in clinical placement in residential aged care facilities. INTRODUCTION: Nursing education helps prepare students to provide quality care to older adults. Nursing programs across the globe are championing the integration of content on the care of older adults into their curricula as well as recognizing the value of clinical placements that focus exclusively on this population. Staff nurses who work in residential aged care facilities often work alongside students. In this role, they can support faculty and mentor students. This review explored faculty and staff experiences of nursing student placements in such facilities. INCLUSION CRITERIA: This review considered qualitative studies that address the experiences of faculty and staff nurses working with nursing students in residential aged care facilities. Studies published in English from 1995 onward were included. METHODS: The literature search was conducted in CINAHL, MEDLINE, Embase, and ERIC. The search for unpublished articles included Proquest Dissertations and Theses and Google searches of the Canadian Nurses Association and American Nurses Association websites. Papers were screened by two reviewers independently against the inclusion criteria. Those meeting the criteria were appraised using the JBI critical appraisal checklist for qualitative research. Key findings from included studies were extracted using a standardized tool and classified as unequivocal, credible, or not supported. This review followed the principles of meta-aggregration in line with the JBI approach. RESULTS: Six studies, published between 2001 and 2017, were included in the review. A total of 32 findings were extracted and aggregated into nine categories. From the nine categories, four synthesized findings were developed: i) students enhance the environment, whereby faculty and staff perceive that student presence enhances the residential aged care work and living environment, ii) effort is required by faculty and staff to make the experience work, reflecting a need for faculty and staff to accept and work with negativities, iii) residential aged care facilities provide rich learning experiences, indicating an appreciation for available learning opportunities, and iv) importance of a residential aged care-academic partnership for a collaborative approach in creating positive experiences for faculty and staff working with students in this setting. CONCLUSION: Faculty and staff experiences highlight that residential aged care has the potential to provide students with valuable learning experiences, including how to provide comprehensive and quality nursing care to older adults. A lack of resources in residential aged care inspires faculty and staff to be creative in how they work with students. However, working with students can be challenging for faculty who lack interest and expertise in caring for older adults in this setting. Additionally, staff can become frustrated when they perceive that students do not value the learning opportunities that are available or do not appreciate the expertise required to work with older adults. Partnerships between residential aged care facilities and academic programs can ensure that faculty and staff have the support and resources required to optimize the clinical placements for students. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020168698.

Nursing students' experiences of a post-licensure practical nurse bridging program: a qualitative systematic review protocol.

OBJECTIVE: This systematic review will synthesize the qualitative literature on students' experiences of a post-licensure practical nurse to registered nurse bridging program. INTRODUCTION: The worldwide shortage of registered nurses has prompted governments and educational institutions to develop alternative pathways to nursing licensure. One strategy used to increase the supply of registered nurses is bridging programs. These grant practical nurses academic credit for previous educational and practical experience, which allows them to complete a Bachelor of Nursing degree in a shorter period of time. However, attrition in bridging programs is a concern. Understanding the experiences of students enrolled in bridging programs will help identify their specific needs and the educational support needed for them to successfully transition into the registered nursing role. INCLUSION CRITERIA: This review will include published and unpublished studies that examine the experiences of practical nurses enrolled in bridging programs. Studies published in English will be considered, with no date limitations. METHODS: Databases to be searched include CINAHL, MEDLINE, Embase, and ERIC. Gray literature will be searched for in ProQuest Dissertations and Theses and GreyNet International. Reference lists of included studies will also be reviewed to identify additional studies. The critical appraisal of selected studies and the extraction of data will be independently undertaken by two reviewers using JBI methodology. The findings will be pooled using meta-aggregation to produce comprehensive synthesized findings. A ConQual Summary of Findings will also be presented. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021278408.

Perceptions and experiences of health care professionals and staff with animal-assisted interventions in health care settings: a qualitative systematic review protocol.

