Search

Abstract Introduction Healthcare organizations experience difficult challenges as a result of nursing staff turnover. This is because it not only interrupts continuity of service but also its financial implications. Aim The purpose of the study was to find out the effects of work engagement on nurses' intentions to leave their jobs while considering resilience as a mediating factor. Methods The study used a descriptive-analytical design using a survey questionnaire on nurses working in different healthcare settings. The Utrecht Work Engagement Scale, the Brief Resilience Scale, and the Turnover Intention Scale were among the validated scales that were employed. The hypothesized relations were tested using descriptive and mediation analyses at a significance of

Abstract Background Sexual well-being is a key part of being human yet often remains shrouded in secrecy and poorly addressed in the clinical setting. The impact of burns and its long-term sequelae often lead to concerns regarding body image disturbance, self-esteem issues, and interpersonal challenges which can impact on an individual’s sexual well-being. However, existing post-burn rehabilitation programmes usually lack components addressing concerns regarding sexual well-being. As a part of a larger project, we developed a nurse-led aftercare programme, and this study sought to examine the effects of the programme in addressing the post-burn sexual well-being of adult burn survivors. Methods A randomised controlled trial approach was used. Sixty burn survivors aged ≥ 18 years with burn size ≥ 10% total burn surface area were assigned to intervention and control groups. Participants in the intervention group underwent the nurse-led aftercare programme which involved pre-discharge support and proactive follow-up support over 8 weeks. The sexuality subscale of the Burn Specific Health Scale-Brief was used to evaluate the outcome of interest. Data were collected at three timepoints: baseline (T0), post-intervention (T1), and follow-up (T2). Results Using a corrected p value of 0.017, the study observed only statistically significant time effect at both T1 and T2. Both group and interaction effects were statistically insignificant for this outcome. Conclusion Issues regarding sexual well-being are often considered sacred and may be challenging to discuss. Thus, a longer duration of the intervention may be considered with ongoing training of practitioners to identify and resolve emerging challenges. Despite the non-significant interaction and group effects, including sexual well-being support in post-burns rehabilitation programmes will facilitate access to and utilisation of the service among burn survivors who may need it. Trial registration Prospectively registered on 14th August 2020. ClinicalTrials.govNCT04517721.

Abstract BackgroundThe aging population highlights the need to maintain both physical and psychological well-being. Frailty, a multidimensional syndrome, increases vulnerability to adverse outcomes. Although physical exercise is effective, adherence among older adults with frailty is often low due to barriers. Motion-based video games (MBVGs) may enhance motivation and engagement. ObjectiveThis study aims to evaluate the effect of individualized exercise programs that combine MBVGs, intergenerational support, and therapeutic frameworks on physical, cognitive, and social frailty outcomes in community-dwelling older adults. MethodsThis randomized controlled trial was conducted from March 2022 to October 2023 across 6 community centers in Hong Kong. Participants aged 60 years and above with mild neurocognitive disorder were recruited, screened, and randomly assigned to either an intervention (n=101) or control group (n=101). The intervention included an 18-week program with 12 supervised exercise sessions utilizing motion-based technology, led by occupational therapists and assisted by youth volunteers. Data were collected at baseline (T1) and postintervention (T2), focusing on physical, cognitive, and social frailty outcomes, as well as client-related metrics. Statistical analyses were performed using SPSS, with significance set at P ResultsA total of 202 participants were recruited, with a mean age of 78.8 years (SD 7.8). Both groups showed improvements in balance from T1 to T2, with a significant time effect (βPβPβPβP ConclusionsThe growing aging population necessitates innovative strategies to support aging in place. Results indicated statistically significant improvements only in BMI and cognition, while other outcomes such as loneliness, balance, and eHealth literacy showed positive trends but lacked significance. Despite the limitations observed, particularly regarding the role of volunteer support and the diverse needs of community-dwelling older adults, the findings contribute to the foundation for future research aimed at enhancing biopsychosocial outcomes. Future studies should explore tailored interventions that consider individual preferences and abilities, as well as evaluate specific components of motion-based video games to optimize their effectiveness.

BackgroundThe wearable monitoring device (WMD) is emerging as a promising tool for community-dwelling older adults to monitor personal health, enhance awareness of their activities, and promote healthy behaviors. However, the sustained use of WMDs among this population remains a significant challenge. ObjectiveThis study aims to implement an interventional program that promotes and motivates the continued use of WMDs among older adults through a peer and professional support approach. This program will facilitate the integration of WMDs into their daily lives. MethodsThis feasibility trial examined the following: (1) the usability of the WMD from the users’ perspectives; (2) the feasibility of the Live With Wearable Monitoring Device program; and (3) the effectiveness of the Live With Wearable Monitoring Device program among community-dwelling older adults. The intervention, based on Self-Determination Theory, involved using the Live With Wearable Monitoring Device program over a 3-month period, with ongoing professional and peer support provided by community health workers, aided by a nurse and social workers. This support included 1 home visit and biweekly communication via WhatsApp. Data were collected at baseline and at 1, 3, and 6 months. ResultsA total of 39 participants were enrolled in the intervention group, while 37 participants were in the control group. The recruitment rate was high (76/89, 85%), and the attrition rate was low (8/76, 11%), indicating that the program is feasible for older adults. Participants in the intervention group exhibited higher self-efficacy, lower anxiety levels, and used the smartwatch more frequently, in terms of both days and hours, compared with the control group. A between-group difference was observed in self-efficacy between the intervention and control groups (β=3.31, 95% CI 0.36-6.25, P=.03), with statistically significant higher mean values recorded at all 4 time points. ConclusionsIt is clear that merely providing a WMD to older adults does not guarantee its usage, particularly for those unfamiliar with how to utilize its health-related functions in their daily routines. This study implemented a theory-based program aimed at enhancing the ongoing use of WMDs among older adults, suggesting that continuous professional and peer support may significantly influence WMD usage. Trial RegistrationClinicalTrials.gov NCT05269303; https://clinicaltrials.gov/ct2/show/NCT05269303

Abstract Background As the population ages, a plethora of digital and mobile health applications for assistance with independent living have emerged. Still unknown, however, is how older adults sustain the use of these applications. Aim This study sought to explore the experiences of older adults following their participation in a programme that combined the use of an mHealth application with proactive telecare nursing support. Methods We employed a concurrent mixed-methods design for this study. The quantitative strand included a survey, whereas the qualitative strand included open-ended questions as part of the survey to understand the participants’ experiences. Participants for this study were community-dwelling older adults who had taken part in an interventional study that sought to examine the effects of mHealth and nurse support. A convenience sampling approach was employed to recruit potential participants for this study. Findings : Fifty-five older adults participated. The majority expressed positive attitudes and satisfaction with the app and the nurses’ support. The app and nurses’ support helped participants to understand their health status and obtain health information. Reasons to halt app usage included technical issues and limited social support. Conclusion Mobile apps with professional follow-up support could potentially support older adults in the community, although emerging concerns need to be addressed to sustain long-term usage of these apps.

