Aims
To evaluate the effects of eHealth cardiac rehabilitation (CR) on health outcomes of coronary heart disease patients and to identify programme design, which may lead to more effective health ...benefits.
Design
A systematic review and meta‐analysis following Cochrane Handbook for Systematic Reviews of Interventions.
Data sources
Medline, EMBASE, CLNAHL, Web of Science, Scopus, PsycINFO, Cochrane Central Register of Controlled Trails, PubMed and CNKI were searched over the period from 1806 to April 2019.
Review methods
A systematic review and meta‐analysis of randomized controlled trials to examine the effect of eHealth CR on health outcomes of coronary heart disease patients. We used RevMan 5.3 for risk of bias assessment and meta‐analysis and GRADE software for generating findings.
Results
In all, 14 trials with 1,783 participants were included. eHealth CR has significantly promoted duration of physical activity, daily steps, quality of life (QoL) and re‐hospitalization. Using comparative analysis of programme design elements, including mode of delivery, intervention content, motivational strategies and social support, between the effective and ineffective eHealth CR, it was found that comprehensive empowerment strategies and follow‐up care by tele‐monitoring may be the crucial characteristics leading to more favourable treatment effect.
Conclusion
eHealth CR is effective in engaging patients in active lifestyle, improving QoL and reducing re‐hospitalization. Future research needs to test the effects of comprehensive CR programmes by incorporating empowerment strategies and tele‐monitoring as active components.
Impact
eHealth has been increasingly applied to increase accessibility and uptake of CR. Integrative evidence to indicate its effects on health outcomes is lacking. This review identified its positive effects on some behavioural, psychosocial and health service use outcomes. Together with insights about which programme design elements may positively shape the outcomes, this review informs the role and practice of cardiovascular nurses in promoting evidence‐based eHealth CR.
目的
评价电子医疗心脏康复(CR)对冠心病患者健康结果的影响,并确定方案设计,以期带来更为有效的健康效益。
设计
根据《干预措施系统评估科克兰手册》开展系统评估与荟萃分析。
数据来源
通过Medline、EMBASE、CLNAHL、Web of Science、Scopus、PsycINFO、Cochrane 临床对照试验中心注册数据库、PubMed和中国知网数据库对1806年至2019年4月期间的文献进行检索。
评估方法
针对随机对照试验展开系统评估与荟萃分析,以研究电子医疗心脏康复对冠心病患者健康结果的影响。我们采用RevMan 5.3进行偏倚风险评估以及荟萃分析,同时应用GRADE软件生成发现结果。
结果
共纳入了14项试验,涉及1,783名受试者。电子医疗心脏康复可显著地提高体力活动时间、日常生活步数、生活质量(QoL)和再入院情况。通过对有效和无效电子医疗心脏康复之间的方案设计要素,包括释药行为、干预内容、激励策略和社会支持进行比较分析,结果发现综合授权策略以及远程监测的后续护理可能对产生更为有利的治疗效果起决定作用。
结论
电子医疗心脏康复可有效促使患者积极运动,提高生活质量,降低再住院率。今后的研究需将增强能力战略和远程监测作为有效方式来测试综合心脏康复方案的效果。
影响
电子医疗已不断应用于增加心脏康复的可及性和摄取量。尚无综合证据表明其对健康结果的影响。本次评估确定了其对某些行为、心理社会和卫生服务使用结果的积极影响。结合针对何种方案设计要素可能对结果产生积极影响的研究发现,本次评估说明了对心血管护士在促进循证电子医疗心脏康复方面的作用和实践。
Aims
To evaluate the current evidence that examined the effects of nurses’ work environment interventions on nurse, patient, and hospital outcomes; and the key intervention characteristics.
Design
...Quantitative systematic review without meta‐analysis.
