Patient and caregiver expectations of emergency department care: A scoping literature review

BackgroundCommunication between health care providers (HCPs) and patients and/or their caregivers in the chaotic emergency department (ED) context can be challenging and potentially impact health outcomes and patient satisfaction. Studies examining strategies to improve communication of patient and caregivers expectations of care in an ED are widely dispersed.MethodsWe conducted a scoping review of the published and grey literature to examine the extent, range and nature of existing research evidence regarding strategies to enhance communication of patient and caregiver expectations of care in an ED.ResultsOf the 599 articles retrieved, 24 met the inclusion criteria. Most of the studies identified included patients (n = 9) or caregivers (n = 8) as the population of interest, while the remainder examined the expectations of a mix of patients, parents/caregivers, and/or HCPs (n = 7). The majority (n = 21) of the studies did not communicate patient/caregiver expectations to HCPs.ConclusionThis scoping review highlights the paucity of available research literature evaluating strategies to communicate patient and caregiver ED expectations. Our findings identify the need for experimental designs in future studies to evaluate implementation strategies for ED expectation tools with a particular emphasis on measuring the impact of sharing patient expectations with HCPs.     

Teaching and learning about dementia care among undergraduate nursing students: A scoping review

AimReview available evidence on teaching methods and learning outcomes among undergraduate nursing students regarding care for people with dementia. Background: The debilitating nature and the rapidly growing number of dementia cases will cause significant increase in the demand of healthcare services. Nurses play an essential role in improving the quality of care for people with dementia, although some evidence suggests that training in dementia care among nurses is poor.DesignA scoping review of the literature. following the Joanna Briggs Institute methodology for scoping reviews. The source of evidence selection adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review.MethodsData sources were Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Education Resources Information Centre and Scopus. Inclusion criteria were studies found through database search up to 15th December 2020, published in English or Spanish with data regarding any method used for dementia education among undergraduate nursing students.Results19 studies were included in this review. The identified methods were simulation (n = 5), awareness-raising activities (n = 4), placement (n = 3), home visits (n = 3), combined activities (n = 3) and service learning (n = 1). Learning outcomes were measured in terms of knowledge, attitudes, preparedness, empathy, self-confidence, self-efficacy, awareness and students´ perceptions.ConclusionsThis scoping review has found high heterogeneity among dementia education programs and learning outcomes. Nursing education can be enhanced by designing and measuring effective and evidence-based educational interventions so that nursing students develop competencies which make it easier to deliver quality care for people with dementia.     

Ethical elements in priority setting in nursing care: A scoping review

BackgroundNurses are often responsible for the care of many patients at the same time and have to prioritise their daily nursing care activities. Prioritising the different assessed care needs and managing consequential conflicting expectations, challenges nurses’ professional and moral values.ObjectiveTo explore and illustrate the key aspects of the ethical elements of the prioritisation of nursing care and its consequences for nurses.Design, data sources and methodsA scoping review was used to analyse existing empirical research on the topics of priority setting, prioritisation and rationing in nursing care, including the related ethical issues. The selection of material was conducted in three stages: research identification using two data bases, CINAHL and MEDLINE. Out of 2024 citations 25 empirical research articles were analysed using inductive content analysis.ResultsNurses prioritised patient care or participated in the decision-making at the bedside and at unit, organisational and at societal levels. Bedside priority setting, the main concern of nurses, focused on patients’ daily care needs, prioritising work by essential tasks and participating in priority setting for patients’ access to care. Unit level priority setting focused on processes and decisions about bed allocation and fairness. Nurses participated in organisational and societal level priority setting through discussion about the priorities. Studies revealed priorities set by nurses include prioritisation between patient groups, patients having specific diseases, the severity of the patient’s situation, age, and the perceived good that treatment and care brings to patients. The negative consequences of priority setting activity were nurses’ moral distress, missed care, which impacts on both patient outcomes and nursing professional practice and quality of care compromise.ConclusionsAnalysis of the ethical elements, the causes, concerns and consequences of priority setting, need to be studied further to reveal the underlying causes of priority setting for nursing staff. Prioritising has been reported to be difficult for nurses. Therefore there is a need to study the elements and processes involved in order to determine what type of education and support nurses require to assist them in priority setting.     