Abstract Background There was a substantial documented call for healthcare professionals to provide compassionate care during the COVID-19 pandemic and significant criticism voiced when it was lacking. This study aimed to explore perspectives on compassionate care among healthcare professionals providing care during the COVID-19 pandemic. The study focuses on healthcare professionals who participated in a wide range of COVID-19 measures, including testing, quarantine, diagnosis, and care provision (patients with COVID-19 or patients with other illnesses and comorbid with COVID-19). Methods A qualitative design with an interpretative phenomenological analysis approach was used. Twenty frontline healthcare professionals (15 nurses and five physicians) who had worked in COVID-19 facilities in China were interviewed individually. Results Participants stated that a commitment to ‘offering oneself’ and ‘balancing the advantages/disadvantages’ in providing care during the pandemic were key to alleviate population-level suffering. On a personal level, they described a desire for obtaining ‘mutual support’ and improving ‘professional competencies’ to safeguard their physical and mental well-being. Two professional competencies were notable: coping with grief and implementing infection control across the organization. Additionally, they emphasized the importance of receiving support from the health care organization, the public, and leaders in creating an ‘environment conducive to fostering compassionate care.’ Conclusion Healthcare professionals recognized the centrality of compassionate care during the pandemic which entailed a commitment to offering themselves, the balancing of advantages and disadvantages in order to find the best solution, as well as the need to safeguard themselves using professional competencies. Such findings can enrich the contemporary understanding of compassion, including when it is lacking. Support from the healthcare organization, the public, and leadership were crucial in fostering compassionate care in healthcare professionals during the pandemic and in moving the field forward in the future.

BackgroundThe use of wearable monitoring devices (WMDs), such as smartwatches, is advancing support and care for community-dwelling older adults across the globe. Despite existing evidence of the importance of WMDs in preventing problems and promoting health, significant concerns remain about the decline in use after a period of time, which warrant an understanding of how older adults experience the devices. ObjectiveThis study aims to explore and describe the experiences of community-dwelling older adults after receiving our interventional program, which included the use of a smartwatch with support from a community health workers, nurses, and social workers, including the challenges that they experienced while using the device, the perceived benefits, and strategies to promote their sustained use of the device. MethodsWe used a qualitative descriptive approach in this study. Older adults who had taken part in an interventional study involving the use of smartwatches and who were receiving regular health and social support were invited to participate in focus group discussions at the end of the trial. Purposive sampling was used to recruit potential participants. Older adults who agreed to participate were assigned to focus groups based on their community. The focus group discussions were facilitated and moderated by 2 members of the research team. All discussions were recorded and transcribed verbatim. We used the constant comparison analytical approach to analyze the focus group data. ResultsA total of 22 participants assigned to 6 focus groups participated in the study. The experiences of community-dwelling older adults emerged as (1) challenges associated with the use of WMDs, (2) the perceived benefits of using the WMDs, and (3) strategies to promote the use of WMDs. In addition, the findings also demonstrate a hierarchical pattern of health-seeking behaviors by older adults: seeking assistance first from older adult volunteers, then from social workers, and finally from nurses. ConclusionsOngoing use of the WMDs is potentially possible, but it is important to ensure the availability of technical support, maintain active professional follow-ups by nurses and social workers, and include older adult volunteers to support other older adults in such programs.

Abstract Background Men with breast cancer experience unique physical and emotional challenges. However, a thorough understanding of these experiences including the psychosocial effects and supportive care needs have received less attention. In some settings, men with breast cancer experience stigma within the healthcare system and their care needs are not prioritised. This influences the level of professional support offered, consequently worsening their health and well-being outcomes. This review explored the variabilities in the experiences and treatment modalities of male breast cancer (MBC) across different contexts. Methods All primary study designs including qualitative, quantitative, and mixed methods studies that reported on the experiences, treatment approaches and outcomes of MBC were included in this systematic review. Six databases (Embase, Medline, PsycINFO, Global Health, CINAHL and Web of Science) were searched for articles from January 2000 to September 2023. A results-based convergence synthesis was used for data analysis and reported using PRISMA guidelines. Results Of the studies screened (n = 29,687), forty-four fulfilled the predetermined criteria and were included. Our findings relating to the experiences and treatment approaches of MBC are broadly themed into three parts. Theme 1—Navigating through a threat to masculinity: describes how males experienced the illness reflecting on detection, diagnosis, coming to terms with breast cancer, and disclosure. Theme 2- Navigating through treatment: captures the experiences of undergoing breast cancer treatment/ management following their diagnosis. Theme 3—Coping and support systems: describes how MBC patients coped with the disease, treatment process, aftercare/rehabilitative care, and the available support structures. Conclusions Men experience a myriad of issues following a breast cancer diagnosis, especially with their masculinity. Awareness creation efforts of MBC among the public and healthcare practitioners are urgently required, which could change the perception of men in promoting early diagnosis, adherence to treatments, post-treatment monitoring, oncological results and a better quality of life. Considerations for training, education and development of specialised guidelines for healthcare practitioners on MBC would provide the necessary knowledge and skills to enhance their practice through the adoption of person-centred and male-specific care strategies. Professional care intervention and support for MBC should not end after the diagnosis phase but should extend to the entire treatment continuum and aftercare including future research focusing on MBC specific clinical trials. Trial registration PROSPERO Registration No. CRD42021228778.

