bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vaccination timeliness in preterm infants: An integrative review of the literature
Authors: Sisson Helen , Gardiner Eric , Watson Roger 
Published: June 2017

Aims and objectivesTo take a systematic approach to reviewing the scientific literature examining the timeliness of vaccination in preterm infants and to identify any factors associated with timeliness.BackgroundPreterm infants are vulnerable to infection and guidance advocates they are vaccinated in accordance with their full‐term peers. Vaccination is well tolerated and protective immune responses are observed, yet some early enquiries suggest that preterm infants experience unwarranted delays. The recent surge in pertussis cases and the increase in vaccinations administered make this a topic requiring further exploration.DesignAn integrative review of the empirical literature.MethodsStudies were identified following a search of Medline, Academic Search Premier, Cochrane Database of Systematic Reviews and the Cumulative Index to Nursing and Allied Health Literature. The review methods used were influenced by a narrative synthesis approach. The retrieval of papers adhered to recognised reporting standards.ResultsFourteen studies were identified, which indicated that infants with the lowest gestational ages and birthweights experience the greatest delays. Vaccination timeliness is influenced by hospitalisation and increased postdischarge follow‐up. There was a lack of consensus to indicate that parental socio‐economic status and level of education were indicators for a delay. The studies propose that many delays are unjustified and not according to genuine contraindications.ConclusionThis review indicates that preterm infants are not vaccinated in a timely manner. Those involved in vaccinating preterm infants must be informed of the genuine contraindications to avoid unnecessary delays putting preterm infants at an increased risk of infection.Relevance to clinical practiceCare providers should acknowledge the risk of a delay in preterm infants and actively promote vaccination in this population. Regular training should help to negate the occurrence of inappropriate delays, and careful discharge planning is needed to ensure that preterm infants are vaccinated on time.
Nurses' knowledge on diabetic foot ulcer disease and their attitudes towards patients affected: A cross‐sectional institution‐based study
Authors: Kumarasinghe Sriyani A. , Hettiarachchi Priyadarshika , Wasalathanthri Sudharshani 
Published: June 2017

Aims and objectivesTo assess nurses' knowledge on diabetic ulcer disease and their attitudes towards patients suffering from it and to identify factors which influence them.BackgroundDiabetic wound care is an evolving specialty with the rising prevalence of diabetes foot complications. As nurses play a key role in wound care, their knowledge and attitudes are important in providing optimum care to patients.DesignDescriptive cross‐sectional survey design.MethodsThe study was conducted in three teaching hospitals. Data were collected using a pretested, validated, self‐administered questionnaire from purposively recruited, voluntarily participating nurses (n = 200) who were in diabetic wound care practice for ≥1 year.ResultsLack of formal wound care training was reported by 91.2%. Mean knowledge score was 77.9 (range 53.3–100 on a scale from 0–100) with 57.8% of nurses obtaining ≥80%. Nurses demonstrated an overall positive attitude towards caring for diabetic ulcer patients (median = 41, range 23–50 on a scale from 10–50). However, the study identified deficits in core knowledge and some negative attitudes such as insensitivity to pain. Statistically significant associations were seen between nurses' knowledge and duration of nursing, wound care experience and the type of unit they are attached to. In‐service education (77.2%) and knowledge sharing with peers (77.9%) were the most popular knowledge‐updating sources. Although 98.6% of nurses were interested in wound care, only 8.3% wished to engage in research. No correlation was observed between nurses' knowledge and attitudes.ConclusionGaps in core knowledge and negative attitudes may be attributed to inadequate training, suboptimal update of knowledge and lack of interest in wound care research.Relevance to clinical practiceWound care training should be made mandatory to improve quality of care given by nurses to patients with diabetic ulcers. Continuous professional development, evidence‐based practices and wound care research should be encouraged.
Factors influencing medication adherence in patients with gout: A descriptive correlational study
Authors: Chua Xin Hui Jasmine , Lim Siriwan , Lim Fui Ping , Lim Yee Nah Anita , He Hong‐Gu , Teng Gim Gee 
Published: June 2017

