Family involvement in preventing delirium in critically ill patients: A systematic review and meta-analysis.
International journal of nursing studies
BACKGROUND:Humanized care is a novel concept in the prevention of delirium, with family involvement being a crucial component. Currently, there is controversy regarding the effectiveness of family involvement in preventing delirium among critically ill patients, and the impact of varying levels of family involvement on delirium prevention remains unclear. OBJECTIVE:The purpose of this study is twofold: (a) to investigate the influence of family involvement on delirium among critically ill patients, and (b) to explore the effectiveness of different levels of family involvement in preventing delirium in these patients. DESIGN:A systematic review and meta-analysis. METHODS:From database inception to July 2024, a comprehensive search was conducted across PubMed, EMBASE, CINAHL, Web of Science, and the Cochrane CENTRAL database. Randomized controlled trials that examined family involvement were included in the review. RESULTS:This review included a total of 11 randomized controlled trials, encompassing 3113 critically ill patients. Family involvement was found to significantly reduce the incidence of delirium among critically ill patients (RR = 0.46, 95%CI = 0.31 to 0.69), decrease the duration of delirium (WMD = -2.18, 95 % CI = -4.14 to -0.22), and shorten the length of Intensive Care Unit (ICU) stay (WMD = -1.46, 95%CI = -2.43 to -0.50). Three different levels of family involvement-direct participation in care (RR = 0.37, 95%CI = 0.26 to 0.51), family visits and companionship (RR = 0.56, 95 % CI = 0.25 to 1.25), and indirect participation (RR = 0.77, 95 % CI = 0.29 to 2.07)-varies in their effectiveness for delirium prevention. CONCLUSIONS:Family involvement significantly impacts delirium prevention in critically ill patients. The effectiveness of delirium prevention varies depending on the level of family involvement, with direct participation of family members in caregiving demonstrating a more pronounced effect in reducing delirium incidence among critically ill patients. REGISTRATION:The review protocol has been registered in the PROSPERO International prospective register of systematic reviews (CRD42024563095).
10.1016/j.ijnurstu.2024.104937
Digital technologies in nursing: An umbrella review.
International journal of nursing studies
BACKGROUND:Digital technologies promise to reduce nurses' workload and increase quality of care. However, considering the plethora of single and review studies published to date, maintaining a comprehensive overview of digital technologies' impact on nursing and effectively utilizing available evidence is challenging. OBJECTIVE:This review aims (i) to map published reviews on digital nursing technologies, based on their aims and the specific technologies investigated, to synthesize evidence on how these technologies' uses is associated with (ii) nurses' work-related and organizational factors, professional behavior, and health and work safety and (iii) ethically relevant outcomes for people in need of care. DESIGN:Preregistered overview of reviews (PROSPERO-ID: CRD42023389751). SETTING(S):We searched for systematic reviews in eight databases, five key journals, and reference lists of included reviews published in English until May 21, 2024. METHODS:We used the AMSTAR 2 checklist to assess the methodological quality of included reviews reporting associations with nursing outcomes. The extracted data were analyzed by their frequency and narratively synthesized. RESULTS:We identified 213 reviews on digital technologies' uses in the nursing sector. Most of these focused on information and communication technologies. The most frequently reported research objectives encompass technology usage and/or general experiences with it and technology-related consequences for care recipients. Regarding work-related and organizational factors, beneficial impacts were found for the execution of nursing tasks, information management and job control. Depending on the technology type, reviews reported mixed effects for documentation activities, communication/collaboration and mainly negative effects on nurses' workload. Concerning occupational safety and health-related and further nurse outcomes, reviews reported mostly positive effects on nurses' job satisfaction and professional competence. Adverse effects related to mental and physical strain, such as increased frustration, fatigue, and burnout. Regarding ethically relevant outcomes, robotic and telecare technologies had the most reported findings. Most evidence concerned effects on the principles of beneficence/non-maleficence and respect for autonomy. CONCLUSIONS:Digital nursing technologies' legitimacy hinges on their impact on patient outcomes and nurses' work, safety, and health. This review identifies a diverse array of these technologies, with both positive and negative effects. However, due to narrative limitations, meta-analysis was impractical. Future research should quantitatively assess the effects of various digital nursing technologies on work, safety, health, and ethical outcomes. TWEETABLE ABSTRACT:Research on digital tech in nursing lacks focus on key work factors, occupational health and ethical outcomes. #NursingTech #ResearchGaps.
