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Aim: To explore the risk factors associated with postoperative cognitive dysfunction in older patients within the first 7 days after non‐neurosurgical surgery and anaesthesia. Design: A systematic review. Methods: Following, PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta‐analyses). Checklist, a systematic review of studies published from January 2018 to January 2024. The literature search was conducted across six electronic online databases, including PubMed, EMBASE, Scopus, Ovid, MEDLINE and Science Direct, and the Johns Hopkins Nursing Evidence‐Based Practice Evidence Rating Scale was used for study appraisal. Results: The initial search yielded 1750 studies. The review included 19 studies which comprised prospective observational, case–control and retrospective studies. The prevalence of postoperative cognitive dysfunction ranged from 19% to 64% among older adults undergoing non‐neurosurgery. The identified risk factors were classified into three phases including preoperative, intraoperative and postoperative. Preoperative risk factors were found in age, educational attainment, malnutrition, preoperative biomarkers and co‐morbidities. Intraoperative risk factors were the duration of the operation, blood loss during the operation and anaesthesia used. Postoperative risk factors consisted of postoperative biomarkers and postoperative pain. Patient or Public Contribution: The result from this review may assist researchers and healthcare providers in assessing the underlying causes and risk factors of postoperative cognitive dysfunction, and in formulating suitable preventative and therapeutic strategies for older adults with non‐neurosurgery during the short‐term postoperative period. [ABSTRACT FROM AUTHOR]

Aim: To report an analysis of the concept of community empowerment. Design: Concept analysis. Data Sources: Literature published in the CINAHL, PubMed, Scopus and Medline electronic databases from 2016 to 2022 were systematically searched from 30 July to 1 October 2022. Method: The amended guideline from Walker and Avant's approach (2011) to concept analysis was performed in nine stages: choosing a concept, determining the purpose of analysis, identifying definitions of the concept, defining attributes, identifying a model case, identifying antecedents, identifying consequences, defining empirical referents and applying the concept to nursing practice. Results: Community empowerment is a fundamental idea in health promotion that may assist communities in defining priorities, making choices, developing strategies and executing them to improve health and minimize inequalities in health. Community empowerment is an effective tool that advanced practice nurses (APNs) may employ to eliminate health inequities and promote community health. Conclusion: This concept analysis is one step towards broadening nurses' understanding of one of the ideas of health promotion. Additionally, the concept of community empowerment represents an opportunity for additional research in nursing that is applicable to communities. Impact Community empowerment has served as a guiding paradigm for both theory and practice in health promotion. Also, it is recognized that social, economic and environmental elements have a direct effect on health status. However, community empowerment research in advanced nursing practices is limited. This paper will guide future nursing research on community empowerment that goes beyond involvement and engagement, for this is an effective strategy APNs can use to address health disparities and improve community health. [ABSTRACT FROM AUTHOR]

Introduction/Objective: This review aimed to summarize articles describing caregiver burden and the relationship between health outcomes as well as describing interventions focusing on this population. Methods: The review used the PRISMA statement and Whittemore and Knafl guidelines. The search engines Scopus, PubMed, Ovid (PsycINFO), and CINAHL were searched for articles published in English. Results: This review included 30 studies that met the criteria. Physical, psychological, and social factors were associated with HF caregiver burden. HF caregiver interventions included health education, post-discharge home visits, phone calls, counseling, and support groups that demonstrated some potential to reduce the caregivers' burden. Discussion: Healthcare provider team should screen for caregiver burden and promote healthy behaviors, and strategies to improve quality of life. Further studies should include caregivers as care team members and embed social networking in the interventions for reducing HF caregiver burden. The caregivers' burden could influence the poor outcomes of care, including physical, psychological, societal, and functional dimensions. Future interventions should develop to alleviate HF caregiver burden. [ABSTRACT FROM AUTHOR]

Background: Heart failure is a troublesome condition with high healthcare utilization and cost. Most individuals with heart failure experience multiple symptoms including breathlessness, pain, depression, and anxiety. Purpose: The aim of this study was to review the literature describing the use of the Edmonton Symptom Assessment Scale to assess the burden of symptoms and the impact of symptoms on heart failure outcomes including quality of life and functional outcomes. Methods: The search engines PubMed, Scopus, CINAHL, and Web of Science were searched from January 2001 to March 2020. A review of literature was undertaken using key terms "heart failure," "CHF," "cardiac failure," "heart decompensation," "myocardial failure," "Edmonton Symptom Assessment Scale". Hand searching of articles was also undertaken. Results: The search resulted in 33 relevant articles, which were imported into Rayyan, a Web-based systematic review software program. We present synthesis of results of studies (1) using the Edmonton Symptom Assessment Scale as an assessment of symptom burden and (2) evaluating the impact of symptom burden on quality of life and functional status. Conclusion: This review highlighted the Edmonton Symptom Assessment Scale as a predictive instrument to identify symptom burden, symptom clusters, and symptom changes for patients living with heart failure. The clinical use of the Edmonton Symptom Assessment Scale may identify treatment priorities, promote self-management, inform the treatment plan, and advance effective therapeutic adjustments. The symptom burden in heart failure is high, and improving the symptom experience is an important focus of future healthcare interventions. The Edmonton Symptom Assessment Scale has utility in heart failure management due to psychometric properties and ease of administration. Clinical Implications: The Edmonton Symptom Assessment Scale may be useful in measuring patient-reported symptom burden in patients with heart failure in the clinical setting because it correlates well with other heart failure measures on quality of life and functional outcomes and provides useful information on symptom burden. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This systematic review and meta‐analysis reports the seroprevalence of SARS‐CoV‐2 antibodies among nurses. Background: With a growing body of literature reporting the positive serology for SARS‐CoV‐2 antibodies among healthcare workers, it remains unclear whether staff at the point of direct patient care are more prone to developing and transmitting the virus. Given nurses make up the majority of the global health workforce, outbreaks among these workers could severely undermine a health system's capability to manage the pandemic. We aimed to summarise and report the seroprevalence of SARS‐CoV‐2 antibodies among nurses globally. Design: Systematic review and meta‐analyses. Methods: This systematic review was developed, undertaken and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guideline. We searched the electronic medical literature databases: MEDLINE; CINAHL; and EMBASE for studies reporting the seroprevalence of SARS‐CoV‐2 antibodies among nursing staff. Studies that reported nursing specific data were included in this review. Study quality was evaluated using the Joanna Briggs Institute checklist for studies reporting prevalence data. Studies were stratified according to the World Health Organisation region classifications, and results were presented using forest plots and summary prevalence and variance was estimated using a random effects model. Results: Our electronic search identified 1687 potential studies, of which 1148 were screened for eligibility after duplicates were removed, and 51 of the studies were included in our meta‐analysis. The overall seroprevalence of SARS‐CoV‐2 antibodies among nurses was estimated to be 8.1% (95% CI 6.9%–9.4%) among the 60,571 participants included in the studies. Seropositivity was highest in the African region (48.2%, 95% CI 39.2%–57.3%), followed by the European region (10.3%, 95% CI 8.0%–12.5%), the Region of the Americas (8.4%, 95% CI 6.0%–10.7%), the South‐East Asia region (3.0%, 95% CI 0.00%–6.5%) and the Western Pacific region (0.5%, 95% CI 0.0%–1.0%). Pooled estimates were unable to be calculated in the Eastern Mediterranean region due to insufficient studies. Conclusion: The seroprevalence of SARS‐CoV‐2 antibodies among nurses is comparable to other healthcare workers, and possibly similar to the general population. Early adoption and adherence to personal protective equipment and social distancing measures could explain these similarities, meaning the majority of staff contracted the virus through community transmission and not in a healthcare setting. Relevance to clinical practice: Fear and uncertainty have been features of this pandemic, including among nurses. This meta‐analysis should provide some comfort to nurses that risks are similar to community exposure when adequate PPE is available and there is an adherence to infection control measures. [ABSTRACT FROM AUTHOR]

