bluuebunny/crossref_metadata_2025_split huggingface dataset:
Registered nurses’ own experience of using a nurse‐initiated pain protocol based on their working experience
Authors: Sturesson Lars , Falk Ann‐Charlotte , Ulfvarson Johanna , Lindström Veronica 
Published: October 2017

Aims and objectivesTo explore registered nurses’ (RNs) own experience of using the nurse‐initiated pain protocol (NIPP) in the emergency department (ED) based on their working experience.BackgroundPain is known to be one of the most common symptoms among adult patients seeking care at the ED. Several strategies aiming to improve pain management have been developed. Despite some improvements in pain management using NIPP, a large number of patients continue to have inadequate pain treatment when cared for in EDs.Design and methodA cross‐sectional study design based on a questionnaire was used. The variable working experience was based on a theory that experience will make a change in RNs’ knowledge. Descriptive statistics and Pearson's chi‐square tests were used for analysing quantative data. Qualitative data were analysed by summative content analysis.ResultsSeventy RNs answered the questionnaire (response rate 42%) and 61% considered the NIPP adequate to relieve patients’ acute pain at the ED. No significant difference was found on how the RNs used the NIPP. However, qualitative data showed that more experienced RNs adapt the NIPP according to the patients’ needs in a higher extent.ConclusionA majority of the RNs consider the NIPP to be adequate to relieve patients’ acute pain in the ED. An increase in working experience showed an impact on how the NIPP was used, with an increase in pain management that is personalised depending on individual patients’ needs. The RNs used several alternatives to both dosage and type of medication when the ED becomes crowded.Relevance to clinical practiceRegistered nurses’ working experience should be considered when planning nursing schedules to be better able to meet patients’ needs. Guidelines should be developed and evaluated by both healthcare professionals and patients.
Variation in nurse self‐reported practice of managing chest tubes: A cross‐sectional study
Authors: Lu Cui , Jin Ying‐hui , Gao Weijie , Shi Yue‐xian , Xia Xinhua , Sun Wen‐xi , Tang Qi , Wang Yunyun , Li Ge , Si Jinhua 
Published: October 2017

Aims and objectivesTo reveal nurses’ self‐reported practice of managing chest tubes and to define decision‐makers for these practices.BackgroundNo consensus exists regarding ideal chest‐tube management strategy, and there are wide variations of practice based on local policies and individual preferences, rather than standardised evidence‐based protocols.DesignThis article describes a cross‐sectional study.MethodsQuestionnaires were emailed to 31 hospitals in Tianjin, and the sample consisted of 296 clinical nurses whose work included nursing management of chest drains. The questionnaire, which was prepared by the authors of this research, consisted of three sections, including a total of 22 questions that asked for demographic information, answers regarding nursing management that reflected the practice they actually performed and who the decision‐makers were regarding eight chest‐drain management procedures. McNemar's test was used to analyse the data.ResultsThe results indicated that most respondents thought that it was necessary to manipulate chest tubes to remove clots impeding unobstructed drainage (91.2%). Most respondents indicated that dressings would be changed when the dressing was dysfunctional. At the same time, more than half of respondents approved of changing dressings routinely, and the frequency of changing dressings varied. When drainage was employed for pleural effusion and for a pneumothorax, 64.6% and 94.5% of respondents, respectively, considered that underwater seal‐drainage bottles should be changed routinely, and the frequency of changing bottles both varied. The results indicated that nurses were the primary decision‐makers in the replacement of chest tubes, manipulation of chest tubes and monitoring of drainage fluid.ConclusionsThere was considerable variation in respondents’ self‐reported clinical nursing practice regarding management of chest drains. The rationale on which respondents’ practices were based also varied greatly. This study indicated that nurses were the primary decision‐makers for three of eight procedures regarding management of chest drains, which reflects that clinical nurses’ decision‐making power regarding management of chest drains was weak.Relevance to clinical practiceThis study describes the nurse‐reported practices of Chinese nurses from Tianjin, including changing and selecting dressing types, manipulating chest tubes, clamping drains and replacing drainage bottles, and the study defines who the decision‐makers were for these interventions. By focusing on nurses’ self‐report of behaviours in managing chest drains (actual nursing practice vs. nursing knowledge), this article also relates the literature to the research findings and denotes the gaps in knowledge for future research.
Effects of home‐based lower limb resistance training on muscle strength and functional status in stable Chronic obstructive pulmonary disease patients
Authors: Chen Yi , Niu Mei'e , Zhang Xiuqin , Qian Hongying , Xie Anwei , Wang Xiya 
Published: October 2017

