Effect of peer support on health outcomes in patients with cardiac pacemaker implantation: A randomized,controlled trial

The aim of this study was to examine the effect of a nurse‐led telephone‐based peer support program on health outcomes in patients after cardiac pacemaker implantation. Seventy six patients who received cardiac pacemaker implantation were recruited as participants and randomly assigned to either the peer support group or the usual care group. The usual care group received routine care and health education measures provided by nurses; the peer support group received telephone‐based peer support. Health‐related quality of life, self‐care knowledge–attitudes–practice, postoperative anxiety and depression, compliance with attending scheduled follow‐up visits, and the incidence of postoperative complications were evaluated at baseline and 6 months’ postintervention for the two groups. The result showed that the interventions had a better effect on self‐care knowledge–attitudes–practice, postoperative anxiety and depression, and compliance with attending scheduled follow‐up visits in the peer support group than in the usual care group. This study confirms that telephone‐based peer support improves self‐care ability, compliance with attending scheduled follow‐up visits, and reduces postoperative anxiety and depression more effectively than conventional nurse care among patients with cardiac pacemaker implantation.     

Factors predicting perceived improved health after emergency room visits

Aim. This study examines the key factors contributing to perceived improved health after emergency room (ER) visits. Background. Perceived health is a subjective measure of health status. It is an important and useful concept in nursing and assessment of health services because it reflects the clients’ own assessment of his/her health, which may have led to their subsequent health‐seeking behaviour. Methods. Secondary analysis of a main study which aimed at examining the effects of nurse follow‐up on ER revisits using randomized‐controlled trial. In this study, binary logistic regressions were conducted to identify factors associated with the dependent variable, perceived improved health 30 days after the index ER visit. Data were collected from 795 subjects and the sources of data were from medical records and telephone interviews. Results. Gender, income, usual practice in managing minor illness, what to do other than attending the ER, nurse follow‐up, general self‐rated health, triage, considered other doctors on the day of index ER visit, times of attending general outpatient clinic and times of attending general practitioner were found to be significantly associated with perceived improved health 30 days after the index ER visit. Conclusion. Many of the variables identified in this study that predicted perceived improved health concurred with previous findings. What is of interest is that nurse follow‐up but not multiple medical consultations helped enhance perceived improved health. We speculate that there was no continuity of care in the multiple medical consultations. Where as in the nurse follow‐up, the nurse was able to follow through the care of individuals, monitor their progress and make appropriate referrals. This study shows that the nurse is an appropriate person to mediate the health needs of individuals and the healthcare system and to enhance health maintenance for individuals in the community without excessively using medical services. Relevance to clinical practice. The nurses providing care during the transitional phase should not only include the traditional clinical or hospital system variables, but should also take into account the general health perception of patients, because these are the predictors of health services utilization and morbidity.     

Comparison of a co‐produced mental health service to traditional services: A co‐produced mixed‐methods cross‐sectional study

This study investigates the differences between a co‐produced experimental mental health centre and traditional day centres. For this purpose, we used a collaborative and mixed‐method approach in two complementary studies: (i) a quantitative cross‐sectional study designed to compare users' hospitalization rates and their use of psychiatric medications and (ii) a qualitative study designed to explore and document the experienced differences between co‐produced and traditional services. In the quantitative cross‐sectional study, surveys were administered to 37 users of one co‐produced mental health service and to 40 users of traditional mental health services. A negative binomial regression analysis was performed to examine the relationships between predictors and users' hospitalization rates. After adjusting for the potential confounders, users of the co‐produced centre reported a 63.2% reduced rate of hospitalizations compared with users of traditional mental health services (P = 0.002). Furthermore, 39% of users of the co‐produced centre reported a reduction or even withdrawal from psychiatric medications against 22% of the comparison group (P = 0.036). In the qualitative study, six main differences emerged from a thematic analysis of a large user‐led focus group. In the participants' experiences, the co‐produced service focused on (i) parity and respectful relationships, (ii) people's strengths, (iii) freedom, (iv) psychological continuity, (v) social inclusion, and (vi) recovery orientation. Our research provides empirical evidence concerning the ‘preventive aspect’ of co‐produced mental health services. Additionally, new insights into how different stakeholders, particularly users of co‐produced mental health services, experience the differences between co‐produced and traditional mental health services are provided.     