Objectives: Frailty is a syndrome characterized by increased vulnerability and reduced ability to maintain homeostasis after stressful events that results in an increased risk for poor outcomes. Frailty screening could potentially be valuable in cardiac surgery risk assessment. The purpose of this review is to evaluate the current literature linking multicomponent frailty assessment and invasive cardiac surgery outcomes. Methods : We searched PubMed, EMBASE, and CINAHL; 1887 articles met the search criteria, and each was independently reviewed by 2 reviewers. Results : The 19 eligible studies assessed 52 291 subjects using 17 different frailty measurements. The most commonly used instruments were the Fried Frailty Phenotype and the Clinical Frailty Scale. Between 9% and 61% of participants were found to be frail in each study. All 19 studies included mortality as an outcome, 12 included surgical complications, 12 included hospital length of stay, 3 included quality of life, and 2 included functional status. Nine found statistically significant differences in survival between frail and nonfrail patients, 6 of 12 found that frail patients had a longer length of stay, 4 of 12 found that frail patients were more likely to experience major complications, and 2 of 2 found that frail patients were more likely to have a decrease in functional status. Conclusion : Although some studies lacked power, the majority confirmed that frail patients are more likely to experience poor outcomes. Further research is needed to determine which frailty measure provides the best predictive validity and to identify interventions to mitigate the risks that major cardiac surgery poses to frail patients. [ABSTRACT FROM AUTHOR]

The prevalence of noncommunicable diseases (NCDs) is increasing worldwide. Buddhist monks in Thailand play a critical role in health as community leaders accounting for 0.3% of the population. However, some monks require treatment and hospitalization to alleviate the burden of NCDs due to religious beliefs and practices during ordainment. Risk factors for NCDs among Buddhist monks, and the relationship to social determinants of health (SDH) remain unclear. This integrative review examined the prevalence of NCDs and explored the relationship between SDH and health outcomes among Buddhist monks. Cohort, descriptive, and correlational studies published in both English and Thai languages were identified from the PubMed, Science Direct, CINAHL, and Thai journal databases. Keywords included "Thai Buddhist monks," "non‐communicable diseases," and "prevalence". Twenty‐two studies were selected. Obesity and hypertension were the most prevalent NCDs. Religious beliefs and practices influence SDH domains and play an important role in the lifestyle and health behaviors among Buddhist monks. Further understanding of the impact of the religious lifestyle is needed, particularly given the role and influence of monks in society. [ABSTRACT FROM AUTHOR]

Background: A history of unethical research and deficit-based paradigms have contributed to profound mistrust of research among Native Americans, serving as an important call to action. Lack of cultural safety in research with Native Americans limits integration of cultural and contextual knowledge that is valuable for understanding challenges and making progress toward sustainable change. Aim: To identify strategies for promoting cultural safety, accountability, and sustainability in research with Native American communities. Method: Using an integrative review approach, three distinct processes were carried out: (1) appraisal of peer-reviewed literature (Scopus, PubMed, and ProQuest), (2) review of grey literature (e.g. policy documents and guidelines), and (3) synthesis of recommendations for promoting cultural safety. Results: A total of 378 articles were screened for inclusion, with 55 peer-reviewed and grey literature articles extracted for full review. Recommendations from included articles were synthesised into strategies aligned with eight thematic areas for improving cultural safety in research with Native American communities. Conclusions: Research aiming to understand, respect, and acknowledge tribal sovereignty, address historical trauma, and endorse Indigenous methods is essential. Culturally appropriate, community-based and -engaged research collaborations with Native American communities can signal a reparative effort, re-establish trust, and inform pragmatic solutions. Rigorous research led by Native American people is critical to address common and complex health challenges faced by Native American communities. Impact statement: Respect and rigorous methods ensure cultural safety, accountability, and sustainability in research with Native Americans. [ABSTRACT FROM AUTHOR]

Background: Fiscal constraints, an ageing populations and the increasing burden of chronic conditions are stressing health systems internationally. Nurses are the linchpin of effective healthcare delivery and their success is dependent on adequate staffing models, which must align knowledge, skills and competencies with workload. Objectives: To compare measures of nursing workload in adult inpatient settings. Design, data sources and review method: A review of published studies characterising nursing workload measures was undertaken. Databases—PubMed and CINHAL—were used to identify published studies. A description of the psychometric properties of each measure and its use in an inpatient setting was required for inclusion. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement was used to guide and report the review. Results: Of the 1,422 studies identified, 15 met the inclusion criteria. Nursing workload was measured in the intermediate care unit (n = 6), overall hospital (n = 7), emergency department (n = 1) and burn unit (n = 1) settings and also by mailed survey (n = 1). Eleven different workload measures were identified. The National Aeronautics and Space Administration Task Load Index (n = 3), Therapeutic Intervention Scoring System (n = 3) and Nursing Activities Score (n = 2) were the most common nursing workload measures identified with reported psychometric properties. Conclusion: Researchers, clinicians and hospital administrators should carefully identify and assess the psychometric properties of nursing workload measures before using these in routine practice. Relevance to clinical practice: Gaining a consensus on effective nursing workload measures is a crucial step in designing appropriate staffing models and policies, improving nurse productivity and well‐being, as well as enhancing patient health outcomes in inpatient settings. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify factors associated with the caregiving appraisal of informal caregivers. Background: Caregiving appraisal, the cognitive evaluation of the caregiving situation, is an essential factor in determining positive or negative caregiving outcomes. Identifying factors associated with appraisal is fundamental for designing effective health promotion strategies. Design: A systematic review. Methods: PubMed, EMBASE, CINAHL, PsycINFO, Social Sciences Citation Index, Scopus, CNKI and Wanfang Database were searched for papers published from 1984 to December 2018. Keywords related to informal caregivers' caregiving appraisal were used. Cross‐sectional and cohort studies were included. The Quality Assessment and Validity Tool for Correlational Studies, and the CASP Cohort Study Checklist were used for quality assessment. Descriptive and narrative synthesis were used to analyse data. Social ecological model was used for classifying the associated factors into different levels. The PRISMA checklist was followed. Results: Forty studies were included. The quality of the studies was moderate to high. Data were organised into three levels (individual, interpersonal and community level) and categorised into modifiable factors (e.g. patient behavioural problems, caregiver self‐efficacy and social support) and nonmodifiable factors (e.g. caregiving duration, gender and education). The majority of studies have investigated the factors at the individual level. Conclusion: There are inconsistencies in the understanding of caregiving appraisal, and consensus is needed for conceptual clarity. Caregiving appraisal is associated with three levels of factors. These modifiable factors provide evidence for designing evidence‐based interventions, and the nonmodifiable factors help identify confounding factors in assessment and appraisal. Relevance to clinical practice: Nurses are the best‐placed healthcare professionals to support informal caregivers. The three levels of associated factors and the interactive approaches provide direction for informing clinical nursing practice. They also provide evidence for healthcare researchers and policymakers to develop interventions and theoretical perspectives and to better allocate healthcare resources. [ABSTRACT FROM AUTHOR]

