Use and impact of virtual reality simulation in dementia care education: A scoping review

BackgroundCommunication and empathy are considered as key competences in the care of persons with dementia. Virtual reality might be an effective intervention to train informal and professional caregivers of persons with dementia in order to improve their communication skills and empathy.ObjectivesThe aim of this study was to map the use and impact of virtual reality simulation in dementia care education.MethodA scoping review was performed. Studies with all types of qualitative or quantitative design published since 2007 in English, French or German were included if a virtual reality intervention was examined in a dementia care education setting (e.g. nursing school, caregiver training). The literature search was conducted in six databases (MEDLINE, CINAHL, PsycINFO, Web of Science Core Collection, ERIC, and Inspec), including an additional hand search as well as backward and forward citation tracking of included studies. Charted data was narratively reported by clustering results according to study characteristics and impact of virtual reality.ResultsThe review process resulted in the inclusion of six studies published between 2012 and 2017. Two of them are ongoing studies. Three studies had a one group pre-post-test design and in one study a post-test only design was applied. The samples consisted of caregivers of people with dementia as well as students and varied in size between seven and 126. Eight different outcomes were measured, e.g. empathy, competence, and stress. Interventions resulted in improvements of caregivers' and students' empathy and competences among other outcomes.ConclusionsNo studies with controlled design and group comparisons are available yet. There are some indications that virtual reality might be an effective intervention to train caregivers of persons with dementia. Little is known about the use and impact of virtual reality in dementia-related education. Since studies are rare and do not address effectiveness, the findings of this review can substantially contribute to guide further research on this topic.     

Integrative Review of Nurse-delivered Community-Based Physical Activity Promotion

PurposeThe purpose of this integrative review is to 1) describe intervention attributes, 2) describe the role of nurses in community PA promotion, and 3) describe the efficacy of the interventions in terms of PA behavior change.MethodsComputerized database and ancestry search strategies located distinct intervention trials between 1990 and 2015.ResultsThirteen national and international studies with 2,353 participants were reviewed. Multi-dose, face-to-face, group-based interventions with or without individual-based contacts for 6 months or less were the most common intervention delivery modes. Only 40% (n = 5) of the studies integrated health behavior theory into intervention design. Less than half of the studies demonstrated efficacy in increasing PA.ConclusionsResults suggest that group-based community interventions, such as exercise classes, group walking and group education/counseling, may be more effective in increasing PA compared to individual-based education. Additional rigorously designed studies are warranted to explore the indicators for successful community-based PA promotion.     

Increasing value and reducing waste by optimizing the development of complex interventions: Enriching the development phase of the Medical Research Council (MRC) Framework

BackgroundIn recent years there has been much emphasis on ‘research waste’ caused by poor question selection, insufficient attention to previous research results, and avoidable weakness in research design, conduct and analysis. Little attention has been paid to the effect of inadequate development of interventions before proceeding to a full clinical trial.ObjectiveWe therefore propose to enrich the development phase of the MRC Framework by adding crucial elements to improve the likelihood of success and enhance the fit with clinical practiceMethodsBased on existing intervention development guidance and synthesis, a comprehensive iterative intervention development approach is proposed. Examples from published reports are presented to illustrate the methodology that can be applied within each element to enhance the intervention design.ResultsA comprehensive iterative approach is presented by combining the elements of the MRC Framework development phase with essential elements from existing guidance including: problem identification, the systematic identification of evidence, identification or development of theory, determination of needs, the examination of current practice and context, modelling the process and expected outcomes leading to final element: the intervention design. All elements are drawn from existing models to provide intervention developers with a greater chance of producing an intervention that is well adopted, effective and fitted to the context.ConclusionThis comprehensive approach of developing interventions will strengthen the internal and external validity, minimize research waste and add value to health care research. In complex interventions in health care research, flaws in the development process immediately impact the chances of success. Knowledge regarding the causal mechanisms and interactions within the intended clinical context is needed to develop interventions that fit daily practice and are beneficial for the end-user.     