Strategies to support transitions from hospital to home for children with medical complexity: A scoping review

BackgroundChildren with medical complexity constitute a small but resource-intensive subgroup of children with special health care needs. Their medical fragility and resource-intensive needs put them at greater risk for inadequate transitions from hospital to home-based care, and subsequent adverse outcomes and hospital re-admissions.ObjectiveThis scoping literature review was conducted to map empirically researched interventions, frameworks, programs or models that could inform or support the transition from hospital to home for children with medical complexity.DesignWe conducted a scoping review using the methodology outlined by the Joanna Briggs Institute.Data sourcesIn consultation with an experienced librarian, we searched PubMed, EMBASE and CINAHL for English-language articles published from the date of origin to February 2016. We also hand-searched four high impact journals and searched the reference lists of relevant articles.Review methodsTwo reviewers independently screened the literature results according to inclusion criteria. Empirically designed studies that targeted children <18 years old who were specifically defined as medically complex or fragile and transitioning from acute care to home were included. Data were extracted using a predefined tool. Quality appraisal of the articles was conducted using the mixed methods appraisal tool (MMAT). Thematic analysis was carried out to identify existing patterns or trends in the included studies.ResultsOf the 2088 abstracts retrieved, 14 studies met the inclusion criteria. Following analysis, we identified three major categories of interventions: Comprehensive care plans (n = 3), Complex Care Programs (n = 8) and Integrated delivery models (n = 3). The overall quality of included studies was moderate, with 21% (n = 3) scoring 0.25, 29% (n = 4) scoring 0.50, 43% (n = 6) scoring 0.75, and 7% (n = 1) scoring 1.0.ConclusionsIn the absence of evidence-based guidelines to ensure adequate transitions from hospital to home for children with medical complexity, identification of potential models to support this transition is imperative. We identified interventions, frameworks, models and programs in the literature that might inform the development of such guidelines; however, there is a need for consensus around the definition for children with medical complexity and the limited number of these studies and lack of high quality of evidence signals the need for further research to improve the transition from hospital to home and ultimately, improve patient and family outcomes.     

Factors impacting on psychological wellbeing of international students in the health professions: A scoping review

BackgroundThere are increasing numbers of international students undertaking health professional courses, particularly in Western countries. These courses not only expose students to the usual stresses and strains of academic learning, but also require students to undertake clinical placements and practice-based learning. While much is known about general issues facing international students, less is known about factors that impact on those studying in the health professions.ObjectivesTo explore what is known about factors that influence the psychological wellbeing of international students in the health professions.DesignA scoping review.Data sourcesA range of databases were searched, including CINAHL, Medline, Scopus, Proquest and ERIC, as well as grey literature, reference lists and Google Scholar.Review methodsThe review included qualitative or quantitative primary peer reviewed research studies that focused on international undergraduate or postgraduate students in the health professions. The core concept underpinning the review was psychological issues, with the outcome being psychological and/or social wellbeing. Thematic analysis across studies was used to identify key themes emerging.ResultsA total of 13 studies were included in the review, from the disciplines of nursing, medicine and speech-language pathology. Four key factor groups emerged from the review: negotiating structures and systems, communication and learning, quality of life and self-care, and facing discrimination and social isolation.ConclusionsInternational health professional students face similar issues to other international students. The nature of their courses, however, also requires negotiating different health care systems, and managing a range of clinical practice issues including with communication, and isolation and discrimination from clinical staff and patients. Further research is needed to specifically explore factors impacting on student well-being and how international students can be appropriately prepared and supported for their encounters.     

