Perceived barriers to early goal-directed mobility in the intensive care unit: Results of a quality improvement evaluation

BackgroundA multicentre randomised trial demonstrated improved outcomes for intensive care unit (ICU) patients using early, goal-directed mobility implemented by nurses.ObjectivesThe aim of the study was to evaluate barriers to nursing mobility, using a validated survey, during an ongoing quality improvement (QI) project (2019) in a medical ICU and determine changes from the pre-QI (2017) baseline.MethodsNurses, nurse practitioners, physician assistants, and clinical technicians completed the 26-item Patient Mobilization Attitudes and Beliefs Survey for the ICU (PMABS-ICU). An overall score and three subscale scores (knowledge, attitudes, behaviour), each ranging from 0 to 100, were calculated; higher scores indicated greater barriers.ResultsSeventy-five (93% response rate) nurses, eight (100%) nurse practitioners and physician assistants, and 11 (100%) clinical technicians completed the PMABS-ICU. For all respondents (N = 94), the mean (standard deviation) overall PMABS-ICU score was 32 (8) and the knowledge, attitudes and behaviour subscale scores were 22 (11), 33 (11), and 34 (8), respectively. Among all respondents completing the survey in both 2017 and 2019 (N = 46), there was improvement in the mean (95% confidence interval) overall score [?3.1 (?5.8, ?0.5); p = .022] and in the knowledge [?5.1 (?8.9, ?1.3); p = .010] and attitudes [?3.9 (?7.3, ?0.6); p = .023] subscale scores. Among all respondents (N = 48) taking the PMABS-ICU for the first time in 2019 compared with those taking the survey before the QI project in 2017 (N = 99), there was improvement in the mean (95% confidence interval) overall score [?3.8 (?6.5, ?1.1); p = .007] and in the knowledge [?6.9 (?11.0, –2.7); p = .001] and attitude [?4.3 (?8.1, –0.5); p = .027] subscale scores.ConclusionsUsing a validated survey administered to ICU nurses and other staff, before and during a structured QI project, there was a decrease in perceived barriers to mobility. Reduced barriers among those taking the survey for the first time during the QI project compared with those taking the survey before the QI project suggests a positive culture change supporting early, goal-directed mobility implemented by nurses.     

The effect of core stability training with ball and balloon exercise on respiratory variables in chronic non-specific low back pain: An experimental study

BackgroundStudies have shown the involvement of respiratory characteristics and their relationship with impairments in non-specific low back pain (NS-LBP). The effects of core stability with a combined ball and balloon exercise (CBB) on respiratory variables had not been investigated.ObjectiveTo evaluate the effectiveness of CBB on respiratory variables among NS-LBP patients.Study designpre- and post-experimental study.ParticipantsForty participants were assigned to an experimental group (EG) [n = 20] and control group (CG) [n = 20] based on the study criteria.InterventionsThe EG received CBB together with routine physiotherapy and the CG received routine physiotherapy over a period of 8 weeks. Participants were instructed to carry out the exercises for 3 days per week. The training was evaluated once a week and the exercises progressed based on the level of pain. Outcome measures: Primary outcomes were maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and maximum voluntary ventilation (MVV). The secondary outcomes were measured in the numeric rating scale (NRS), total faulty breathing scale (TFBS), cloth tape measure (CTM) and lumbo-pelvic stability. Results: The MIP increased significantly among the EG when compared with that in the CG (p > 0.05).The EG showed a significant increase in MVV (p = 0.04) when compared to the CG (p = 0.0001). There was a significant reduction in pain for both groups. The MEP, TFBS, chest expansion and core stability showed no changes in either group. Conclusion: CBB was effective in improving respiratory variables among NS-LBP patients.     