Theories underlying health promotion interventions among cancer survivors

OBJECTIVES: To review the theories that have been the basis for randomized controlled trials (RCTs) promoting health behavior change among adults diagnosed and treated for cancer. DATA SOURCES: Electronic databases and recent review papers. CONCLUSION: Several theories have been used in intervention development: Transtheoretical Model, Motivational Interviewing, Social Learning and Social Cognitive Theory, Theory of Planned Behavior, and Cognitive Behavioral Theory. There is support for the efficacy of some of these interventions. However, there has been limited assessment of theory-based constructs and examination of the mediational role of theoretical constructs in intervention efficacy. IMPLICATIONS FOR NURSING PRACTICE: There is a need to apply theory in the development of interventions to assess the effects of the intervention on the constructs and to conduct mediational tests of these constructs.     

Rationale and design of Smart Walk: A randomized controlled pilot trial of a smartphone-delivered physical activity and cardiometabolic risk reduction intervention for African American women

BackgroundAfrican American (AA) women perform low levels of physical activity (PA) and are disproportionally burdened by cardiometabolic disease conditions when compared to White women and the U.S. population as a whole. These disparities emphasize the need for innovative and effective interventions to increase PA and reduce cardiometabolic disease risk among AA women. Recent evidence suggests that mobile health (mHealth) interventions have the potential to increase PA and reduce cardiometabolic disease risk factors. Few studies have examined the efficacy of mHealth PA interventions among racial/ethnic minorities, including AA women. This represents a missed opportunity given the reported success of technology-delivered PA interventions in predominately White populations and the high use of technology among AA women.ObjectiveTo describe the design, theoretical rationale, and cultural relevance of Smart Walk, a culturally sensitive smartphone-delivered PA intervention for AA women.Design and methodsSmart Walk is an 8-month, randomized controlled pilot trial designed to increase PA and reduce cardiometabolic disease risk among AA women. Sixty physically inactive AA women with obesity will be assigned to receive either a culturally relevant intervention designed to increase PA (by targeting leisure-time, household chore/task-related, and occupational PA) or a culturally relevant wellness attention-matched control condition. Outcomes will be assessed at baseline, 4 months, and 8 months, and include feasibility and acceptability of the PA intervention and evaluation of effects on PA and cardiometabolic risk factors.SummarySmart Walk represents a culturally relevant, theory-based approach to promote PA and reduce cardiometabolic disease risk in AA women.     

Effectiveness of primary healthcare educational interventions undertaken by nurses to improve chronic disease management in patients with diabetes mellitus,hypertension and hypercholesterolemia: A systematic review

BackgroundDiabetes, hypertension and hypercholesterolemia are important chronic health problems that are becoming increasingly frequent worldwide. Educational interventions are a challenge for health teams. Nurses play a major role in overall health by providing educational interventions to help improve self-management outcomes.ObjectivesTo evaluate the effectiveness of primary health care educational interventions undertaken by nurses to improve metabolic control and/or chronic disease management in individuals with Type 2 diabetes mellitus, hypertension, and hypercholesterolemia.MethodsThe methodology drew on systematic review without meta-analyses, methods developed by the Cochrane Collaboration. Elements related to content were chosen following the PRISMA statement. The databases of Pubmed, Web of Science, CINAHL, PsycInfo, Cuiden, Enfispo, and the Cochrane Library were consulted. Reference lists from relevant articles were also examined for additional references. Three authors independently assessed eligibility of studies for inclusion. A review of randomised controlled trials published between 2000 and 2015 was undertaken. Furthermore, an analysis of selected studies was carried out, in which nurses actively participated in the implementation of educational interventions in primary health care centres in order to improve control and chronic disease management in Type 2 diabetes mellitus, hypertension and hypercholesterolemia.ResultsOut of the 20 studies included in the systematic review, one had a low risk of bias, 14 an uncertain risk of bias, and five a high risk of bias. Although several studies showed significant changes in the measured variables, few significant differences were maintained over time, observed only in metabolic indicators and clinical variables more than in lifestyle behaviour. In addition, although most of the studies dealt with issues related to lifestyle behaviours such as nutrition, physical activity, and tobacco and alcohol use, few measured changes after the intervention. Finally, the difficulty in comparing the studies included in the review laid in the heterogeneity in educational strategies, the evaluation methods used, and the disparity of assessment tools, which made it difficult to establish the characteristics of the most effective interventions during the time of treatment for diabetes, hypertension, and hypercholesterolemia.ConclusionsAlthough there are numerous interventions that aim to control diabetes, hypertension, and hypercholesterolemia, the observation was that the results obtained are difficult to maintain over time. Therefore, it is necessary to continue to create high-quality interventions, with a low risk of bias and based on solid theoretical frameworks, not only to treat current symptoms of the disease but also to help prevent cardiovascular disease.     

