Clinical Nursing Research

Social support can play a crucial role in psycho-social well-being of people with chronic conditions. There is limited information about the experiences, barriers and sources of social support of Arab people affected by chronic conditions. The purpose of this review is to explore the experiences, barriers and sources of social support of Arab people affected by chronic conditions. A scoping review of the literature, based on Preferred Reporting Items for Scoping Reviews and Meta-Analyses (PRISMA) guidelines. Articles (n = 13) were identified for appraisal based on a group of inclusion and exclusion criteria. Eight articles were included in the final analysis. Three broad themes were identified: (a) Social support benefits—physical, emotional and financial benefits; (b) Source of social support—family and friends support, and (c) Support services utilization—cultural barrier, Arab migrants language and unfamiliarity with the health system barriers. Appropriate future support programs should be tailored based on Arab cultural beliefs and the inherent responsibility of the family together inside the Arab community.

Although hallucinations are prevalent in psychiatric disorders, such as psychosis or dementia, no studies were to be found in literature about the nursing process addressing the focus “Hallucination”. This literature review, which is integrated with a scoping study framework, was performed to determine a clinical data model addressing the focus “Hallucination”. PRISMA checklist for scoping reviews was followed. From the total of 328 papers found, 32 were selected. The findings of this review were summarized according to the nursing process addressing the focus “Hallucination”. These findings led to determine a clinical data model addressing the focus “Hallucination”, comprising the elements of the nursing process. This clinical data model may contribute toward improving nursing decision-making and nursing care quality in relation to a client suffering from hallucination, as well as contribute toward producing more reliable nursing-sensitive indicators.

Animal assisted therapy (AAT) programs are popular and there has been a proliferation of programs across settings. However, the research to support this intervention has not kept pace. This is particularly so for people who are hospitalized. This investigation aimed to explore the effects of the AAT dog visitation program on patients. A single group pre-post quasi-experimental design evaluated the effect of pet therapy on patients. Measures included salivary cortisol, anxiety, wellbeing, comfort, respiratory and heart rate. Analysis indicates a significant reduction in heart and respiratory rates p < .01 and level of anxiety p < .000 with improved levels of comfort and well-being p < .000. The salivary cortisol result was non-significant p = .623. This ATT dog program resulted in reduced anxiety levels and decreased heart and respiratory rates while improving subjective measures of comfort and wellbeing.

The aim of this study was to determine which factors are related to Accidents and Emergency Unit (AEU) use by the elderly Spanish population. Observational analysis of the 2014 European Survey of Health in Spain (ESHS-2014; N = 6,520) and the 2017 Spanish Health Survey (SHS-2017; N = 7,024) was employed. About one third (4,095, 30.2%) of the sample used the AEU, and they were primarily women (32.6%). Comorbidity (p = .01), presence of physical limitation in the prior 6 months to the survey, and a history of several diseases (p < .001)—as in diabetes (p < .001), osteoarthritis (p < .001), and chronic bronchitis, emphysema, or chronic obstructive pulmonary disease (p < .001)—were associated with AEU visits in both surveys. Female sex and several cardiovascular diseases were only significant in the ESHS-2014. In the SHS-2017, depressive status was an independent risk factor. This epidemiological data allow a better understanding of the use of AEU, suggesting indications for the care process.

The purpose of this study was to investigate, within the sociocultural context of Korea, mothers’ experiences caring for their child being treated in a hospital for leukemia. Study participants included 11 mothers who visited a hospital for their child’s follow-up care after treatment for leukemia. The researchers investigated the mothers’ experiences in caring for their children using a qualitative study design. Through interviews, the researchers identified five categories of experiences among participants, including, “Death anxiety,” “Feeling guilty,” “Fulfilling responsibilities as a mom,” “Feeling overwhelmed by life,” and “Feeling grateful.” In the course of treatment, mothers tended to feel pressured to be a good mother, and sometimes felt overwhelmed by life. Healthcare providers need to grasp the difficulties faced by mothers taking care of their children hospitalized for treatment of leukemia, and must develop programs to reduce the burden on mothers and increase their families’ functioning.