10.1016/j.ijnurstu.2024.104950
Benefits of an educational intervention on functional capacity in community-dwelling older adults with frailty phenotype: A randomized controlled trial.
International journal of nursing studies
BACKGROUND:There is an urgent demand for nurses to expand their knowledge and skills in managing frailty in primary care. Frailty is a multifaceted condition that is prevalent among older adults and often leads to reduced functional capacity. Currently, there is a limited understanding of the effectiveness of educational interventions aimed at improving functional capacity among community-dwelling frail older adults in a primary care setting. OBJECTIVE:This study aimed to evaluate the impact of an educational program on functional capacity among pre-frail and frail older adults living in the community. DESIGN:A 12-month, multicenter, randomized controlled trial. SETTINGS:The FRAGSALUD study was conducted across 14 healthcare centers situated within the regions of Cadiz and Malaga, Spain. PARTICIPANTS:A total of 199 frail/pre-frail community-dwelling older adults (74.2 ± 6.4 years). METHODS:Participants who met at least one Fried's criteria were assigned to either the control group (n = 90), which received usual healthcare assistance, or the intervention group (n = 109). The 6-month intervention comprised four group sessions and six telephone calls conducted by professional nurses, sport scientists, and nutritionists. This educational program focused on guidelines for physical activity, nutritional habits, cognition, and psychosocial well-being. Functional capacity was assessed using questionnaires for basic (Barthel Index) and instrumental (Lawton and Brody Scale) activities of daily living. All outcome measures were evaluated at baseline, immediately after the intervention (6-month), and six months after the intervention as a follow-up (12-month). Differences in functional capacity (Barthel Index and Lawton and Brody Scale scores) across the three time points were analyzed using Friedman's ANOVA, with Wilcoxon signed-rank test for pairwise comparisons. RESULTS:At both 6-month and 12-month assessments, the control group showed a statistically significant decline in basic and instrumental activities of daily living compared to the intervention group, which maintained similar levels, preventing this age-related decline. CONCLUSIONS:The educational intervention, designed for easy implementation within healthcare systems, especially for nurses, successfully maintained levels of functional capacity in basic and instrumental activities of daily living, while the control group experienced a decline in functional capacity during the 12-month follow-up. Thus, educational interventions are encouraged for preserving the functional independence of frail/pre-frail older adults living in the community. REGISTRATION:This trial was registered at ClinicalTrials.gov (Identifier: NCT05610605) and the first participant was registered in March 2022. TWEETABLE ABSTRACT:The FRAGSALUD educational intervention prevents the age-related decline in functional independence over 12 months in frail older adults.
10.1016/j.ijnurstu.2024.104955
Effects of advanced practice nurses on health-care costs, quality of care, and patient well-being: A meta-analysis of randomized controlled trials.
International journal of nursing studies
BACKGROUND:The growing recognition of advanced practice nurses' role has been challenged by the need for decreased health-care costs while ensuring quality of care and patient well-being. However, limited evidence exists from previous reviews evaluating the effectiveness of advanced practice nurses. OBJECTIVES:To investigate the effects of advanced practice nurses on health-care costs, quality of care, and patient well-being. DESIGN:A meta-analysis of randomized controlled trials. METHODS:A literature search was conducted in CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, and Web of Science from their inception to June 2023. The primary outcome was health-care costs, including total cost with direct (hospitalization, medication, and diagnostic costs) and indirect costs. The secondary outcomes were quality of care (hospitalization, readmission, length of stay, mortality and patient satisfaction) and well-being [mental (anxiety, depression), physical (pain, fatigue), and quality of life]. Hedges' g and odds ratio with corresponding 95 % confidence intervals were calculated using a random-effects model to obtain pooled effect estimates for the primary and secondary outcomes. Heterogeneity was determined using I and Q statistics, and moderator analysis was performed to determine the sources of heterogeneity. Publication bias was evaluated using the Begg and Mazumdar rank correlation and Egger's test and through the visual inspection of a funnel