Can physical activity be used to maintain cognitive function in nursing home residents with dementia? A literature review

Background: Dementia is a noncommunicable disease with no effective prevention, treatment or cure. Evidence is emerging for the use of exercise to decelerate cognitive decline; however, few studies exist among nursing home residents and an optimum exercise protocol is yet to be determined.

Objectives: To determine the effectiveness of physical activity in maintaining cognitive function in nursing home residents with dementia.

Methods: Databases searched included CINAHL, MEDLINE complete, SPORTDiscus and ScienceDirect. Six relevant studies were identified and critically appraised using the Effective Public Health Practice Project Quality Assessment Tool.

Results: All trials included different exercise programmes with various activity types and duration; all control interventions were social activities. Three studies demonstrated improved cognition in the intervention group, whilst one study observed a slower decline. Four studies found statistically significant cognitive decline in the control groups. Two studies observed no significant changes in either the intervention or control groups. Overall, there is moderate evidence that physical activity can effectively maintain cognitive function in nursing home residents with dementia.

Conclusions: All interventions had a favourable effect on cognition. Results suggest that aerobic exercise of longer duration may be most effective for those with mild-to-moderate cognitive impairment; whilst multimodal programmes may be most effective for moderate-to-severe dementia. Combining an exercise programme with standard daily activities appears no more effective than exercise alone. Future research should aim to determine an optimum exercise protocol and whether the positive effects on cognition can be maintained long term with continued exercise.     

Interventions to prevent and manage overweight or obesity in preschool children: A systematic review

ObjectivesThe preschool period is a pivotal time for lifestyle interventions to begin the establishment of long-term physical activity and healthy eating habits. This systematic review sought to (a) examine the effects of prevention and management interventions on overweight/obesity among children aged 2–5 years, and (b) explore factors that may influence intervention effects.DesignA systematic review of randomized controlled studies was conducted.Data sourcesSix databases, including PubMed, CINAHL, EMBASE, PsycINFO, ERIC, and Cochrane library, were searched for relevant studies.Review methodsData were extracted and checked by two reviewers. Each study was appraised based on 4 quality indicators adapted from the Cochrane Handbook for Systematic Reviews of Interventions. A narrative summary technique was used to describe the review findings.ResultsThirty-seven articles describing 32 randomized controlled trials and 29 unique interventions were retained. Eight of 23 prevention and 4 of 6 management interventions resulted in significant weight loss, with 3 prevention and 5 management interventions showing sustained effects over 6 to 24 months. Of the 12 efficacious interventions, 10 included physical activity and nutrition components, 9 actively involved parents, and only 4 were theory-based. Interactive education was the most common strategy used for parents in prevention interventions, compared to behavioral therapy techniques in management interventions. For children, interactive education and hands-on experiences involving physical activity and healthy eating were equally used.ConclusionsManagement interventions showed greater effects in weight loss compared to prevention interventions. Future prevention interventions in preschool children should target both parents and children, and focus on physical activity and nutrition through interactive education and hands-on experiences, although intervention effects were less than optimal. Management interventions should focus on parents as the “agents of change” for physical activity and nutrition while integrating behavioral therapy techniques and interactive education.     

The Effectiveness of Telenursing Interventions on Patient Outcomes for Colorectal Cancer Patients: A Systematic Review and Meta-Analysis