Consistent with global trends, population aging in South Korea is necessitating increasing admissions to intensive care units (ICU). This integrative review describes the challenges experienced by family caregivers of ICU patients in South Korea and evaluates relevant intervention studies. Using Whittemore and Knafl’s methods, we identify and synthesize findings from 20 (14 descriptive and 6 experimental design) articles and evaluate study quality. South Korean ICU family caregivers reported challenges such as feelings of powerlessness and vulnerability, difficulty in maintaining their own health and well-being, and mixed feelings regarding patients’ transition to the general ward. Intervention studies, which were based on quasi-experimental design, examined modified visiting hours, information provision strategies, nurse-led transitional care programs, and educational support. Findings highlight the current state of the science in this topic area in South Korea. Future studies should use more robust methods, such as longitudinal cohort studies and randomized controlled trials.

Implementing and performing early mobilization is a complex process requiring multidisciplinary input and cooperation. To gain insight in its facilitators and barriers, various surveys have been developed. A systematic review was conducted, to identify the psychometric properties, feasibility and suitability of questionnaires to assess facilitators and barriers of early mobilization in critically ill patients. Data were extracted regarding a.o. definition of early mobilization, development, psychometric properties, content and themes, question format. The search identified 537 publications of which 13 unique questionnaires were included. The questionnaires showed wide variation in extensiveness of development. Only six questionnaires actually assessed validity and reliability. Which questionnaire to choose depends on the aim of its use, required level of detail and specifics of the ICU, though three questionnaires were recommended as their definition of early mobilization covered a broad range of activities, including nursing related mobility activities. International consensus on what constitutes early mobilization is desirable.

Untreated pain and pain management with opioids are independent precipitating factors for delirium. This retrospective study evaluated the relationships among pain severity, its management with opioids, and the onset of delirium in older adult patients admitted to the surgical intensive care unit (SICU). Consecutive patients aged 65 or greater admitted to the SICU over a 5-month period were examined (n = 172). When assessed using a multivariable general estimating equation model, opioids (chi-square [χ²], 12.34, p = .0004), but not pain (χ², 3.31, p = .0688) were significant in predicting next-day delirium status. Controlling for pain, patients exposed to opioids were 2.5 times more likely to develop delirium than patients not exposed (95% Confidence Interval: 1.44–4.36). Our data shows that opioid administration predicted the onset of next-day delirium. In an effort to prevent delirium, future research should focus on opioid-sparing pain management approaches to mitigate pain and delirium.

Delirium is a reversible impairment of metabolism in the human brain. Early detection is important, and an effective screening tool for nurses is crucial. The Delirium Observation Screening (DOS) scale is one such screening tool; however, its diagnostic test accuracy has not yet been thoroughly examined. This study, therefore, aimed to evaluate the accuracy of the scale through a systematic review and meta-analysis. In July 2019, a search was conducted in the MEDLINE, CINAHL, Embase, and PsycARTICLES databases, and following a review against pre-defined eligibility criteria, eight studies were finally included. The quality assessment tool of diagnostic accuracy studies was applied to each study and a hierarchical regression model was used to calculate the pooled estimates of sensitivity (90%; 76%–97%, CI 95%) and specificity (92%; 88%–94%, CI 95%). The findings indicated a high diagnostic test accuracy for the DOS scale.

