Hematopoietic stem cell transplantation strongly affects the care of patients suffering from malignant hematologic disorders and the implementation of interventions such as continuous care can affect ...the outcomes of treatment in a positive way. The aim of the current study was to determine the effect of implementing a continuous care model on self-care behavior in patients receiving HSCT between 2019 and 2020 in Shariati Hospital affiliated to Tehran University of Medical Sciences.
This semi-experimental study was conducted on 48 patients who were considered as candidates for HSCT at the Hematology, Oncology and Stem Cell Transplant Research Center, Shariati Hospital. Participants for the present study were selected by the continuous care model based on the inclusion criteria. A 4-stage continuous care model (CCM) developed was used as an intervention in the study. A valid and reliable assessment questionnaire designed to measure the self-care behaviors of the patient (PHLP2) was used for the collection of demographic information. It was completed in the first and fourth stages of implementing the continuous care model. Data were analyzed using SPSS 22 software (Chicago, IL, USA). Moreover, the Chi-square test, pair t-test, and independent samples t-test were used in this study.
There was no statistically significant difference between the intervention and control group in terms of demographic variables (p>0.05). Prior to intervention, no statistically significant difference was observed in the mean self-care score among HSCT patients in the intervention and control group (p=0.590), while, after the intervention, a statistically significant difference was observed in the mean self-care score among HSCT patients in the intervention and control group (p<0.001).
The study concluded that due to the increase in the number of patients undergoing HSCT across the country in recent years as well as the ease of implementation and low cost of this strategy to promote the self-care of HSCT recipients, relevant authorities ought to do it with the proper planning and policy nationwide. According to the results of the study, the use of a continuous care model on self-care behavior in patients receiving HSCT is recommended.
ABSTRACT Objective: To analyze the care model in Primary Health Care from the perspective of access and comprehensive care. Method: Qualitative research, with data collected from May to December 2021 ...in each regional health center in the state of Paraná through recorded interviews using a semi-structured script with 26 managers. IRAMUTEQ software was used to process and group the data into five classes. The results were analyzed using dialectical hermeneutics. Results: Two classes showed actions related to the attributes of access and comprehensiveness present in the care model. Actions to increase access included the participation of a multi-professional team to promote comprehensive care and the use of technological resources while maintaining the biomedical model. Final considerations: During the pandemic, there was adaptation and resilience on the part of managers who organized the care model and the inclusion of technological tools to facilitate access and continuity of care.
RESUMEN Objetivo: analizar el modelo asistencial en Atención Primaria a la Salud desde la perspectiva del acceso y la atención integral. Método: investigación cualitativa, con datos recogidos de mayo a diciembre de 2021, en cada centro regional de salud del estado de Paraná, a través de entrevistas grabadas, utilizando un guion semiestructurado con 26 gestores. Se utilizó el software IRAMUTEQ para procesar y agrupar los datos en cinco clases. Los resultados se analizaron utilizando la hermenéutica dialéctica. Resultados: dos clases mostraron acciones relacionadas con los atributos de acceso e integralidad, presentes en el modelo de atención. Las acciones para aumentar el acceso incluyeron la participación de un equipo multiprofesional para promover la atención integral y la inclusión de recursos tecnológicos, manteniendo el modelo biomédico. Consideraciones finales: durante la pandemia, hubo adaptación y resiliencia por parte de los gestores que organizaron el modelo de atención, incluyendo herramientas tecnológicas para facilitar el acceso y la continuidad de la atención.
RESUMO: Objetivo: analisar o modelo assistencial na Atenção Primária à Saúde na perspectiva do acesso e integralidade do cuidado. Método: pesquisa qualitativa, com dados coletados no período de maio a dezembro de 2021, em cada regional de saúde do estado do Paraná, por meio de entrevistas gravadas, de roteiro semiestruturado com 26 gestores. Utilizou-se o software IRAMUTEQ para processamento e agrupamento dos dados em cinco classes. A análise dos resultados foi conduzida pela Hermenêutica dialética. Resultados: evidenciaram-se em duas classes ações relacionadas aos atributos acesso e integralidade, presentes no modelo assistencial. As ações para ampliação do acesso contaram com a participação de equipe multiprofissional na promoção da integralidade do cuidado e inserção de recursos tecnológicos, mantendo, porém, o modelo biomédico. Considerações finais: durante a pandemia, houve adaptação e resiliência por parte dos gestores que organizaram o modelo assistencial, a inclusão de ferramentas tecnológicas para facilitar o acesso e a continuidade do cuidado.
Aims and objectives
To elucidate the synergies between fundamental care and seminal nursing theories.