Meeting the needs? Perceived support of a nurse‐led lifestyle programme for young adults with mental illness in a primary health‐care setting

Being a young adult with mental illness challenges all aspects of health, including an increased risk for developing lifestyle‐related diseases. There is a lack of lifestyle programmes in primary health care that target physical, mental, and social needs for young adults with mental illness. The aim of the present study was to describe the experiences of young adults with mental illness receiving support from a nurse‐led lifestyle programme, and how this support was related to their life context, including challenges and coping strategies. Two focus groups and six individual interviews were performed with 13 young adults (16–25 years), and analysed using a qualitative content analysis. The findings showed that the young adults experienced challenges in their daily lives, including psychiatric symptoms, lack of social understanding, and loneliness. The study indicated that the programme could support lifestyle habits with its components of supportive interpersonal relationships, awareness of coping strategies, understanding of health and illness, and cognitive support (e.g. schedules and reminders). However, the programme could not meet everyone's needs for new social relationships or more comprehensive support. Even so, this nurse‐led programme provides health information‐management strategies that could easily be integrated in a primary health‐care setting.     

Effect of telephone follow‐up on adherence to a diabetes therapeutic regimen

Aim: To determine whether a nurse telephone follow‐up service could improve the level of adherence to a diabetes therapeutic regimen for patients with type 2 diabetes. Methods: A total of 61 patients attended a 3 day diabetes self‐care program at the Iranian Diabetes Society. They were randomly assigned to one of the experimental or control groups. A telephone follow‐up program was applied to the experimental group for 3 months, twice per week for the first month and weekly for the second and third months. The data‐collection instruments included a data sheet to record the glycosylated hemoglobin (HbA1c) level and a questionnaire. The data were collected at baseline and after 12 weeks. Results: There were significant differences between the control and the experimental groups in their adherence to a diabetic diet, exercise, foot care, blood glucose monitoring, and medication‐taking. Also, the HbA1c levels differed significantly between the two groups after 3 months. Conclusion: A nurse‐led telephone follow‐up was effective in enhancing the level of adherence to a diabetes therapeutic regimen, such that the HbA1c level decreased.     

Perceptions of crisis care in populations who self‐referred to a telephone‐based mental health triage service

Although psychiatric crises are very common in people with mental illness, little is known about consumer perceptions of mental health crisis care. Given the current emphasis on recovery‐oriented approaches, shared decision‐making, and partnering with consumers in planning and delivering care, this knowledge gap is significant. Since the late 1990s, access to Australian mental health services has been facilitated by 24/7 telephone‐based mental health triage systems, which provide initial psychiatric assessment, referral, support, and advice. A significant proportion of consumers access telephone‐based mental health triage services in a state of crisis, but to date, there has been no published studies that specifically report on consumer perceptions on the quality and effectiveness of the care provided by these services. This article reports on a study that investigated consumer perceptions of accessing telephone‐based mental health triage services. Seventy‐five mental health consumers participated in a telephone interview about their triage service use experience. An eight‐item survey designed to measure the responsiveness of mental health services was used for data collection. The findings reported here focus on the qualitative data produced in the study. Consumer participants shared a range of perspectives on telephone‐based mental health triage that provide invaluable insights into the needs, expectations, and service use experiences of consumers seeking assistance with a mental health problem. Consumer perceptions of crisis care have important implications for practice. Approaches and interventions identified as important to quality care can be used to inform educational and practice initiatives that promote person‐centred, collaborative crisis care.     

Efficacy of tele‐nursing consultations in rehabilitation after radical prostatectomy: a randomised controlled trial study

The dramatic increase in prostate cancer incidence causes higher demands for public health care. To meet these demands, fast track pathways have been introduced in radical prostatectomy. However, the short length of hospital admission leaves less time for patient education. The aim of this study was to investigate whether nurse‐led telephone consultations (TCs) could optimize resources and secure rehabilitation and patient satisfaction in the post‐operative period. This study is a prospective randomized controlled trial. A random sample of 95 consecutively enrolled patients was randomized to either intervention or standard follow‐up. The intervention was an additional TC 3 days post‐operatively. The care and patient education offered during hospitalization was similar for all patients. Randomization took place at discharge and was controlled externally. Data were collected from medical records and questionnaires 2 weeks post‐operatively. We found no difference in the overall efficacy regarding patient satisfaction, sense of security and post‐operative discomfort. Some patients had unmet needs and TCs provided better rehabilitation regarding management of bowel function, pain, catheter and wound care. There was no difference in the need of post‐operative contact to other health care affiliates. In general, patients were sufficiently educated in managing early rehabilitation and they expressed high satisfaction and sense of security in the post‐operative period after discharge regardless of TC. Therefore, TCs will not be the standard procedure, but the results have increased awareness in daily clinical practice and optimized the clinical pathway in general. The results indicate commitment and high adherence to clinical guidelines among the nursing staff.     