One of the principal complications in patients in the intensive care unit, particularly in those receiving mechanical ventilation, is medication-induced delirium. The present study aimed to intensively analyze pharmaceutical factors affecting the development of delirium in mechanically ventilated patients using the electronic health records. The present study was designed as a retrospective case–control study. The delirium group included 500 mechanically ventilated patients. The non-delirium group included 2,000 patients who were hospitalized during the same period as the delirium group and received mechanical ventilation. A total of seven types of medications (narcotic analgesics, non-narcotic analgesics, psychopharmaceuticals, sleep aid medications, anticholinergics, steroids, and diuretics), conventionally used to manage mechanical ventilation, were found to be major risk factors associated with the occurrence of delirium. Since these medications are an integral part of managing mechanically ventilated patients, prudent protocol-based medication approaches are essential to decrease the risk of delirium.

Fall-related serious injuries pose risks to patients and healthcare organizations. This retrospective, single-hospital study used a 38 variable instrument to understand characteristics of those who sustained a fall with serious injury. Analyses included descriptive statistics, frequency, and Chi-square tests of associations between key variables and outcomes of moderate versus major injury. Age range 25–91 years, predominantly 60–69 years (23.3%), and mostly male (50.9%). Highest percentage occurred between 0:00 and 06:59 (39.6%), and on Oncology service (28.3%). Fallers were in the room, (81.1%), sustained major injury (73.6%), fractured a major bone (43.4%), had altered mobility prior to the fall (67.9%), and had received at least one narcotic dose within 24 hours before the fall (43.2%). The associations between injury severity and age, gender, altered mobility, fall risk assessment pre-fall, and unit service line are not statistically significant, however have small-to-moderate clinical significance. This study adds to the literature in identifying characteristics of patients who sustain a fall-related serious injury.

To clinically validate the defining characteristics of nursing diagnoses related to self-care deficits in feeding, bathing, toileting, and dressing in patients with stroke. A diagnostic accuracy study was conducted with a sample of 135 patients with stroke. Sensitivity and specificity were calculated based on the latent class analysis method using the random effects model. The prevalence of diagnoses was 23.5% for Bathing self-care deficit, 18.5% for Dressing self-care deficit, 13.3% for Toileting self-care deficit, and 7.5% for Feeding self-care deficit. Fourteen defining characteristics were sensitive, and 17 were specific. Hemorrhagic stroke and note 4 on the Rankin scale was associated with self-care deficits. Of the 37 defining characteristics of the four diagnoses studied, 19 were clinically validated according to the latent class analysis model. These most accurate clinical indicators contribute to the development of the care plan for patients with stroke.

Spousal support is likely to influence the rehabilitation motivation of stroke survivors who require long-term rehabilitation. This study was conducted to examine the reciprocal effects of the depressive symptoms and marital intimacy of stroke survivors and their spouses, and identify the factors that influence the rehabilitation motivation of stroke survivors. For this cross-sectional descriptive study, 72 stroke survivor-spouse couples were recruited from four rehabilitation hospitals in South Korea in 2017. The collected data were analyzed using path analyses with SPSS 20.0 and the R package. There were significant differences in the actor effects of stroke survivors’ and spouses’ depressive symptoms on the marital intimacy of the survivors and their spouses. The perceived marital intimacy of spouses was significantly associated with the rehabilitation motivation of stroke survivors. In order to enhance their rehabilitation motivation, it is necessary to periodically assess the depressive symptoms and perceived marital intimacy of their spouses.

The aim of this study is to examine experiences of patients undergoing bariatric surgery according to Roy’s adaptation model (RAM). This is a qualitative study with a phenomenological design. The sample included patients undergoing bariatric surgery (N: 32). Of all the patients 84.37% were female and 59.38% were married. According to results of the content analysis, adaptive patient behavior was described by the themes “My life has changed”, Everything is beautiful” “I can cope” and “Luckily, I have them” and their nonadaptive behavior was described by the themes “What if I cannot succeed”, “Bad news” and “So many people, so many views”. Patients having bariatric surgery experience various difficulties in adapting to their life and bodies, but the surgery leads to improvements in their body image, social life, personal relationships, and maintenance of roles. However, some patients can be afraid of postoperative complications and experience anxiety about regaining weight.