Abstract The study compared perceived differences in Quality of Work‐Life (QoWL) among nurse clinicians and educators and coping strategies used by nurses. Design A cross‐sectional study. Methods From August and November 2020, the study measured the QoWL and coping strategies of 360 nurses with two scales using a multi‐stage sampling technique. The data were analysed with descriptive, Pearson correlation and multivariate linear regression analyses. Results Quality of Work‐Life was generally low among nurses; nurse educators, however, had better QoWL than clinical nurses. Age, salary and nature of work predicted the QoWL of nurses. Work‐family segmentation, seeking assistance, open communication and recreational activities were employed by most nurses to cope with challenges. With the rate of workload and work‐related stress associated with COVID‐19, nurse leaders must advocate for evidence‐based coping strategies to deal with work and family life stress.

Abstract Aims To identify the challenges facing burn care nurses and burn patients' family members and to explore the relationship between the above challenges. Design Whittemore and Knafl's integrative review. Methods Databases used for this review included Cochrane Library, Web of Science, PubMed and Embase. The original research published from January 2010 to November 2021 was selected. Studies reporting the challenges of family members or nurses of burn patients identified through extensive database search were considered for inclusion. The Mixed‐Method Appraisal‐Tool was applied for the evaluation of the quality of the literature. The analysis approach used was content analysis. Results Of the 2746 identified studies, 17 studies were included. Key findings related to the challenges facing nurses and family members of burn patients were extracted. The themes relating to burn care nurses included ethical and religious issues, clinical issues, work–life imbalance and limited support. The themes relating to family members included family's different views on prognosis and treatment, work–life imbalance, psychological issues and lack of multifaceted support. The challenges for the formal and informal caregivers are similar and there is existence of some shared concerns. If the above challenges are not resolved, support for the burn patients may be adversely affected. Corresponding measures should be taken to overcome such challenges.

A burn has been described as a family injury warranting the delivery of family-centered care (FCC) across the continuum of burns management. This assertion notwithstanding, only limited progress has been made to develop and implement FCC interventions in the burn unit. As a starting point, this study sought to formulate a tentative framework to underpin FCC in burn care. A multi-method design comprising an umbrella review and the secondary data analysis of qualitative datasets was employed. Following these, the findings were merged and aligned to the Universal Model of FCC to formulate the burn-specific FCC framework. For the umbrella review, four review articles met the criteria for inclusion. Following a data synthesis of the review findings and their integration with the qualitative dataset, four meta-themes that encapsulate the shared needs/concerns of family members of both pediatric and adult burn survivors emerged: (1) psychosocial concerns, (2) issues relating to role changes, (3) logistical concerns, and (4) requiring information. These issues were mapped to the following components of the Universal Model of FCC: family support, education, collaboration, and communication. All these are underpinned by dedicated policies, procedures, and consideration of the family context. Testing and further empirical work are needed to refine and implement the framework across the continuum of burn management.

Abstract Introduction With the rise in global migration, hospitals and health systems in developed countries are looking to supplement their workforces with migrant nurses who have been reported to feel devalued, underutilized with experience of deskilling and unmet expectations as they transitioned. Despite the plethora of literature reporting on the experiences of internationally trained nurses, only limited work has been done regarding understanding the experiences of Migrant African nurses. Thus, this study sought to synthesize existing qualitative studies to develop in-depth understanding of the transitioning experiences of migrant African nurses, their career progression and to highlight existing gaps to guide future studies as well as inform policies. Method A meta-synthesis was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Enhancing transparency in reporting the synthesis of qualitative research statement. A pre-planned search strategy was developed guided by the SPIDER tool for qualitative synthesis searching EMBASE via OVID, CINAHL via EBSCO, PubMed, Web of Science, and PsychINFO databases. We included published studies that 1) focused on migrant African nurses, 2) employed a qualitative design and 3) reported in English. Results The search yielded 139 studies of which nine studies met the inclusion criteria and included in final synthesis. Three themes with corresponding subthemes emerged from data synthesis: 1) Navigating reality shock (a. Navigating a new culture, b. Survival strategies and support amidst the shock); 2) Discrimination and limited opportunities for promotion (a. Prejudices and preference for White over Black, b. Lack of recognition and limited opportunities for a workplace promotion); and 3) Finding one’s feet (a. Standing up for oneself and looking beyond discrimination, b. Experiencing growth). Conclusion Transitioning to a new setting can be a challenging experience for migrant African nurses warranting the availability of a tailor-made adaptation or orientation programme. Though African nurses may experience discrimination and prejudices as part of their transition, they consider their situation to be better off compared to back home. Therefore, clear transitioning policies which focus on career pathways are required by hiring institutions, and migrant nurses should be proactive in taking active roles in pushing their career ahead, instead of maintaining a culture of silence.

Abstract Background With today’s complex needs of the population and high demands in quality of care, there will be a continuing need for expanding role of nurses to assume more responsibilities in healthcare. Newly graduated nurses, who possess the competence to function as Registered Nurses, will soon recognize that lecture-based, passive delivery of content is not sufficient to deal with the complex healthcare environment. Aim This study aimed to compare the effects of a blended video watching and peer learning program and the usual lecture-based program on the levels of satisfaction and self-confidence in learning, perceptions of peer learning, and academic performance of students enrolled in a master’s nursing program. Methods A quasi-experimental study was conducted. The program was offered to Master of Science in Nursing students during Spring 2021 (intervention group, n = 46), while the usual face-to-face lectures and tutorial classes were provided to students enrolled during Fall 2020 (control group, n = 46). Results There was a statistically significant increase in satisfaction, self-confidence in learning, and academic performance in the intervention group after learning in a blended video-watching and peer learning mode. Conclusion This study fills a knowledge gap to meet the learning needs of time-conscious, part-time students working full time in hospitals.