Data Sources
Nine databases (British Nursing Index, CINAHL, EMBASE, Global Health, Global Health Archives, MEDLINE, Ovid Nursing, PubMed, and Web of Science) were searched following Systematic review Without Meta‐analysis guideline to elicit studies that examined effects of interventions aimed at improving nurses’ work environments among peer‐reviewed publications from inception to April 2019.
Methods
Database search used the following keywords: nurs*, patient, hospital, healthcare intervention, organizational improvement, nurs*adj4 outcome, patient adj4 outcome*, hospital adj4 outcome*, and their MeSH terms. The Cochrane's Risk of Bias in Non‐Randomized Studies of Intervention (ROBINS‐I) was used for quality appraisal. Donabedian model of Quality of Care was used as the framework to categorize interventions components focusing on structure and process aspects of the nurse work environments.
Results
The interventions included the use of accreditation process, educational strategies, and participatory approach. By defining the interventions which demonstrated positive effects on the nurse, patient, and hospital outcomes as effective, it appears that they are more consistently characterized as focusing on process improvement, adopting participatory approach, with greater involvement of frontline and nurse executives and at unit‐level implementation.
Conclusion
Although the heterogeneity in the design of the review studies precludes making conclusive insights on the best evidence to improve nurses’ work environments, the review informs the major research gaps in the topic area and the ways to design better interventions to enhance the outcomes.
Impact
The study provides insights on intervention components and strategies that can contribute to healthy nurse work environments. By adapting unit‐level process improvements that actively involve frontline and nurse executives, nurse leaders may provide a more directed approach towards achieving favourable outcomes.
目的
评估护士工作环境干预措施影响护士、患者和医院结果的现有证据；以及主要的干预特征。
设计
无荟萃分析的定量系统评估。
数据源
根据无荟萃分析的系统评估指南，检索了九个数据库，即英国护理索引（British Nursing Index）、CINAHL、EMBASE、全球健康（Global Health）、全球健康档案（Global Health Archieves）、MEDLINE、奥维德护理（Ovid Nursing），PubMed和科学网（Web of Science），旨在从一开始到2019年4月在同行评审的出版物中研究旨在改善护士工作环境的干预措施的效果。
方法
数据库搜索使用以下关键字：护理（nurs*）、患者（patient）、医院（hospital）、医疗保健干预（healthcare intervention）、组织改善（organization improvement），护理结果（nurs * adj4 outcome）、患者结果（patient adj4 outcome*）、医院结果（hospital adj4 outcome*）及其MeSH术语。科克伦（Cochrane）的非随机干预研究偏倚风险评估工具（ROBINS‐I）用于质量评估。以多纳贝德“护理质量”模型为框架，对关注护士工作环境的结构和过程方面的干预因素进行分类。
结果
干预措施包括使用认证程序、教育策略和参与式方法。通过将对护士、患者和医院结果产生积极影响的干预措施定义为有效的干预措施，这些干预措施的特点似乎更加一致：注重流程改进、采用参与式方法、一线护士和护士主管以及单位级别的更多参与。
结论
尽管回顾性研究设计的异质性使得无法对改善护士工作环境的最佳证据做出结论性的见解，但该综述揭示了主题领域的主要研究差距以及设计更好的干预措施以提高结果的方法。
影响
该研究提供了有关改善护士工作环境的干预措施和策略的见解。通过调整单位级流程改进，让一线护士和护士主管积极参与，护士领导可以提供更有针对性的方法来实现理想的结果。
Aims
To test the effect of a teamwork enhancement and quality improvement program named ‘Nurturing Effective Teams and Continuous Quality Improvement’ on nurses’ work environments in the hospital ...setting.
Design
Mixed‐method study with quasi‐experimental controlled trial and focus group interviews.