OBJECTIVE: The objective of this review is to examine the perceptions and experiences of health care professionals and staff in implementing or coordinating animal-assisted interventions in health care settings. INTRODUCTION: Animal-assisted interventions are applied in the areas of health, education, and human services to help improve individuals' health and wellness. The positive effects of animal-assisted interventions on individuals have been shown in multiple health disciplines, from pediatrics to long-term care, and include outcomes such as decreased feelings of loneliness and increased feelings of support. The increase of animal-assisted interventions in human health has initiated growing research on health care professionals' perceptions and experiences of these interventions. No current qualitative systematic reviews have focused solely on health care professionals' and staff's perceptions of animal-assisted interventions. Conducting such a review will advance understanding of how these providers perceive and engage with animal-assisted interventions as well as their influence and role in coordinating these interventions. INCLUSION CRITERIA: This review will consider qualitative primary studies that address the perceptions and experiences of health care professionals and staff in implementing or coordinating animal-assisted interventions in health care settings. METHODS: Nine bibliographic databases will be systematically searched for published and unpublished studies by employing a three-step search strategy. Studies published from database inception to present and in English will be considered. Two reviewers will independently appraise the studies and extract qualitative data using the standardized JBI critical appraisal and data extraction instruments. Findings from the review will be categorized according to similarity in meaning, and categories will be subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021258909.

Concept Analysis and Proposed Definition of Community Health Center.

Background: Community health centers (CHCs) have been used for delivery of health services since the 1920s and originally were intended to provide care to underserved populations. CHCs have become an integral part of healthcare systems in many countries; however, the term CHC is used synonymously with other concepts and there is no clear definition for CHC. The purpose of our concept analysis was to determine how CHCs are described in the literature and to develop a concept definition for CHC. Methods: Informed by the 8-step process described by Walker and Avant, we searched for literature spanning disciplines within health, business, and policy. We used a systematic review process to identify a range of peer-reviewed articles that help illustrate the attributes, antecedents, and consequences of CHCs. A total of 102 articles from 7 databases were included in our concept analysis. Results: We distinguished 6 attributes of a CHC: primary care; accessibility; preventative care; defined population; health promotion; and comprehensive and integrated care. About 4 antecedents fundamental to a CHC included: secure funding; vision and support; adequate human resources; and governance structure. Consequences of CHCs are improved health outcomes, efficiency, and cost-effective provision of healthcare services. Conclusions: Our concept analysis revealed core characteristics of CHCs that assisted us in synthesizing a concept definition for CHC. These characteristics and our proposed definition will help provide clarity on the concept of CHC to benefit evaluation, research, and policy development of CHCs.

Nurses' provisions for self-determination when caring for clients with cognitive impairment who live in a residential aged care facility: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to examine and map knowledge of nursing provisions for self-determination while providing care to clients with cognitive impairment in residential aged care facilities. INTRODUCTION: Maintaining the ability to have choices and to make decisions about daily activities is important for older adults. In residential aged care facilities, nurses' can be challenged to preserve clients' self-determination in favor of ritualistic care routines and a perceived duty to care. Moreover, nurses may perceive that their professional responsibilities to protect clients requires them to guard against decisions that are considered unwise or pose a risk to clients' health or safety. Insight into how nurses negotiate choice with clients with cognitive impairment who are living in a residential care facility will provide an in-depth understanding of the role self-determination plays in clients' lives. INCLUSION CRITERIA: The scoping review will consider research and narrative reports on nursing provisions for self-determination in clients with cognitive impairment who are living in a residential aged care facility. The concepts of interest are self-determination and nursing provisions. Self-determination is defined as client choice and nursing provisions are the intentional reactions to clients' expressed choices. METHODS: This scoping review will aim to locate published and unpublished literature employing a three-step search strategy. Only papers published in English from 1995 onward will be included. Data extracted from included papers will outline details on the participants, context, strategy, activity, and outcomes. Extracted data will be reported in a tabular form and presented narratively to address the review objective.

Nurses' provisions for self-determination in residents with cognitive impairment who live in a residential aged care facility: a scoping review.

