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It is unclear whether specialist palliative care teleconsultation leads to an improvement in patient symptom scores

2017-12-19T05:54:40-08:00

Commentary on: Hoek PD, Schers HJ, Bronkhorst EM, et al. The effect of weekly specialist palliative care teleconsultations in patients with advanced cancer—a randomized clinical trial. BMC Med 2017;15:119.

Implications for practice and research

  • Routine assessment of symptoms during palliative care teleconsultation is essential, but awareness to the potential for attention to symptoms to add to patients’ suffering is needed. 

  • Research in palliative care needs to take into consideration the issues of recruitment/retention, and studies must be planned to ensure adequate power.

  • Clinically meaningful endpoints for symptom measures are needed to measure both within-group and between-group change.

  • Context

    There is a growing body of evidence that earlier integration of palliative care in the trajectory of advanced illness can improve quality of life. This has led to increasing calls for specialist palliative care services that are scalable and can be delivered outside of urban centres.




    For the times they are a-changing

    2017-12-19T05:54:40-08:00

    As I sat down to write this editorial, the song The Times They Are a-Changin’ started playing. This could not be truer for nurse education in the UK at the moment. Indeed, it would be easy to feel overwhelmed by the amount and scope of change. In my current role, I am responsible for overseeing the implementation of a preregistration nursing curriculum based on the new Nursing and Midwifery Council (NMC) standards. (More information about the new NMC standards is available at: https://www.nmc.org.uk/education/programme-of-change-for-education/programme-change-education/ and in an EBN blog at: http://blogs.bmj.com/ebn/2017/07/03/consultation-on-the-new-education-standards-have-your-say/.)

    As editor of Evidence Based Nursing (EBN), I am keen to ensure the pedagogy underpinning our new curricula is educationally sound. This is particularly important as a recent review of preregistration nursing curricula in the UK found that only 42% of curricula documents used the words pedagogy and where they did this was often superficial.




    Social media supremacy: a force of change paving the way for the next generation of healthcare and research

    2017-12-19T05:54:40-08:00

    EBN engages readers through a range of Online social media activities to debate issues important to nurses and nursing. EBN Opinion papers highlight and expand on these debates.

    This month’s opinion draws on an EBN Twitter chat that focused on using social media in healthcare. Access the blog at http://blogs.bmj.com/ebn/ and the Storify at http://storify.com/SimonRStones/healthcare-2-0.

    Background

    Social media is an interactive communication platform that enables conversations among individuals. The presence and use of social media has grown exponentially in the last decade, revolutionising the way in which we communicate with each other. The phrase social media is often used interchangeably to describe popular social networking sites such as Facebook, Instagram and Twitter. With a generation of millennials who are likely to seek initial medical advice from the internet, the healthcare community must embrace social media and its relevance to modern society. Considering over 40% of...




    Nursing issues

    2017-12-19T05:54:40-08:00

    EBN perspectives bring together key issues from the commentaries in one of our nursing topic themes.

    Introduction

    This article is part of Evidence Based Nursing (EBN) Perspective series. In this series, published commentaries related to a specific nursing theme are collated and highlights are discussed. The topic for this edition is ‘nursing issues’, covering 21 commentaries published from October 2016 over a 12-month period. A summary of works is organised into key themes, research methods are identified and important implications for practice and future research are explored.

    Key themes

    The 21 commentaries are grouped into three themes (box): professional issues—which include nursing workforce and workplace issues; evidence-based nursing carespecifically related to patient therapies and patient and family perspectives—giving rise to the patient and family voice.

    Box

    Evidence-Based Nursing commentaries on nursing issues (October 2016–October 2017)

    Theme 1: Professional issues—nursing workforce/workplace

  • Staffing and...




  • What is a case study?

    2017-12-19T05:54:40-08:00

    What is it?

    Case study is a research methodology, typically seen in social and life sciences. There is no one definition of case study research.1 However, very simply... ‘a case study can be defined as an intensive study about a person, a group of people or a unit, which is aimed to generalize over several units’.1 A case study has also been described as an intensive, systematic investigation of a single individual, group, community or some other unit in which the researcher examines in-depth data relating to several variables.2

    Researchers describe how case studies examine complex phenomena in the natural setting to increase understanding of them.3 4 Indeed, Sandelowski5 suggests using case studies in research means that the holistic nature of nursing care can be addressed. Furthermore, when describing the steps undertaken while using a case study...