Aims and objectivesTo examine the factors influencing adherence to urate‐lowering therapy in patients with gout in Singapore.BackgroundGout is the most common type of chronic inflammatory arthritis. Urate‐lowering therapy is used to treat gout by reducing serum uric acid levels. However, adherence to urate‐lowering therapy among patients remains poor. To date, there have been no available studies based on a conceptual framework that examined factors influencing medication adherence in patients with gout.DesignCross‐sectional, descriptive correlational study.MethodsA convenience sample of outpatients (n = 108) was recruited between October 2014–January 2015 from a tertiary hospital in Singapore. Outcomes were measured by relevant valid and reliable instruments. Descriptive statistics and parametric tests including multiple linear regression were used to analyse the data.ResultsAlthough 44.4% of the participants were high adherers to urate‐lowering therapy, the mean adherence level was moderate. Significant differences in medication adherence scores were found among the subgroups of gender, ethnicity, marital status, employment status and presence of comorbidity. Medication adherence was positively significantly correlated with age, number of comorbidities and beliefs about medicines. Linear regression showed that higher level of beliefs about medicines, presence of comorbidity and being married were factors positively influencing medication adherence.ConclusionsThis study revealed moderate adherence to urate‐lowering therapy in patients with gout in Singapore, indicating the need for strategies to improve adherence by considering its main influencing factors. Future research should be conducted to develop interventions targeted at modifying patients' beliefs about medicines in order to improve medication adherence.Relevance to clinical practiceFindings from this study allow healthcare providers to quickly and easily identify patients who may have low adherence. Nurses should take the lead in educating patients on the mechanism of urate‐lowering therapy and highlight the importance of adhering to it.
“Pain relieved, but still struggling”—Critically ill patients experiences of pain and other discomforts during analgosedation
Authors: Berntzen Helene , Bjørk Ida Torunn , Wøien Hilde 
Published: June 2017

Aims and objectivesTo explore how critically ill patients treated according to a strategy of analgosedation experience and handle pain, other discomforts and wakefulness.BackgroundPatients experience both pain and discomfort while in the intensive care unit. International guidelines recommend focused pain treatment and light sedation. An analgosedation protocol favouring pain management, light sedation and early mobilisation was implemented in our university hospital medical and surgical intensive care unit in Norway in 2014. The analgosedation approach may affect patients’ experiences of the intensive care unit stay.DesignExploratory, descriptive design using semi‐structured interviews.MethodEighteen adult patients treated in intensive care unit >24 hr and receiving mechanical ventilation were interviewed 1–9 days after intensive care unit discharge. Ten patients were re‐interviewed after 3 months. Data were analysed using the “systematic text condensation” approach.FindingsFour main categories emerged from the analysis: “In discomfort, but rarely in pain,” “Struggling to get a grip on reality,” “Holding on” and “Handling emotionally trapped experiences.” “Pain relieved, but still struggling” was the overarching theme. Analgosedation provided good pain relief, but patients still described frequent physical and psychological discomforts, in particular related to mechanical ventilation, not understanding what was going on, and experiences of delusions. To come to terms with their intensive care unit stay, patients needed to participate, trust in others and endure suffering. After hospital discharge, patients described both repression of experiences and searching for recognition of what they had gone through.Relevance to clinical practiceDespite good pain relief during analgosedation, other discomforts were commonly described. Critically ill patients still experience an intensive care unit stay as a traumatic part of their illness trajectory. Nurses need to attend carefully also to discomforts other than pain.
Influence of gender, BMI and body shape on theoretical injection outcome at the ventrogluteal and dorsogluteal sites
Authors: Larkin Theresa A , Ashcroft Elfriede , Hickey Blake A , Elgellaie Asmahan 
Published: June 2017

Aims and objectivesThis study aimed to determine the influences of gender, BMI and observed body shape on subcutaneous fat and muscle thicknesses, and theoretical injection outcome, at the ventrogluteal and dorsogluteal intramuscular injection sites.BackgroundDebate continues as to whether the dorsogluteal or ventrogluteal injection site is more reliable for a successful intramuscular injection outcome. Subcutaneous fat and muscle thicknesses at the injection site are direct determinants of intramuscular injection outcome. BMI and observed body shape influence gluteal subcutaneous fat and muscle thicknesses, and therefore injection outcome, with potentially distinct effects at the ventrogluteal and dorsogluteal sites.DesignThis was a cross‐sectional study.MethodsDemographic data were collected, and subcutaneous fat and muscle thicknesses were quantified bilaterally at the dorsogluteal and ventrogluteal injection sites using ultrasound, for 145 participants (57% female).ResultsSubcutaneous fat and muscle were significantly thicker at the dorsogluteal than the ventrogluteal site, and 75% and 86% of participants would receive a successful intramuscular injection at these sites, respectively. There were significant effects of gender, BMI and observed body shape on subcutaneous fat thickness and theoretical injection outcome at both sites. Females, obese individuals and endomorph individuals had thicker subcutaneous fat and were more likely to have a subcutaneous injection outcome.ConclusionsGender, BMI and observed body shape could be used to guide site and needle length selection when administering gluteal intramuscular injections to increase the likelihood of a successful intramuscular injection outcome.Relevance to clinical practiceBoth gluteal injection sites should be avoided in obese individuals and endomorph individuals. An intramuscular injection will be successful: using a 32‐mm needle at the ventrogluteal site for all males and normal‐weight females and using a 38‐mm needle for all females at the ventrogluteal site, and for all males and at least 98% of females at the dorsogluteal site.
Understanding nurses’ concerns when caring for patients from diverse cultural and ethnic backgrounds
Authors: Markey Kathleen , Tilki Mary , Taylor Georgina 
Published: June 2017