Aims and objectivesThis study aimed to determine the effect of home‐based lower limb resistance training (LLRT) in patients with stable COPD.BackgroundPulmonary rehabilitation (PR) in COPD patients has been substantially investigated, but the rehabilitation components differ among studies. Few works have focused on home‐based LLRT. Furthermore, few studies have assessed muscle strength and functional status by isokinetic/isometric extensor muscle peak torque (PT) and five‐repetition sit‐to‐stand test (FTSST), respectively.DesignA randomised controlled design was adopted.Methods(i) The home‐based LLRT consisted of six sets of lower limb training cycles by self‐gravity resistance and Thera‐band resistance at 8–12RM, 20–30 min/session and 3 sessions/week for 12 weeks. (ii) The intervention group (n = 25) received routine PR guidance and home‐based LLRT, whereas the control group (n = 22) received routine PR guidance only. The muscle strengths, FTSST durations, 6‐min walking distances (6MWDs) and COPD assessment test results at enrolment and week 12 were compared.ResultsRelative to the baseline findings, all the indexes of muscle strength (isometric extensor muscle PT, isometric extensor muscle PT to body weight ratio [PT/BW], isokinetic extensor muscle PT and isokinetic extensor muscle PT/BW) did not significantly change in the intervention group. Meanwhile, no significant intragroup difference was noted among the indexes of muscle strength (except for isometric extensor muscle PT) in the control group. The FTSST decrease was significant between and within groups. By contrast, the 6MWD significantly increased within both groups, but not between the groups. The COPD assessment tool score decreased significantly within the intervention group.ConclusionsCompared with routine PR guidance, home‐based LLRT can improve not only the muscle strength and exercise endurance but also the lower limb functional status.Relevance to clinical practiceOur developed home‐based LLRT intervention is simple, safe and feasible in stable COPD patients and could hence be promoted in clinical practice.
The effect on pain of three different nonpharmacological methods in peripheral intravenous catheterisation in adults
Authors: Yılmaz Dilek , Güneş Ülkü Yapucu 
Published: October 2017

Aims and objectivesTo compare the effectiveness in reducing pain during peripheral intravenous catheterisation of coughing, blowing into a spirometer and squeezing a stress ball.BackgroundPeripheral intravenous catheterisation is widely performed by nurses; it causes pain and discomfort to patients.DesignThis was a single‐blind randomized controlled study.MethodsThe sample of the study consisted of 120 males who came to donate blood. Before the peripheral intravenous catheterisation, the individuals were divided by a simple randomisation method into four groups: a coughing group, a blowing into a spirometer group, a stress ball squeezing group and a control group. During the procedure, the pain levels felt by the individuals were assessed using the visual analog scale by a nurse who was blinded to the procedure.FindingsThe mean pain of the individuals in the coughing group was found to be 19.5 mm (SD: 13.6), that of the spirometer group was 28.3 mm (SD: 20.2), that of the stress ball group was 32.1 mm (SD: 23.8) and that of the control group was 45.5 mm (SD: 19.5). Statistical analysis showed a significant difference between the mean pain scores of individuals in the control group and those of individuals in the coughing, spirometer and stress ball groups.ConclusionThe techniques of squeezing a stress ball, blowing into a spirometer and in particular coughing, depending on the potential mechanism of the Valsalva manoeuvre and diverting attention, are effective techniques in reducing the pain of peripheral catheterisation procedures.Relevance to clinical practiceIt is important that nurses should be aware of pain and stress experienced by patients during invasive procedures. For this reason, nurses should have knowledge of proven nonpharmacological methods which can reduce pain to a minimum.
Medication administration and interruptions in nursing homes: A qualitative observational study
Authors: Odberg Kristian Ringsby , Hansen Britt Sætre , Aase Karina , Wangensteen Sigrid 
Published: October 2017