Effect of an exercise program with blood flow restriction on the muscular strength of patients with chronic kidney disease: A randomized clinical trial

IntroductionAn arteriovenous fistula (AVF) is performed in chronic kidney disease (CKD) patients before hemodialysis, who may benefit from exercise. The aim of this study was to evaluate the effect of an exercise program associated with partial limb blood flow restriction (BFR) on handgrip strength (HGS) and forearm circumference of CKD patients.MethodsA total of 26 patients with CKD were randomized to the BFR experimental group (EG, n = 12) and to the non-BFR control group (CG, n = 14) prior to AVF, and underwent isometric exercises for the flexor muscles of the fingers and elbow where the AVF will be performed.ResultsThere were no differences at the end of eight weeks of training between the EG and CG groups [F (1.23) = 0.03, p = 0.96] regarding the HGS and the forearm circumference [F (1.23) = 0.90, p = 0.76], however muscle strength [F (1.23) = 189.84, p < 0.001] and forearm circumference [F (1.23) = 540.90, p < 0.001] improved between baseline and the results at the end of the program.ConclusionPartial BFR training was not superior to the CG for the outcomes evaluated in this study. Further studies should be conducted so that an indication of an exercise protocol for the evaluated outcomes is prescribed in order to be effectively offered in clinical practice.     

Acute effects of myofascial reorganization on trapezius muscle oxygenation in individuals with nonspecific neck pain

Background and purposeNonspecific neck pain (NNP) is a common idiopathic disorder in the general population that affects the trapezius muscle (TM) and blood supply, thereby compromising the fascial system. Myofascial reorganization (MR) is a physical therapy technique that can influence the dynamics of local fluids reducing excessive muscle tension and capillary constriction, and increasing local blood flow. This study aimed to investigate whether MR improves peripheral muscle oxygenation.MethodsThis was a quasi-experimental study with an intentional non-probability sample. Fifty participants (women: 36, men: 14) with and without NNP were assigned to either the experimental group (EG: n = 25, with NNP, subjected to MR) or the control group (CG: without NNP, no MR intervention). TM oxygenation was measured using near-infrared spectroscopy (NIRS) before and after a single intervention. All participants were evaluated and reassessed after 10 min.ResultsThe results revealed that immediately after 10 min of MR, the EG exhibited an increase in the oxyhemoglobin level of the medium fibers of the TM (0.72 ± 1.47 vs. −0.14 ± 1.33 mmol/dL, p = 0.01). In addition, functional disability (CG: 5.48 ± 5.58%/EG: 21.12 ± 7.73%) and neck pain were measured using the neck disability index. The pain pressure threshold (CG: 70.49 ± 32.29 kgf/EG: 51.08 ± 27.65 kgf) and pain intensity (CG: 0.76 ± 1.56/EG: 3.28 ± 2.35) were also measured.ConclusionThe findings indicate that application of MR for 10 min increases the tissue oxyhemoglobin level in the TM of the group with NNP compared to the CG without NNP.     

Pain management in the older adult: The relationship between nurses' knowledge,attitudes and nurses' practice in Ireland and Jordan

BackgroundResearch studies regarding nurses' knowledge attitudes and practice in the older adult are limited. Furthermore, none of these studies attempted to investigate the relationship between knowledge attitudes and practice. Furthermore, little studies compared nurses' knowledge, attitudes and practice between Eastern and Western countries.AimTo describe the factors associated with nurses' acute pain management practice in the context of caring for older adult patients.MethodA quantitative, correlational, comparative and cross-sectional survey approach.Data collectionData were collected using survey questionnaire.SampleA sample of 267 registered nurses from Ireland and Jordan (one private hospital in each country).ResultsA multiple linear regression analysis revealed that nurses' general knowledge and attitude towards pain management was associated with their pain management practice, with a regression coefficient of 0.14 (p = 0.002). However, knowledge of pain in the elderly failed to reach a statistically significant relationship with pain management practice. In regards to country and gender, Irish nurses had an average score that was 2.61 points higher than Jordanian nurses (p < 0.001), female nurses had an average score that was 0.67 points higher than male nurses (p = 0.025). The overall regression model was significant (p < 0.001) with an R² value of 43.2%, indicating that 43.2% of the variation in scores was explained by knowledge, attitude and practice.ConclusionMore research studies combining the three concepts (knowledge, attitude and practice) are recommended in the area of pain management.     