How to communicate with family members of the critically ill in the intensive care unit: A scoping review

ObjectiveTo map the existing approaches to communication with family members of the critically ill in the intensive care unit and the corresponding implementation requirements and benefits.MethodsWe conducted a scoping review in February 2022 by searching PubMed, CINAHL, APA PsycINFO, and Cochrane Library for articles published between 2000 and 2022. We included records of all designs that met our inclusion criteria and applied frequency counts and qualitative coding.ResultsThe search yielded 3749 records, 63 met inclusion criteria. The included records were of an interventional (43 %) or observational (14 %) study design or review articles (43 %), and provided information in three categories: communication platforms, strategies, and tools. For implementation in the intensive care unit, the approaches required investing time and resources. Their reported benefits were an increased quality of communication and satisfaction among all parties involved, improved psychological outcome among family members, and reduced intensive care unit length of stay and costs.ConclusionThe current approaches to communication with patients’ family members offer insights for the development and implementation of communication pathways in the intensive care unit of which the benefits seem to outweigh the efforts. Structured interprofessional frameworks with standardised tools based on empathic communication strategies are encouraged.     

Supporting families of patients who die in adult intensive care: A scoping review of interventions

BackgroundFamilies who perceive themselves as prepared for an impending death experience reduced psychological burden during bereavement. Understanding which interventions promote death preparedness in families during end-of-life care in intensive care will inform future intervention development and may help limit the burden of psychological symptoms associated with bereavement.AimTo identify and characterise interventions that help prepare families for the possibility of death in intensive care, incorporating barriers to intervention implementation, outcome variables and instruments used.DesignScoping review using Joanna Briggs methodology, prospectively registered and reported using relevant guidelines.Data sourcesA systematic search of six databases from 2007 to 2023 for randomised controlled trials evaluating interventions that prepared families of intensive care patients for the possibility of death. Citations were screened against the inclusion criteria and extracted by two reviewers independently.ResultsSeven trials met eligibility criteria. Interventions were classified: decision support, psychoeducation, information provision. Psychoeducation involving physician-led family conference, emotional support and written information reduced symptoms of anxiety, depression, prolonged grief, and post-traumatic stress in families during bereavement. Anxiety, depression, and post-traumatic stress were assessed most frequently. Barriers and facilitators to intervention implementation were seldom reported.ConclusionThis review provides a conceptual framework of interventions to prepare families for death in intensive care, while highlighting a gap in rigorously conducted empirical research in this area. Future research should focus on theoretically informed, family-clinician communication, and explore the benefits of integrating existing multidisciplinary palliative care guidelines to deliver family conference within intensive care.Implications for clinical practiceIntensive care clinicians should consider innovative communication strategies to build family-clinician connectedness in remote pandemic conditions. To prepare families for an impending death, mnemonic guided physician-led family conference and printed information could be implemented to prepare families for death, dying and bereavement. Mnemonic guided emotional support during dying and family conference after death may also assist families seeking closure.     

数字健康干预用于食管癌患者营养支持的范围综述

目的:对数字健康干预在食管癌患者营养支持中的应用研究进行范围综述,以识别数字健康的干预形式、内容要素和应用效果,为未来该领域的研究提供参考依据。方法:系统检索PubMed、Web of Science、EBSCO、中国知网、维普数据库、万方数据库、中国生物医学数据库,检索时间为建库至2023年9月1日,对纳入文献进行汇总和分析。结果:纳入18篇文献,数字健康干预的主要形式包括通讯软件、应用程序、网站平台;内容要素主要涉及成立营养管理团队、居家肠内营养指导、个体化饮食方案、建立个人营养档案、交流互动、心理疏导,功能锻炼;结局指标包括生理、心理、生活质量、自我管理、安全性与可行性指标。结论:数字健康干预拓展了食管癌患者营养支持的形式,能够改善食管癌患者的营养状况,且多学科、多要素联合的方式更受青睐。数字健康干预在食管癌患者营养支持中具有较高的接受度和满意度,但仍面临许多挑战。今后在“互联网+护理服务”和分级诊疗管理模式下,研究者可进一步拓宽数字健康干预的形式和内容要素,为患者提供更加便捷、专业、规范的护理服务,以期改善食管癌患者营养支持的干预效果。     