    Yoga intervention may improve health-related quality of life (HRQL), fatigue, depression, anxiety and sleep in patients with breast cancer

    2017-12-19T05:54:40-08:00

    Commentary on: Cramer H, Lauche R, Klose P, et al. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer  Cochrane Database Syst Rev 2017;1:CD010802.

    Implications for practice and research

  • Yoga intervention may slightly improve short-term health-related quality of life, fatigue, depression, anxiety and sleep in patients with breast cancer.

  • The evidence base for yoga intervention could be strengthened if future studies concentrate on replicability of results and limiting potential bias.

  • Context

    Breast cancer is the most prevalent cancer among women in both developing and developed countries1 where over 1.67 million new cases are diagnosed each year worldwide.2 As such, there is a growing need to address the quality of life of patients with breast cancer throughout the treatment trajectory, from their point of diagnosis to remission. This study by Cramer and colleagues responds to a trend in...




    Using a decision aid may prompt some younger women (38-50 years) to rethink breast cancer screening plans

    2017-12-19T05:54:40-08:00

    Commentary on: Ivlev I, Hickman EN, McDonagh MS, et al. Use of patient decision aids increased younger women’s reluctance to begin screening mammography: a systematic review and meta-analysis. J Gen Intern Med 2017;32:802–13.

    Implications for practice and research

  • Patient decision aids appear to increase the proportion of women aged 38–50 who do not intend to undergo breast cancer screening (8.5% absolute difference).

  • More high-quality research is needed, including large-scale randomised controlled trials in additional settings, with a focus on important outcomes such as knowledge and informed choice.

  • Context

    Mammographic screening for breast cancer may lead to both benefit (breast cancer mortality reduction) and harm (overdiagnosis of cancers that would never become clinically relevant, and false-positive screening results where no cancer is present). The trade-offs among these potential consequences of screening vary in magnitude and importance depending on women’s age, health and personal values. Patient decision aids (PtDAs)...




    Non-invasive positive pressure ventilation should be considered in patients with COPD and persistent hypercapnia at least 2 weeks after resolution of acute respiratory failure

    2017-12-19T05:54:40-08:00

    Commendary on: Murphy PB, Rehal S, Arbane G, et al. Effect of home noninvasive ventilation with oxygen therapy vs oxygen therapy alone on hospital readmission or death after an acute COPD exacerbation: a randomized clinical trial. JAMA 2017;317:2177–86.

    Implications for practice and research

  • Non-invasive positive pressure ventilation (NPPV) should be considered in patients with chronic obstructive pulmonary disease (COPD) with persistent hypercapnia 2–4 weeks after resolution of acute respiratory failure.

  • Timely follow-up after hospitalisation for acute respiratory failure is important.

  • Further trials are needed to confirm the findings and to clarify which patients benefit most, the role of concurrent obstructive sleep apnoeas and optimal ventilator settings of NPPV in stable hypercapnic COPD.

  • Context

    NPPV improves outcomes and should be standard care in patients with acute hypercapnic respiratory failure, indicated by respiratory acidosis, in COPD.1

    Chronic hypercapnia is common in patients with...




    Routine supplementary oxygen for the normoxic patient with suspected acute myocardial infarction is no longer warranted

    2017-12-19T05:54:40-08:00

    Commentary on: Fu S, Lv X, Fang Q, et al. Oxygen therapy for acute myocardial infarction: a systematic review and meta-analysis. Int J Nurs Stud 2017;74:8–14.

    Implications for practice and research

  • In the absence of robust evidence that oxygen is beneficial or harmful, patients with suspected acute myocardial infarction (AMI) should have oxygen therapy titrated to oxygen saturation levels in accordance with guidelines.

  • A large randomised trial, Determination of the role of oxygen in suspected acute myocardial infarction (DETO2X-AMI),1 has recently reported no mortality difference at 365 days between normoxic patients with suspected AMI who received oxygen versus ambient suggesting supplementary oxygen can safely be withheld in such patients.

