The association between leaving intentions and burnout gives policymakers and nurse managers the opportunity to pay attention to burnout and its precursors as potential drivers of professional leaving. The study has the same limitations of many cross-sectional studies by focusing on work life and omitting contextual factors such as economic and family background. Future studies should consider actual leaving rather than intentions, adopt more developed models of organisational leaving
Nursing shortages are a recurrent problem in healthcare systems worldwide. Two basic mechanisms are considered to maintain and develop a sufficient nursing workforce: first, increasing the inflow of personnel into the active nursing workforce (eg, through training or immigration) and second, decreasing the outflow of nurses from the active...]]>
Women need to be informed about the effect of treatment for breast cancer on sexual well-being. Routine assessment of sexual well-being prior to, and on completion of, treatment for breast cancer should be conducted. The training and resource needs of healthcare professionals should be identified to enable them to provide more information on sexual well-being.
Cancer treatment affects sexuality and physical intimacy during and often long after completion of treatment, with many cancer survivors suffering from permanent sexual dysfunction.
An online survey which aimed to evaluate sexual well-being, information needs,...]]>
Population ageing is expected to produce a dramatic increase in the number of individuals with dementia. Patients’ social isolation and loneliness are potentially modifiable risk factors for poor cognitive functioning. Attention to a patient's social environment may help preserve cognitive functioning in at-risk older adults.
With the dramatic increase in life expectancy in developed countries, it has become important to identify factors that may mitigate the rising prevalence of cognitive dementia. The social environment in which older adults live has been linked to dementia, but the specific features of the social environment that are predictive have been elusive. Shankar and colleagues investigated the extent to which social isolation and perceived social isolation (loneliness) were predictive of declines in cognitive functioning.
A longitudinal...]]>
Greater calcium intake is encouraged for bone health, but has unclear cardiovascular consequences. In a large cohort of Swedish women, total calcium intake of <600 or ≥1400 mg/day was associated with an increased risk of total mortality (TM) and cardiovascular disease mortality (CVDM). It is important to emphasise adequate dietary calcium intake in patients, with calcium supplementation only when necessary.
Sufficient calcium intake is required for bone health. Recommended daily calcium increases with age, reaching 1500 mg/day by the age of 65 years. Intake of calcium-rich foods tends to be inadequate, with a large proportion of predominantly older women taking high-dose calcium supplements
In 2010, a key trial testing a palliative care intervention for patients with non-small-cell lung cancer was published. Findings from the present study will help define what palliative care specifically provides.
Professional organisations in the fields of oncology, such as the American Society of Clinical Oncology
Staff education appears important prior to introduction of new track and trigger (T&T) scoring and response systems. Staff confidence, knowledge and use of T&T and early response systems may assist early detection of patient deterioration. Further research on the impact of T&T models on patient outcomes is warranted.
Internationally, training in and use of T&T scoring systems along with a variety of rapid response strategies and regular observation-taking are believed to be useful foundations to assist nurses’ detection of deteriorating patients. In the UK, recommendations have been made for the introduction of these systems.
Female adolescents with a shorter duration between the age of menarche and first sexual intercourse are at an increased risk of high-grade cervical disease. Clinical counselling should include clear recommendations to obtain human papillomavirus (HPV) vaccination well before first intercourse to reduce the future risk of high-grade cervical lesions among sexually naïve female adolescents.
Ruiz and colleagues present associations between a shorter interval between menarche and first sexual intercourse on subsequent risk of high-grade cervical intraepithelial neoplasia (CIN-2+) or adenocarcinoma in situ among young women (16–23 years), in phase III randomised controlled trials (RCTs) in Colombia and Finland. Carcinogenic HPV infection is the main cause of invasive cervical cancer (ICC). Given that...]]>
Chlorhexidine-impregnated wash cloths have been shown to have some effect on multidrug-resistant acquisition and hospital-acquired blood stream infections in intensive care settings. Further research, including cost-effectiveness, is required to confirm these findings in intensive care units and in other healthcare settings.