Impact of nurse‐led behavioural counselling to improve metabolic health and physical activity among adults with mental illness

The life expectancy of adults with mental illness is significantly less than that of the general population, and this is largely due to poor physical health. Behavioural counselling can improve physical health indicators among people with non‐communicable disease. This repeated‐measures, single‐group intervention trial evaluated the effects of a 19‐week behavioural counselling programme on metabolic health indicators and physical activity levels of outpatient adults with mental illness. Sixteen participants completed the intervention that comprised individual face‐to‐face counselling sessions with a registered nurse every 3 weeks, and progress reviews with a medical practitioner every 6 weeks. Assessment included self‐report and objective measurement of physical activity, and measures of blood pressure and anthropometry. Statistically‐significant changes were demonstrated between baseline and post intervention for participants’ waist circumference (P = 0.035) and waist‐to‐height ratio (P = 0.037). Non‐significant improvements were demonstrated in weight and physical activity. The findings indicated that adults with mental illness can engage in a nurse‐led behavioural counselling intervention, with improvements in some metabolic health measures after 19 weeks. It is recommended that behavioural counselling programmes for adults with mental illness be sustained over time and have an ‘open door’ policy to allow for attendance interruptions, such as hospitalization.     

Effectiveness of a self‐management support program for Thais with type 2 diabetes: Evaluation according to the RE‐AIM framework

Delivering diabetes self‐management support is an enormous challenge for healthcare providers with limited human resources. We conducted a cluster randomized controlled trial to assess the effectiveness of a DSMS program incorporating the computer‐assisted instruction. The RE‐AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was applied to evaluate the DSMS program. Ten Public Health Centers in Bangkok, Thailand were randomized into either DSMS program or usual care. Forty eligible patients with type 2 diabetes in each Public Health Center were randomly selected. Totally, 403 patients (200 controls and 203 interventions) participated. About 93.8% participants completed the six‐month follow‐up. Over six months, adjusted mean changes of hemoglobin A1c (?0.14%, 95% confidence interval = ?0.02 to ?0.26, fasting plasma glucose (?6.37 mg/dL, ?1.95 to ?10.78), health behaviors (3.31 score, 2.27 to 4.34), and quality of life (1.41 score, 0.69 to 2.12) were significantly improved in intervention compared to control group. In conclusion, the DSMS program facilitates Public Health Centers to accomplish their support for people with diabetes.     

Nurse and midwifery prescribing in Ireland: A scope‐of‐practice development for worldwide consideration

For 10 years, select Irish nurses and midwives who pass a rigorous 6 month theory and practical program can prescribe medications and other medicinal products. Given the need for timely, accessible, and affordable health‐care services in all countries, this nursing/midwifery education and practice development is worthy of examination. Irish nurse/midwife prescribing occurred following long‐term deliberative nursing profession advocacy, nursing education planning, nursing administration and practice planning, interdisciplinary health‐care team support and complementary efforts, and government action. A review of documents, research, and other articles was undertaken to examine this development process and report evaluative information for consideration by other countries seeking to improve their health‐care systems. Nurse/midwife prescribing was accomplished successfully in Ireland, with the steps taken there to initiate and establish nurse/midwife prescribing of value internationally.     

After critical care: a study to explore patients' experiences of a follow-up service

Aims and objectives. To establish patients’ experiences after discharge from critical care and to evaluate implementation of a follow‐up service. Background. Government recommendations advise critical care follow‐up to prevent readmission and address problems after discharge. Admission to critical care results in significant psychological and physiological sequelae. Design. A prospective, longitudinal and exploratory study of surgical cancer patients requiring >48 hours in critical care. Qualitative interviews were conducted and short questionnaires were used. Methods. Patient Expert Advisory Groups were invited to participate in research design. Patients were visited in the ward at days 1 and 5 after discharge, invited to nurse‐led follow‐up clinic and interviewed at three and six months. Short questionnaires were administered at six and 12 months. Findings. Twenty‐seven patients participated in the study. All patients experienced benefit from the service. Emergent themes included: rehabilitation from critical care: physiological issues and needs, memories: real and unreal, uncertainty and fear and empathy. A core theme of reassurance was underlying through the research. Issues while in critical care included: the need for nursing presence, nightmares, delusions, confusion, fear of ward transfer, inability to remember, disorientation and being prepared for the experience. After discharge, issues shifted to longer term needs. Psychological support, in the form of the follow‐up clinic, proved useful. The ability to move on with life after discharge varied and uncertainty about the future and their cancer had an impact upon this. Recovery was made easier through the follow‐up clinic. Patients required reassurances that their experiences were valid and also wanted reassurances about their cancer. Conclusion. Critical care causes various difficulties for patients that may impinge on recovery. Incorporating patients into the design process helps identify needs more closely. Follow‐up proved beneficial and highlighted the role nurses have in improving patient experiences after discharge from critical care. Nurses should be vigilant for both immediate and longer‐term needs. Relevance to clinical practice. This research into nurse‐led follow‐up clinics after critical care highlights an important, and often neglected, part of the critical illness continuum. Attending such clinics may help reassure patients after discharge from critical care.     