Aims: To examine the delirium point prevalence studies conducted in different inpatient settings and to discuss the implication of the findings for delirium screening, assessment, prevention and management. Background: Delirium—a common and distressing condition manifesting as an acute decline of attention and cognition—is frequently overlooked, misdiagnosed or treated inappropriately. This neuropsychiatric syndrome manifests as changes in attention, cognition and awareness, with resultant impact on behaviour, function and emotions. Delirium is recognised as a patient management challenge in the inpatient setting, and there is a need to understand the current point prevalence and assessment practices of delirium. Design: A systematic review and meta‐analysis. Methods: A systematic review of published delirium prevalence studies in inpatient settings was conducted and the implications of findings for delirium screening, assessment, prevention and management identified. The random‐effects meta‐analysis was conducted among studies measuring delirium point prevalence. The PRISMA statement was used to report systematic review and meta‐analysis. Results: Nine studies were included in the review, with sample sizes ranging from 47–1867. Delirium point prevalence ranged from 9%–32%. Hypoactive delirium was the most common subtype, ranging from 23%–78%. Fifteen delirium screening tools or assessment or diagnostic methods were used. Comorbid dementia was present in up to 50% of inpatients. Conclusions: Gaining a consensus on effective delirium instruments, the time windows for assessment and measurement will be crucial in driving benchmarking and quality improvement studies. Relevance to clinical practice: Consistent identification of high‐risk patients and treatment settings with elevated risk, accompanied by the implementation of effective preventive and management strategies, are critical to addressing delirium—a frequent and burdensome condition, that adversely affects patient outcomes. [ABSTRACT FROM AUTHOR]

International clinical practice guidelines recommend that patients with chronic heart failure receive timely and high-quality palliative care. However, integrating palliative care is highly variable and dependent on decision-making and care models. This meta-synthesis aimed to examine health care professionals' decision-making processes and explore factors impacting decisions to refer or deliver palliative care in chronic heart failure. The electronic databases SCOPUS, CINAHL, and Medline were searched. Included studies were those that reported health care professionals' perceptions of palliative care in chronic heart failure through qualitative data collection, were written in English, and were peer-reviewed articles. Included articles were analysed using Thomas and Harden's approach. The dual-process theory was used and applied a priori to organise the findings. The perception of palliative care as a transition and active treatment failure fit within the intuitive system of thinking in the dual-process theory. The theme that overlapped into both intuitive and analytical systems of thinking was acquiring patient and illness information themes reflecting the analytical system of thinking were professional role and experience, pre-existing decision pathways, and balancing viewpoints. This meta-synthesis identified factors influencing the decision-making process in referring patients with chronic heart failure to palliative care. The findings from this review highlight the need for further development of decision-making tools or facilitate guidelines to assist health care professionals' shared decision-making to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: The purpose of this systematic review was to (a) examine the effects of interventions delivered by a heart failure professional for mild cognitive impairment and dementia on cognitive function, memory, working memory, instrumental activities of daily living, heart failure knowledge, self-care, quality of life and depression; and (b) identify the successful elements of these strategies for heart failure patients with mild cognitive impairment or dementia. Methods and results: During March 2018, an electronic search of databases including CINAHL, MEDLINE, EMBASE and PsycINFO was conducted. All randomised controlled trials, which examined an intervention strategy to help heart failure patients with mild cognitive impairment or dementia cope with self-care, were included. An initial search yielded 1622 citations, six studies were included (N = 595 participants, mean age 68 years). There were no significant improvements in cognitive function and depression. However, significant improvements were seen in memory (p =0.015), working memory (p =0.029) and instrumental activities of daily living (p =0.006). Nurse led interventions improved the patient's heart failure knowledge (p =0.001), self-care (p <0.05) and quality of life (p =0.029). Key elements of these interventions include brain exercises, for example, syllable stacks, individualised assessment and customised education, personalised self-care schedule development, interactive problem-solving training on scenarios and association techniques to prompt self-care activities. Conclusions: Modest evidence for nurse led interventions among heart failure patients with mild cognitive impairment or dementia was identified. These results must be interpreted with caution in light of the limited number of available included studies. [ABSTRACT FROM AUTHOR]

Background: Clinical deterioration and adverse events in hospitals is an increasing cause for concern. Rapid response systems have been widely implemented to identify deteriorating patients. Aim: We aimed to examine the literature highlighting major historical trends leading to the widespread adoption of rapid response systems, focussing on Australian issues and identifying future focus areas. Method: Integrative literature review including published and grey literature. Results: Seventy-eight sources including journal articles and Australian government matierlas resulted. Pertinent themes were the increasing acuity and aging of the population, importance of hospital cultures, the emerging role of the consumer, and proliferation, evolution and standardisation of rapid response systems. Discussion: Translating evidence to usual care practice is challenging and strongly driven by local factors and political imperatives. Conclusion: Rapid response systems are complex interventions requiring consideration of contextual factors at all levels. Appropriate resources, a skilled workforce and positive workplace cultures are needed for these systems to reach their full potential. [ABSTRACT FROM AUTHOR]

Context: Heart failure is a chronic complex syndrome that is common and burdensome. International clinical practice guidelines recommend that healthcare providers communicate palliative care options with patients with heart failure. Objectives: The aim of this study was to conduct an integrative review to evaluate how healthcare providers perceived communication barriers to offering information to individuals in the palliative phase of heart failure. Methods: Four databases and the gray literature were searched from January 1987 to February 2017. Inclusion and exclusion criteria were applied. Studies were graded for strength and quality using a critical appraisal tool, and key themes were extracted and synthesized. Results: Ten articles met the full inclusion criteria. Most studies were qualitative or nonexperimental studies of good quality. Authors of several studies found that healthcare providers lacked basic knowledge about palliative care or did not possess sufficient knowledge to effectively provide care. Poor knowledge of palliative care created a barrier between the provider and the patient. Inadequate education or inexperience in palliative care led to the resistance of health providers to implementing a palliative approach. Conclusions: The results of this review emphasize a lack of knowledge asa barrier to delivering palliative care. Healthcare providers caring for individuals with heart failure need palliative care knowledge, skills, and competencies to ensure that this vulnerable population receives holistic patient-centered care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine what is known about hypertension among adults living in Haiti. Background: Hypertension is the leading cause of morbidity, the identified cause of heart failure in 45% of patients and is associated with more than 70% of cardiovascular disease‐related hospital admissions in Haiti. Design: An integrative review of the literature. Methods: Searching four databases from 2007 to 2018, Whittemore and Knafl's method was used to review the literature. Three nurse researchers independently reviewed and appraised each publication applying the Johns Hopkins Evidence‐based Practice Appraisal tool. Results: Eight publications were identified and appraised for level and quality of evidence. The synthesis of the literature yielded common themes of (i) high prevalence of hypertension among adults living in rural areas, (ii) public health challenges, (iii) lack of knowledge and awareness of hypertension and (iv) barriers to effective treatment. Conclusion: Hypertension is a highly prevalent disease in Haiti that is understudied and warrants attention. To better serve this vulnerable population, culturally tailored prevention strategies and disease management programmes are recommended. Relevance to clinical practice: There is a lack of quality evidence to guide nurses in the management of hypertension for this vulnerable population. Identification of barriers to effective treatment among this underserved population will assist nurses and other healthcare professionals in identifying best possible practices for patient care in clinical settings across Haiti. [ABSTRACT FROM AUTHOR]

Background: Frailty is an independent predictor of mortality across many conditions. Reported rates of frailty in heart failure range from 15% to 74%. There are several instruments available to assess frailty; however, to date there has been no consensus on the most appropriate instrument for use in individuals with heart failure. Aims: To identify how frailty is assessed in individuals with heart failure and to elucidate which domains of frailty are most frequently assessed. Methods: Key electronic databases were searched (MEDLINE, COCHRANE Central and CINAHL) to identify studies that assessed frailty in individuals with heart failure using a formal frailty instrument. Results: Twenty studies published in 24 articles were included, for which a total of seven unique frailty instruments were identified. The most commonly used instrument was the Frailty Phenotype (n= 11), with the majority of studies using a modified version of the Frailty Phenotype (n= 8). The second most commonly used instrument identified was the Comprehensive Geriatric Assessment (n= 4). Conclusion: There is an increasing interest in the assessment of frailty, but, to date, there is no frailty instrument validated specifically in the heart failure population. [ABSTRACT FROM AUTHOR]