Hospital-acquired blood stream infections (BSI) remain as an important cause of morbidity and mortality in intensive care units (ICUs) and other high-risk settings. Incidence rates vary considerably, depending on factors such as patient characteristics, type of invasive procedures, infection control practices, definitions and duration of hospital stay. Recently reported BSI rates in intensive care settings range between 0.28 and 22 per 1000 ICU patient-days
This study provides evidence that antimicrobial urethral catheters may not benefit patients admitted to hospital for elective surgery and therefore standard catheters are recommended. Further research is needed to determine whether antimicrobial urethral catheters would benefit patients hospitalised for medical or critical care reasons.
Around 25% of the hospitalised patients undergo short-term indwelling catheterisation,
Maternal mental health should be routinely assessed in paediatric settings where the presenting problem is the infant. The emergency department (ED) setting is an opportune place for the identification of postnatal depression (PND) and referral for support. Study findings should be replicated in other ED settings, with more socioeconomically diverse samples and confirmed through the use of diagnostic interviews.
PND is a common mental health problem with community prevalence estimates internationally ranging between 8% and 20%.
Counselling mothers to help settle babies with high levels of feeding/sleeping/tactile reactivity may help prevent the development of functional somatic symptoms (FSS) in children. Further research is required to identify additional risk factors for FSS and the evaluation of preventative interventions.
FSS in children are physical symptoms that cannot be ascribed to a medical disease. FSS affect approximately 10% of children and adolescents: when frequent and causing impairment they can lead to unproductive and costly medical assessments.
The study aimed to investigate...]]>
The combination of coughing, as a result of chronic obstructive pulmonary disease (COPD), and urinary incontinence (UI), can adversely affect quality of life. Healthcare providers must actively screen for UI in patients who smoke, have a chronic cough and/or who are diagnosed with COPD, as early treatment may improve quality of life.
It is estimated that worldwide, over 200 million people are living with UI.
Interventions are needed to help work teams recognise the signs of bullying and take steps to address the behaviour. Continued attention is required to address organisational responses and protective systems for occupational violence (OV) and workplace bullying (WB). Further research is required with nurses exposed to OV and WB to establish the efficacy of intervention programmes and nurses satisfaction with these programmes.
Workplace violence in its various forms is an issue of major concern to nursing. Over the course of their working life, few nurses escape this violence, and many are vulnerable to harm or injury stemming from exposure.
Commentary on: Zwakhalen SM, Van’t Hof CE, Hamers JP. Systematic pain assessment using an observational scale in nursing home residents with dementia: exploring feasibility and applied interventions. J Clin Nurs 2012;21:3009–17.
Observational behavioural tools often fail to identify pain among people with dementia, rendering their utility to clinical practice questionable. Caregivers used strategies such as redirecting rather than analgesic medication. Further research is needed to explore the most effective strategies for decreasing pain in this context. This likely includes using different assessment strategies, different treatment protocols and staff mentoring.
The underdetection of pain in people with dementia is commonplace
Commentary on: Tyler CP, Paneth N, Allred EN, et al. ELGAN Study Investigators. Brain damage in preterm newborns and maternal medication: the ELGAN study. Am J Obstet Gynecol 2012;207:192.e1–9.
Maternal aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) may increase the risk of cerebral palsy in extremely preterm infants. It would seem, however, that aspirin given to women at high-risk for pre-eclampsia may be beneficial. Exposure to NSAIDs should be considered with caution until further information is available.
The issue of taking medications during pregnancy and the risks involved has been the topic of many reviews. Aspirin is a NSAID that is prescribed to prevent recurrent abortion and to reduce the risk of pre-eclampsia. From animal studies it has been suggested that NSAIDs when taken during pregnancy have the potential to result in perinatal brain injury.
Data were extracted from the Extremely Low Gestational Age Newborns...]]>
Commentary on: Hulzebos EH, Smit Y, Helders PP, et al. Preoperative physical therapy for elective cardiac surgery patients. Cochrane Database Syst Rev 2012;11:CD010118.
Cardiac surgery patients are at risk of postoperative pulmonary complications. The incidence of postoperative pulmonary complications varies in the literature, because of inconsistent definitions for postoperative pulmonary complication. More large-scale randomised controlled trials are needed to determine the value of preoperative physical therapy in cardiac surgery patients.