Aims and objectivesTo explore the experiences of both student and qualified nurses of caring for patients from diverse cultural, ethnic and linguistic backgrounds, in one region of Ireland. Hearing the stories, experiences and attitudes of nurses has the potential to influence future clinical practice and has implication for nurses, nurse educators and nurse managers and leaders.BackgroundThere is a wealth of international literature highlighting the importance of providing culturally sensitive care. However, global reports of culturally insensitive care continue. There is a paucity of in‐depth research exploring the actual concerns and challenges nurses experience when caring for patients from diverse cultural and ethnic backgrounds, as well as what influences their actions and omissions of care in practice.DesignA qualitative exploratory descriptive design adopting the principles of a classic grounded theory approach was used.MethodsFocus groups (n − 10) and individual face‐to‐face interviews (n − 30) were conducted with student and qualified nurses studying and working in one region of Ireland. As data were collected, it was simultaneously analysed using the classic grounded theory methodological principles of coding, constant comparison and theoretical sampling.FindingsUncertainty was the consistent main concern that emerged. Feelings of ambiguity of how to act were further influenced by a lack of knowledge, an awareness of ethnocentric beliefs and the culture of the organisation in which participants learn and work in. Instead of finding answers to uncertainties, participants demonstrated a lack of commitment to meeting patients’ needs in a culturally appropriate way.ConclusionsThis study adds new perspectives to our understanding of enablers and barriers to culturally sensitive care. It explains the poignant effect of uncertainty and describes how nurses were unable (or unwilling) to find answers when in doubt. It raises questions that remain unanswered in the existing literature, as to why nurses feel it is acceptable to choose to do nothing about their lack of cultural knowledge and the uncertainties which follow.Relevance to clinical practiceIdentifying the nature and implications of the uncertainty experienced when providing care for patients from diverse cultural and ethnic backgrounds is an important contributing factor to improving cultural sensitivity and quality care.
Open‐label randomised controlled trial about application of bundle care in prevention of unplanned extubation of nasobiliary drainage catheter after endoscopic retrograde cholangiopancreatography
Authors: Zhao Chun‐mei , Qian Jun‐bo , Zhang Chun‐mei , Lin Gang 
Published: June 2017

Aims and objectivesTo observe the effects of bundle care on preventing unplanned extubation of nasobiliary drainage catheter after endoscopic retrograde cholangiopancreatography.BackgroundPreventing unplanned extubation has become a difficult problem for nursing staff because the catheter is stiff, fine and long.DesignA total of 114 cases that experienced nasobiliary drainage after endoscopic retrograde cholangiopancreatography for the first time in our hospital from April 2015–July 2016 were enrolled in this study. According to receiving routine nurse or bundle nurse, these cases were randomly divided into control (n = 56) and intervention (n = 58) group.MethodThe unplanned extubation incidence, contact area between tape and catheter and tensile resistance were compared between the two groups.ResultsThe contact area was one square centimetre in the control group and 5 cm2 in the intervention group. Tensile resistance was significantly higher in the intervention group than in the control (all p < .05). Unplanned extubation incidence was significantly lower in the intervention group (1.72%, 1/58) than in the control (12.5%, 7/56) (p = .0305).ConclusionBundle care can effectively decrease unplanned extubation incidence after endoscopic retrograde cholangiopancreatography.Relevance to clinical practiceThis study provides a basis for decreasing unplanned extubation incidence.
Characteristics of an effective nursing clinical instructor: The state of the science
Authors: Collier Angela D 
Published: June 2017