Methods
Twelve units from two Philippine tertiary government hospitals will be matched and allocated to have 72 nurses receiving the teamwork enhancement and quality improvement program, or no intervention. The program focuses on enhancing the nurse autonomy, leadership and management support, teamwork, and workload management, delivered in two phases: (a) teamwork enhancement training using team strategies and tools to enhance the performance and patient safety; and (b) implementation of quality improvement projects using the model for improvement to identify priority unit issues and change ideas and tested using the Plan‐Do‐Study‐Act cycle. The 6‐month implementation includes two trainings and seven mentoring sessions with a quality improvement facilitator. Primary outcome is the nurses’ work environment and secondary outcomes are job satisfaction, burnout risk, turnover intention, and perceived quality of care provided measured at the nurse‐level using self‐administered survey and measured at 0, 3, and 6 months. Focus group interviews will be conducted among 14–16 nurse subjects to explore their experience during the program, while other stakeholders will be interviewed to reflect the program effects. Generalized equation modelling will be used to identify the program effects on the quantitative outcomes and content analysis will be used for qualitative data.
Discussion
Establishing measures to improve the nurses’ work environments can be used to address poor nurse outcomes in high workload and low‐resource settings.
Impact
A favourable nurse work environment is the cornerstone to sustainable nursing workforce and positive outcomes. This study will provide explicit evidence to inform the effect of a structured evidence‐based protocol in improving nurses’ work environment given resource‐limited context.
Trial Registration: China Clinical Trial Registration Center (CciCTR), Registration number ChiCTR1900021754 (March 8, 2019).
目的
在医院环境下,探讨‘培育高效团队及持续提高素质’的增强团队合作与素质提高计划对护士工作环境的影响。
设计
准实验对照试验与焦点小组访谈相结合的混合方法研究。
方法
将对来自菲律宾两所三级公立医院的12个单位进行将进行匹配和分配,让72名护士接受增强团队合作与素质提高计划,或不进行干预。该计划的重点是加强护士的自主性、领导力和管理支持、团队合作和工作量管理,分两个阶段进行:(a)使用团队战略和工具进行增强团队合作培训,从而提高护士的表现和患者安全;(b)实施素质提高项目,使用素质提高模型确定优先单元问题和变更思路,并进行计划‐执行‐研究‐行动周期测试。此项目为期六个月,包括两次培训和七次的指导课程,以及一个素质提高指导老师。主要结果是护士的工作环境,次要结果是工作满意度、职业倦怠风险、离职倾向和感知护理质量,采用自我管理式调查在护士中进行测量,并在0、3和6个月进行测量。焦点小组访谈将在14‐16名护士受试者中进行,探索他们在项目期间的经验,而其他利益相关者将接受访谈以反映项目的效果。广义方程模型将用于确定项目对定量结果的影响,内容分析将用于定性数据。
讨论
制定改善护士工作环境的措施,可以解决高工作量、低资源环境下护士工作效果差的问题。
影响
良好的护士工作环境是可持续护理队伍和积极成果的基石。本研究将提供明确的证据,证明在资源有限的情况下架构式循证协议对改善护士工作环境的效果。
试验注册
中国临床试验注册中心(CciCTR),注册号:ChiCTR1900021754(2019年3月8日)
Defining compassionate nursing care Su, Jing Jing; Masika, Golden Mwakibo; Paguio, Jenniffer Torralba ...
Nursing ethics,
03/2020, Letnik:
27, Številka:
2
Journal Article
Recenzirano
Background:
Compassion has long been advocated as a fundamental element in nursing practice and education. However, defining and translating compassion into caring practice by nursing students who ...are new to the clinical practice environment as part of their educational journey remain unclear.
Objectives:
The aim of this study was to explore how Chinese baccalaureate nursing students define and characterize compassionate care as they participate in their clinical practice.
Methods:
A descriptive qualitative study design was used involving a semi-structured in-depth interview method and qualitative content analysis. Twenty senior year baccalaureate nursing students were interviewed during their clinical practicum experience at four teaching hospitals.
Ethical considerations:
Permission to conduct the study was received from the Institutional Review Boards and the participating hospitals.