Pain knowledge,attitudes and beliefs of Australian osteopaths drawn from a nationally representative sample of the profession

BackgroundPain has been identified as a global health issue with substantial effects on individuals and society. Health professionals managing pain complaints must have appropriate knowledge of pain neurophysiology, and attitudes and beliefs towards pain management that align with current practice guidelines.ObjectivesEvaluate Australian osteopaths' current level of knowledge of pain neurophysiology and their beliefs and attitudes towards pain, and explore associations with demographic variables.MethodAustralian osteopaths drawn from a nationally representative practice-based research network received the questionnaire. The questionnaire included demographic information, Neurophysiology of Pain Questionnaire (NPQ), Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Attitudes to Back Pain Scale in Musculoskeletal Practitioners (ABS-mp).ResultsComplete responses were received from 211 osteopaths (21.3% response rate). The mean total NPQ score was equivalent to 72.2% correct responses. The PABS-PT Biomedical scale mean score was 38.8 ( ±9.1, α = 0.81) and the Biopsychosocial scale was 22.3 ( ±3.3, α = 0.38). ABS-mp mean factor scores suggest osteopaths support psychological approaches (22.1, ±3.3, α = 0.71) but endorsed more treatment sessions for those with back pain (15.9, ±4.7, α = 0.71). Trivial correlations between measures and most demographic variables were observed. Osteopaths who undertook further studies in pain had higher mean NPQ scores, with moderate negative correlations with a lower PABS-PT Biomedical subscale score (ρ = −0.45, p < 0.01).ConclusionsAustralian osteopaths demonstrate a range of pain neurophysiology knowledge, and beliefs and attitudes towards pain. The findings support the positive impact of professional development for improving pain knowledge in this population.     

Effects of psychological intervention for Korean infertile women under In Vitro Fertilization on infertility stress,depression, intimacy,sexual satisfaction and fatigue

This quasi-experimental study with a nonequivalent control group pretest-posttest design was conducted to evaluate the effects of a psychological intervention program for 50 women with infertility (experimental group: 26, control group: 24) utilizing assisted reproductive technology. The experimental group received six four-hour sessions of intervention, with outcomes measured at baseline and four weeks post-intervention. The experimental group demonstrated significant improvements in marital intimacy (z = 6.528, p < .001) and sexual satisfaction (z = 3.148, p = .003) and significant reductions in depression (z = −4.850, p < .001) and fatigue (z = −4.597, p < .001). Thus, the program can alleviate depression and fatigue. Further, psychological intervention centered on the marital and personal dimensions may improve marital intimacy and sexual satisfaction.     

Knowledge and attitudes of family members towards postpartum depression

BackgroundPostpartum depression (PPD) has been recently recognized as a public health issue. While family members play an important role in early recognition of PPD among women, research that explores family members awareness on PPD is limited from India.AimTo explore the knowledge and attitudes of family members towards postpartum depression.MethodsThis was a cross-sectional survey carried out among family members of postpartum women (N = 202) at a pediatric tertiary care center. The data was collected through face to face interview technique using a structured questionnaire.ResultsThe mean scores on knowledge (18.92 ± 3.27) attitude (31.39 ± 4.91) scales suggest that a majority of the participants had a good level of knowledge (54%) and positive attitudes (69.7%) towards women with postpartum depression. However, misconceptions and negative stereotypes related to postpartum depression still prevailed. Family members who had a good level of education (χ2 = 4.21, p < 0.05) and had come across women with postpartum depression (χ2 = 13.27, p < 0.001) hold positive attitudes towards postpartum depression compared to family members with a lower level of education and those did not come across women with postpartum depression.ConclusionThe findings of the present study suggest the need for educational campaigns to improve perinatal mental health literacy and address prejudices and negative stereotypes related to postpartum depression among family members.     

Visual and haptic verticality misperception and trunk control within 72 h after stroke

IntroductionStroke patients often exhibit an altered perception of verticality, but there are no studies evaluating verticality perception in the first 72 h after stroke and its relationship with trunk control. Therefore, this study aimed to analyze visual and haptic verticality in the acute phase of stroke.MethodsThis was a cross-sectional study conducted with two groups: (a) 13 individuals with stroke and (b) 12 healthy participants. We assessed verticality via the subjective visual vertical (SVV) and the subjective haptic vertical (SHV); and we measured trunk control with the Trunk Impairment Scale (TIS). We performed t-tests to compare the SVV and SHV between groups. Pearson correlation was performed between verticality tests with National Institutes of Health Stroke Scale (NIHSS) and the TIS.ResultsParticipants with recent stroke presented higher true and absolute SVV deviation values than did the control group. There was significant negative correlation between absolute (r = −0.57; p = 0.02) and true SVV (r = −0.54; p = 0.01) with TIS scores There was also significant positive correlation between absolute (r = 0.63; p = 0.009) and true SVV (r = 0.61; p = 0.003) with NIHSS. A significant negative correlation between NIHSS and TIS scores also was found (r = −0.80; p = 0.005).ConclusionIndividuals with acute stroke presented larger variability in their perceptions of visual verticality than did healthy controls, and verticality perceptions were positively correlated with trunk impairment.     