Assessing falls risk in older adult mental health patients: A Western Australian review

Falls are a common and costly complication of hospitalization, particularly in older adult populations. This paper presents the results of a review of 139 falls at two older adult mental health services in Western Australia, Australia, over a 12‐month period. Data were collected from the hospital incident report management system and from case file reviews of patients who sustained a fall during hospitalization. The results demonstrated that the use of different risk assessment and falls management tools led to variations in practice, policies, and management strategies. The review identified mental health‐specific falls risk factors that place older people with a mental illness at risk when admitted to the acute mental health setting. With the expansion of community mental health care, many older people with a mental illness are now cared for in a variety of health‐care settings. In assessing falls risk and implementing falls‐prevention strategies, it is important for clinicians to recognize this group as an ambulant population with a fluctuating course of illness. They have related risks that require specialized falls assessment and management.     

Stigmatization and self‐determination of preregistration nurses: A path analysis

The concept of stigma and the stigmatizing behaviours of health‐care professionals can have a profound influence on people with mental illness. A key construct that has been identified as influencing our behaviours is self‐determination. As such, in the present study, we attempted to examine the connection and influence of motivational measures on the stigmatization of preregistration nurses. Data were collected once using three surveys that measured the motivational responses and stigmatizing behaviours of preregistration nurses after an approved mental health clinical placement. Using a path analysis, the results indicated that psychological needs significantly influenced preregistration nurses’ self‐determination towards work. In addition, self‐determination was a significant influence on the stigmatization behaviours of preregistration nurses. The results of the present study provide initial empirical evidence that supports the importance of professional self‐determination and the potential connection of quality care, as illustrated with the low stigmatizing behaviours of preregistration nurses who are more self‐determined towards their work/career. Because of the significant results of the present study, it is recommended that future research is needed that uses self‐determination theory as a lens to understand the application and importance within the field of nurse education.     

The Effectiveness of Nurse‐Led,Home‐Based Pulmonary Rehabilitation in Patients with COPD in Turkey

The goal of this study was to determine the effectiveness of nurse‐led, home‐based pulmonary rehabilitation in patients with stage 3 or 4 chronic obstructive pulmonary disease (COPD), according to the Global Initiative for COPD (GOLD) staging system. The study consisted of 32 patients—a nurse‐led, home‐based pulmonary rehabilitation group (16) and a control group (16). In the rehabilitation program, patients received education about their diseases and performed breathing exercises and lower‐ and upper‐extremity aerobic exercises at their homes during the 3‐month period of the study. There was meaningful improvement in the rehabilitation group in terms of pulmonary function tests (FEV₁% predicted value), artery blood gases (PaCO₂), quality of life, dyspnea, and functional capacity. On the other hand, no meaningful change was observed in the control group. The study showed that the nurse‐led, home‐based pulmonary rehabilitation program had positive effects on the patients with COPD.     

Problematizing health coaching for chronic illness self‐management

To address the growing costs associated with chronic illness care, many countries, both developed and developing, identify increased patient self‐management or self‐care as a focus of healthcare reform. Health coaching, an implementation strategy to support the shift to self‐management, encourages patients to make lifestyle changes to improve the management of chronic illness. This practice differs from traditional models of health education because of the interactional dynamics between nurse and patient, and an orientation to care that ostensibly centres and empowers patients. The theoretical underpinnings of coaching reflect these differences, however in its application, the practices arranged around health coaching for chronic illness self‐management reveal the social regulation and professional management of everyday life. This becomes especially problematic in contexts defined by economic constraint and government withdrawal from activities related to the ‘care’ of citizens. In this paper, we trace the development of health coaching as part of nursing practice and consider the implications of this practice as an emerging element of chronic illness self‐management. Our purpose is to highlight health coaching as an approach intended to support patients with chronic illness and at the same time, problematize the tensions contained in (and by) this practice.     