Results:
Baccalaureate nursing students defined and characterized compassionate care as a union of “empathy” related to a nurse’s desire to “alleviate patients’ suffering,” “address individualized care needs,” “use therapeutic communication,” and “promote mutual benefits with patients.” Students recognized that the “practice environment” was characterized by nurse leaders’ interpersonal relations, role modeling by nurses and workloads which influenced the practice of compassionate care by nursing personnel.
Conclusion:
Compassionate care is crucial for patients, nurses, and students in their professional development as well as the development of the nursing profession. In order to provide compassionate care, a positive practice environment promoted by hospital administrators is needed. This also includes having an adequate workforce of nurses who can role model compassionate care to students in their preceptor role while meeting the needs of their patients.
Compassion is a core value of the nursing profession which enables nurses to empathize with and help alleviate patient suffering. Literature increasingly reports a lack of compassion in patient care ...by students and junior nurses; empirical knowledge regarding experiences of compassionate care among nursing students remains understudied. Student experiences in the clinical setting may influence their development of compassion competencies. This study explored the experiences of baccalaureate nursing students in gaining competencies to deliver compassionate care during their clinical practice year. A descriptive qualitative study using semi-structured in-depth interviews was conducted. Thematic analysis was employed, generating six themes. The first three themes depict positive aspects of compassion development, including ‘gaining patient acceptance,’ ‘motivation for professional growth,’ and ‘establishing an emotional bond with patients.’ On the other hand, the other three themes capture the barriers to compassionate care, ‘distrust,’ ‘fear of harm due to violence,’ and ‘heavy workload.’ The positive and negative experiences shared by students indicate that hospital and nursing administrators need to foster a positive practice environment and nursing instructors should become role models to encourage compassionate care.
•Providing compassionate care helps nursing students to gain acceptance by patients and be motivated for professional growth.•Students’ experiences of distrust, violence and heavy workload from patients and instructors hinder compassionate care.•Hospital and nursing administrators need to foster a positive practice environment.•Nursing instructors should be role models to promote compassionate care.
Sustainable human resources for health in supportive organizational environments are essential to optimizing healthcare services. Extensive evidence has reinforced the impact of healthy nurse work ...environments on patient safety, reduction of missed care and adverse events, reduction of hospitalization costs and stay, and nurses' job performance, burnout, satisfaction, and retention. However, there is limited evidence on specific strategies that are applicable in settings with heavy workloads and limited resources like nursing workforce source countries such as the Philippines. This study developed and investigated the effects of a teamwork enhancement and quality improvement program on the nurses' work environment (NWE), job satisfaction, burnout experience, intention to leave, and perceived quality of care provided; and explored the nurses' perceptions about the NWE improvement program and their experiences throughout the intervention period. A preliminary phase through a narrative synthesis identified the existing scope of knowledge on strategies to improve NWE in the hospital context and identified the more crucial design characteristics for more favorable outcomes. Phase 1 is a countrywide, cross-sectional, sequential mixed-methods study that explored the NWE in the Philippines. The Donabedian model of quality of care underpinned the association between the structural, process, and outcome aspects of NWE. In particular, this phase examined the ability of the more modifiable process variables to moderate between unfavorable effects of non-modifiable NWE structural variables on nurses' outcomes. Using a qualitative approach, this study also further explained how the NWE structural and process aspects shape the nurses' outcome. As informed by the results of Phase 1, insights from the preliminary narrative synthesis and literature review, an innovative program titled "Nurturing Effective Teamwork and Continuous Quality Improvement" (NET-CQI) program was developed to improve the NWE. The program involved a teamwork enhancement training using Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS 2.0®), and the implementation of quality improvement projects using the Model for Improvement to identify priority unit issues and change ideas, and tested using the Plan-Do-Study-Act cycle focused at enhancing nurse autonomy, leadership and management support, teamwork, and workload management. Phase 2 was