Postoperative pulmonary complications are a common cause of morbidity and mortality after cardiac surgery. The reasons for the lung function impairment are multifactorial and include anaesthesia, cardiopulmonary bypass, the surgery itself, analgesia and postoperative immobility. The reported incidence varies in the literature, depending on the specific criteria used for the definition of a postoperative pulmonary complication and the diagnostic techniques used to detect them. Efforts have been made to identify those patients who have a higher...]]>
Dr Howell has undertaken some excellent work on the mechanisms of action for cranberries and urinary tract infections (UTIs) and she raises some interesting points in her commentary. However I must dispute some of the assertions she makes.
Dr Howell argues that Cochrane reviews have been used to evaluate drug therapies, but they may not be the most effective way to review randomised controlled trials (RCTs) of food products. Cochrane methods are primarily designed to systematically search, identify, quality assess and synthesise RCTs of a range of interventions. In addition to evaluating the effectiveness of drug therapies, Cochrane reviews cover an extensive range of other topics such as health technologies, complementary therapies and dietary interventions including food products, for example, garlic
Not all cranberry products contain enough active proanthocyanidins (PACs) for clinical efficacy. Consumers should look for products containing 36 mg of PACs. Cranberry is nearly as effective as low-dose antibiotics for urinary tract infection (UTI) prevention in women and children and does not cause antibiotic resistance. If cranberry products are being recommended to patients, conclusions of this one review do not provide sufficient reasons to change current practices.
UTIs are a significant public health challenge with more than 15 million cases in the USA each year, with their treatment accounting for 15% of all community-prescribed antibiotics at a cost of $500 million annually. For decades, cranberry juice and powders have been routinely recommended by healthcare practitioners for the prevention of UTIs. Meta-analyses of the clinical studies on cranberry are occasionally published...]]>
Out-of-hospital cardiac arrest (OHCA) is a major public health problem. For decades, guidelines prescribed mouth-to-mouth (MTM) ventilation as the first step in resuscitation of both primary and secondary cardiac arrest. The report by Iwami and associates is another observational study in patients that found improved survival of patients with primary OHCA who received chest compression only cardiopulmonary resuscitation (CO-CPR) by bystanders.
Bystander-initiated MTM ventilation alternating with chest compressions was initially the standard, and has been in the guidelines for bystander CPR for patients with cardiac arrest for a half century. Two decades of research in our physiological laboratory at the University of Arizona Sarver Heart Center led us to conclude...]]>
Abdominal pain is common in children, and frequently associated with anxiety, depression, school absenteeism and physical complaints such as headache and limb pain. Assessment and treatment of children with abdominal pain should be underpinned by a biopsychosocial approach. Functional abdominal pain research should use standardised research tools and definitions such as the Rome III criteria.
Between 20% and 40% of school children have weekly abdominal pain accounting for 2–4% of childhood medical consultations in the USA.
Screening for prenatal depressive symptoms and pregnancy anxiety is recommended. In predicting birth outcomes, essential controls include antidepressant use, medical risk conditions, body mass index and smoking. Analyses should consider low birth weight (LBW) and preterm birth (PTB) together to determine any distinct psychosocial risk factors and establish precise pathways.
The prevalence of prenatal depression and anxiety ranges between 5% and 16% and the consequences are extensive.
Policy makers and nurse leaders making staffing decisions must take into account the evidence linking nurse staffing, skill mix and patient outcomes. Researchers must continue to investigate staffing models to determine the most cost-effective model that supports quality care and take full advantage of the registered nurse workforce, especially given predicted shortages.