OBJECTIVE: This scoping review aimed to map the existing literature about nursing provisions for self-determination in residents with cognitive impairments living in residential aged care facilities. INTRODUCTION: Freedom to decide for oneself and express preferences about daily care is important for all older adults. When older adults transition to residential aged care facilities, they may experience barriers to self-determination due to routine care practices and staff attitudes about autonomy. This is particularly true for residents living with cognitive impairments. Residents with cognitive impairments are often prevented from making choices that nursing staff perceive to be unwise or harmful, as nurses uphold their professional duties to protect and care. This can result in the denial of preferences and the right to self-determination. Mapping the ways nurses balance their duty to protect with residents' rights to self-determine provides insight into nurses' roles and residents' experiences of care. INCLUSION CRITERIA: Research and narrative articles about nursing provisions for self-determination in residents with cognitive impairments living in residential aged care facilities were included in this review. The main concepts explored were nurses' provisions and residents' self-determination. Self-determination included residents' preferences and expressions of choice, while nurses' intentional reactions to residents' preferences were considered nurses' provisions. METHODS: The review included qualitative and quantitative studies as well as text and opinion papers. Only studies and papers published in English from 1992 onwards were included. The databases searched were CINAHL (EBSCO), MEDLINE (Ovid), Embase (Elsevier), and ERIC (EBSCO). The search for unpublished papers included ProQuest Nursing and Allied Health Database, ProQuest Dissertations and Theses, and Google (with advanced search strategies). The reference lists of included articles were searched for additional studies not captured by the search strategy. Data were extracted using a standardized tool created by the authors and included details on study design, strategies to promote, and conditions that deny residents' self-determination. Charting tables were developed to record and analyze data related to the review questions. RESULTS: The final set of 17 articles were published from 1995 to 2018. The literature was analyzed in relation to the review's four questions to map the boundaries of the nurse's role in providing for residents' self-determination. Nurses' roles as investigators, advocates, protectors, and assessors emerged as critical to providing for self-determination. CONCLUSIONS: Literature about this topic has tended to describe nursing provisions for self-determination in people with cognitive impairments in terms of an ethical dilemma between the resident's right to act autonomously and their right to protection as a vulnerable population. In mapping the literature, this scoping review demonstrates a more complex process at work in providing for self-determination in the context of cognitive impairment and highlights a need for deeper reflexivity around nurses' understandings of personhood and autonomy. Further research should focus on determining if nurses' perceptions of residents' experience with self-determination are accurate. The complexity of self-determination in the context of cognitive impairment and nurses' advocacy role highlights the need for ongoing support and education for staff working in residential aged care facilities.

Experiences of family members of patients treated with targeted temperature management post cardiac arrest: a qualitative systematic review protocol.

OBJECTIVE: The objective of this review is to evaluate the experiences of family members of patients who receive targeted temperature management following the return of spontaneous circulation after a cardiac arrest. INTRODUCTION: Since 2002, targeted temperature management has become an international standard of care for the preservation of neurological status for patients following a cardiac arrest and who remain comatose. During this process, survivors are placed into a mild hypothermic state with their body temperature maintained at 32°C to 36°C for a minimum of 24 hours. It is during this time that family members experience the uncertainty of whether their loved one will survive, or if any negative long-term sequelae will be experienced. While much is known about the physical application and management of targeted temperature management, less is known about the psychosocial aspects of this treatment. INCLUSION CRITERIA: This review will consider qualitative studies that address the experiences of family members of adult patients who have received targeted temperature management following a cardiac arrest. METHODS: CINAHL, ProQuest Nursing and Allied Health Source, PsycINFO, PubMed (MEDLINE), Scopus, Sociological Abstracts, and Web of Science will be searched for relevant studies. Studies published in English and French from 2002 onward will be considered. Two reviewers will independently appraise studies and extract qualitative data using the JBI standardized critical appraisal and extraction instruments. Findings from the review will be categorized according to similarity in meaning, and categories subjected to a meta-aggregation to produce a single comprehensive set of synthesized findings. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020142942.