Which public health approach to palliative care? An integrative literature review

Background: Public health and palliative care are both broad disciplines with blurred boundaries. There is growing support for an alignment of palliative care to public health. Given the novel nature of this alignment and the ambiguity of the parent definitions, there is an understandable lack of clarity around this merged model.

Methods: The aim of this study is to describe the theoretical features of the public health approach to palliative care as articulated in the current research literature. An integrative literature review was conducted using systematic methods to identify qualitative and quantitative studies that expressly support such an approach.

Results: The search identified 18 studies. A thematic synthesis of these studies identified three different paradigms of a public health approach to palliative care within the current empirical research. These were defined as a health-promotion approach focussed on empowerment at community level, a World Health Organisation approach which focussed on systems at country level, and a population-based approach which typically viewed palliative care issues from an epidemiological perspective.

Conclusion: This review highlights that the public health approach to palliative care is understood in various ways. It is important that future research studies clarify which public health approach they are referring to.     

An integrative literature review of pre-registration nursing students’ attitudes and perceptions towards primary healthcare

BackgroundThere is a renewed focus on the role of primary healthcare within the health system due to an ageing population, increasing cost of acute healthcare services, and an emphasis on developing healthier communities. Associated with this focus is the need for an increase in primary healthcare workforce capacity. Despite this, primary healthcare is rarely prioritised within the pre-registration nursing curricula. By understanding the perspectives and experiences of student nurses regarding clinical placement in primary healthcare, educators and industry will be better informed to support the student nurse within this setting.AimThe aim of this integrative literature review was to identify the established knowledge regarding the attitudes, perceptions and experiences of student nurses attending clinical placement within primary healthcare.MethodsA search of electronic databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), Pubmed, Proquest, Informit, Scopus, Clinical Key and Google Scholar was undertaken. The review included papers over a 10 year period; January 2007 to December 2017. Quality evaluation was undertaken using a Mixed Methods Appraisal Tool and the selected papers were then analysed thematically.FindingsAnalysis identified two interrelated themes. The first theme primary healthcare clinical experience is comprised of three sub themes; learning on placement, context of care, and support on placement. This theme discusses students understanding of primary healthcare practice and learning. The second theme attitudes towards primary healthcare also comprises three sub themes including focus on acute care, usefulness of placement, and autonomy in practice. This theme highlights the varied perspectives and attitudes pre-registration student nurses hold towards nursing within primary healthcare and their clinical placement experience.ConclusionStudent nurses are reported to have both positive and negative attitudes towards primary healthcare nursing. Despite this, clinical placement within primary healthcare is generally well received by the student nurse. To support student nurses in their learning within primary healthcare, it is essential to offer both theoretical content and clinical experiences which address preconceptions and attitudes towards the setting.     

An integrative review of primary health care nurses’ mental health knowledge gaps and learning needs

BackgroundThe global COVID-19 pandemic has escalated the prevalence of mental illness in the community. While specialist mental health nurses have advanced training and skills in mental health care, supporting mental health is a key role for all nurses. As front-line health care professionals, primary health care (PHC) nurses need to be prepared and confident in managing mental health issues.AimTo critically analyse and synthesise international literature about the knowledge gaps and learning needs of PHC nurses in providing mental health care.Design and methodsAn integrative review. The quality of papers was assessed using the Mixed Methods Appraisal Tool. Data were extracted into a summary table and analysed using narrative analysis.Data sourcesCINAHL, Ovid MEDLINE, Web of Science and EBSCO electronic databases were searched between 1999 and 2019. Papers were included if they reported original research which explored mental health education/training of nurses working in PHC.FindingsOf the 652 papers identified, 13 met the inclusion criteria. Four themes were identified: preparedness; addressing knowledge gaps, education programs, and facilitators and barriers.DiscussionDespite increasing integration of physical and mental health management in PHC, there is limited evidence relating to knowledge gaps and skills development of PHC nurses or their preparedness to provide mental health care.ConclusionFindings from this review, together with the global increase in mental illness in communities arising from COVID-19, highlight the need for PHC nurses to identify their mental health learning needs and engage in education to prepare them to meet rising service demands.     

Health and social care professionals’ attitudes to interprofessional working and interprofessional education: A literature review

The healthcare setting is a rich learning environment for students to experience interprofessional working (IPW) and interprofessional education (IPE). However, opportunities for IPE are limited, and student experiences of effective IPW are varied. This raises the question of how IPW and IPE are valued by health or social care professionals. A search of the literature was carried out to identify studies of health and social care staff attitudes to IPW and IPE. This review provides a summary of the main factors found to influence attitudes and the strengths and limitations of these studies. Professional background and prior IPE experience were identified as the influencing factors for which there is most evidence. The main limitations of the studies accessed included a focus on the value of IPE for staff, as opposed to students, and a limited number of studies considering the relationship between attitudes to IPW and the value placed on IPE. It is important that health and social care professionals lead by example by working collaboratively and providing students with opportunities for IPE. Identifying the variables influencing attitudes to IPW and IPE may assist in improving IPW and experiences of IPE for students learning in the healthcare setting.     