A comparison of breastfeeding women's,peer supporters' and student midwives' breastfeeding knowledge and attitudes

In the United Kingdom over 90% of women do not breastfeed for as long as they would like, despite widespread knowledge of the benefits of breastfeeding. Negative attitudes and low levels of knowledge in staff supporting breastfeeding may be a contributing factor. This paper reports on the breastfeeding knowledge and attitudes in two key workforce groups; student midwives (n = 19) and Breastfeeding Network peer supporters (n = 36) and compares them with breastfeeding women (n = 23). All three groups had high knowledge and attitude scores, but peer supporters had significantly higher levels than student midwives or breastfeeding women. Student midwives' knowledge of breastfeeding was higher than breastfeeding women's but they had similar breastfeeding attitude scores. The higher knowledge and attitude scores in peer supporters may be attributed to the effectiveness of their training, which includes challenging their existing breastfeeding attitudes and debriefing their personal breastfeeding experience. It is suggested that midwives' breastfeeding attitudes are affected by their community culture and their personal experience of breastfeeding. It is proposed that midwifery training should continue to embrace a biopsychosocial model, including training to improve breastfeeding attitudes, particularly for professionals from areas where breastfeeding is not the cultural norm, or who have had negative personal breastfeeding experiences.     

Effectiveness of a multimodal intervention and the simulation flow to improve empathy and attitudes towards older adults in nursing students: A crossover randomised controlled trial

AimThe aims of this study were (1) to develop a multimodal intervention according to the NLN Jeffries Simulation Theory planned to improve attitudes and empathy towards older adults in undergraduate nursing students using theoretical contents, age simulation suits, and storytelling of old participants, and (2) to evaluate the influence of the simulation flow on the effectiveness of this intervention in improving attitudes and empathy towards older adults.BackgroundThe increase in longevity in recent decades has led to an increase in the demand for professionals linked to the care of the older adults. Some studies indicate that health care professionals lack empathy and understanding toward older adults. Therefore, it is essential to introduce innovative teaching strategies to improve attitudes and empathy toward older adults in future health professionals.DesignA crossover randomised controlled trial.MethodsA three-period crossover randomised controlled trial with an experimental group, a control group (that transitions to a delayed experimental group) was conducted on 70 nursing students after the initial 73 were allocated. A multimodal intervention was used that, in addition to geriatric nursing theory, incorporated complex age simulation suit and student-older adult interaction. Pre-test and post-test data were obtained through the Jefferson Scale of Empathy and Kogan’s Attitudes towards Older People Scale. Thus, students in the experimental group 1 received the following simulation flow: Geriatric Nursing Theory + Seminar with age simulation suit + student-older adult interaction. The students in the delayed experimental group 2 received this order: Geriatric Nursing Theory +Seminar without Age simulation suit + student-older adult interaction + Age simulation suit.ResultsStatistically significant differences were observed in both empathy (t = 3.155, p = 0.001, d = 0.782), and attitudes (t=3.256, p=0.001, d=0.803) when comparing control group scores (who only received the theoretical contents of the seminar) and experimental group 1 scores after receiving the full multimodal simulation (i.e. a seminar wearing an age simulation suit + volunteer interaction with an older adult). Regarding the order of educational strategies in the simulation flow, there were significant differences in the empathy scores found when both groups had received the full intervention. Accordingly, training with age simulation suits followed by storytelling provides better scores in empathy than in the opposite direction (t = 2.028, p = 0.048, d = 0.54).ConclusionsThe use of a multimodal intervention, implementing an age simulation suit and the narration of an older adult's life experiences (in this order), improves attitudes and empathy.     