plot. RESULTS:In this review, we included 22 studies involving 7764 participants, mostly women (56.4 %). Compared with other health professionals, advanced practice nurses significantly reduced patients' total costs (g, -0.21; 95 % confidence interval, -0.30 to -0.12), lowered direct costs (g, -0.15; 95 % confidence interval, -0.22 to -0.08), and decreased hospitalization costs (g, -0.19; 95 % confidence interval, -0.34 to -0.04). As well, advanced practice nurses significantly lowered hospital readmissions (odds ratio, 0.25; 95 % confidence interval, 0.11 to 0.57), increased patient satisfaction (g, 0.54; 95 % confidence interval, 0.31 to 0.77), reduced anxiety (g, -0.36; 95 % confidence interval, -0.71 to -0.00), depression (g, -0.28, 95 % confidence interval, -0.46 to -0.10), pain (g, -0.20; 95 % confidence interval, -0.35 to -0.04), and fatigue (g, -0.24; 95 % confidence interval, -0.41 to -0.07). Patient satisfaction improved in disease management, follow-up care, and blended intervention, although did not reach statistical significance. CONCLUSION:Integrating advanced practice nurses into health-care settings contributes to reducing health-care cost, improving quality of care, and enhancing patient well-being. This meta-analysis provides evidence supporting advanced practice nurses, reinforcing their vital role in the health-care system and highlighting the need for initiatives and advocacy to enhance their scope of practice and promote advanced education. REGISTRATION:PROSPERO (CRD42023449803). TWEETABLE ABSTRACT:This meta-analysis revealed that advanced practice nurses reduce health-care costs, improve quality of care, and enhance patient well-being. @4_INAns.
10.1016/j.ijnurstu.2024.104953
Health changes from trans-theoretical model-based education in older adults with mild cognitive impairment: A randomized controlled trial.
International journal of nursing studies
BACKGROUND:Low awareness and misconceptions surrounding mild cognitive impairment highlight the urgent need for effective health education. Reluctance to seek intervention and poor adherence to management strategies make behavior-oriented health education essential. OBJECTIVE:To assess the effectiveness and clinical significance of a trans-theoretical model-based health education program on cognitive-behavioral outcomes in older adults with mild cognitive impairment. DESIGN:A two-arm and assessor-blinded randomized controlled trial. SETTINGS AND PARTICIPANTS:100 community-dwelling older adults with mild cognitive impairment in Huzhou, China. METHODS:Participants were randomly assigned to a trans-theoretical model-based health education program (weekly 45-60 min sessions for 8 weeks, followed by 12 weeks of unsupervised practice) or a wait-list control group receiving standard health education. Disease knowledge, behavioral stage, and adherence to health management behaviors were assessed at baseline, 8-week, and 20-week. Effects were evaluated at the group level via generalized estimating equation and at the individual level using reliable and clinically significant change. RESULTS:The trans-theoretical model-based health education program demonstrated significant effects over the wait-listed control. Generalized estimating equation analyses showed statistically significant effects on behavioral stage (β = 1.04, 95%CI = 0.34-1.75; β = 1.72, 95%CI = 0.95-2.49), disease knowledge (β = 1.14, 95%CI = 0.26-2.02; β = 1.78, 95%CI = 0.87-2.69), and adherence to health management behaviors (β = 6.20, 95%CI = 2.03-10.37; β = 10.74, 95%CI = 6.47-15.01) at both measured intervals. Additionally, global cognitive function (β = 0.60, 95%CI = - 0.18-1.38; β = 2.42, 95%CI = 1.64-3.20), Purdue Pegboard Test Assembly and Bimanual Tasks (β = 0.16/0.38, 95%CI = - 0.21-0.53/-0.18-0.94; β = 0.96/1.80, 95%CI = 0.57-1.35/1.17-2.43) improved significantly over time. Reliable and clinically significant change analyses at 8 weeks indicated significant improvements in the intervention group: 57 % of participants improved in disease knowledge (22 % clinically significant), 90 % in adherence to health management behaviors (17 % clinically significant), and 61 % in global cognitive function (10 % clinically significant). By 20 weeks, these rates increased to 63 % (29 %), 100 % (25 %), and 78 % (27 %). However, non-significant improvements in depression symptoms and sleep quality were found at individual-level assessment. CONCLUSIONS:This study shows that the trans-theoretical model-based health education program effectively enhances cognitive-behavioral health outcomes in older adults with mild cognitive impairment, with benefits persisting for 12 weeks. Future research should further explore the potential mechanisms underlying the cognition and behavior-enhancing effects of this program. REGISTRATION NUMBER:ChiCTR1900028351.