运用健康信念模式评价1215名妇女乳腺癌健康教育的效果

目的运用健康信念模式,了解妇女的健康信念对其乳房自检行为的影响。方法对天津市1215名妇女在问卷调查基础上进行乳腺癌健康教育,对培训前后的效果进行评价并分析影响妇女乳房自检行为的因素。结果调查对象在接受培训后知识、态度和行为均有不同程度的提高与改变。在影响乳房自检行为的健康信念的4个参数中,培训前:乳房自检行为与“感知到的障碍”有关(OR值为1.345,95%CI为1.287~1.405);培训后:乳房自检行为与“感知到的益处”和“感知到的障碍”有关(OR值分别为1.217,1.271,95%CI分别是1.075~1.377,1.216~1.328)。结论妇女的乳房自检率低下,对乳腺癌及乳房自检相关知识了解不多,但知识的增多不一定带来行为的改变,从接受健康信息到行为的转变必须以态度的确立为前提,健康教育的重点应在于帮助人们认识到可能的障碍和困难,找到解决的方法。     

Influence of spirituality on moral distress and resilience in critical care staff: A scoping review

ObjectiveThe Covid 19 pandemic has created a situation in which critical care staff experience moral distress. For reducing moral distress, resources such as spirituality can be used. The aim of this scoping review is to explore whether spirituality mitigates the moral distress of critical care staff and strengthens their resilience. The spiritual resources will be identified and the ability of the staff to use spiritual resources will be explored.MethodologyA scoping review of studies reporting on the association between spirituality, moral distress, and resilience. Qualitative and quantitative studies from 2020 that examined critical care staff are included. This scoping review used the five-step framework proposed by Arksey and O'Malley and was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework for scoping reviews. The literature searches were conducted in 12 databases.Results13 studies met inclusion criteria. Critical care staff declaring themselves as spiritual have a higher risk of moral distress and are often not able to use spiritual resources on their own. For effective use of spiritual resources to reduce moral distress, staff need to be skilled in the practice of spirituality with the aim to find inner peace, focus on the positive, and regain a sense of purpose in the work.ConclusionSpirituality does not automatically help the critical care staff to cope with moral distress and strengthen resilience. Institutions need to create conditions in which the critical care staff are supported to use their spiritual resources.Implication for clinical practiceInstitutions need to involve staff more in the design, implementation, and delivery of spiritual interventions to minimise moral distress. Further research is necessary to examine the impact of critical care staff’s demographic characteristics on their spirituality, moral distress, and resilience.     

One to one specialling and sitters in acute care hospitals: A scoping review

BackgroundOne to one specialling is a type of care which is provided to ensure the safety of patients who may be suffering from cognitive impairment, exhibit challenging behaviour, or may be at risk of falls or of causing harm to themselves or others. Care such as this, often referred to as ‘specialling’ or ‘sitting’ is common practice in most hospitals around the world, but there is a lack of evidence regarding its cost effectiveness and the quality of care provided.AimThe aim of this scoping review was to explore the breadth and scope of literature on one to one specialling, sitters and similar types of care in acute secondary care settings, in order to identify the challenges and concerns relating to the quality of care (process and outcomes) and cost effectiveness emerging from the literature, and determine the implications of this for policy, practice and future research.DesignThis review was based on scoping review methodology following a five stage scoping review process. A keyword search was conducted in the following databases: MEDLINE, Scopus, CINAHL Plus, Web of Science, ProQuest Social Science, and ProQuest Nursing and Allied Health. The time limit placed on the search was January 2000 to April 2016. Inclusion and exclusion criteria were applied. The Mixed Methods Appraisal Tool was used to assess the quality of primary research articles.FindingsForty-four articles were included in the review. We found a lack of clarity in the terms used to describe one to one specialling and variability in what this type of care entails, who provides the care and the needs of patients requiring this type of care. High costs of specialling are often seen as a concern, but there was a lack of economic evaluations considering the full cost of specialling and balancing these against the benefits. Some of the articles proposed alternatives to one to one specialling or the use of sitters, but only some of these were evaluated.ConclusionThere is wide variation in what specialling and one to one care entails, which can in turn lead to the provision of poor quality care. A reduction in this variation and improved quality care might be achieved through the development of guidelines, training and standardized decision-making tools. Further research on the impact of one to one specialling on patient outcomes and cost would be beneficial, as well as robust evaluations of the alternatives to specialling.     