Background Globally, nurse-led post-acute stroke clinics have been developed to provide secondary care services to stroke survivors. Although synthesized evidence supports the idea that the secondary prevention services delivered by nurses in these clinics can improve the functional ability of stroke survivors and reduce their readmission rates, long travel and waiting times, high costs, and the pandemic have limited the utilization of such clinics. Telecare consultations are a new modality for expanding public access to healthcare services, although how it can be applied in nurse-led clinics has not been reported. Objective The aim of this study is to determine the feasibility and effects of telecare consultations in nurse-led post-acute stroke clinics. Methods The study adopts a quasi-experimental design. The participants will receive three secondary stroke care consultations in 3 months provided via telecare by experienced advanced practice nurses. The outcome measures include feasibility (reasons for refusing to participate and for dropping-out, the attitudes and satisfaction of both the advanced practice nurses and their patients towards the programme), and preliminary effectiveness (degree of disability after stroke, activities of daily living, instrumental activities of daily living, health-related quality of life, depression) outcomes. Data will be collected at pre-(T1) and post-(T2) intervention. Conclusions The findings of this study may help facilitate the implementation of telecare consultations in a nurse-led post-acute stroke clinic, which may benefit the stroke survivors who are having mobility restrictions from accessing customary healthcare services and may protect them from being exposed to the infectious risk.

Abstract Aim To synthesize evidence on the concept of reassurance in nursing practice. Design Integrative review. Review Method PubMed, OVID MEDLINE, CINAHL and PsycINFO were searched from their inception to the 30 May 2020. The search results were screened. We assessed the quality of primary studies using the Mixed Method Appraisal Tool. Included studies were analysed using narrative synthesis. The review protocol was pre‐registered (PROSPERO‐CRD42020186962). Results Thirty‐two papers out of the 2,771 search results met our inclusion criteria. The synthesis of evidence generated three intricate themes, namely “antecedents of reassurance,” “defining attributes of reassurance” and “outcomes of reassurance.” Emotional distress was the main antecedent of reassurance. The three sub‐themes identified under defining attributes of reassurance include self‐awareness, emotional connectedness and verbal and non‐verbal techniques. Ultimately, reposing the confidence of patients and their families in healthcare professionals and the care delivery process to enable them to overcome their challenges constitutes the outcomes of reassurance.

Objective The ongoing pandemic has accentuated the use of telecare services; however, only limited progress has been made in understanding the barriers and facilitators to using these services. In order to move towards sustaining such essential services, the present study aimed to ascertain the experiences of stroke survivors and healthcare providers regarding the utilization of a post-stroke telecare service in Hong Kong. Methods Interpretive description was employed for this study. Semi-structured discussions and interviews were undertaken with nine stroke survivors and four stroke nurses who delivered the telecare services. The principles of thematic analysis were inductively followed to analyse the data. The Standards for Reporting Qualitative Research checklist was used to guide the reporting of the data. Results Three themes emerged: (a) pre-existing post-discharge service pathways; (b) push factors/facilitators for telecare usage; and (c) barriers to telecare usage. Overall, the telecare service was considered a significant alternative and one that complements conventional face-to-face follow-ups. Stroke survivors were motivated to use the service because it was convenient and flexible. However, significant barriers exist, including technical issues and a lack of guidelines and training opportunities for healthcare providers. Conclusions Although telecare is still evolving, several factors drive stroke survivors to use the service. Attention needs to be paid to the emerging barriers to improve long-term usage of the service. Clear guidelines are needed to underpin the development and implementation of telecare services.

BackgroundAlthough mobile health application (mHealth app) programs have effectively promoted disease self-management behaviors in the last decade, usage rates have tended to fall over time. ObjectiveWe used a case management approach led by a nurse and supported by a health-social partnership team with the aim of sustaining app usage among community-dwelling older adults and evaluated the outcome differences (i.e, self-efficacy, levels of depression, and total health service usages) between those who continued to use the app. MethodsThis was a 3-arm randomized controlled trial. A total of 221 older adults with hypertension, diabetes, or chronic pain were randomized into 3 groups: mHealth (n=71), mHealth with interactivity (mHealth+I; n=74), and the control (n=76). The mHealth application was given to the mHealth and mHealth+I groups. The mHealth+I group also received 8 proactive calls in 3 months from a nurse to encourage use of the app. The control group received no interventions. Data were collected at preintervention (T1), postintervention (T2), and at 3 months’ postintervention (T3) to ascertain the sustained effect. ResultsA total of 37.8% of mHealth+I and 18.3% of mHealth group participants continued using the mHealth app at least twice per week until the end of the sixth month. The difference in app usage across the 2 groups between T2 and T3 was significant (χ21=6.81, P=.009). Improvements in self-efficacy (β=4.30, 95% CI 0.25-8.35, P=.04) and depression levels (β=–1.98, 95% CI –3.78 to –0.19, P=.03) from T1 to T3 were observed in the mHealth group participants who continued using the app. Although self-efficacy and depression scores improved from T1 to T2 in the mHealth+I group, the mean values decreased at T3. Health service usage decreased for all groups from T1 to T2 (β=–1.38, 95% CI –1.98 to –0.78, P

Abstract Introduction Given that maternal mortality is a major global health concern, multiple measures including antenatal care visits have been promoted by the global community. However, most pregnant women in Ghana and other sub-Saharan African countries do not attain the recommended timelines, in addition to a slower progress towards meeting the required minimum of eight visits stipulated by the World Health Organization. Therefore, this study explored the trends in antenatal care visits and the associated factors in Ghana from 2006 to 2018 using the Multiple Indicator Cluster Surveys. Methods The study used women datasets (N = 7795) aged 15 to 49 years from three waves (2006, 2011, and 2017-2018) of the Ghana Multiple Indicator Cluster Surveys (GMICS). STATA version 14 was used for data analyses. Univariable analyses, bivariable analyses with chi-square test of independence, and multivariable analyses with robust multinomial logistic regression models were fitted. Results The study found a consistent increase in the proportion of women having adequate and optimal antenatal attendance from 2006 to 2018 across the women’s sociodemographic segments. For instance, the proportion of mothers achieving adequate antenatal care (4 to 7 antenatal care visits) increased from 49.3% in 2006 to 49.98% in 2011 to 58.61% in 2017-2018. In the multivariable model, women with upward attainment of formal education, health insurance coverage, increasing household wealth, and residing in the Upper East Region were consistently associated with a higher likelihood of adequate and/or optimal antenatal care attendance from 2006 to 2018. Conclusion Women who are less likely to achieve optimal antenatal care visits should be targeted by policies towards reducing maternal mortalities and other birth complications. Poverty-reduction policies, promoting maternal and girl-child education, improving general livelihood in rural settings, expanding health insurance coverage and infrastructural access, harnessing community-level structures, and innovative measures such as telehealth and telemedicine are required to increase antenatal care utilization.