Background
Nursing theories are often criticised for their limited clinical relevance, with the ...existence of a theory‐to‐practice gap widely acknowledged. Pervasive examples of poor‐quality care, particularly for people's most fundamental needs, raise questions as to whether nursing theories sufficiently prioritise fundamental care. The Fundamentals of Care Framework (hereinafter “the Framework”) represents a valid, comprehensive and evidence‐based description of fundamental care. The Framework captures the complexity and multidimensionality of fundamental care delivery, predicated on the nurse–patient relationship; integration of physical, psychosocial and relational needs; and a supportive context. Despite strong face validity, the Framework's alignment with seminal nursing theories remains unexplored.
Design
Narrative review.
Method
Twenty‐nine seminal nursing theories were included. Categories for analysis were developed inductively and deductively, focusing on the themes of relationship, integration of care, context and the theories’ ease of use. Results are reported in accordance with PRISMA‐ScR guidelines.
Results
Though relationship, integration of care and context and were features shared across a number of nursing theories, no single theory depicts these collectively to the same extent as the Framework. In particular, integration of physical, psychosocial and relational aspects of care was found to be poorly described in the theories.
Conclusion
Failure to account for integration of care means that nursing theories continue to conceptualise fundamental care as a series of discrete tasks. To ensure relevance at the point of care, future nursing theories must accurately reflect the complexities of fundamental care delivery, specifically the need to integrate multiple care needs simultaneously, alongside being straightforward to apply in practice.
Relevance to clinical practice
Bridging the theory‐to‐practice gap requires a nursing discourse that is relevant at the point of care. We provide suggestions for how future nursing theories can bridge this gap.
Family-centered empowerment model (FCEM) is a concept that strengthens the family to help a chronic patient to obtain a better quality of life (QoL). The effects of FCEM on QoL of chronic patients ...are still inconclusive. Therefore, this meta-analysis was conducted to evaluate the effect of FCEM on QoL of adult patients with chronic diseases.
Following an online search PubMed/MEDLINE, Scopus, Web of Science, ProQuest, OVID, EMBASE, EBSCO, PsycINFO and Persian databases (Irandoc, IranMedex, SID and MagIran), all studies that tested the impact of FCEM on QoL of patients with chronic diseases were included. Cochrane Risk of Bias Tool was used to assessment the quality of included randomized clinical trials (RCTs) and before/after studies. Analyses were conducted by STATA16.
Six hundred and ninety-seven studies were identified for screening. After screening process, 11 eligible studies were included in this meta-analysis. There were significant intervention effects in all QoL dimensions, physical and mental subscales and QoL total score (All P < 0.05). The minimum lower bound for SMD was 0.61 (95%CI: 0.96 to 1.66), indicating an increasing effect of the intervention on all QOL dimensions. The results showed substantial heterogeneity between the studies for all QoL dimensions, physical and mental subscales and QoL total scores (P < 0.001).
FCEM is an appropriate model with a simple and effective application for families with a patient suffering from a chronic illness. Nursing education planners and healthcare providers could benefit from this model for improving the nursing education curriculum and accrediting programs.
•Having a person with a chronic disease affect the living of the other family members.•FCEM is a concept that strengthens the family to help a chronic patient for better quality of life•FCEM is an appropriate model with a simple and effective application for families with a patient suffering from a chronic illness.•Nursing education planners and healthcare providers could benefit from this model.
Background and Objectives: Heart Failure (HF) can cause poor quality of life (QoL). Self-care can lead to desirable outcomes in health. Orem’s self-care model is one of the methods that include ...patients in care and emphasizes self-care. This study aims to review various studies used Orem’s self-care model to assess the QoL of HF patients. Methods: This is a systematic review study that was conducted from October to December 2021. The search was conducted in Web of Science, MagIran, Irandoc, IranMedex, Information Database Scientific (SID), Scopus, Cochran, Google Scholar and PubMed databases for related studies in both Persian and English without time limit using the keywords heart failure, self-care, Orem, and QoL in Persian and English with “AND” and “OR” operators. The Critical Appraisal Skills Programme Checklist was used to check the quality of articles. Finally, of 865837 found articles,12 eligible articles were reviewed. Results: Based on Orem’s self-care model, the QoL of patients with HF was at a moderate level. QoL was significantly associated with age, gender, number of children, level of education, occupation, living in an urban area, ejection fraction, length of hospital stay, recreational activities, self-care behaviors, self-care education, management, self-confidence, functional capacity, underlying diseases, comorbidity, depression, anxiety, and personality type D. Conclusion: Considering the positive effect of using Orem’s self-care model on the QoL of patients with HF, health care providers are recommended to use this model to improve the QoL of patients with HF.
This article appraises models and theories related to advanced nursing practice. It argues that while the role of the advanced nurse practitioner builds on and extends beyond traditional nursing, it ...remains firmly grounded in 'caring'.
The stereotype that nurses 'care' and doctors 'cure' is fading. Increasingly, nurses have crossed boundaries and conducted independent assessment, diagnosis, prescribing and consultation, which used to be the doctor's role. Confusion and argument have arisen due to the higher-level practice of the advanced nurse practitioner, as many questions where these 'doctor nurses' stand.