ObjectiveTo systematically review existing telenursing interventions for patients with colorectal cancer and determine the effects of such interventions on health-related quality of life and health care service utilization.Data SourcesWe conducted a systematic review and meta-analysis after protocol registration. International databases, including PUBMED, EMBASE, CINAHL, Web of Science, SCOPUS, and CENTRAL and Korean databases, were searched. The last search was conducted on June 8, 2021. Two authors independently selected relevant studies, evaluated their methodological quality, and extracted data. A meta-analysis of randomized controlled trials was conducted using the statistical software STATA 16.0. Of the 223 articles retrieved, 7 were included for narrative synthesis and 3 were used for the meta-analysis. There were 857 patients in the telenursing group and 842 patients in the conventional group. Three studies applied theoretical frameworks for designing the intervention.ConclusionThe effect of telenursing intervention was not different from that of usual care. However, both readmission rates and emergency department visits were lower in the telenursing group than in the usual care group, although these trends were not statistically significant.Implications for Nursing PracticeThese findings indicate that telenursing intervention did not differ from usual care in terms of health-related quality of life while reducing readmission and emergency department visits in a nonstatistically significant manner. Therefore, telenursing interventions could serve as a partial alternative to current face-to-face interventions for patients with colorectal cancer.     

Effects of coping skills training in school‐age children with type 1 diabetes

Children with type 1 diabetes are at risk for negative psychosocial and physiological outcomes, particularly as they enter adolescence. The purpose of this randomized trial (n = 82) was to determine the effects, mediators, and moderators of a coping skills training intervention (n = 53) for school‐aged children compared to general diabetes education (n = 29). Both groups improved over time, reporting lower impact of diabetes, better coping with diabetes, better diabetes self‐efficacy, fewer depressive symptoms, and less parental control. Treatment modality (pump vs. injections) moderated intervention efficacy on select outcomes. Findings suggest that group‐based interventions may be beneficial for this age group. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32: 405–418, 2009     

Development of an obesity prevention and management program for children and adolescents in a rural setting

This study applied theory-based health behavior change constructs to childhood obesity prevention. Constructs such as goal setting, self-efficacy, and readiness for change were used within a rural community-based program designed to be developmentally appropriate for 6th graders. The project included 2 studies across 12 months. The 1st assessed the scope of the obesity problem within a 3-county area with key stakeholders in health and education. The 2nd implemented a pilot community intervention program within a rural middle school. Participants in the intervention included 65 middle-school students and the families of 25 of these students. Qualitative and quantitative analyses were conducted to assess the effectiveness of the intervention. Changes from pre- to postintervention on relevant measures were statistically significant for families but not for students. Issues related to family versus individual behavior change are discussed, along with implications for managing behaviorally based activity and nutrition interventions within a rural community.     

Chronic disease interventions for people with visual impairment: A systematic review

AimTo identify the characteristics of chronic disease interventions for people with visual impairment (PVI) and provide suggestions for future interventions.BackgroundChronic diseases are more common in PVI than people without visual impairment, and PVI have difficulty managing chronic diseases due to physical, social, and psychological problems associated with visual impairment. However, evidence regarding chronic disease intervention for PVI is limited.MethodsThis review was guided by the PRISMA methodology. Data were extracted and checked, and each study was evaluated to ensure their methodological quality using appropriate tools based on the study design. Findings were described through a qualitative synthesis, and the above process was carried out by all four researchers.Results28 studies were selected. The intervention for mental disorders was the most common with about 39.3%, followed by stroke (25.0%), diabetes (17.8%), various chronic diseases (10.7%), chronic pain (3.6%), and scoliosis (3.6%). Most of the intervention was delivered individually, and the place of intervention often depends on the preference or convenience of PVI. A wide range of intervention materials was used, from large print, audio, or braille version reading materials to technology products. Based on the results, the main areas of the outcomes were daily living function, psychological conditions, and quality of life.ConclusionsThis review identified the components of interventions for PVI and provided intervention strategies. In particular, chronic disease interventions for PVI should be planned by considering how and where appropriate interventions are provided, various available materials, and the problems to be addressed.     