Abstract Background The emergence of the Coronavirus disease has heightened the experience of emotional burden among healthcare staff. To guide the development of support programmes, this review sought to aggregate and synthesise qualitative studies to establish a comparative understanding of the experiences of healthcare staff caring for persons with the disease. Design A meta-ethnography approach was used to aggregate and synthesise primary qualitative studies. Database search was undertaken from January to November 2020. A standardised tool was used to extract data from the identified primary studies. The studies were translated into each other to formulate overarching concepts/ metaphors which formed the basis of undertaking a narrative synthesis. Results Eight qualitative studies met the inclusion criteria. Two overarching metaphors/ concepts were formulated from the primary studies: 1) surviving to thriving in an evolving space and 2) support amid the new normal. The initial phase of entering the space of caring during the outbreak was filled with psychological chaos as healthcare staff struggled to survive within the context of an illness which was not fully understood. Gradually, healthcare staff may transition to a thriving phase characterised by resilience but still experienced heavy workload and physical/ emotional exhaustion predisposing them to burnout and compassion fatigue. Fear persisted throughout their experiences: fear of contracting the disease or infecting one’s family members/ loved ones remained a key concern among healthcare staff despite infection precaution measures. Healthcare staff who contracted the disease felt isolated with additional fears of dying alone. The sources of support were varied with a strong emphasis on peer support. Conclusions Healthcare staff caring for persons infected with the Coronavirus disease are at risk of burnout and compassion fatigue and require ongoing mental health support commensurate to their needs. Staff who contract the disease may require additional support to navigate through the illness and recovery. Policies and concerted efforts are needed to strengthen support systems and build resilience among healthcare staff.

Abstract Background Transitioning from the burn unit to the home/community can be chaotic with limited professional support. Some adult burn survivors may face varied concerns leading to poor outcomes in the early post-discharge period with limited access to professional help. Based on these, a nurse-led transitional burns rehabilitation programme has been developed and the current trial aims to ascertain its effects as well as explore the implementation process. Methods A single-centre, double-arm randomised controlled trial with a process evaluation phase will be utilised for this study. All adult burn survivors aged ≥ 18 years with burn size ≥ 10% total burn surface area at the site during the study period will be screened for eligibility at least 72 h to discharge. A sample size of 150 will be block randomised to treatment (receiving the nurse-led transitional care programme and routine post-discharge service) and control groups (receiving routine post-discharge service). The nurse-led transitional care programme comprises of predischarge and follow-up phases with the delivery of bundle of holistic interventions lasting for 8 weeks. There are three timelines for data collection: baseline, immediate post intervention, and 4 weeks post-intervention. Discussion The findings from this study can potentially inform the development and organisation of post-discharge care and affirm the need for ongoing comprehensive home-based care for burn survivors and their families Trial registration ClinicalTrials.gov NCT04517721 . Registered on 20 August 2020

SignificanceUsing mHealth apps alone at home without the support of healthcare experts could mean that older adults might not fully utilize the functions of the apps, recognize their benefits, and sustain their use. Incorporating an integrated health-social partnership model to support the app usage when further help is needed by the older adults might maximize the apps' benefits in the long term.ObjectivesThis study aimed to examine the benefits of adding nursing interaction supported by a health-social partnership model in the use of mHealth, and the sustained beneficial effects on psychological outcomes, including quality of life, self-efficacy, and depression, among older adults after the completion of the program.MethodsA three-arm, randomized controlled trial design was adopted. Community-dwelling older adults with chronic pain, hypertension, or diabetes, were randomly assigned to either the mHealth, mHealth with interactivity, or control group. Subjects in both the mHealth and the mHealth with interactivity groups received the mHealth application. In addition, the mHealth with interactivity group received support from a nurse case manager, who was supported by a health-social partnership team. mHealth apps and services from a nurse case manager were not provided to the control group. The primary outcome measure was quality of life, and secondary outcomes were self-efficacy and depression. Data were collected at pre-intervention (T1), post-intervention (T2), and at 3 months post-intervention to measure the sustained effect of the program.ResultsThere were 74 mHealth+I, 71 mHealth, and 76 control group subjects enrolled in the program. No statistically significant between-group, within-group, and interaction effects between group and time in both physical component summary (PCS) and mental component summary (MCS) scores were found among the three groups. The mHealth group showed an improvement in PCS and depression scores from T1 to T2, sustained at T3; while the mHealth+I group demonstrated improved self-efficacy from T1 to T2, with a decrease at T3.ConclusionAdding nurse-directed telephone calls may be of little to no benefit at all in the long term. Future studies may consider a longer intervention period to build and sustain quality of life and self-efficacy levels among community-dwelling older adults.Clinical trial registrationwww.ClinicalTrials.gov, identifier: NCT03878212.

The emergence of the coronavirus pandemic led to the implementation of several precautionary measures across the globe. For densely populated regions in the world, this may have been challenging given the proximity of people to one other. Thus, this brief report sought to compare the measures across 2 densely populated locations, Hong Kong and Gaza. Epidemiological data was obtained from governmental online repositories and was compared with the data presented by the Johns Hopkins coronavirus map to ensure consistency. Descriptive statistics were used to interpret the data obtained over the period of the study. The data suggested that although Hong Kong and Gaza implemented similar strategies, Gaza recorded marginally higher cases compared with Hong Kong in the same timeframe. The strategies implemented in both settings included border closures, social distancing, proper hand hygiene, and mask usage. Cultural and socio-demographic differences may have played a part in this variation in case numbers, in addition to lessons Hong Kong had previously learned from a similar outbreak. As the pandemic is ongoing it is essential that public sensitization to adherence to precautionary measures at the personal/family level does not occur.