The intensive care unit volume–mortality relationship,is bigger better? An integrative literature review

ObjectiveTo explore the association between patient volume in intensive care units (ICUs) and risk-adjusted mortality.BackgroundLarge multi-speciality ICUs are emerging in response to increasing demand for critical care. Consolidation of resources through regionalisation of services aims to contain costs and optimise demand management and operational synergies. Higher patient volumes in ICU have been associated with improved outcomes. Limited evidence exists, however, to suggest an optimal volume of patients in terms of risk-adjusted mortality.Review methodRetrospective integrative literature review.Data sourcesEMBASE, PubMed and Cumulative Index to Nursing and Allied Health Literature electronic databases.Inclusion criteriaPrimary studies of risk adjusted mortality in adult ICU patients published between 1995 and 2012.Exclusion criteriaStudies of admissions following elective procedures.ResultsTwenty quantitative observational studies were included in this review. Studies were primarily retrospective with three conducted prospectively. Nine studied mechanically ventilated patients, six included all admissions to ICU, three reported on patients with sepsis and one study each on patients post cardiac arrest and those receiving renal replacement therapy. A significant association was evident in sixteen studies suggesting a lower risk of adjusted mortality in higher-volume units. The association was not consistent across all diagnosis. A non-linear relationship observed in two studies noted no mortality benefit occurring above a volume threshold of 450 cases annually per diagnostic category and above 711 cases not specific to a diagnostic group.ConclusionPatient mortality may be improved in large capacity ICUs. However, the association is not consistent across all diagnostic groups. Risk adjusted mortality is increased in low volume ICUs. There appears to be a high volume threshold at which point the risk adjusted mortality benefit is also lost suggesting a window of optimal ICU organisational performance exists between low and high volumes. Further prospective research is recommended into clinical outcomes in high volume ICUs to explore association between organisational efficiency and quality of care.     

Do healthier nurses make better health promotors? A review of the literature

This discussion paper draws on a review of the literature to explore factors that might promote or inhibit healthier nursing practice. The term healthier nursing practice, used here, refers to the way commitment to health promoting practices at organisational, professional and personal levels is demonstrated and achieved. Health promotion is a holistic concept that calls for the creation of empowered relationships between self, others, and the environment to improve wellness. Nurses have often struggled to achieve this within their patient encounters and even more so within their own personal and professional life experiences. Two factors were identified in the literature review that appear to significantly impact on this situation, the organisational environment within which nurses practice and their educational exposure to health promoting opportunities. There are a number of parallel processes identified that illustrate the difficulties nurses have in their experiences of working with patients and with themselves in promoting healthier lives. Action learning is advocated as an effective way for nurses to address what are sometimes perceived as being insurmountable barriers to developing health promoting opportunities for patients and the individual nurse.     

Examining family and community nurses’ core competencies in continuing education programs offered in primary health care settings: An integrative literature review

AimTo identify gaps in existing family and community nurse (FCN) continuing education programs and to investigate whether FCN core competencies are covered in continuing education programs offered in primary health care settings.BackgroundIn global pandemics such as COVID-19, there is an urgent need for staff development using transformative learning and help registered nurses build up their competencies and form a new professional identity as family and community nurses (FCNs). Therefore, FCN education programs become of high importance to enhance nurses’ core competencies through continuing education.MethodsAn integrative review of the literature was conducted applying the Whittemore and Knafl methodological strategy for studies published between 2015– June 2021.ResultsFCN core competencies, including the “decision-making process, navigation as care coordinator and patient advocate and promoting individual and family health to support the quality of nursing care,” were poorly covered in the FCN programs. Specifically, e-health played a very limited role in FCN continuing education, while ethics, managing change, managing disparity and diversity and leadership skills, did not emerge at all.ConclusionThe identified gaps can be incorporated into future FCN continuing education programs and may help improve nurses’ competence and health care delivery and support new integrated models of care, namely, person-centered and community-based models.     

Nurses’ resilience and the emotional labour of nursing work: An integrative review of empirical literature

BackgroundThe emotional labour of nursing work involves managing the emotional demands of relating with patients, families and colleagues. Building nurses’ resilience is an important strategy in mitigating the stress and burnout that may be caused by ongoing exposure to these demands. Understandings of resilience in the context of emotional labour in nursing, however, are limited.ObjectivesTo investigate the state of knowledge on resilience in the context of emotional labour in nursing.DesignIntegrative literature review.Data sourcesCINAHL, Medline, Scopus, and PsycINFO electronic databases were searched for abstracts published between 2005 and 2015 and written in English. Reference lists were hand searched.Review methodsWhittemore and Knafl’s integrative review method was used to guide this review. The constant comparative method was used to analyze and synthesize data from 27 peer-reviewed quantitative and qualitative articles. Methodological quality of included studies was assessed using the Mixed Methods Assessment Tool.ResultsEmotional labour is a facet of all aspects of nursing work and nurse-patient/family/collegial interactions. Emotional dissonance arising from surface acting in emotional labour can lead to stress and burnout. Resilience can be a protective process for the negative effects of emotional labour. Several resilience interventions have been designed to strengthen nurses’ individual resources and reduce the negative effects of workplace stress; however they do not specifically address emotional labour. Inclusion of emotional labour-mitigating strategies is recommended for future resilience interventions.ConclusionResilience is a significant intervention that can build nurses’ resources and address the effects of emotional dissonance in nursing work. There is a need for further investigation of the relationship between resilience and emotional labour in nursing, and robust evaluation of the impact of resilience interventions that address emotional labour.     