Perceived control and quality of life among recipients of implantable cardioverter defibrillator

BackgroundPerceived control is strongly associated with health-related quality of life (HRQOL) among patients with chronic conditions, and it is possible to increase perceived control with appropriate intervention. Little is known about the relationship between perceived control and HRQOL in implantable cardioverter defibrillator (ICD) recipients.ObjectivesTo determine the relationship of perceived control with quality of life in ICD recipients and to determine predictors of perceived control in this population.MethodsA total of 263 ICD recipients (63% male, age 61 ± 14 years) completed the Control Attitude Scale-Revised to measure perceived control and completed self-reported measures on potential correlates of perceived control (i.e., depressive symptoms, anxiety, social support, and ICD concerns). The EuroQol-5D was used to measure HRQOL. Regression analysis was used to determine predictors of perceived control and its relationship to HRQOL, controlling for covariates.ResultsLower perceived control (β = 0.30, p < .01), and higher levels of depression (β = −0.30, p < .01) and anxiety (β = −0.18, p < .05) predicted lower levels of HRQOL. Higher anxiety (β = −0.17, p < .05), higher depression (β = −0.23, p < .05), lower social support (β = 0.26, p < .01), and higher ICD-related concerns (β = −0.16, p < .05) independently predicted lower perceived control.ConclusionsInterventions targeting patients' ICD concerns and psychosocial factors before, and continuing after, ICD insertion are needed to improve ICD recipients' perceived control and, in turn, their HRQOL.     

Exploring the work of nurses who administer chemotherapy to children and young people

Purpose of the researchTo explore the knowledge, attitudes and beliefs of nurses who administer chemotherapy to children and young people.Methods and sampleA national postal survey of nurses working within the 21 cancer centres in the United Kingdom and Ireland. The questionnaire included 25-items addressing the attitudes, beliefs and concerns regarding nurses’ roles, support mechanisms and educational preparation related to administration of chemotherapy.ResultsIn total 286/507 (56%) questionnaires were returned. The majority of nurses worked in inpatient +/-outpatient (78%) settings and most gave chemotherapy on a daily basis (61%). The median time working in oncology was 10 [range 0.5–32] years and time administering chemotherapy was 8 [0.1–32] years. Aspects of administration that caused the most worry included treatment side-effects, extravasation, dealing with allergic/anaphylactic reactions and knowledge deficits in colleagues. There was no significant difference in worry according to level of nurse education but those with an oncology qualification had less Knowledge-related worry (p = 0.05). There was no difference in attitude according to level of education or having an oncology qualification. There were significant correlations between time qualified, time working in oncology and the number of years administering chemotherapy and the worry domains (ranging from r = −0.14 to r = −0.24, p < 0.05); and attitude to chemotherapy (ranging from r = 0.12 to r = 0.26, p < 0.001).ConclusionAs anticipated nurses new to chemotherapy administration were initially anxious about the role and they worried about making a drug error. Education and support from colleagues appears to have a positive effect on reducing worry and increasing competence.     

Efficacy of the Pilates versus general exercises versus educational workshops on neuromuscular parameters: A randomized controlled trial

IntroductionMuscle strength, flexibility and changes in muscle recruitment patterns are usually associated to low back pain (LBP). Physical exercises can reverse the adverse changes associated to LBP.ObjectivesCompare Pilates, general exercises and educational workshop on muscle flexibility, strength and recruitment of the trunk extensor muscles in women with LBP.MethodsForty-six women were randomly divided into Pilates group (PG, n = 16), general exercise group (GEG, n = 15), and educational group (EG, n = 15). This study sought to determine flexibility, muscle strength, and muscle recruitment of right (RIL), left (LIL) iliocostalis lumbar; right (RMU) and left (LMU) lumbar multifidus muscles. Both PG and GEG performed 16 exercise sessions, while EG attended 4 workshops. Statistical analysis used data sample from Shapiro-Wilk test, Pearson's correlation, multivariate analysis, mixed variance analysis, and Cohen's index.ResultsFlexibility showed no differences (p > 0.05). Muscle strength increased in the intragroup analysis for PG (p = 0.003) and GEG (p = 0.002); however, the intergroup analysis presented no difference. Intergroup showed statistically significant differences for the recruitment of RMU in PG (p < 0.001). Intragroup analysis presented differences after interventions in PG for RIL (p = 0.001); in GEG for LIL (p = 0.005); and in EG for RIL (p = 0.007), LIL (p = 0.002) and RMU (p < 0.001).ConclusionsNone of the groups showed flexibility improvements. PG and GEG increased muscle strength through intragroup analysis. Intergroup analysis showed an increase in recruitment of the RMU muscle in PG and all groups demonstrated significant improvements in the intragroup analysis.     