Background: Malaria remains one of the leading causes of morbidity and mortality among children under 5 years old in many low- and middle-income countries. According to the Ghana National Malaria Control Program, malaria kills at least three children every day and also tops the outpatient department cases in Ghana. Objective: The present study sought to determine the knowledge of malaria among caregivers of children under 5 years at Kenyasi Health Center, Ghana. Materials and Methods: The study was a descriptive, cross-sectional study. One hundred and three caregivers with children under 5 years old were recruited using the systematic random sampling technique, and data were collected using a structured questionnaire. Results: The findings revealed that majority (98%) of the respondents knew at least one cause of malaria. Furthermore, all respondents knew at least one complication of malaria and majority (97%) knew at least one preventive measure of malaria. Conclusion: Caregivers of children have adequate knowledge about malaria and its mode of transmission. Further education on the implementation of the preventive methods is still needed to help reduce the incidence of malaria among children.

Abstract Background About 85% of breast cancer patients attending Komfo Anokye Teaching Hospital (KATH), Ghana, present with stage III/IV disease. In spite of great investments into the early diagnosis and management of breast cancer, late presentation persists and poses a barrier to realising the possible benefits of the gains made in breast cancer management. This study assessed the symptom appraisal and medical health seeking behaviour of women with either locally advanced or metastatic breast cancer attending breast clinic at KATH. Method In-depth interviews of women presenting with clinical stage III/IV breast cancer were conducted to explore the women’s care seeking pathways after symptom identification until arrival at KATH from May 2015 to March 2016. Thematic data analysis was conducted using the Andersen behavioural model for health service use. Results Fifteen women aged 24–79 years were interviewed. The time from symptom identification to reporting to KATH was 4–24 months. The initial symptom was a breast lump or breast swelling which all the women identified themselves. These were initially appraised as not serious because most importantly, they did not interfere with their daily function. Symptom progression such as prevented them from undertaking their usual economic, social and family function triggered seeking care from health facilities. The availability of money to pay for care and diagnostic investigations influenced the time taken to navigate the referral pathway. While the women initially deferred healthcare for reasons related to their ability to perform economic, family and social roles, ultimately, aggressively pursuing healthcare was also for the same economic, family and social reasons or goals. Conclusion Deciding to seek care and pursue treatment for breast cancer symptoms may be much more complicated than it appears. Economic, family and social function significantly drive the health seeking process both at the personal and health facility phases of health seeking. Breast cancer education messages must be adapted to incorporate these functional goals and their influence on symptom appraisal and decision making to seek help and not just focus on the breast symptom as an isolated entity.

BackgroundIn recent years, telehealth has become a common channel for health care professionals to use to promote health and provide distance care. COVID-19 has further fostered the widespread use of this new technology, which can improve access to care while protecting the community from exposure to infection by direct personal contact, and reduce the time and cost of traveling for both health care users and providers. This is especially true for community-dwelling older adults who have multiple chronic diseases and require frequent hospital visits. Nurses are globally recognized as health care professionals who provide effective community-based care to older adults, facilitating their desire to age in place. However, to date, it is unclear whether the use of telehealth can facilitate their work of promoting self-care to community-dwelling older adults. ObjectiveThis review aims to summarize findings from randomized controlled trials on the effect of nurse-led telehealth self-care promotion programs compared with the usual on-site or face-to-face services on the quality of life (QoL), self-efficacy, depression, and hospital admissions among community-dwelling older adults. MethodsA search of 6 major databases was undertaken of relevant studies published from May 2011 to April 2021. Standardized mean differences (SMDs) and their 95% CIs were calculated from postintervention outcomes for continuous data, while the odds ratio was obtained for dichotomous data using the Mantel–Haenszel test. ResultsFrom 1173 possible publications, 13 trials involving a total of 4097 participants were included in this meta-analysis. Compared with the control groups, the intervention groups of community-dwelling older adults significantly improved in overall QoL (SMD 0.12; 95% CI 0.03 to 0.20; P=.006; I2=21%), self-efficacy (SMD 0.19; 95% CI 0.08 to 0.30; P

Introduction: The original use of face masks was to help protect surgical wounds from staff-generated nasal and oral bacteria. Currently governments across the world have instituted the mandatory use of masks and other face coverings so that face masks now find much broader usage in situations where close contact of people is frequent and inevitable, particularly inside public transport facilities, shopping malls and workplaces in response to the COVID-19. Objective: We conducted a rapid review to investigate the impact face mask use has had in controlling transmission of respiratory viral infections. Method: A rapid review was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Five electronic databases (CINAHL, Embase, Medline, PsycINFO and Global Health) were searched from database inception to date, using pre-defined search terms. We included all studies of any design and used descriptive analysis to report summary statistics of search results. Data were extracted including sample characteristics, study design, respiratory virus being controlled, type of face masks used and their effectiveness. Results: 58 out of 84 studies met the inclusion criteria, of which 13 were classified as systematic reviews and 45 were quantitative studies (comprising randomised controlled trials, retrospective cohort studies, case control, cross-sectional, surveys, observational and descriptive studies). N = 27 studies were conducted amongst healthcare workers wearing face masks, n = 19 studies among the general population, n = 9 studies among healthcare workers the general population and patients wearing masks, and n = 3 among only patients. Face masks use have shown a great potential for preventing respiratory virus transmission including COVID-19. Conclusion: Regardless of the type, setting, or who wears the face mask, it serves primarily a dual preventive purpose; protecting oneself from getting viral infection and protecting others. Therefore, if everyone wears a face mask in public, it offers a double barrier against COVID-19 transmission.