Purpose Older people account for the highest proportion of mortality from extreme weather events associated with climate change. This article aims to describe the health impacts of climate change on older people. Type of Study An integrative review was conducted with 30 studies retrieved from PubMed, EBSCO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) on climate stressors, determinants of resilient capacity, risk factors, and health outcomes. Findings Heat, temperature variability, and air pollution increase mortality risk in older people, especially from cardiovascular and respiratory diseases. Floods are linked with increasing incidence of post-traumatic stress disorder, depression, and anxiety. Facing these adversities, older people exhibit both vulnerability and resilience. Conclusions Research gaps exist in understanding the full spectrum of the resilience experience of older people, and appreciating areas wherein nursing can play a pivotal role. Clinical Relevance Recognizing the vulnerabilities of older people in the context of climate change is important. Identifying opportunities to promote resilience is an important focus for nurses to develop tailored and targeted nursing interventions. [ABSTRACT FROM AUTHOR]

Background: Despite most expected deaths occurring in hospital, optimal end-of-life care is not available for all in this setting. Aim: To gain a richer and deeper understanding of elements of end-of-life care that consumers consider most important within the hospital setting. Design: A meta-synthesis. Data sources: A systematic search of Academic Search Complete, AMED, CINAHL, MEDLINE, EMBASE, PsycINFO, PubMed, Google, Google Scholar and CareSearch for qualitative studies published between 1990 and April 2015 reporting statements by consumers regarding important elements of end-of-life hospital care. Study quality was appraised by two independent researchers using an established checklist. A three-stage synthesis approach focusing on consumer quotes, rather than primary author themes, was adopted for this review. Results: Of 1922 articles, 16 met the inclusion criteria providing patient and family data for analysis. Synthesis yielded 7 patient and 10 family themes including 6 common themes: (1) expert care, (2) effective communication and shared decision-making, (3) respectful and compassionate care, (4) adequate environment for care, (5) family involvement and (6) financial affairs. Maintenance of sense of self was the additional patient theme, while the four additional family themes were as follows: (1) maintenance of patient safety, (2) preparation for death, (3) care extending to the family after patient death and (4) enabling patient choice at the end of life. Conclusion: Consumer narratives help to provide a clearer direction as to what is important for hospital end-of-life care. Systems are needed to enable optimal end-of-life care, in accordance with consumer priorities, and embedded into routine hospital care. [ABSTRACT FROM AUTHOR]

Aims and objectives To summarise the literature describing new graduate nurse transition to professional practice within the primary health care (PHC) setting. Background There is a plethora of research literature spanning several decades about new graduate nurse transition in the acute care setting. Yet, the experiences of new graduate nurse in the PHC setting is unremarkable particularly considering the increasing demand for skilled health care workers and focus of health reform to provide care where people work and live. Design Electronic data bases, Academic Search Complete, EBSCO, Medline, Psyc INFO, CINHAL, and ERIC were searched using a combination of terms and synonyms arising from three key concepts which identify the phenomenon; 'transition', 'new graduate registered nurse' and 'primary health care. An inclusive search strategy placed no limits on language or publication date. Results Of the 50 articles located and examined for relevance; 40 were sourced through databases and 10 from Google Scholar/Alerts and hand-searching references. None of the 19 articles retained for analysis addressed all key concepts. Conclusions Some challenges of researching the professional transition of graduate nurses in PHC settings included, an absence of definitive transition models, a dearth of literature and deference to acute care research. Relevance to clinical practice Nursing in PHC settings, particularly the client's home is notably different to hospital settings because of higher levels of isolation and autonomy. Societal changes, health reform and subsequent demand for skilled workers in PHC settings has caused health care providers to question the logic that such roles are only for experienced nurses. Implications arise for education and health service providers who desire to close the theory practice gap and mitigate risk for all stakeholders when next generation nurses have limited opportunities to experience PHC roles as undergraduates and newly graduated registered nurses are already transitioning in this setting. [ABSTRACT FROM AUTHOR]

African migrant women represent a rapidly growing cohort of new arrivals in many countries. Many of these women demonstrate strength and resilience throughout the stressful migration process. In this integrative review, we explore the literature on African migrants' resilience using an ecological framework. Nine peer-reviewed journal articles and six grey literature documents were reviewed. Key internal and external factors in achieving resilience were identified, discussed, and diagrammatically represented using Bronfenbrenner's Ecological Framework under micro-, meso-, exo-, and macro-levels. Our findings show that the capacity for resilience demonstrated during migration could have implications for policy and practice. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence remains a global problem and is of particular concern in Latina diasporas. Aim: To identify effective elements of interventions to address intimate partner violence in Latina women. Method: The systematic review was undertaken according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We focused the search on intervention studies assessing intimate partner violence as an outcome measure and on publications in English and Spanish from the last 11 years (2004–2015). Results: Despite the scope of the problem, from the 1,274 studies screened only four met the search criteria and only a single study included an exclusive Latino population. Of the four interventions, one was only as effective as the control treatment. Heterogeneity of study populations and designs prohibited meta-analytic methods. Conclusions: Theoretically derived interventions that are gender specific, culturally appropriate, target mutual aid through group dynamics, and that are developed collaboratively with the target population are likely to be most effective. [ABSTRACT FROM AUTHOR]

Background Increasingly there is a focus on self-care strategies for both malignant and non-malignant conditions. Models of self-care interventions have focussed on the individual and less on the broader context of family and society. In many societies, decision-making and health seeking behaviours, involve family members. Objective To identify elements of effective family-centred self-care interventions that are likely to improve outcomes of adults living with chronic conditions. Design Review paper. Data sources MEDLINE (Ovid), CINAHL, Academic Search Complete, PsychInfo and Scopus between 2000-2014. Review methods Quantitative studies targeting patient outcomes through family-centred interventions in adults were retrieved using systematic methods in January, 2015. Search terms used were: 'family', 'spouse', 'carer', 'caregiver', 'chronic', 'chronic disease', 'self-care', 'self-management' and 'self-efficacy'. Reference lists were reviewed. Risk of bias assessment was performed using the Cochrane Collaboration's tool. Data were reported using a narrative summary approach. Results Ten studies were identified. Improvements were noted in readmission rates, emergency department presentations, and anxiety levels using family-centred interventions compared with controls. Elements of effective interventions used were a family-centred approach, active learning strategy and transitional care with appropriate follow-up. Conclusions Involving the family in self-care has shown some positive results for patients with chronic conditions. The benefits of family-centred care may be more likely in specific socio-cultural contexts. Limitations The review has year limits and further research needs to identify support for both the patients and family caregivers. [ABSTRACT FROM AUTHOR]

Aim A discussion of the conceptual elements of an intervention tailored to the needs of Lebanese families. Background The role of informal caregiving is strongly recommended for individuals with chronic conditions including heart failure. Although this importance is recognized, conceptual and theoretical underpinnings are not well elucidated nor are methods of intervention implementation. Design Discussion paper on the conceptual underpinning of the FAMILY model. Methods and data sources This intervention was undertaken using linked methods: (1) Appraisal of theoretical model; (2) review of systematic reviews on educational interventions promoting self-management in chronic conditions in four databases with no year limit; (3) socio-cultural context identification from selected papers; (4) expert consultation using consensus methods; and (5) model development. Results Theories on self-care and behavioural change, eighteen systematic reviews on educational interventions and selected papers identifying sociocultural elements along with expert opinion were used to guide the development of The FAMILY Intervention Heart Failure Model. Theory and practice driven concepts identified include: behavioural change, linkage, partnership and self-regulation. Implications for nursing Heart failure is a common condition often requiring in-hospital and home-based care. Educational interventions targeting the socio-cultural influences of the patients and their family caregivers through a structured and well-designed program can improve outcomes. Conclusion As the burden of chronic diseases increases globally, particularly in emerging economies, developing models of intervention that are appropriate to both the individual and the socio-cultural context are necessary. [ABSTRACT FROM AUTHOR]