Evaluation of a nurse‐led service for follow up of patients with prostate cancer

The incidence of prostate cancer in Scotland continues to grow; men are now living with their disease which can be seen as an increased burden for the health service and in particular the Uro‐Oncology team which delivers its treatment and manage its follow up. A new model of follow up was established for men who have received treatment for prostate cancer, replacing conventional outpatient clinic. The virtual prostate cancer follow‐up clinic was set up for men who are 2 years post radiotherapy with stable prostate‐specific antigen. The aim of this follow up was to improve the patient experience of living with prostate cancer and reduce the high demand to the service. A successful bid to Macmillan allowed a nurse to be employed by the department for a 3‐year project post. The aim of this role was to develop the prostate cancer follow‐up clinic and evaluate this new way of working. Method A questionnaire was designed to obtain the views of the patients who were recipients of care and treatment from the clinical nurse specialist rather than the oncologist. The questionnaire was sent to all 302 men recruited to this new clinic. The patients were asked six questions which focused on support/communication, problems experienced and improvement. Results for 191 questionnaires were returned out of the 302 questionnaires sent, giving a 63·2% response rate. About 98% was very happy with the new service, 98·8% of patients reported being well supported by this new service. The success of this new follow‐up system will allow us to use this model for men post prostatectomy and receiving hormone suppression treatment. The role of the uro‐oncology nurse is vital to ensure that this clinic continues to be effective and give positive outcomes for patients with prostate cancer and the team involved in their journey.     

Effectiveness of an educational self‐management program for outpatients with chronic heart failure

Aim: The occurrence rate of chronic heart failure (CHF) in Japan is estimated to be 50 000 per one million persons. It is important for the Japanese medical financial system to institute a program of disease management in order to prevent the deterioration of persons with CHF. However, there are still few studies on the disease management of CHF in Japan. Therefore, the purpose of this study was to provide an educational self‐management program to Japanese outpatients with CHF in order to improve their clinical outcomes. Methods: A randomized, controlled trial with 102 outpatients with CHF was conducted. There were 50 participants in the intervention group and 52 participants in the control group. The control group received medical treatment and standard care. In addition to this, the intervention group also received an educational program for 6 months. The program consisted of six nurse‐directed sessions that were provided to each outpatient once per month in a clinical setting for a total of 6 months. A follow‐up session was conducted each month for 6 months. The data collection was carried out at the start of the program and at 3, 6, 9, and 12 months. Results: Significant differences could be observed in the primary and secondary outcomes and in the process indicators between the two groups after the program began. In other words, all the indicators improved for the intervention group, compared to the control group. Therefore, this program was considered to be effective. Conclusion: Further long‐term care is necessary for outpatients with CHF in order to prevent their deterioration and to maintain their health status, even though this 6 month program did provide them with proper knowledge regarding self‐care for CHF and affected their therapy results.     

Cost‐effectiveness of a nurse‐led education and psychosocial programme for patients with chronic heart failure and their partners

Aims and objectives.  This randomised controlled trial was conducted to estimate the cost‐effectiveness of a nurse‐led education and psychosocial support programme for patients with heart failure (HF) and their partners. Background.  There are few studies evaluating cost‐effectiveness of interventions among HF patient–partner dyads. Methods.  Dyads randomised to the experimental group received nurse‐led counselling, computer‐based education and written materials aimed at developing problem‐solving skills at two, six and 12 weeks after hospitalisation with HF exacerbation. The dyads in the control group received usual care. A cost‐effectiveness analysis that included costs associated with staff time to deliver the intervention and travel costs was conducted at 12 months. Quality‐adjusted life‐year (QALY) weights for patients and partners were estimated by SF‐6D. Results.  A total of 155 dyads were included. The intervention cost was €223 per patient. Participants in both groups showed improvements in QALY weights after 12 months. However, no significant difference in QALY weights was found between the patients in the two groups, nor among their partners. Conclusion.  The intervention was not proven cost‐effective, neither for patients nor for partners. The intervention, however, had trends (but not significant) effects on the patient–partner dyads, and by analysing the QALY gained from the dyad, a reasonable mean cost‐effectiveness ratio was achieved. Relevance to clinical practice.  The study shows trends of a cost‐effective education and psychosocial care of HF patient–partner dyads.