Implementation of nonpharmacologic physical restraint minimization interventions in the adult intensive care unit: A scoping review

ObjectiveTo identify the elements informing the successful implementation of nonpharmacologic physical restraint minimization interventions in adult intensive care unit patients. To map those elements to innovation, context, recipients and facilitation domains of the integrated–Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and to describe the outcomes of those interventions.MethodologyA scoping review of studies published in English reporting on restraint minimization interventions in adult intensive care units. We searched seven databases (MEDLINE, CIHAHL, Embase, Web of Science, Cochrane Library, PROSPERO and Joanna Briggs) from inception to 2021. Two authors independently screened articles for inclusion, extracted study characteristics and mapped intervention data to the i-PARIHS domains.ResultsSeven studies met inclusion criteria. Innovations comprised multicomponent interventions including education, decision aids/protocols and restraint alternatives. No studies utilised an implementation science framework to diagnose the baseline practice context. A commonly reported barrier to restraint minimization was a risk averse culture. Change was mostly driven by the external context (i.e. national regulations). Overall, nurses were the primary facilitators and recipients of practice change. Outcomes were changes in restraint incidence and prevalence abstracted from the medical record. However, no study validated the accuracy of restraint documentation. All studies documented an initial decrease in physical restraint use, but no long-term results were reported.ConclusionRestraint minimization intervention studies report nurse-facilitated multicomponent interventions and short-term practice change. Future restraint minimization research incorporating implementation science frameworks, interprofessional teams and patient/family perspectives is warranted.     

Strategies for retention of nursing students: A scoping review

Retention of students in nursing programs is a costly concern that affects the supply and demand of nurses to the healthcare system. Successful retention strategies require consideration of social and academic institutional systems with attention to student integration in a program. This systematic review explores implemented retention strategies in nursing programs worldwide and provides guidance for nursing programs and researchers considering the retention question. Joanna Briggs Institute scoping review methods informed this review. CINAHL, ERIC, PsychINFO, and MEDLINE, databases were searched from January 1998 to December 2019. Data was extracted from 112 full text papers and dissertations. Papers were of varying quality and inconsistently evaluated, usually lacking theoretical grounding. Student participants in strategies were preselected by racial minority status or through various markers of academic performance. Retention strategies described in the literature are single program and multifactorial, with mentorship, study skills, literacy and language approaches, and tutoring the most common components. Reports of graduation rates or attrition rates through comparison with a pre-strategy time period or a comparison group were the most informative evaluations. Whole-program strategies that provided pathway options to students based on reading assessments or other academic criteria were the most comprehensive and effective strategies presented in the literature.     

People brought to the emergency department under involuntary assessment orders: A scoping review

BackgroundSome people with mental health problems arrive to the Emergency Department (ED) under involuntary assessment orders (IAOs) and can have complex medical and socioeconomic factors, which may impact on the delivery of care in the ED. Therefore, this scoping review aimed to identify, evaluate and summarise the current literature regarding the demographic characteristics, clinical characteristics and outcomes for people brought to the ED under IAOs.MethodA scoping review was undertaken guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines and the Arksey and O’Malley framework.ResultsIn total 21 articles were included in this review. People under IAOs most commonly present to EDs with suicidal ideation/intent, with interagency involvement noted when responding to these people in the pre-hospital setting. Most people arriving to ED under IAOs were reported to experience length of stay longer than four hours.ConclusionThis review highlights the limited information pertaining to people brought to EDs under an IAO. High levels of mental health problems and extended length of stay for people under IAOs suggests the need for interagency collaboration to inform the development and implementation of models of care that incorporates social determinants of health and are tailored to this complex population.     