Aims and objectives The purpose of this review was to explore what is known about interruptions and distractions on medication administration in the context of undergraduate nurse education. Background Incidents and errors during the process of medication administration continue to be a substantial patient safety issue in health care settings internationally. Interruptions to the medication administration process have been identified as a leading cause of medication error. Literature recognises that some interruptions are unavoidable; therefore in an effort to reduce errors, it is essential understand how undergraduate nurses learn to manage interruptions to the medication administration process. Design Systematic, critical literature review. Methods Utilising the electronic databases, of Medline, Scopus, PubMed and CINAHL, and recognised quality assessment guidelines, 19 articles met the inclusion criteria. Search terms included: nurses, medication incidents or errors, interruptions, disruption, distractions and multitasking. Results Researchers have responded to the impact of interruptions and distractions on the medication administration by attempting to eliminate them. Despite the introduction of quality improvements, little is known about how nurses manage interruptions and distractions during medication administration or how they learn to do so. A significant gap in the literature exists in relation to innovative sustainable strategies that assist undergraduate nurses to learn how to safely and confidently manage interruptions in the clinical environment. Conclusions Study findings highlight the need for further exploration into the way nurses learn to manage interruptions and distractions during medication administration. This is essential given the critical relationship between interruptions and medication error rates. Relevance to clinical practice Better preparing nurses to safely fulfil the task of medication administration in the clinical environment, with increased confidence in the face of interruptions, could lead to a reduction in errors and concomitant improvements to patient safety. [ABSTRACT FROM AUTHOR]

Background: The majority of expected deaths occur in hospitals where optimal end-of-life care is not yet fully realised, as evidenced by recent reviews outlining experience of care. Better understanding what patients and their families consider to be the most important elements of inpatient end-of-life care is crucial to addressing this gap. Aim and design: This systematic review aimed to ascertain the five most important elements of inpatient end-of-life care as identified by patients with palliative care needs and their families. Data sources: Nine electronic databases from 1990 to 2014 were searched along with key internet search engines and handsearching of included article reference lists. Quality of included studies was appraised by two researchers. Results: Of 1859 articles, 8 met the inclusion criteria generating data from 1141 patients and 3117 families. Synthesis of the top five elements identified four common end-of-life care domains considered important to both patients and their families, namely, (1) effective communication and shared decision making, (2) expert care, (3) respectful and compassionate care and (4) trust and confidence in clinicians. The final domains differed with financial affairs being important to families, while an adequate environment for care and minimising burden both being important to patients. Conclusion: This review adds to what has been known for over two decades in relation to patient and family priorities for end-of-life care within the hospital setting. The challenge for health care services is to act on this evidence, reconfigure care systems accordingly and ensure universal access to optimal end-of-life care within hospitals. [ABSTRACT FROM AUTHOR]

Background: Immigration, both voluntary and forced, is driven by social, political and economic factors. Accordingly, some discussions and debates have emerged in recent years about the impact of migration on the health status of migrants. The aim of this review was to identify the impact of migration on the health status of Iranian immigrants and present a conceptual framework to facilitate the design and delivery of services and supports for this particular immigrant group. Methods: Data for this integrative review were collected from Medline, PsycINFO, Scopus, ProQuest, Academic Search Complete, CINAHL, and Google Scholar search engine. The database search was limited to peer-reviewed literature, published in English, between 1980 and 2013. Results: Twenty six articles were included in the review. Analysis revealed several factors influencing the mental health of immigrants, including language insufficiency; unemployment; sense of discrimination; cultural shock; lack of social support; lack of information about health care services; and intimate partner violence. Conclusion: Findings of this review have contributed to development of a conceptual framework that delineates the impact of migration on Iranian immigrants' health. This conceptualization may also help in addressing the needs of other vulnerable groups during the transition phase of migration. [ABSTRACT FROM AUTHOR]

Aims and objectives This review will (1) explore factors related to thirst in chronic heart failure and (2) describe interventions to alleviate thirst in chronic heart failure patients. Background Thirst is a common and troublesome symptom of chronic heart failure. Despite the burden and prevalence of this symptom, there are limited strategies to assist in its management. Design This is a review of literature on the burden of thirst, contributors to thirst and potential management strategies of thirst in patients with chronic heart failure. Methods Medline, Cumulative Index for Nursing and Allied Health, PubMed and Scopus were searched using the key words thirst, chronic heart failure, angiotensin II, fluid restriction and intervention. Of the 165 citations yielded, nine studies ( n = 9) were included. The eligibility criteria included participants with confirmed diagnosis of chronic heart failure, randomised controlled studies or any studies with thirst as primary or secondary outcome, in humans and in English. There was no limit to the years searched. Results Factors related to thirst in chronic heart failure were condition; prolonged neurohormonal activation, treatment; pharmacological interventions and fluid restriction and emotion. No intervention studies were found in chronic heart failure patients. Interventions such as artificial saliva and chewing gum have been investigated for their effectiveness as a thirst reliever in haemodialysis patients. Conclusion Thirst is a frequent and troublesome symptom for individuals with chronic heart failure. It is highly likely that this contributes to poor adherence with fluid restrictions. Chewing gum can help alleviate thirst, but investigation in people with heart failure is needed. Relevance to clinical practice Increasing awareness of thirst and interventions to relieve it in clinical practice is likely to improve the quality of care for people with chronic heart failure. [ABSTRACT FROM AUTHOR]

Background: Thirst is a bothersome symptom of chronic heart failure (CHF) which impacts adversely on quality of life. Despite this, limited work has been done to investigate thirst as a symptom or to develop reliable and valid measures of thirst in CHF. The purpose of this manuscript is to establish which tools have been used in research to measure thirst in CHF. Methods: Medline, PubMed, Cumulative Index for Nursing and Allied Health, and Scopus were searched using following key words thirst, heart failure, measure, scale, randomised controlled trials and multicentre studies. Results: The search discovered 37 studies of which 6 studies met the inclusion criteria. One study was a research abstract and five were full-text studies. To date, there are only three measurement tools utilised in studies examining thirst in CHF patients [Visual Analogue Scale (VAS), Numeric Rating Scale and Thirst Distress Scale]. Conclusion: Thirst in CHF is measured in a non-systematic way. In recent studies, the VAS has been used to measure thirst intensity. While this measurement tool is very easy and quick to administer, using a uni-dimensional tool in conjunction with a multi-dimensional tool may be beneficial to capture all dimensions of thirst. In order to manage thirst efficiently, consistent measurement of thirst in CHF is vital. [ABSTRACT FROM AUTHOR]