A literature review.
Databases, including CINAHL, Medline and Google Scholar, were searched.
Databases were searched, and relevant studies and review articles from 1970 to 2023 were identified using the following keywords: 'advanced nurse practitioner', 'nurse practitioner', 'advanced nursing', 'advance practice', 'nurse practitioner', 'nursing theory' and 'nursing model'.
Although advanced nurse practitioners identify themselves as nurses, there is limited use of nursing theory to conceptualize this new level of practice and to define their contribution to the multi-disciplinary team. It is noted that a holistic approach to personalized patient care, based on therapeutic relationships and effective communication, may help us identify the unique contribution of the advanced nurse practitioner.
The development of advanced nursing theory needs to capture this holistic approach and its caring element to recognize the value and strengthen the identity allegiance of this hybrid role.
Holistic approach and patient-centred care, effective communication and the therapeutic relationship are strong characteristics relating to ANP practice, the latter of which is yet to be clearly defined and captured in nursing theories. Conceptualizing ANP practice and capturing their valuable nursing care will enable better understanding and clarity for the role to realize its full potential.
Primary continuity intensivists and nurses for long-stay patients (LSPs) in pediatric intensive care units (PICUs) are understudied strategies used to mitigate the fragmented care of typical rotating ...care models.
To investigate the advantages and disadvantages of primary continuity intensivists and nurses for LSPs as perceived by their parents and PICU providers.
We conducted a prospective cross-sectional mixed-methods study of the perspectives of parents whose children were admitted to a PICU for >10 days and had one or more complex chronic conditions regarding the care provided by their PICU intensivists and nurses. As part of a trial, patients had been randomized to care provided by a rotating on-service intensivist who changed weekly and by PICU nurses who changed every 12 hours (usual care group) or to care provided by the same on-service intensivist plus a primary continuity intensivist and primary nurses (primary group). In addition, PICU providers (intensivists, fellows, and nurses) were queried for their perspectives on primary intensivists and nurses. Novel questionnaires, assessed for content and face validity and for readability, were used. The parental questionnaire involved indicating their degree of agreement with 16 statements about their children's care. The provider questionnaire involved rating potential advantages of primary continuity intensivists and nurses and estimating the frequency of disadvantages. Descriptive statistics and divergent stack bar charts were used; parents' and providers' responses were compared, stratified by their children's group (usual care or primary) and provider role, respectively.
The parental response rate was 71% (120 completed questionnaires). For 10 of 16 statements, parents whose children had primary continuity intensivists and nurses indicated significantly more positive perceptions of care (e.g., communication, listening, decision making, problems due to changing providers). The provider response rate was 61% (117 completed questionnaires); more than 80% believed that primary intensivists and nurses were highly or very highly beneficial for LSPs. Providers perceived more benefits for patients/families (e.g., informational continuity, facilitating and expediting decision making) than for staff/institutions (e.g., staff satisfaction). Providers reported associated stress, expenditure of time and effort, and decreased staffing flexibility with primary practices.
Perceived benefits of primary continuity intensivists and nurses by both parents and providers support more widespread adoption and study of these continuity strategies.
Nursing professional practice models (PPMs) are known to have beneficial effects on nurse and patient outcomes. Determining what components should be present in a PPM, how to implement a PPM, and ...evaluating the outcomes associated with a PPM is less certain. Therefore, as part of a larger project to develop a nursing PPM for use within the United States Military Health System, this study aimed to conduct a systematic literature review on nursing PPMs. Specifically, the review sought to investigate components, implementation, and outcomes of PPMs in current literature. A total of 37 articles were included in the review. The literature supported the development of 12 recommendations for creating, implementing, and evaluating a nursing PPM. As health care facilities develop their own PPMs or reassess their current PPMs, findings from this review may assist hospital leadership by providing the most recent evidence on the strategic value of nursing PPMs in contemporary health care.
To deal with the upcoming challenges and complexity of the nursing profession, it is deemed important to reflect on our current organization of care. However, before starting to rethink the ...organization of nursing care, an overview of important elements concerning nursing care organization, more specifically nursing models, is necessary. The aim of this study was to conduct a mapping review, accompanied by an evidence map to map the existing literature, to map the field of knowledge on a meta-level and to identify current research gaps concerning nursing models in a hospital setting. Next to nursing models, two other organizational correlates seem to be of importance when looking at the organization of nursing care: nurse staffing and skill mix. Although it seems that in recent research, the theoretical focus on the organization of nursing care has been left behind, the increasingly complex healthcare environment might gain from the use of nursing theory, or in this case, care delivery models. As almost no fundamental studies have been done toward the combination of care delivery models, nurse staffing, and skill mix, those elements should be taken into account to fully capture the organization of nursing care in future research.
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