Aims and objectivesTo contribute in‐depth knowledge of the characteristics of medication administration and interruptions in nursing homes. The following research questions guided the study: How can the medication administration process in nursing homes be described? How can interruptions during the medication administration process in nursing homes be characterized?BackgroundMedication administration is a vital process across healthcare settings, and earlier research in nursing homes is sparse. The medication administration process is prone to interruptions that may lead to adverse drug events. On the other hand, interruptions may also have positive effects on patient safety.DesignA qualitative observational study design was applied.MethodsData were collected using partial participant observations. An inductive content analysis was performed.ResultsFactors that contributed to the observed complexity of medication administration in nursing homes were the high number of single tasks, varying degree of linearity, the variability of technological solutions, demands regarding documentation and staff's apparent freedom as to how and where to perform medication‐related activities. Interruptions during medication administration are prevalent and can be characterised as passive (e.g., alarm and background noises), active (e.g., discussions) or technological interruptions (e.g., use of mobile applications). Most interruptions have negative outcomes, while some have positive outcomes.ConclusionsA process of normalisation has taken place whereby staff put up with second‐rate technological solutions, noise and interruptions when they are performing medication‐related tasks. Before seeking to minimise interruptions during the medication administration process, it is important to understand the interconnectivity of the elements using a systems approach.Relevance to clinical practiceStaff and management need to be aware of the normalisation of interruptions. Knowledge of the complexity of medication administration may raise awareness and highlight the importance of maintaining and enhancing staff competence.
Evaluation of a nurse‐led intervention to improve adherence to recommended guidelines for prevention of venous thromboembolism for hip and knee arthroplasty patients: A quasi‐experimental study
Authors: Lockwood Rosemarie , Kable Ashley , Hunter Sharyn 
Published: October 2017

Aims and objectivesTo measure adherence to a nurse‐led evidence‐based venous thromboembolism prevention programme (intervention) compared to usual care in hip and knee arthroplasty patients and associated clinical outcomes.BackgroundVenous thromboembolism morbidity and mortality of hospitalised patients is a major concern for health professionals. Venous thromboembolism prevention guidelines have been developed; however, adherence to guidelines is variable.ParticipantsThere were 410 potential participants who were adult patients that were booked for elective hip or knee arthroplasty at the two study sites during a 2‐year period (2011–2013). Of these, 27 did not meet the inclusion criteria, and the remainder were eligible for inclusion in the study (intervention siten = 196 and control siten = 187, total populationn = 383).MethodsThis study adopted a quasi‐experimental design, using an intervention and control study site, conducted in two private hospitals in a regional area in Australia.ResultsThe intervention group had a mean compliance score of 11.09, higher than the control group score of 7.19. This is equivalent to a compliance rate of 85% and 55%, respectively, and indicates that adherence at the study site was significantly higher. Patient adherence and outcomes in the postdischarge period were not significantly different between the study sites.ConclusionThis study demonstrated a nurse‐led intervention achieved high adherence with translating evidence‐based guidelines into routine patient care for hip and knee arthroplasty patients. Nurses can be critical to implementing clinical practice guidelines and adopting preventive programmes in acute care to improve patient outcomes and reduce postoperative venous thromboembolism in arthroplasty patients.Relevance to clinical practiceThis research demonstrates the capacity of nurses to lead the translation of evidence‐based practice guidelines for prevention of venous thromboembolism into routine patient care.
The meaning of rituals after a stillbirth: A qualitative study of mothers with a stillborn baby
Authors: Tseng Ying‐Fen , Hsu Min‐Tao , Hsieh Yueh‐Tzu , Cheng Hsiu‐Rong 
Published: October 2017