Aims and objectives To review community programmes promoting self-care or self-management for older people with chronic disease in Thailand. Background Identifying successful elements of culturally appropriate and effective community-based interventions to promote self-care with chronic illness is increasingly important. Design Integrative review. Data sources CINAHL, Medline, Health Source Nursing Academic databases. Methods Integrative review of peer-reviewed articles written between 1946-2012. Articles were included if they described self-care, self-management, chronic disease and community care interventions targeting older people in Thailand. Results Of the 58 articles retrieved, only 13 articles met the eligibility criteria. Elements of effective interventions included: (1) providing culturally sensitive information, (2) including approaches of shared decision-making and mutual goal setting and (3) flexibility within the intervention to adapt to participant needs. Conclusions Shared decision-making and mutual goal setting between interventionists and patients improved health behaviours and outcomes. Moreover, the flexibility to adopt the intervention to local characteristics demonstrated positive results. Relevance to clinical practice Promoting effective self-care and self-management behaviours is critical to improving outcomes for chronic conditions. The tailoring and targeting of interventions appropriate to individuals and communities are likely to be most effective in leveraging behaviour change. This review has identified that mutual goal setting improved health behaviours. The flexibility to adopt self-care interventions to community-based settings showed improved patient outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the healthcare needs of older Arab migrants, focussing on Arab- Australians and their socio-cultural characteristics. Background Disparities in accessing healthcare services and addressing healthcare needs are evident among ethnic minorities including Arab migrants, particularly, older people. Racial stereotyping can also affect their ability to use these services. Arabs are a populous and diverse group with a long history of global migration. Australia is one of the most multicultural societies in the world, and Arab- Australians constitute an important ethnic minority group. Design Systematic review. Methods The electronic databases Academic Search Complete ( EBSCO), MEDLINE (Ovid), Ageline, ProQuest, CINAHL, PubMed, PsychINFO and Google Scholar were searched from 1990-October 2012. Search terms included health care needs, aged care, ethnic, cultural, linguistics, social, ethnic groups, culturally and linguistically diverse, nonEnglish speaking, ageing, elderly, Arabs, Arabic-speaking and Australia. Results Eight articles reviewing the healthcare issues of Australians from Arabic-speaking background were identified using the search strategy. An additional eight articles were identified through hand searching. Conclusions Racial stereotyping can alter health-seeking behaviours and healthcare treatment. Increasing the understanding of specific cultural attributes of Arab- Australians will contribute to improving health outcomes. Relevance to clinical practice Healthcare providers and policymakers need to adopt more effective ways of communication with Arab- Australians to provide more culturally competent care and achieve better health outcomes. [ABSTRACT FROM AUTHOR]

Background: Pneumonia is a common cause of hospitalization in Aboriginal and Torres Strait Islander men and women. Aim: This article seeks to describe the importance of immunizing against pneumonia in Aboriginal Australians and suggest strategies for screening and follow-up. Method: An integrative literature review, using both published and gray literature was undertaken to identify methods of screening and surveillance strategies for pneumococcus. Results: The literature was summarized under the following themes: Pneumococcal disease; prevention strategies; access to care; improving access to vaccinations; culturally competent interventions and the role of Aboriginal health professionals. Conclusion: Community controlled conditions and the role of the Aboriginal Health Workers are seen as critical to reducing health disparities. Nurses can play a critical role in bridging the gap between mainstream and community controlled organizations. Working to increase the numbers of Aboriginal health professionals is a critical step in improving health outcomes for Aboriginal and Torres Strait Islander peoples. [ABSTRACT FROM AUTHOR]

Abstract: Context: Cancer pain is a common, burdensome problem, which is not well managed despite evidence-based guidelines. Objectives: To develop insights for managing barriers and optimizing facilitators to adult cancer pain assessment and management within a comprehensive framework of patient care. Methods: We undertook a systematic review and synthesis of qualitative studies. Medline, PsycINFO, Embase, AMED, CINAHL, and Sociological Abstracts were searched from May 20 to 26, 2011. To be included, the articles had to be published in a peer-reviewed journal since 2000; written in English; and report original qualitative studies on the perspectives of patients, their significant others, or health care providers. Article quality was rated using the checklist of Kitto et al. Thematic synthesis followed a three-stage approach using Evidence for Policy and Practice Information and Co-ordinating Centre-Reviewer 4 software: 1) free line-by-line coding of “Results,” 2) organization into “descriptive” themes, and 3) development of “analytical” themes informative to our objective. At Stage 3, a conceptual framework was selected from the peer-reviewed literature according to prima facie “fit” for descriptive themes. Results: Of 659 articles screened, 70 met the criteria, reporting 65 studies with 48 patient, 19 caregiver, and 21 health care provider samples. Authors rarely reported reflexivity or negative cases. Mead and Bower's model of patient-centered care accommodated 85% of the descriptive themes; 12% more related to the caregiver and service/system factors. Three themes could not be accommodated. Conclusion: Findings highlight the need to integrate patient/family education within improved communication, individualize care, use more nonpharmacological strategies, empower patients/families to self-manage pain, and reorganize multidisciplinary roles around patient-centered care and outcomes. These conclusions require validation via consensus and intervention trials. [Copyright &y& Elsevier]

The article discusses a systematic review on methods, quality, and results of delirium prevalence and incidence studies in palliative care inpatient populations. The review involved a systematic search of the literature identified prospective studies and majority of the participants with advanced cancer, considering implications for delirium screening. Evidence showed that hypoactive delirium was the most prevalent delirium subtype and concluded that the need for screening is well supported.

Background: There has been increasing emphasis on evidence-based approaches to improve patient outcomes through rigorous, standardised and well-validated approaches. Clinical guidelines drive this process and are largely developed based on the findings of systematic reviews (SRs). This paper presents a discussion of the SR process in providing decisive information to shape and guide clinical practice, using a purpose-built review database: the Cochrane reviews; and focussing on a highly prevalent medical condition: hypertension. Methods: We searched the Cochrane database and identified 25 relevant SRs incorporating 443 clinical trials. Reviews with the terms 'blood pressure' or 'hypertension' in the title were included. Once selected for inclusion, the abstracts were assessed independently by two authors for their capacity to inform and influence clinical decisionmaking. The inclusions were independently audited by a third author. Results: Of the 25 SRs that formed the sample, 12 provided conclusive findings to inform a particular treatment pathway. The evidence-based approaches offer the promise of assisting clinical decision-making through clarity, but in the case of management of blood pressure, half of the SRs in our sample highlight gaps in evidence and methodological limitations. Thirteen reviews were inconclusive, and eight, including four of the 12 conclusive SRs, noted the lack of adequate reporting of potential adverse effects or incidence of harm. Conclusions: These findings emphasise the importance of distillation, interpretation and synthesis of information to assist clinicians. This study questions the utility of evidence-based approaches as a uni-dimensional approach to improving clinical care and underscores the importance of standardised approaches to include adverse events, incidence of harm, patient's needs and preferences and clinician's expertise and discretion. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the evidence base and rationale underpinning the various infections control strategies during central venous catheter insertion and to promote discussion about the key, recurring concepts and recommendations in the literature. Logistical and organisational factors relating to central venous catheter insertion are also examined. Background Catheter-related bloodstream infections following the insertion of central venous catheters are associated with significant patient mortality and morbidity, prolonged hospital stays and increased economic costs. Limited published literature specifically examines microbial contamination during the peri-insertion process. Methods An integrative literature review supervised by a health informatics librarian was undertaken. On the basis of these data, considerations for clinical practice are provided. Retrieved articles were categorised under the following themes: risk of contamination at insertion; clinical and organisational impact of contamination; strategies for reducing contamination; controversies and challenges with decontamination strategies; recommendations for practice and implications for further research and organisational practice. Results Specific recommendations for reducing catheter-related bloodstream infections based on recurring themes include the following: reducing microbial burden on skin prior to the central venous catheter insertion; decreasing contact of gloves and insertion equipment with the patient's skin; using specifically trained staff to prepare and maintain a sterile field; and ensuring a sterile technique is adhered to throughout the central venous catheter insertion process. The need for organisational, procedural and clinical practices to support better healthcare outcomes is demonstrated. Highlighting the importance of executive support and regular review of policy and guidelines are necessary to improve patient outcomes. Conclusions Preventing infections related to central venous catheters requires the integration of clinical, organisational and workforce factors. [ABSTRACT FROM AUTHOR]