This study explored the impact of skill mix model changes on patient outcomes in a critical care environment, specifically, a respiratory care centre based in a southern Taiwan medical centre. It identified that the cost of ventilator-dependent patients in Taiwan in 1999 was 3.5 billion New Taiwan dollars, equivalent to US$ 121 million. In this context, controlling the costs of healthcare while maintaining...]]>
Gestational diabetes mellitus (GDM) is an independent risk factor for stress, urge and mixed urinary incontinence (UI), up to 2 years postpartum. Postpartum UI and its effects on quality of life are more severe in women with GDM. Women with GDM should be informed of an increased risk of postpartum UI. Postpartum UI may be a strong motivating factor to increase control of GDM and, later, prevent the development of type 2 diabetes mellitus (DM). Research should compare those with good GDM control versus poor control to demonstrate the effect on postpartum UI.
UI affects up to 50% of middle-aged and older women with significant economic, social and psychological consequences.
Commentary on Walker N, Howe C, Bullen C, et al. The combined effect of very low-nicotine content cigarettes, used as an adjunct to usual Quitline care (nicotine replacement therapy and behavioural support), on smoking cessation: a randomised controlled trial. Addiction 2012;107:1857–67.
Adding very low nicotine content (VLNC) cigarettes to nicotine replacement therapy (NRT) and behavioural support may help some smokers become abstinent. Use of VLNCs did not increase serious adverse health events when used with NRT. We cannot assume VLNCs would be as safe without NRT because there may be more compensatory smoking.
There are proven interventions to help smokers quit, both behavioural (group, individual, telephone-based counselling) and pharmacological (NRT, medications).
Conflicting evidence regarding the role of vitamin D in allergic disease highlights the need for well-designed clinical trials. This study and others suggest that early life vitamin D insufficiency may increase eczema risk. Supplementation during pregnancy may increase cord blood vitamin D and subsequent early life exposure.
The human fetus is dependent on maternal vitamin D status during gestation. Vitamin D deficiency rates in pregnant women have been reported as being more than 70% in some clinical practices.
Commentary on: Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2012;11:CD006145
Encouraging cancer patients to follow a structured exercise programme reduces self-reported fatigue. The optimal exercise programme (aerobic, resistance, mind–body or a combined programme) remains undecided; however, evidence supports regularly participating in an exercise programme either at home or in a formal facility. Longitudinal randomised controlled trials (RCTs) of exercise interventions in cancer patients that include biomarkers of the interacting pathways in cancer-related fatigue, such as the inflammatory, nervous system, metabolic and hypothalamic-pituitary-adrenal (HPA)-axis, are critically needed.
Cramp and Byron-Daniel conducted a systematic review of studies addressing the important issue of exercise and its therapeutic benefit in reducing cancer-related fatigue (CRF) both during and after cancer treatment. Fatigue is a commonly reported symptom among newly diagnosed cancer patients (70–100%), those undergoing treatment and even long-term survivors. CRF...]]>
The study highlights the impact of challenging behaviour on nursing staff. It is important that the problems associated with challenging behaviour are attended to and that staff are supported in their work. Future studies should examine if other aspects, such as coping resources, could be a protective factor for nursing distress.
An increasing proportion of people with dementia has and will continue to be admitted to nursing homes or similar accommodations such as special care units. One of the reasons for being admitted to such institutions is challenging, behavioural or psychological symptoms in dementia. Several studies have shown that challenging behaviour is highly prevalent
Commentary on: Brölmann FE, Ubbink DT, Nelson EA, et al. Evidence-based decisions for local and systemic wound care. Br J Surg 2012;99:1172–83.
Evidence-supported interventions to manage chronic wounds include elastic, high or multilayer compression and systemic pentoxifyllene for venous ulcers; hyperbaric oxygen and local hydrogels applied after debridement for diabetic ulcers; systemic prostanoids and spinal cord stimulation for arterial ulcers; and avoidance of local therapeutic ultrasound for healing pressure ulcers. Evidence-supported interventions to prevent pressure ulcers include high-specification foam and low air-loss mattresses, and pressure-relieving overlays on operating room tables. Evidence-supported interventions for acute wound healing include topical honey for burns, tap water for cleansing soft tissue injury, prophylactic antibiotics for hand bites and avoidance of silver sulfadiazine as a topical agent. Many common wound care therapies have had no trials conducted to assess their effectiveness. More high-quality research studies are urgently needed to determine best practices...]]>
Commentary on: Arts EE, Landewe-Cleuren SA, Schaper NC, et al. The cost-effectiveness of substituting physicians with diabetes nurse specialists: a randomized controlled trial with 2-year follow-up. J Adv Nurs 2012;68:1224–34
Care provided by diabetes nurse specialists to uncomplicated patients with diabetes was not inferior to physician care, in terms of patient quality of life and expenditures. Care patterns were not equal between study groups; diabetes nurse specialists followed a preset protocol and had referral limitations.