10.1016/j.ijnurstu.2024.104961
Sickness presenteeism, job burnout, social support and health-related productivity loss among nurses in the Chinese nurses' health cohort study (TARGET): A cross-sectional survey.
International journal of nursing studies
BACKGROUND:Sickness presenteeism has potential negative impacts on job burnout and health-related productivity loss among clinical nurses, whereas social support has been identified as a potential mitigating factor for such impacts. However, there is limited evidence regarding the relationships and mechanisms between sickness presenteeism, job burnout, social support, and health-related productivity loss. OBJECTIVE:To explore the role of job burnout and social support in the association between sickness presenteeism and health-related productivity loss among female nurses. DESIGN:A cross-sectional study. SETTING(S):105 hospitals conveniently selected from 36 cities in 15 provinces in China. PARTICIPANTS:50,653 registered female nurses. METHODS:This study utilizes the cross-sectional data from the baseline survey of the Chinese nurses' health cohort study (Towards A Revolution in GETting nurses' health ticked, TARGET), conducted from December 2020 to February 2024. Variables were measured using the Sickness Presenteeism Questionnaire, Stanford Presenteeism Scale, Maslach Burnout Inventory, and Perceived Social Support Scale. Data analyses were performed using independent sample t-tests, Pearson correlation analysis, one-way analysis of variance, multivariate linear regression analysis, and the Process 4.0 macro plug-in method. RESULTS:A total of 42,843 valid questionnaires were collected with an 85% response rate. The incidence of sickness presenteeism among female nurses was 62 %. Sickness presenteeism was positively correlated with job burnout and health-related productivity loss, and job burnout was also positively correlated with health-related productivity loss. Conversely, social support was negatively associated with sickness presenteeism, job burnout and health-related productivity loss. The findings showed that the association between sickness presenteeism and health-related productivity loss was partially mediated by job burnout. Moreover, the direct and indirect effects within the mediation model were moderated by social support. When levels of social support were high, the impact of sickness presenteeism on job burnout and health-related productivity loss was weaker, as was the impact of job burnout on health-related productivity loss. CONCLUSIONS:Hospital administrators and nurses themselves can mitigate the adverse effects of sickness presenteeism on health-related productivity loss by alleviating job burnout and increasing levels of social support. By addressing these significant challenges, they can more effectively manage the consequences of sickness presenteeism and job burnout among nurses. REGISTRATION:The protocol of TARGET was registered in the China Clinical Trial Registry (ChiCTR2100043202). TWEETABLE ABSTRACT:The study analyses TARGET data to explore the mechanisms between sickness presenteeism and health-related productivity loss.
10.1016/j.ijnurstu.2024.104962
Job satisfaction among hospital nurses: An updated literature review.
International journal of nursing studies
BACKGROUND:Nurses' job satisfaction has long been a global concern because of the critical significance it holds on nurse turnover and the quality and safety of patient care. OBJECTIVES:To perform an updated literature review of the newly emerging studies on job satisfaction among hospital nurses. DESIGN:Literature review. DATA SOURCES:Ten electronic database (PubMed, Web of Science, Embase, CINAHL, PsycINFO, Applied Social Sciences Index, CNKI, SinoMed, CQVIP, WanFang) were searched for studies published between September 2018 and May 2024. REVIEW METHODS:Studies were included if they published in English or Chinese and focused on job satisfaction of qualified general nurses working in acute care hospitals. Data extraction, synthesis and content analysis were performed. RESULTS:Of the 28,584 studies originally identified, 52 studies were included in the final review. Thirty-eight influencing factors and twenty-nine predictors of nurses' job satisfaction across the domains of demographic characteristics, individual cognition and behaviors, and working environment and management were newly added in this updated review. Sixty-five factors, which were further grouped into eight subcategorizations: demographic characteristics, personality traits, emotion, behaviors, psychological and cognitive factors, organizational climate, leadership and management, were additionally identified as related factors of nurses' job satisfaction. Factors relating to nurses' individual cognition and behaviors mainly played mediating roles in the mediating pathways linking various factors with job satisfaction. CONCLUSIONS:This review provides improved understanding of nurses' job satisfaction. Future studies could further explore the mechanisms by which factors relating to working environment and management predict or affect nurses' job satisfaction. The newly identified intrinsic factors from the mediating or moderating pathways offered valuable intervention insights for the improvement of nurses' job satisfaction.
10.1016/j.ijnurstu.2024.104964