Background. Aboriginal and Torres Strait Islander peoples experience inferior outcomes following diagnosis of lung cancer. Aim. To examine the experience of lung cancer in this population and identify reasons for poorer outcomes and lower levels of treatment compared with non-Aboriginal and Torres Strait Islander peoples, and opportunities for early intervention. Method. Literature was sought via electronic database searches and journal hand-searching for the period from January 1995 to July 2010. Databases used included Indigenous Health Info Net, SCOPUS, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Health Insite and Google Scholar. Findings. Exposure to risk factors, cultural and spiritual values, remoteness and geographic characteristics, entrenched socioeconomic inequalities and racism contribute to reduced service access and poor outcomes. The review highlighted a complex interplay of individual, social, health system and environmental factors that impact on optimal lung cancer care and lung cancer outcomes. Considering the burden of lung cancer within a framework of social determinants of health is necessary for policy-making and service planning and delivery. Conclusions. It is imperative that the disproportionate burden of lung cancer in Aboriginal and Torres Strait Islander peoples is addressed immediately. Whilst strategic interventions in lung cancer prevention and care are needed, service providers and policy makers must acknowledge the entrenched inequality that exists and consider the broad range of factors at the patient, provider and system level. Primary care strategies and health promotion activities to reduce risk factors, such as smoking, must also be implemented, with Aboriginal and Torres Strait Islander peoples' engagement and control at the core of any strategy. This review has indicated that multifaceted interventions, supported by enabling policies that target individuals, communities and health professionals, are necessary to improve lung cancer outcomes and disparities. [ABSTRACT FROM AUTHOR]

Abstract: Context: Systematic reviews and meta-analyses suggest that community specialist palliative care services (SPCSs) can avoid hospitalizations and enable home deaths. But more information is needed regarding the relative efficacies of different models. Family caregivers highlight home nursing as the most important service, but it is also likely the most costly. Objectives: To establish whether community SPCSs offering home nursing increase rates of home death compared with other models. Methods: We searched MEDLINE, AMED, Embase, CINAHL, the Cochrane Database of Systematic Reviews, and CENTRAL on March 2 and 3, 2011. To be eligible, articles had to be published in English-language peer-reviewed journals and report original research comparing the effect on home deaths of SPCSs providing home nursing vs. any alternative. Study quality was independently rated using Cochrane grades. Maximum likelihood estimation of heterogeneity was used to establish the method for meta-analysis (fixed or random effects). Potential biases were assessed. Results: Of 1492 articles screened, 10 articles were found eligible, reporting nine studies that yielded data for 10 comparisons. Study quality was high in two cases, moderate in three and low in four. Meta-analysis indicated a significant effect for SPCSs with home nursing (odds ratio 4.45, 95% CI 3.24–6.11; P <0.001). However, the high-quality studies found no effect (odds ratio 1.40, 95% CI 0.97–2.02; P =0.071). Bias was minimal. Conclusion: A meta-analysis found evidence to be inconclusive that community SPCSs that offer home nursing increase home deaths without compromising symptoms or increasing costs. But a compelling trend warrants further confirmatory studies. Future trials should compare the relative efficacy of different models and intensities of SPCSs. [Copyright &y& Elsevier]

Objectives: To identify patient, provider and system factors predicting rehospitalisation in adults with heart failure (HF). Method: The electronic data bases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and Psychlnfo were searched from 1996-2008 to identify studies identifying predictors of rehospitalisation from which the factors of patient, provider and systems were extracted. Results: A total of 62 elements were identified. These elements were then sorted into patient, provider and system categories. Risk factors identified for rehospitalisation were predominantly related to clinicalfactors. There were less factors identifying risk from the perspective of provider and health care systems. Conclusions: In people with HF it is likely that non-clinicalfactors including provider and system play an important role in rehospitalisation. There is a need to identify individuals at risk of rehospitalisation and tailor disease management programmes accordingly. [ABSTRACT FROM AUTHOR]

Introduction: Aboriginal and Torres Strait Islander children have higher rates of disability than non-Indigenous children and are considered doubly disadvantaged, yet there is very little data reflecting prevalence and service access to inform design and delivery of services. Failing to address physical, social, and psychological factors can have life-long consequences and perpetuate longstanding health disparities. Methods: A narrative literature review was undertaken to identify peer reviewed literature describing factors impacting on the prevention, recognition, and access to support and management of disability in Indigenous Australian children. Results: Twenty-seven peer-reviewed journal articles met inclusion criteria. The majority of articles focused on the hearing loss and learning disabilities consequent of otitis media. Few articles reported data on urban or metropolitan Indigenous populations or described interventions. Individual/community-, provider-, and systems level factors were identified as impacting on recognition and management of disability in young Indigenous children. Conclusions: Given the burden of childhood disability, the limited literature retrieved is concerning as this is a barometer of activity and investment. Solutions addressing childhood disability will require collaboration between health, social and educational disciplines as well as an increased investment in prevention, identification and promotion of access. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases contribute substantially to the poor health and reduced life expectancy of indigenous Australians. Heart failure is a common, disabling, progressive and costly complication of these disorders.The epidemiology of heart failure and the adequacy of relevant health service provision in Indigenous Australians are not well delineated.Methods: A systematic search of the electronic databases PubMed, Embase, Web of Science, Cinahl Plus, Informit and Google Scholar was undertaken in April 2012 for peer-reviewed journal articles relevant to the topic of heart failure in Indigenous Australians. Additionally, a website search was done to identify other pertinent publications,particularly government reports.Results: There was a paucity of relevant peer-reviewed research, and government reports dominated the results.Ten journal articles, 1 published conference abstract and 10 reports were eligible for inclusion. IndigenousAustralians reportedly have higher morbidity and mortality from heart failure than their non-Indigenouscounterparts (age-standardised prevalence ratio 1.7; age-standardised hospital separation ratio ≥3; crude per capital hospital expenditure ratio 1.58; age-adjusted mortality ratio >2). Despite the evident disproportionate burden of heart failure in Indigenous Australians, the accuracy of estimation from administrative data is limited by poor indigenous identification, inadequate case ascertainment and exclusion of younger subjects from mortality statistics.A recent journal article specifically documented a high prevalence of heart failure in Central Australian Aboriginal adults (5.3%), noting frequent undiagnosed disease. One study examined barriers to health service provision for Indigenous Australians in the context of heart failure.Conclusions: Despite the shortcomings of available published data, it is clear that Indigenous Australians have an excess burden of heart failure. Emerging data suggest that undiagnosed cases may be common in this population.In order to optimise management and to inform policy, high quality research on heart failure in IndigenousAustralians is required to delineate accurate epidemiological indicators and to appraise health service provision. [ABSTRACT FROM AUTHOR]

To review and synthesise, systematically, the research findings regarding motivational interviewing and to inform education, research and practice in relation to cardiovascular health. Motivational interviewing is designed to engage ambivalent or resistant clients in the process of health behaviour change, and it has been widely used in different clinical conditions such as substance abuse, dietary adherence and smoking cessation. Motivational interviewing has also been proposed as a method for improving modifiable coronary heart disease risk factors of patients. Systematic review. Eligible studies published in 1999-2009 were identified from the following databases: CINAHL, Medline, PsycINFO, Cochrane Library, EBSCO, Web of Science, Embase and British Nursing Index. A manual search was conducted of bibliographies of the identified studies and relevant journals. Two researchers independently reviewed the studies. Four meta-analyses, one systematic review and three literature reviews of motivational interviewing and five primary studies of motivational interviewing pertaining to cardiovascular health were identified. Despite a dearth of primary studies in cardiovascular health settings, there appears to be strong evidence that motivational interviewing is an effective approach focusing on eliciting the person's intrinsic motivation for change of behaviour. Motivational interviewing is an effective approach to changing behaviour. It offers promise in improving cardiovascular health status. This review indicates that motivational interviewing is a useful method to help nurses improve health behaviour in people with coronary risk factors. [ABSTRACT FROM AUTHOR]