The effectiveness of traditional Chinese medicine-based lifestyle interventions on biomedical,psychosocial, and behavioral outcomes in individuals with type 2 diabetes: A systematic review with meta-analysis

BackgroundIntegrative diabetes care, which combines conventional diabetes therapy with traditional Chinese medicine (TCM)-based interventions, has gained popularity worldwide. Numerous TCM-based lifestyle modification approaches have been proposed for individuals with type 2 diabetes (T2DM).ObjectivesTo synthesize and present the best available evidence on the effectiveness of TCM-based lifestyle interventions in individuals with T2DM.DesignWe undertook a systematic review of randomized controlled trials or controlled clinical trials.Data sourcesSix English and four Chinese electronic databases were searched from their inceptions to December 2016.Review methodsTrials investigating the effectiveness of various TCM-based lifestyle interventions among adults with T2DM were reviewed. Studies were excluded if TCM-based lifestyle interventions were only part of the intervention regimen. Two reviewers independently selected studies according to pre-specified inclusion and exclusion criteria and appraised the risk of bias of the included studies. One reviewer extracted details of the included studies and the second reviewer checked the extracted data critically. When feasible, data were statistically pooled for meta-analysis. Otherwise, narrative summaries were used.ResultsTwenty-four studies were included. The pooled analysis of the eight studies on tai chi showed tai chi practice for at least 150 min per week was beneficial in lowering glycosylated hemoglobin (mean difference, −1.48%; 95%CI, −2.58% to −0.39%; p < 0.001). Tai chi was effective in reducing fasting blood glucose (mean difference, −1.14 mmol/L; 95%CI, −1.78 to −0.50 mmol/L; p < 0.001) and body mass index (mean difference, −0.62; 95%CI, −1.14 to −0.11; p = 0.02), and improving quality of life. The effects of tai chi on blood pressure and waist circumference were inconclusive due to the limited number of studies. The meta-analysis of the 12 studies on ba duan jin demonstrated beneficial effects on glycosylated hemoglobin (mean difference, −0.77%; 95%CI, −0.97% to −0.56%; p < 0.001), fasting blood glucose (mean difference, −0.82 mmol/L; 95%CI, −1.05 to −0.59 mmol/L; p < 0.001), body mass index (mean difference, −2.77; 95%CI, −4.11 to −1.43; p < 0.001), and depression (mean difference, −4.53; 95%CI, −7.12 to −1.94; p < 0.001). Conclusions on the effects of ba duan jin on quality of life cannot be drawn because only two studies measured the outcome. Evidence regarding the effectiveness of other TCM-based lifestyle interventions is limited.ConclusionsTai chi and ba duan jin are potentially effective options for individuals with T2DM to improve biomedical and psychosocial well-being. Further well-designed studies are needed to explore the optimal intervention dose and to investigate the effectiveness of other TCM-based lifestyle interventions.     

Patient,family-centred care interventions within the adult ICU setting: An integrative review

ObjectivesPatient, Family-Centred Care (PFCC) is internationally advocated as a way to improve patient care. The aim of this integrative review was to extend the knowledge and understanding by synthesising empirical evidence of PFCC interventions within the adult intensive care unit (ICU) setting.Review method usedAn integrative review methodological framework was employed, permitting the inclusion of all research designs. A comprehensive and systematic search, selection, quality appraisal, and data extraction of research were conducted to synthesise knowledge and identify research gaps.Data sourcesA systematic search of the following databases was conducted: MEDLINE; CINHAL; PsycINFO; Cochrane Library; Web of Science—Current Contents Connect; Web of Science—Core Collection; The Joanna Briggs Institute EBP Database; ProQuest Sociological Abstracts; and ProQuest Dissertation and Theses Global. Primary research in adult ICUs was included.Review methodsData extracted from the studies included authors, year, country of origin, design, setting, sample, intervention, data collection strategies, main findings and limitations. Study quality was assessed using the Mixed Methods Appraisal Tool.ResultsForty-two articles met the inclusion criteria and were included in the review. Only a third of the papers stated the theory underpinning their study. Three themes emerged with interventions predominantly around Interacting with the target sample; Culture and Connection and Service Delivery interventions were also identified. Few studies integrated more than one dimension of PFCC.ConclusionsResearch into PFCC interventions is diverse; however, few researchers present a multi-dimensional approach incorporating a culture shift to enact PFCC throughout the ICU trajectory. There is an opportunity for future research to describe, develop, and test instruments that measure PFCC based on its multiple dimensions and not on one component in isolation. Importantly, for PFCC to successfully individualise quality patient care, a commitment and enactment of partnerships between health care professionals, patients, and family members is imperative.     