Do adolescent cancer survivors need health care and psychosocial services?: An Indonesian experience

Objective

Advances in childhood cancer treatment have contributed to an increased survival rate among childhood cancer patients. The increasing number of survivors means that more help is needed to support them in dealing with the physical and psychosocial problems following their cancer therapy. This study explored the needs of adolescent cancer survivors in terms of health care and psychosocial services.

How do new midwives’ early workforce experiences influence their career plans? An integrative review of the literature

AimTo explore how the early workforce experiences of new midwives influence their career plans.BackgroundEach year, thousands of new midwives graduate from entry-to-practice midwifery courses, gain professional registration, and enter the workforce. Despite this, the world continues to face a shortage of midwives. The first five years of clinical practice, commonly referred to as the early career period, can be highly stressful for new midwives, contributing to early attrition from the profession. Supporting the transition from midwifery student to registered midwife is vital if we are to grow the workforce. Whilst the early career experiences of new midwives have been more broadly explored; little is currently understood about how these can influence their career plans.MethodsFollowing Whittemore and Knafl’s (2005) five-stage process, an integrative review was conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Nineteen studies met the criteria for inclusion. Thematic analysis was undertaken to organise and present the findings.FindingsThematic analysis, guided by the review question led to the identification of three overarching themes: ‘the need for support’, ‘sustaining health and wellbeing’, and ‘being able to provide safe and effective midwifery care’.ConclusionVery little research to date has specifically explored how the early career experiences of new midwives influence their career plans, particularly within the Australian context. Further research is required to better understand how the early workforce experiences of new midwives can either strengthen their commitment to the profession or contribute to the decision to leave midwifery prematurely. This knowledge would provide a basis for the development of appropriate strategies to minimise early attrition from the midwifery profession and promote career longevity.     

What are the holistic care impacts among individuals living through the COVID-19 pandemic in residential or community care settings? An integrative systematic review

Introduction

To critically synthesise evidence in relation to the holistic care impacts (physical, psychological, social, spiritual, and environmental well-being) among individuals living in residential aged care facilities (RACFs) with restrictions during the COVID-19 pandemic.

Methods

An integrative systematic review followed a pre-registered protocol and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Guidelines. Electronic databases were searched from inception to June 2022. Qualitative, quantitative, and mixed methods studies were included. All articles were double screened according to a pre-determined eligibility criterion. The review process was managed using Covidence systematic review software. Data from the studies were extracted, methodological quality appraisal conducted, and a narrative synthesis conducted.

Results

18 studies were included. The impact of restrictive practices and periods of lockdown impacted older people on all levels of individual quality-of-life. With or without COVID-19, residents experienced functional decline and many experienced malnutrition, increased incontinence, increased pain, and poorer general health and significant psychological distress. Depression increased with reduced social contact, as did anxiety and loneliness. Some residents spoke of suicidal ideation.

Conclusion

It is highly plausible that further outbreaks may prompt knee-jerk reactions from public health departments and governing bodies to continue to restrict and lockdown facilities. Public health COVID-19 outbreak policy for aged care across the globe will need to consider the benefits verses risk debate given the findings uncovered in this review. These findings showed that it is vital that policy considers quality-of-life domains not solely survival rates.     

Do universal school‐based mental health promotion programmes improve the mental health and emotional wellbeing of young people? A literature review

Aims and objectives

To examine evidence—using a range of outcomes—for the effectiveness of school‐based mental health and emotional well‐being programmes.

Background

It is estimated that 20% of young people experience mental health difficulties every year. Schools have been identified as an appropriate setting for providing mental health and emotional well‐being promotion prompting the need to determine whether current school‐based programmes are effective in improving the mental health and emotional well‐being of young people.

Methods

A systematic search was conducted using the health and education databases, which identified 29 studies that measured the effectiveness of school‐based universal interventions. Prisma guidelines were used during the literature review process.

Results

Thematic analysis generated three key themes: (i) help seeking and coping; (ii) social and emotional well‐being; and (iii) psycho‐educational effectiveness.

Conclusion

It is concluded that whilst these studies show promising results, there is a need for further robust evaluative studies to guide future practice.

Relevance to clinical practice

All available opportunities should be taken to provide mental health promotion interventions to young people in the school environment, with a requirement for educational professionals to be provided the necessary skills and knowledge to ensure that the school setting continues to be a beneficial environment for conducting mental health promotion.