Diabetes is economically burdensome worldwide. Treating diabetes and preventing its complications cost at least US$465 billion in 2011, translating to 11% of total healthcare expenditures in adults.
Younger patients with higher preoperative pain and depression are more likely to have higher pain on postoperative day 2 following total knee arthroplasty. Cutaneous pain sensitivity correlates with postoperative knee movement pain but not rest pain, which suggests different underlying pain mechanisms. Future research should investigate whether presurgical intervention on pain and psychological factors can improve postoperative pain and long-term outcomes following total knee arthroplasty (TKA).
TKA is generally regarded as a highly successful procedure to improve pain and function in patients with advanced degenerative joint disease. Perioperative pain management remains a major concern for patients contemplating TKA and residual pain has been associated with dissatisfaction and poor outcome. This study aims to identify which preoperative characteristics are predictive of knee pain immediately following TKA using a comprehensive set of...]]>
Registered nurse (RN) and total nurse turnover are the organisational variables that should be measured and tracked routinely. Working in highly specialised areas is associated with lower turnover, therefore future research should explore characteristics of these areas and how they may be applied to less specialised areas of nursing practice. Future studies should explore determinants of low turnover in government hospitals.
Replacing nurse vacancies in hospitals is a substantial expense and hospitals are wise to explore strategies that minimise nursing turnover. The US hospitals that attracted and retained a high-quality RN workforce despite severe nursing shortages in the early 1980s were termed ‘magnet hospitals’. Magnet hospital certification by the American Nurses Credentialing Center (ANCC) began in the...]]>
Staff need more education around identification of pain and options for management among the older population. Pain assessment methods should be brief and simple, followed by an algorithm for management. The need to explore organisational barriers which inhibit effective management and to develop more creative ways of overcoming such barriers. The need to evaluate treatment pathways.
This study was conducted within two geriatric units in a public teaching hospital in Australia. The authors identify the need to explore pain assessment and management, a complex phenomenon that makes up the decision-making process and includes environment, communication and other previously unexplored influencing factors. We are aware that 50% of older adults in the community experience pain and this increases to 80% in care homes.
Infants whose mothers were treated with antenatal corticosteroids (ANS) after documented fetal lung immaturity at >34 weeks’ gestation had a lower rate of composite respiratory morbidity. There was no statistically significant difference in the rate of special care unit admission. The study supports prolonging pregnancy as long as possible without incurring undue risk to the mother as the most beneficial approach to avoid prematurity-related newborn complications.
Late preterm infants are the fast-growing proportion of preterm infants in the USA, and these infants are at risk for a variety of prematurity-related morbidities, including respiratory and feeding difficulties and neonatal sepsis. While ample evidence supports the use of ANS to decrease respiratory distress syndrome (RDS) in infants born <34 weeks’ gestation,...]]>
Meta-analysis of five studies shows that smoking cessation delivered predominantly via automated text messaging increases quit rates 47–99% compared with minimal intervention. Mobile phone cessation interventions provide quitting tips, social support and motivational messages, tailored to quit stage, multiple times per day at limited cost.
Although healthcare providers are moderately adherent with practice guidelines for asking, advising and assessing tobacco use, adherence to assisting and arranging cessation services remains poor, often due to limited time and training.
General health checks aim to detect risk factors and diseases in healthy people, with the aim of either preventing a disease from developing, or treating a disease earlier in its course. A systematic review of randomised controlled trials (RCTs) of general health checks found that they did not reduce morbidity or mortality, but did increase the number of new diagnoses.
The burden of non-communicable disease such as cardiovascular disease, type 2 diabetes and kidney disease is increasing worldwide.