Aims and objectivesTo analyse the perceived characteristics of an effective nursing clinical instructor and methods for measure instructor effectiveness. This review also examined importance of characteristics based on student age.BackgroundThe clinical instructor has a vital role in clinical education. While the role may be well defined, the characteristics these instructors need to do their jobs effectively are not.DesignAn integrative review from 1985 to present using four key terms: nursing, clinical, teaching and effectiveness. This review revealed 37 articles that met the inclusion criteria for analysis.MethodsInclusion criteria included studies related to nursing clinical teaching effectiveness of the clinical instructor in a direct patient care setting. An integrative review table of the studies was made by the author. Keywords were analyzed in the results column, and same concepts were grouped together.ResultsA synthesis of current research revealed three dominant themes: competency, the ability to develop interpersonal relationships and certain personality traits. The analysis of the literature suggests the ability to develop interpersonal relationships is the most valued skill. Overall, approachability emerged as the most important personality trait needed to be an effective clinical instructor. The analysis also revealed a difference regarding the priority of characteristics based on age of the student.ConclusionThe analysis of the literature suggests the ability to develop interpersonal relationships is the most valued skill for clinical instructors. Overall, approachability emerged as the most important personality trait needed to be an effective clinical instructor.Relevance to clinical practiceFuture studies should continue to evaluate the extent of the dominant themes especially considering the rise of the millennial student generation.
Optimising implementation of a patient‐assessment framework for emergency nurses: A mixed‐method study
Authors: Munroe Belinda , Curtis Kate , Buckley Thomas , Lewis Melinda , Atkins Lou 
Published: June 2017

Aims and objectivesTo determine potential facilitators and barriers and tailor interventions to optimise future implementation of a patient‐assessment framework into emergency nursing practice.BackgroundAn evidence‐informed patient‐assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) improves the quality of patient assessments performed by emergency nurses. Facilitators and barriers must be understood and tailored interventions selected to optimise implementation.DesignA mixed‐method convergent study design was used.MethodsThirty eight early career emergency nurses from five Australian hospitals participated in an education workshop on the HIRAID assessment framework. Simulated clinical scenarios enabled participants to experience conducting a patient assessment with and without using the framework. All participants completed surveys, interviews and focus groups to identify potential facilitators and barriers. Twenty three participants completed follow‐up telephone surveys 4–6 months later. Quantitative and qualitative data were analysed separately using descriptive statistics and inductive content analysis, prior to integration. Implementation interventions were selected using the Behaviour Change Wheel.ResultsNine facilitators and nine barriers were identified to potentially effect implementation of the HIRAID assessment framework. Twelve of the 23 participants (52.2%) who completed follow‐up surveys reported using the framework in the clinical setting. To optimise future implementation, the education workshop needs refinement, and environmental restructuring, modelling and social support are required.ConclusionA multimodal strategy is needed to promote future successful implementation of the HIRAID assessment framework into emergency nursing practice.Relevance for clinical practiceThe successful implementation of the HIRAID assessment framework has the potential to improve nursing assessments of patients in emergency and other acute care settings. This study demonstrates how to systematically identify facilitators and barriers to behaviour change and select interventions to optimise implementation of evidence‐informed nursing practices.
Effect of cross‐linked vs non‐cross‐linked collagen membranes on bone: A systematic review
Authors: Jiménez Garcia J. , Berghezan S. , Caramês J. M. M. , Dard M. M. , Marques D. N. S. 
Published: June 2017

The aim of this study was to conduct a systematic review to compare the clinical outcomes of two different resorbable collagen membranes in terms of regenerated bone volume, postoperative complications and membrane degradation during bone regeneration procedures. Randomized controlled trials (RCT) or controlled trials (CT) that compared both techniques were reviewed on four electronic databases up to December 2015, a manual search was performed on the bibliography of the collected articles and the authors were contacted for additional references if undetected on the electronic and manual search. Membrane exposure was evaluated as a dichotomous outcome and the statistical unit was the membrane. The results were presented as relative risk (RR) with a 95% confidence interval. Eight RCTs and one CT were included in this study. The majority of the studies depicted a bone augmentation area, which ranged from 46.15% to 94.6% for the non‐cross‐link membranes and from 44% to 92.6% for the cross‐link membranes at the 4‐6 month re‐entry surgery. From a total of 289 patients, a forest plot concerning the membrane exposure was constructed using the obtained RR of the included studies. The overall RR was 1.43 (95% CI: 0.85‐2.39) with no statistically significant differences between the two groups, although with a marginal tendency towards higher exposure in the cross‐link membrane group. This systematic review suggests the different membranes present themselves as appropriate for bone regeneration procedures, although cross‐link membranes present higher rates of postoperative complications. However, more RCT with higher sample sizes are needed to evaluate the different membranes. The suggested lack of clinical differences between the compared membranes suggest that further cost‐benefit ratio, tissue integration and postoperative complication oriented studies should be performed so that clinicians can take a patient‐centred, evidence‐based decision.