Background: Approximately 6–20% of burned patients have a concurrent inhalational injury, and the combination of inhalational injury and cutaneous injury may increase the patient’s risk for increased mortality. Objective: To assess the epidemiology and outcomes of burns associated inhalational injury in a Ghanaian tertiary facility. Methodology: A retrospective approach was utilised, from January 2010 to December 2016. Patients’ folders were retrieved to confirm data obtained. Descriptive statistics were generated to understand the characteristics of the study participants. Results: Out of 616 patients admitted at our Burns Intensive Care Unit with cutaneous burns, 59 (9.57%) of them had concurrent inhalational injury. Fifty-four out of the fifty-nine patients died with percentage mortality of 91.53%. More males were admitted with inhalational injury (81.40%) as compared to females. Majority of patients with inhalational injury were within the ages of 21–40 years (n = 21). The total burned surface areas were within 10%–50% with most patients within the limits of 41%–50%. Mean cutaneous burn size was obtained as 41.29% (SD = 21.7). Most patients spent 5–15 days (n = 32) on admission with mean of 11.91 days. Conclusion: Mortality resulting from concurrent burns and inhalational injury is very high. Various advanced techniques and equipment need to be made available for excellent patient management. Keywords: Inhalational injury, Burns, Mortality, Admission

Background: There is limited data from large naturalistic studies to inform prescribing of long-acting injectable medication (LAIs). Guidance is particularly rare in the case of primary mood disorders. Methods: This study describes prescribing trends of LAIs in 3879 patients in Quebec, Canada, over a period of 4 years. Health register data from the Quebec provincial health plan were reviewed. Results: In this specific registry, 32% of patients who received LAIs drugs for schizophrenia had a confirmed diagnosis of bipolar disorder and 17% had a diagnosis of major depressive disorder. Non-schizophrenia syndromes were preferentially prescribed risperidone long-acting antipsychotic, whereas patients with schizophrenia were prescribed an excess of haloperidol decanoate. Patients with non-schizophrenia disorders prescribed long-acting antipsychotics were more frequently treated in primary care compared with patients with schizophrenia. Conclusion: Data from a large number of patients treated naturalistically in Quebec with long-acting antipsychotics suggests that these compounds, prescribed to treat symptoms of schizophrenia and schizoaffective disorders, were maintained when mood symptoms emerged, even in cases when the diagnosis changed to bipolar disorder. This pragmatic study supports the need to explore this intervention as potential treatment for affective disorders.

Background: Burns is one of the injuries associated with epilepsy. Unfortunately, epileptics are afflicted with severe burns when they come in contact with burn substances, due to loss of consciousness while seizing. Objective: This study is designed to inform stakeholders about the incidence, outcomes and trends of burn accidents among epileptics predominantly in the middle belt of Ghana. Methods: A retrospective study of all burn cases (May 2009 to April 2016) resulting from seizures reporting at the Komfo Anokye Teaching Hospital was undertaken. Patient demographics, burns aetiology, total burnt surface area and length of admission were obtained from stored electronic data (Excel) of the Burns Intensive Care Unit (BICU). History related to burn injury were obtained from patients’ folders. Data was statistically analysed using Excel version 2013. Results: Epileptics formed 3.1% (n = 21) of the total BICU admissions and average annual incidence of 2.6 persons per year. Majority of the patients were females (71.42%). Age group 11–30 years formed the preponderance of our patients (n = 18, 85.7%). Only one 0–10 years old and no ≥50 years old patient was admitted. Scalds was the major aetiology (81.0%, n = 17). Ninety-five percent of the patients suffered moderate to major burns. Mean TBSA = 19.1%. Average days on admission was 69.1 days. Mortality rate was 9.5%. Conclusion: Though burns among epileptics is comparatively low in the middle belt of Ghana, it is important that stakeholders continually educate the public on epilepsy and burns prevention. Keywords: Burns, Epileptics, Scald, Superstition, Admission

Background: Though older adults are affected by burn injuries, there has been limited exploration of their characteristics in Ghana. Objective: To assess the epidemiology and outcomes of burn injury among older adults. Methodology: A retrospective approach was utilised. Admission and Discharge Books were used to retrieve records of burn patients aged 60 years and above from 2008 to 2015. SPSS version 21 was used to perform descriptive and multivariate statistical analysis. Results: Out of the 618 admissions, patients aged 60 years and above were 31 (5.0%). Burn injuries were commonest among the 60–69 year group (45.2%). A greater proportion of older adults in the study were farmers (38.7%). The year 2011 recorded the highest admission and death but mortality rates were equally high in all years represented in this study except in 2010. The mean age was 69.74 years. Though more females (67.7%) than males (32.3%) were involved in burn injuries, mortality was marginally higher in males than females. Thermal burns resulting from gas explosion (51.60%) and bush fires (22.60%) were major aetiological factors. Logistic regression analysis indicated that increasing age (p = .002) and increasing TBSA (p

Background: Burns are a major global public health issue affecting persons of all ages. Various studies have indicated that developing countries share a greater burden of the injury. Despite this fact, Ghana as a developing country lacks a burn repository and that makes it difficult to clearly understand the bigger picture of the injury. To this end, this study aimed to systematically review primary studies of burn occurrence in the country. Methodology: A comprehensive literature search was undertaken using PubMed, ScienceDirect, Google Scholar, MEDLINE and EMBASE. The keywords used were “burns, epidemiology, Ghana, injury, flame burn, scald burn, electric burn, chemical burn, contact burn and explosion”. Additional articles were identified by reviewing reference lists. The local journals such as the Postgraduate Medical Journal of Ghana were searched for the articles not indexed in PubMed or EMBASE. MOOSE guidelines were followed in executing this review. At the end of the selection process, seven papers remained and included in the study. Findings: Findings from this review identified that more males than females were involved in burn injuries. Persons within the paediatric age group (particularly those under 10 years of age) were particularly susceptible to burns. This notwithstanding it was noted that there is an increasing occurrence of burns among persons in the working class group (15 years–59 years). Scald was the most common injury among the paediatric age group whilst flame burn was most common among the adult population. The home was noted to be the commonest place for burn occurrence though some disasters at fuel filling stations were recorded. The occurrence of burn was associated with various burned surface area and from the studies reviewed it was noted that higher total burned surface area (TBSA) may be linked to increasing mortality rates. Length of hospitalisation ranged from less than 10 days to 760 days. Epilepsy was reported by one study as a pre-morbid condition. Conclusion: Burns represent a significant public health problem in Ghana and there is a need for the design of more effective intervention to reduce the occurrence of the injury. A larger scale research is imperative to investigate burns epidemiology from a national perspective. Keywords: Burns, Middle belt of Ghana, Epidemiology, Systematic review