An investigation of knowledge,attitude and practice towards simulation among clinical nursing teachers in China: A cross-sectional study

AimThis study aimed to investigate the knowledge, attitude and practice towards simulation among CNTs in China and analyze the influencing factors.BackgroundIn China, simulation is now increasingly used by Clinical Nursing Teachers (CNTs) who are mainly responsible for nurses’ continuing education, novice nurses training and nursing students practice in clinical settings. Over the past 20 years, enrolment scale of nursing education was expanded greatly, and the number of registered nurses increased from 1.22 to 4.10 million in China. To contribute to nurses’ or nursing students’ professional development and successful transition to competent practitioners, CNTs are now being challenged to use simulation to develop more learner-centered educational programs, which could better facilitate learner engagement. As faculty preparation is a prerequisite for conducting quality simulation, it is critical that CNTs have the requisite knowledge and skills to use simulation to its full potential. However, data on CNTs’ knowledge, attitude and practice towards simulation is limited.DesignA cross-sectional study.MethodsA total of 342 CNTs from six tertiary affiliated teaching hospitals of a medical university in Beijing, China, participated in the study. Electronic questionnaire of Nurse Educators’ Knowledge, Attitude and Practice towards Simulation (NEKAPS) was delivered to CNTs. Analysis of variance, t-test were used to analyze data.ResultsThe mean score of knowledge and attitude for all participants was 60.01 ± 13.42 and 81.40 ± 19.99, respectively. The mean practice score was 70.65 ± 22.05 for 162 participants (47.4 %) who had conducted simulation in their hospitals. Participants with higher educational level (F=3.476, p = 0.032) and nursing career length≤ 15 years (t = 2.676, p = 0.008) had higher knowledge scores. However, there were no significant differences among different groups for attitudes. Participants with age ≤ 35 years old (t = 3.355, p = 0.001), nursing teaching length ≤ 10 years (t = 2.073, p = 0.041) and advanced beginner nurses (t = 3.212, p = 0.002) presented higher practice scores.ConclusionsCNTs had a low level of knowledge on simulation. Their attitudes towards simulation were positive, whereas their practices were still lacking. It is highlighted an urgent need for standardized training of CNTs to improve their knowledge and practice towards simulation, so that they can optimize the simulation programs they provide for nurses or nursing students.     

Proximal and distal muscle thickness is different in women with patellofemoral pain but is not associated with knee frontal plane projection angle

ObjectiveThe aim of this study was to compare proximal and distal muscle thickness between patellofemoral pain (PFP) and asymptomatic women (CG) and to verify the possible association between morphology and lower limb alignment during single leg-squat.MethodsThirty women (PFP, n = 15 and CG, n = 15) performed the following evaluations: (i) muscle thickness of external oblique (EO), gluteus medius (GMed), tensor fascia latae (TFL), peroneus (PER) and tibialis anterior (TA); (ii) knee frontal plane projection angle (FPPA) during single-leg squat.ResultsCompared with the CG, PFP showed: (1) smaller GMed (−10.02%; p = 0.04; effect size = 0.82), greater TFL (+18.44%; p = 0.02; effect size = 0.92) and PER (+14.23%; p = 0.02; effect size = 0.87) muscle thickness and greater knee FPPA during single-leg squat (+31.8%; p = 0.04; effect size = 1.12). No differences were observed in EO (+7.17%; p = 0.37; effect size = 0.34) and TA (−1.35%; p = 0.81; effect size = 0.12) muscle thickness. Additionally, we failed to observe significant associations between muscle morphology and knee FPPA in both groups.ConclusionPFP patients showed alterations in proximal and distal muscle thickness, despite the lack of association with poor lower limb alignment. Prospective studies are necessary to determine if differences in muscle morphology are the cause or the consequence of PFP and to confirm the absence of relationship with lower limb alignment.