Aim and objectives: The aim of this paper was to review published manuscripts on the use of midline catheters, the implications of study findings and recommendations for clinical practice in the acute care setting. Design: Modified integrative literature review Methods: Using key MeSH terms, we searched the electronic databases: CINAHL, Medline, and Embase. The Cochrane and Joanna Briggs databases, Google Search Engine and the reference lists of published materials were also searched. Studies were included if they were in the English language and reported the use of midline catheters in adult acute care populations. Manuscripts that described midlines made of aquavene were excluded Results: Two hundred and thirty two (232) papers were identified using the search strategy. From these identified papers, thirty (30) were included in the final review. Thematic analysis identified three major themes. These included: (i) advantages of using midline catheters (ii) disadvantages of using midline catheters (iii) insertion and management issues. Conclusion: Midline catheters have both positive and negative implications for clinical practice. They can be used for extended periods of intravenous therapy without requiring repeated cannulations but are not without risk. Midline catheters have been associated with mechanical and chemical phlebitis along with intravascular thrombosis. As such they are not suitable across the entire adult acute population. Midline catheters reduce the number of repeated cannulations which reduces patient discomfort, increases patient satisfaction and also contributes to organisational efficiency. [ABSTRACT FROM AUTHOR]

This review aims to examine critically, the methods and modes of delivery of handover used in contemporary health care settings and explore the feasibility of a computerised handover system for improving patient safety. Clinicians play a critical role in promoting patient safety, and the handover ritual is recognised as important in exchanging information and planning patient care. Communication failures have been identified as an important cause of adverse incidents in hospitals. Integrative literature review. Search of multiple electronic databases using terms: nursing handover, handoff, shift-to-shift reporting and change of shift report. To date, the focus of research has primarily been on the vehicle of the handover, rather than the content and processes involved in ensuring the reliability and quality of clinical information. Employing a computerised handover system in the clinical arena has the potential to improve the quality and safety of clinical care. Whilst the handover performed from shift-to-shift is a valuable communication strategy, ambiguities and incomplete information can increase the risks of adverse events. Given the importance of effective communication, its key link to patient safety and the frequency of nursing handover, it is imperative that clinical handover undergo increased scrutiny, development and research. This review underscores the challenge in clinical handover and recommends the use of technological solutions to improve communication strategies. [ABSTRACT FROM AUTHOR]

Background: Heart failure is a highly debilitating syndrome with a poor prognosis primarily affecting the elderly. Clinicians wanting timely access to heart failure evidence to provide optimal patient care can face many challenges in locating this evidence. This study developed and validated a search filter of high clinical utility for the retrieval of heart failure articles in OvidSP Medline. Methods: A Clinical Advisory Group was established to advise study investigators. The study set of 876 relevant articles from four heart failure clinical practice guidelines was divided into three datasets: a Term Identification Set, a Filter Development Set, and a Filter Validation Set. A further validation set (the Cochrane Validation Set) was formed using studies included in Cochrane heart failure systematic reviews. Candidate search terms were identified via word frequency analysis. The filter was developed by creating combinations of terms and recording their performance in retrieving items from the Filter Development Set. The filter's recall was then validated in both the Filter Validation Set and the Cochrane Validation Set. A precision estimate was obtained post-hoc by running the filter in Medline and screening the first 200 retrievals for relevance to heart failure. Results: The four-term filter achieved a recall of 96.9% in the Filter Development Set; 98.2% in the Filter Validation Set; and 97.8% in the Cochrane Validation Set. Of the first 200 references retrieved by the filter when run in Medline, 150 were deemed relevant and 50 irrelevant. The post-hoc precision estimate was therefore 75%. Conclusions: This study describes an objective method for developing a validated heart failure filter of high recall performance and then testing its precision post-hoc. Clinical practice guidelines were found to be a feasible alternative to hand searching in creating a gold standard for filter development. Guidelines may be especially appropriate given their clinical utility. A validated heart failure filter is now available to support health professionals seeking reliable and efficient access to the heart failure literature. [ABSTRACT FROM AUTHOR]

Background: Individuals with chronic heart failure experience high symptom burden, reduced quality of life and high health care utilisation. Although there is growing evidence that a palliative approach, provided concurrently with usual treatment improves outcomes, the method of integrating palliative care for individuals living with chronic heart failure across the care continuum remains elusive.Aim: To examine the key elements of integrated palliative care recommended for individuals living with chronic heart failure across the care continuum.Design: Scoping review.Data Sources: Databases searched were CINAHL, Ovid MEDLINE, Scopus and OpenGrey. Studies written in English and containing key strategic elements specific to chronic heart failure were included. Search terms relating to palliative care and chronic heart failure and the Joanna Briggs Institute methodology for scoping reviews was used.Results: Seventy-nine (79) articles were selected that described key elements to integrate palliative care for individuals with chronic heart failure. This review identifies four levels of key strategic elements: 1) clinical; 2) professional; 3) organisational and 4) system-level integration. Implementing strategies across these elements facilitates integrated palliative care for individuals with chronic heart failure.Conclusions: Inter-sectorial collaborations across systems and the intersection of health and social services are essential to delivering integrated, person-centred palliative care. Further research focussing on patient and family needs at a system-level is needed. Research with strong theoretical underpinnings utilising implementation science methods are required to achieve and sustain complex behaviour change to translate key elements. [ABSTRACT FROM AUTHOR]

Objective: This integrative review aimed to appraise the evidence for case conferencing as an intervention to improve palliative care outcomes for older people living with advanced dementia in nursing homes. Design: An integrative review of English language citations from CINHAL, MEDLINE, PSYCHINFO and CareSearch using a palliative care filter was undertaken. Two reviewers screened 238 titles to find 77 relevant articles which were reviewed in detail to identify nine studies that addressed the specific review questions. The analysis process allowed study characteristics, process and outcome measures along with implementation barriers and facilitators to be identified and the results synthesised. Results: The highest level of evidence (Level II) was generated by two randomised controlled case conferencing trials which demonstrated enhance medication management for people with dementia living in a nursing home. Several pre-post test studies suggest that case conferencing enhances palliative symptom management and care outcomes in nursing homes. Qualitative evidence suggests that case conferencing is feasible and worthwhile if the identified barriers are addressed and the facilitators optimised. Conclusions: Case conferencing provides opportunities to improve care palliative care outcomes for older people with dementia by engaging family and all relevant internal and external health providers in prospective care planning. More evidence is needed to determine the efficacy and cost-effectiveness of case conferencing as a strategy for improving care outcomes for older people living with advanced dementia in nursing homes. The evidence generated by this integrative review will be of interest to policy makers, aged care organisations and clinicians alike, especially as services endeavour to meet the increasingly complex care needs of older people admitted to nursing homes with advanced dementia, and the needs of their families. [ABSTRACT FROM AUTHOR]

Abstract: Context: Over the past decade, there has been widespread adoption of end-of-life care pathways as a tool to better manage care of the dying in a variety of care settings. The adoption of various end-of-life care pathways has occurred despite lack of robust evidence for their use. Objectives: This integrative review identified published studies evaluating the impact of an end-of-life care pathway in the acute and hospice care setting from January 1996 to April 2010. Methods: A search of the electronic databases Scopus and Cumulative Index of Nursing and Allied Health Literature as well as Medline and the World Wide Web were undertaken. This search used Medical Subject Headings key words including “end-of-life care,” “dying,” “palliative care,” “pathways,” “acute care,” and “evaluation.” Articles were reviewed by two authors using a critical appraisal tool. Results: The search revealed 638 articles. Of these, 26 articles met the inclusion criteria for this integrative review. No randomized controlled trials were reported. The majority of these articles reported baseline and post implementation pathway chart audit data, whereas a smaller number were local, national, or international benchmarking studies. Most of the studies emerged from the United Kingdom, with a smaller number from the United States, The Netherlands, and Australia. Conclusion: Existing data demonstrate the utility of the end-of-life pathway in improving care of the dying. The absence of randomized controlled trial data, however, precludes definitive recommendations and underscores the importance of ongoing research. [Copyright &y& Elsevier]