Aims and objectivesTo explore the meaning of rituals that women and their families perform after a stillbirth.BackgroundA cultural taboo in Taiwan prohibits discussing death; thus, parents of stillborn babies have no established public mourning or burial ceremonies to perform for their stillborn children. Stillbirths are often treated as if they had never happened.DesignQualitative descriptive study.MethodsIn‐depth interviews, which were transcribed and content analysed, were conducted with a purposive sample of 16 women discharged from two teaching hospitals in Taiwan after they had a stillbirth.ResultsFamilies engaged in rituals for two underlying reasons: to benefit the deceased child and the immediate family. The meanings of the rituals for the child are presented through three themes: (i) sending the baby's spirit to a safe place, (ii) protecting it from suffering and (iii) preparing it for a better reincarnation. The meanings of rituals for the families are presented through four themes: (i) releasing parental guilt by doing their best for the deceased child, (ii) cutting bonds with the child, (iii) avoiding additional misfortune should they mishandle the funeral and (iv) praying for a successful subsequent pregnancy.ConclusionsDeath‐related rituals are highly culturally diverse. This study fills a gap about Asian cultures. Participating in rituals permits a mother to do something for her deceased child, helps relieve her guilt and lets her cope with the stillbirth. Rituals after a stillbirth can help a woman recover from grieving and allow her to hope for a successful subsequent pregnancy.Relevance to clinical practiceHealth professionals should discuss with bereaved parents what rituals they would like to perform and then respect their decisions. A continuum of care and support that exists from the prenatal diagnosis through the stillbirth and beyond is recommended for parents and families during this difficult time.
Hospital discharge processes involving older adults living with dementia: An integrated literature review
Authors: Stockwell‐Smith Gillian , Moyle Wendy , Marshall Andrea P , Argo Alison , Brown Laura , Howe Shelley , Layton Keith , Naidoo Ornissa , Santoso Yuwati , Soleil‐Moudiky‐Joh Elizabeth , Grealish Laurie 
Published: October 2017

Aims and objectivesTo identify barriers and facilitators to engagement of people with dementia and family carers in planning for discharge from hospital.BackgroundHospital discharge can be particularly challenging for older people with dementia. To assist in the development of bespoke discharge processes that address the unique needs of older people with dementia, an integrated review of the literature was undertaken.Design and methodsA four‐stage integrative review framework guided the review. Three search strategies were employed: a computerised database search, a hand search of reference lists and forward citation searching. Paired members of the research team reviewed eligible full‐text papers. The methodological quality of each paper was assessed using the Mixed‐Methods Assessment Tool, followed by data extraction and completion of summary tables. Within and across study analysis and synthesis of study findings was undertaken using thematic synthesis.ResultsFifteen papers were included in the review. Most identified barriers to collaborative discharge processes related to distributed responsibility for discharge, risk averse approaches to discharge, limited family carer confidence, and limited validation of assumptions about family competency to manage at home. Facilitators included supported clinician and family carer engagement, and maintaining independence for activities of daily living.Relevance to clinical practiceReflective analysis of discharge decisions, focused on risk and possible risk aversion, can assist teams to evaluate the quality of their discharge decisions. The use of formal communication strategies such as a patient/family‐held journal of the hospital experience and a structured family meeting early in the hospital admission can enhance family engagement in discharge planning. Prevention of functional and cognitive decline is emerging as critical to improving hospital discharge outcomes.
Oral health matters for the nutritional status of older persons—A population‐based study
Authors: Lindmark Ulrika , Jansson Henrik , Lannering Christina , Johansson Linda 
Published: October 2017