Background: Working in the Intensive Care Unit has been noted to be stressful. Also, caring for a burn injured patient has been observed to present various stressors to nurses. Thus, working in the Burn ICU may be filled with various stressors that nurses need to respond to. However, there is paucity of studies exploring how nurses in the Burn ICU cope. Objective: To explore and describe coping strategies exhibited by nurses working in the Burn ICU. Methodology: An exploratory-descriptive approach was utilised to explore coping strategies exhibited by nurses. Purposive sampling was used to recruit nurses from the Burns Intensive Care Unit (n = 13). Face to face semi-structured interviews were conducted with an interview guide, proceedings audio-recorded and transcribed verbatim. One follow up interview was conducted after the initial interview. Analysis was undertaken using thematic analysis to generate themes. Findings: Three themes with corresponding sub-themes were identified: seeking and obtaining support, distancing oneself and recreation. Conclusion: Considering the useful role that senior nurses played in the unit, there is a need to develop strategies to retain them as well as support the on-going professional development of all nurses. There is also a need to create avenues of release to enable nurses’ talk about their experiences as they provide care to burned patients. Keywords: Coping, Nurses, Intensive Care Unit, Burns

Abstract Background Though ageing is not a disease, it has been associated with the occurrence of conditions which require health service utilisation. Ghana’s population is characterised by a steady growth in the number of older adults and previous studies have noted limited levels regarding utilisation by older persons. Methods Thus, this study utilised a qualitative approach to explore older persons’ experiences regarding out-patient hospital service utilisation in the Asante Akyem North District of Ghana. The aim was to generate findings that will guide future policies. Sixteen semi-structured interviews were conducted and thematic analysis executed. The Andersen’s Behavioural Model was used as a guiding framework. Results Medical condition was noted to characterise the need component of utilisation. Also, perceived effects of ageing, beliefs and past health status predisposed an older person to utilise available services. Beliefs were noted to make an older person utilise either orthodox or herbal services. Despite these, family support (in the form of financial assistance), accessibility (health facility, health professional, medication and information) and health care costs either enabled or prevented an older person from utilising services. Despite the existence of the National Health Insurance Scheme, health care costs are high and that delayed utilisation or made others avoid the services altogether. The care processes were noted to be cumbersome and involved long hours; though these features were noted to be absent whilst utilising traditional medicine services and this provides an avenue for further research in assessing patient outcomes associated with traditional medicine usage. These findings might be contributing factors to why other studies identified limited usage of health services among older persons in Ghana. Conclusion Though older persons in the district may feel the need to utilise health services on outpatient basis, the enabling factors (notably finance) appeared to be a driving force to actual utilisation. Thus, more innovative health care financing strategies are needed to enhance the coverage of health services for older persons in the district.

Background: The older adult population has been noted to be increasing at a steady rate and they have been described as persons at a high risk of being involved in burns. Thus, attention towards trauma among older adults is on the rise and there is a need to understand the characteristics of the injury among this population group. Methods: A narrative review approach was utilised for the study. PubMed, ScienceDirect and Google Scholar were used as search engines to identify studies that focused on burns in older adults or discussed some aspects related to the phenomenon from January 2000 to January 2017. Results: In all, thirty one (31) articles were retrieved. The terms “older adult” and “elderly” was noted to exist in literature with varying age limits. Older persons were noted to form a substantial number of persons affected by burns with flame burn identified as the major type of burns affecting older adults. However, scald burns were recognised to be higher among older females than males. Majority of these injuries were noted to occur within the domestic settings and associated with cooking. The presence of co-morbid factors was reported in most studies with hypertension and diabetes recorded as the commonest. The existence of dementia was noted to be associated with severe burns and double length of hospital stay. Outcomes of the injury included varying mortality rates, worsening of existing premorbid conditions, respiratory complications such as pneumonia and longer hospital stay. The use of a frailty scoring system was noted to offer better outcome prediction as compared to only the chronological age. One study noted that females experienced longer hospitalisation periods as compared to elderly males even though their burns were smaller. Conclusion: Older persons are affected by burns and resources required to meet their needs may be higher due to their longer periods of hospitalisation. The domestic nature of their injuries provides a window of opportunity to design preventive strategies. Also, policies and strategies are needed to protect the well-being of older persons. Further studies are needed to clearly understand gender differences associated with burns as this can impact management strategies. Follow up strategies after discharge need to be considered to understand the outcomes overtime. Also, more prospective studies and randomised control trials are needed in understanding the effectiveness of various interventions used in the clinical management of older persons. Keywords: Older persons, Burns, Incidence, Aetiology

Objective: To explore the phenomenon of surviving burn injury and its associated issues and concerns. Methods: A cross sectional survey approach was utilized to obtain data from one hundred burn survivors who were purposely selected. Descriptive statistics and content analysis were used to analyze data. Results: Findings from the study indicate that burns from flames stood out as a major cause of burns. Physical discomfort/pain, anxiety, needing assistance in meeting self-care needs, financial and social limitations were identified as the major impact of the injury. Furthermore, participants perceived the existence of societal stigma. In addition, hope in God or a spiritual being as well as family support were the two key resources participants relied on to cope effectively. Conclusions: Surviving burn injury is associated with varied physical, social and psychological factors and survivors may need professional assistance to fully adjust after discharge.

Introduction: Hyperthermia in the burn injured patient has been noted to exist either in the presence or absence of infection. However, there is a need to manage this feature aggressively as if left unmanaged; it might lead to other deleterious effects. Objective: Thus, this case report assesses the management strategies instituted in the management of burns associated hyperthermia. Case report: A thirty-four year old male who sustained thermal burns was admitted with a baseline temperature of 36.1 °C. However elevated temperature to the level of 40.40 °C was noted but other tests proved the absence of infection. Several strategies were instituted to resolve the hyperthermic state. Conclusion: It was noted that these strategies possess limited efficacy and there is need to assess other modalities that works best and cost effective. Further research is also warranted in understanding the nature of hyperthermia in the absence of infection in the burned patient. Keywords: Burns, Hyperthermia, Management strategies