Prevention of exposure to influenza among long-stay nursing home residents has the potential to prevent significant morbidity, including functional decline. Nursing home quality measures may need to be adjusted seasonally or for regional influenza severity. Future research is needed to confirm these associations on an individual level and to determine if preventive measures, such as resident and staff vaccination and hand hygiene, can prevent functional decline and other adverse outcomes.
In the USA, 90% of the estimated 24 000 influenza-related deaths each year occur in older adults,
This paper illustrates how findings from two related studies can enhance nursing and midwifery practice through the evaluation of the effectiveness of a family midwives (FMs) intervention. Midwives educated about the health impact of infant maltreatment can be trained to support and strengthen maternal competencies in caring and relating to their infants’ needs. FMs learn more about the multiple risk factors that families have to cope with, can promote stronger infant–parent relationships and support parents in meeting their children's nutritional and well-being needs. Further research is needed to assess the efficacy of a universal FM service to provide the opportunities for positive, non-violent family interactions, as appropriate treatments to meet the needs of vulnerable infants still remain a challenge.
In...]]>
To date, ultraviolet (UV) exposure is the only environmental factor associated with an increased risk of melanoma. There is therefore a need to ensure that the risks associated with artificial UV exposure are quantified. There has been some controversy regarding the association between melanoma and sunbed exposure as some studies have shown positive associations while others have not.
Melanoma has long been linked to UV exposure and this has been established via case-control studies and cohort studies including migration studies from Australia and Europe as well as laboratory studies on animal models. Most case-control studies have shown that exposure to natural sunlight is associated with an increased risk of melanoma, especially for exposure before the age of 35 years and overall relative risk of 1.75.
Pressure ulcers (PUs) are common and often occur in older persons and those with multiple comorbidities. Patients with hospital-acquired PUs (HAPUs) have longer hospital stays and higher rates of morbidity and mortality; therefore, prevention and early detection are important priorities for nursing care. Interpretation of epidemiological studies of PUs is difficult due to variances in data collection methods and PU classification employed, making cross comparisons between clinical sites challenging.
Development of HAPUs is considered an adverse event.
Most studies published in scientific nursing journals explore psychological variables in adult populations. Over the last 25 years less theoretically oriented research has been published in nursing journals. Future studies should expand journal selection to include more clinical and international nursing journals.
Professional journals serve as vehicles for disseminating the findings of research and new knowledge to readers who can use that information in their own practice or research. Studies of journals can reveal important trends in the development of knowledge in a field, how works are related to one another, the most influential journals and patterns in authorship.
Brown et al
This retrospective survey of ambulatory patients with diabetes indicates that self-reported severe hypoglycaemia is associated with increased risk of 5-year mortality. Although the mechanisms are unclear, evaluation of patients with diabetes should include documentation of hypoglycaemia history and management approaches should focus on patient education and scrupulous avoidance of iatrogenic hypoglycaemia.
Hypoglycaemia (<70 mg/dl; 3.9 mmol/l) in people with diabetes is frequently due to exposure to insulin or insulin secretagogues. The acute effects of hypoglycaemia in symptomatic patients, and the disabling effect of severe hypoglycaemia, are well known. However, data on the frequency of hypoglycaemia and magnitude of hypoglycaemia-related mortality are less certain. The investigators set out to determine whether self-reported hypoglycaemia is associated with increased mortality among outpatients attending a specialty diabetes clinic.
A total of 1013 outpatients (21.3% with type...]]>
Early dog contacts are associated with fewer respiratory infections in infants, especially otitis, but not wheezing after adjustment for possible confounders. Early animal contacts are important, possibly leading to changes in immune development and a better resistance to infectious respiratory diseases in infants. Future research is needed to explore the mechanism of the favourable effect of dog exposure and whether similar results occur over a longer period.
Several groups have studied the associations between animal contacts early in life and asthma and allergic diseases in childhood.
If you want to inform your practice with answers to questions such as ‘What is it like for people to suffer chronic pain?’ or ‘What are patients’ understanding and experience of hypertension and taking medication’
There are several different ways of carrying out a qualitative synthesis (for more details, see refs.