Aims and objectivesTo explore the association between oral health and nutritional status in the context of daily care for older people.BackgroundOral problems often increase with age and affect a person's ability to chew and swallow. They might also influence the ability to maintain a satisfactory nutritional status. Oral health awareness is therefore of great importance in nursing care for older people.DesignA retrospective cross‐sectional study.MethodsData from the Swedish quality register, Senior Alert, were used, including structured assessments of both oral and nutritional status using the Revised Oral Assessment Guide—Jönköping and the Mini Nutritional Assessment. In total, 1,156 persons (mean age: 82.8 ± 7.9) had both oral and nutritional assessments registered by the nursing staff in daily care.ResultsApproximately 29% of participants had moderate oral health problems. Another 12% had severe problems. Over 60% of the persons were considered at risk of malnutrition or were malnourished. There was a weak correlation between poor nutritional status and poor oral health, and approximately one‐third of the persons who were at risk or malnourished had simultaneous oral problems. A multivariate logistic regression revealed that when problems involving voice and swallowing were present, there was also a greater possibility of being assessed as at risk of malnourishment or being malnourished.ConclusionThere is a relationship between oral health problems and nutritional status, indicating the importance of evaluating oral health status in older persons with nutritional problems.Relevance to clinical practiceNursing staff involved in care for older people should be aware of the importance of including regular oral health check‐ups in their work. There is also a need for nursing staff members and oral health professionals to exchange knowledge.
Long‐Term Magnetization Transfer Ratio Evolution in Multiple Sclerosis White Matter Lesions
Authors: Zheng Yufan , Lee Jar‐Chi , Rudick Richard , Fisher Elizabeth 
Published: October 2017

ABSTRACTBACKGROUND AND PURPOSEMagnetization transfer ratio (MTR), a magnetic resonance imaging technique used to assess tissue integrity, correlates with demyelination and axonal loss in multiple sclerosis (MS) lesions. In acute white matter lesions, short‐term MTR changes mainly reflect demyelination and remyelination, in addition to edema and axonal and glial changes. Long‐term MTR changes in MS lesions have not been studied extensively.METHODSA new quantitative image analysis method was developed to measure long‐term MTR changes in MS lesions. The method was applied to a group of 59 patients and 14 healthy control subjects followed for 4 years. MTR changes in white matter lesions were analyzed, where lesion voxels were classified into six categories based on starting MTR and change over time. For each patient, the proportion of lesion voxels in each MTR‐change category was calculated. Correlations between long‐term MTR evolution, disability progression, and brain atrophy were investigated.RESULTSThe proportion of lesion voxels in the high stable category correlated with less atrophy progression, while the proportion with low and increasing MTR correlated with increased atrophy. The proportion of lesion voxels in the high and stable MTR lesion category was significantly different between MS disease subgroups. The group with disability progression had a higher proportion of lesion voxels with low and increasing MTR.CONCLUSIONSThese results suggest that long‐term changes in MTR in white matter lesions can be used to distinguish lesion subtypes associated with MS disease progression and improve understanding of the temporal evolution of MS pathology.
Does EU cohesion policy work? Theory and evidence
Authors: Fiaschi Davide , Lavezzi Andrea Mario , Parenti Angela 
Published: October 2017

AbstractThis paper evaluates the effectiveness of European Cohesion Policy in the regions of 12 EU countries in the period 1991–2008, on the basis of a spatial growth model, which allows for the identification of both direct and indirect effects of EU funds on GDP per worker growth. We find that “Objective 1” funds are characterized by strong spatial externalities and a positive and concave effect on the growth of GDP per worker, which reaches a peak at the ratio funds/GDP of approximately 3 percent and becomes non‐significant after 4 percent. “Objective 2” and “Cohesion” funds have nonsignificant effects, while all the other funds exert a positive and significant effect, but their size is very limited. EU Cohesion Policy, moreover, appears to have increased its effectiveness over time. In the period 2000–2006 Objective 1 funds are estimated to have a median multiplier equal to 1.52, and to have added 0.37 percent to the GDP per worker growth. Overall, in the period 1991–2008, funds are estimated to have added 1.4 percent to the median annual growth, and to have reduced regional disparities of 8 basis points in terms of the Gini index.