a quasi-experimental study that examined the effects of NETCQI on overall NWE. The changes in various outcomes between the two study groups over six months were compared using the Generalized Estimating Equation (GEE) model. These include the outcomes of nurse's job satisfaction burnout, perceived quality of care, and its impact on the nurses' autonomy, perception towards the received leadership and management support, and nurses' relationship with physicians. For the preliminary phase, the systematic review included 14 studies on interventions aimed at improving NWE. Initiatives were categorized into educational, accreditation, and participatory approaches. Based on the Donabedian model's ability to explore how the intervention characteristics related to the outcome, the review found that intervention that used a participatory approach as a unit-based strategy to strengthen the process aspects of NWE appeared to be more effective against outcomes. Specifically, the use of the participatory approach was able to enhance nurses' job satisfaction, autonomy and leadership, reduce turnover intent and nurse overtime, enhance patient satisfaction and decrease injuries related to falls and medication errors. Understanding that NWE improvement interventions are context-specific, Phase 1 sought to understand the context of NWE in Philippine government hospitals where the succeeding phase planned for intervention testing. The study recruited 990 nurses from seven randomly selected end-referral hospitals across the archipelago, with the response rate as 75.47%. The NWE was fair and characterized by an exceedingly high bed occupancy rate, understaffing, moderate patient acuity, meager salary, low professional autonomy, and limited management support, with at least 25% intended to leave in the next six months. However, nurses did not perceive themselves as burned out and had moderate job satisfaction. Moderation analysis indicated that NWE process characteristics of nurse autonomy and good nursephysician relations were able to moderate the high patient acuity toward the improved perceived quality of care. Qualitative findings generated six key themes to describe the NWE. The themes include: (a) 'Self-initiated coping for heavy workload jeopardized patient safety and quality of care'; (b) 'Professional status threatened by the unsafe and unhealthy work environment.'; (c) 'Unfair work arrangement and employment status weaken the nurse' desire to stay.'; (d) 'Rigid hierarchical organization culture that aggravates job stress and worsens collegial relationship.'; (e) 'Unresolved internal conflict relating to heavy workload triggers burnout; and (f) Sense of meaning and fulfillment in the journey of professional development and practices. Mixed-methods analysis using meta-matrix confirms the congruence of the generated themes across nurse levels and supported by quantitative analysis results. As for the Phase 2 study, 71 nurses from 13 matched units received NETCQI, while others (n = 70) received usual care. The mean age of the nurses at 35 years (SD ± 9.35), with 62.41% permanently employed, working for an average of 7.65 years, with an average workload of 15 patients per shift, and spending 1 hour on overtime. The attrition rate was 13.46%. At baseline, study groups significantly differed on nurses’ characteristics educational attainment (p = 0.004), engagement in life-long learning (p = 0.037) and nursing position (p = 0.045) favoring the control group. Contradictory to the hypothesis, the results indicated that the NET-CQI did not significantly improve the nurse outcomes and process aspects of NWE over the six-month evaluative period. Process evaluation showed that the experience of the sudden increase in workload due to staffing changes and the experience of a disease outbreak among the intervention group midway through the intervention implementation, as well as organization-level improvements in the control units, might have contributed to the non-significant effects. Nevertheless, the qualitative data indicated that the nurses who participated in the NET-CQI experienced increased professional autonomy, support from nursing leadership and hospital management, and enhanced relationships with physicians. Apart from the high acceptability of the NET-CQI program, nurses in the intervention groups cited heavy workload, poor staffing, and conflicting priorities as major barriers to the implementation of the NET-CQI project. At the same time, QI mentorship and training, and support from hospital administration were facilitators. The findings indicate the acceptance and feasibility of NET-CQI in a workload-burdened health care setting in the Philippine. Despite issues on contextual conduciveness due to threats of history have generated bias in the study findings of lack of statistically significant effects on NWE, the positive narratives from the nurses still imply the potential of the NET-CQI program in improving the process and outcome aspects of NWE. Future studies may need to investigate its more longterm effect with a larger sample in an administratively more stable environment.