Are noise reduction interventions effective in adult ward settings? A systematic review and meta analysis

ObjectiveHigh levels of environmental noise in hospitals disturbs sleep. We aimed to identify, critically appraise and summarise primary research that reports studies that tested interventions to reduce night-time noise levels in ward-settings.DesignSystematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Data sourcesKey health-related and specialist acoustic databases (CINAHL, EMBASE, MEDLINE, The Cochrane Library, PsycINFO, NHS Evidence, Knovel, Journal of the Audio Engineering Society, Journal of the Acoustical Society of America, IEEE Xplore Digital Library, Acta Acustica and Acoustics in Practice) were searched from their inception to April 2017, with no language restrictions.Review methodsExperimental, quasi-experimental and observational study designs assessing the effect of noise reduction interventions on patient outcomes and/or environmental noise levels were included. Two reviewers independently conducted a quality appraisal using a published framework.ResultsIn total, 834 records were identified with nine studies meeting inclusion criteria. Quality appraisal showed that the level of evidence was generally weak. A range of noise reduction interventions were identified: one study implemented a single intervention, whilst the remainder were complex, multi-faceted interventions. Findings from individual studies showed mixed results but preliminary evidence suggests that noise reduction interventions can reduce environmental noise levels in ward settings and improve patients' sleep ratings. Quantitative data from 6 studies were pooled. A random effects meta-analysis determined that a synthesised estimate for the standardised mean difference in total hours sleep (no intervention – intervention) was −0.11 h (95% CI −0.46 to 0.25 h; p = 0.556), with moderate statistical heterogeneity. A random effects meta-analysis determined that a synthesised estimate for the standardised mean difference in awakenings per night (no intervention – intervention) was 0.05 (95% CI −0.20 to 0.29; p = 0.715), with negligible statistical heterogeneity. A random effects meta-analysis determined that a synthesised estimate for the odds ratio for disturbed nights (no intervention: intervention) was 0.75 (95% CI 0.55 to 1.01; p = 0.059), with low statistical heterogeneity.ConclusionsIndividual studies show that noise reduction interventions are feasible in ward settings and suggest they have potential to improve patients' in-hospital sleep experiences. However meta-analyses show insufficient evidence to support the use of such interventions at present. There is a lack of appropriately designed studies to test intervention effectiveness. Robust studies are required to identify the most effective interventions to address this significant and ubiquitous problem.What is known about the topic

• •Noise levels in hospital impact on quantity and quality of sleep and patient experience.
• •Disturbed sleep can have a detrimental impact on health and extend patient recovery.
• •Noise reduction interventions do not receive the priority they deserve.

What this paper adds

• •A comprehensive review of noise reduction interventions used in general ward settings.
• •Noise reduction interventions show the potential to reduce environmental noise and improve patient sleep ratings.
• •Appropriately designed studies are required to provide definitive evidence to demonstrate the effectiveness of noise reduction intervention in ward settings.

     

Effectiveness of knowledge translation interventions to improve cancer pain management

ContextCancer pain is prevalent, yet patients do not receive best care despite widely available evidence. Although national cancer control policies call for education, effectiveness of such programs is unclear and best practices are not well defined.ObjectivesTo examine existing evidence on whether knowledge translation (KT) interventions targeting health care providers, patients, and caregivers improve cancer pain outcomes.MethodsA systematic review and meta-analysis were undertaken to evaluate primary studies that examined effects of KT interventions on providers and patients.ResultsTwenty-six studies met the inclusion criteria. Five studies reported interventions targeting health care providers, four focused on patients or their families, one study examined patients and their significant others, and 16 studies examined patients only. Seven quantitative comparisons measured the statistical effects of interventions. A significant difference favoring the treatment group in least pain intensity (95% confidence interval [CI]: 0.44, 1.42) and in usual pain/average pain (95% CI: 0.13, 0.74) was observed. No other statistical differences were observed. However, most studies were assessed as having high risk of bias and failed to report sufficient information about the intervention dose, quality of educational material, fidelity, and other key factors required to evaluate effectiveness of intervention design.ConclusionTrials that used a higher dose of KT intervention (characterized by extensive follow-up, comprehensive educational program, and higher resource allocation) were significantly more likely to have positive results than trials that did not use this approach. Further attention to methodological issues to improve educational interventions and research to clarify factors that lead to better pain control are urgently needed.