Communication training for health professionals who care for patients with cancer: a systematic review of effectiveness

Background Effective communication is increasingly recognised as a core clinical skill. However, there is evidence that health and social care professionals still lack basic communication skills.Purpose To assess the effectiveness of different communication skills training courses for health professionals in cancer care.Methods We searched six computerised databases and augmented this with a follow-up of references and grey (unpublished) literature. We included all studies evaluating communication training and assessed methodological quality according to the standard grading system of the Clinical Outcomes Group. Data on author, year, setting, objectives, study design and results were extracted and compared in tabular format.Results A total of 47 studies potentially assessing communication training in the area of cancer care were identified. Sixteen papers were included describing 13 interventions. Four were randomised controlled trials (RCTs) (grade I), with samples ranging from 72 to 233 subjects. The others were all grade III. Eleven interventions trained health professionals, two trained medical students. The outcomes measured included communication skills as assessed on audio or video, professionals self-report and patient assessment. All the interventions demonstrated modest improvements (effect sizes ranged 0.15–2) and one found deterioration in the outcomes measured.Conclusion Communication training improves basic communication skills. Positive attitudes and beliefs are needed to maintain skills over time in clinical practice and to effectively handle emotional situations.     

乳腺癌筛查工作中妇幼保健院的角色和任务

乳腺癌是威胁女性健康和生命的最常见的恶性肿瘤。目前，乳腺癌诊疗领域具有规范的诊疗标准，通过筛查而早期发现并尽早治疗是乳腺癌防控工作的有效措施。国家非常重视慢性病防控工作，“健康中国2030”规划纲要提出到2030年，总体癌症5年生存率提高15%，其中乳腺癌生存率的提高至关重要。我国妇幼保健系统在长期实践中形成了“县、乡、村”三级妇幼卫生服务网络以及群防群控和临床诊疗相结合的有效模式，在开展乳腺癌筛查方面具有独特优势。北京市乳腺癌筛查工作开展10余年来，形成了妇幼保健院为主导的组织构架和筛查体系，在乳腺专科的引领下，筛查的技术水平不断提升。在卫生行政部门的支持下，妇幼保健院应利用管理和体系优势开展乳腺癌筛查相关研究，探索适合中国人群的乳腺癌筛查模式。     

Communication training for health professionals who care for patients with cancer: a systematic review of training methods

Background Effective communication is increasingly recognised as a core clinical skill. Many health and social care professionals, however, do not feel adequately trained in communicating and in handling interpersonal issues that arise in the care of patients with cancer.Aim The aim of this paper was to assess the effectiveness of different training methods used in communication training courses for health professionals.Method We searched six computerised databases and augmented this with follow-up of references and grey (unpublished) literature. We included all studies evaluating communication training and assessed methodological quality according to the standard grading system of the Clinical Outcomes Group. Data on author, year, setting, objectives, study design and training methods were extracted and compared in tabular format.Results A total of 47 studies potentially assessing communication training were identified. Sixteen papers were included evaluating 13 interventions. Four were randomised controlled trials (RCTs) (grade a); the others were grade III. Eleven interventions trained health professionals; two trained medical students. Interventions for training in communication skills were characterised by the variety of communication approaches used and a diversity of methods. They were applied to health professionals with very different roles, served different purposes and evaluated a variety of outcome measures: behavioural assessments, patient outcomes and professionals self-report.Conclusions The best results are to be expected from a training programme that is carried out over a longer period of time. Learner-centred programmes using several methods combining a didactic component focusing on theoretical knowledge with practical rehearsal and constructive feedback from peers and skilled facilitators proved to be very effective. Small groups encouraged more intensive participation. Training in communication for both medical or nursing students and senior health professionals is advisable.