  • Context

    Oxygen therapy has been a mainstay of emergency management of patients with suspected AMI for decades. In recent years, systematic reviews have raised concerns that oxygen may be harmful to patients with AMI, but the quality of...




    Preoperative virtual reality experience may improve patient satisfaction and reduce anxiety

    2017-12-19T05:54:40-08:00

    Commentary on: Bekelis K, Calnan D, Simmons N, et al. Effect of an immersive preoperative virtual reality experience on patient-reported outcomes: a randomised controlled trial. Ann Surg 2017;265:1068–73.

    Implications for practice and research

  • The assessment of patient experience is essential for evaluating surgical outcomes.

  • Patient satisfaction with the perioperative experience depends on a patient having experiences that match expectations.

  • By adapting patient expectations to real life, virtual reality (VR) could improve their global experience.

  • Context

    Most patients undergoing surgery are anxious.1 Addressing anxiety is a serious concern for the improvement of patient experience during the perioperative period. A previous study about anxiolytic premedication failed to demonstrate any improvement in patient experience,2 suggesting that treating surgery-induced anxiety as an illness may not be the answer. Besides anxiety, a patients’ need for information is an important aspect that should be addressed because...




    Own mothers milk significantly decreases the risk of bronchopulmonary dysplasia

    2017-12-19T05:54:40-08:00

    Commentary on: Patel AL, Johnson TJ, Robin B, et al. Influence of own mother’s milk on bronchopulmonary dysplasia and costs. Arch Dis Child Fetal Neonatal Ed 2017;102:F256-61.

    Implications for practice and research

  • Strategies concentrating on increasing the use of own mother’s milk (OMM) for very low birth weight (VLBW) infants should be encouraged and a focus in the neonatal intensive care unit (NICU).

  • Future research studies should focus on the impact of OMM on other morbidities of prematurity affecting VLBW infants.

  • Context

    OMM has substantial health benefits for VLBW infants including decreased sepsis, necrotising enterocolitis (NEC) and retinopathy of prematurity.1 2 Limited studies have evaluated the effects of OMM on the incidence of bronchopulmonary dysplasia (BPD) in premature infants. Despite various strategies aimed at decreasing BPD, the incidence remains high for premature infants. In a recent retrospective multicentre study, an exclusive human milk-based diet...




    Stigma is a prominent barrier for parental disclosure of a child with a mental illness

    2017-12-19T05:54:40-08:00

    Commentary on: Eaton K, Ohan JL, Stritzke WGK, et al. Mothers’ decisions to disclose or conceal their child’s mental health disorder. Qualitative Health Research 2017;27:1628–39.

    Implications for practice and research

  • Disclosure and concealment dilemmas create significant challenges for parents of children with a mental illness.

  • Healthcare professionals should empower parents by providing them information about mental illness to share with others to decrease stigma, advice about the best structure for disclosure about their child’s illness and support them when they experience negative consequences of disclosure or concealment.

  • Further research is needed about fathers’, children’s and adolescents’ experiences with disclosure and concealment.

  • Context

    There is a growing body of literature about the dilemmas and practices of concealing and disclosing a mental illness.1 2 The difficulties concerning parents’ disclosure about their child’s mental health may be even greater because childhood mental...




    Parent-infant room-sharing is complex and important for breastfeeding

    2017-12-19T05:54:40-08:00

    Commentary on: Paul IM, Hohman EE, Loken E, et al. Motherinfant room-sharing and sleep outcomes in the INSIGHT study. Pediatrics 2017;140:e20170122.

    Implications for practice and research

  • Solitary infant sleep and early consolidation of infant sleep are not biologically appropriate.

  • In practice, judgement around infant sleep may create stigma and limit productive patient-provider engagement, a trademark of family-centred care.

  • Effective communication of risk reduction strategies for night-time parenting is vital.

  • Sleep research with biological measures integrated with observations, actigraphy and qualitative data is needed.

  • Context

    Night-time parenting is a critical part of life that is understudied. The need to improve the evidence base for health recommendations so that parents have improved opportunity for informed decision-making is urgent. Currently, too little attention is paid to safe postpartum interactions. Mothers are cautious about reporting issues such as infant sleep in clinical visits.1 Fear-based messaging about...




    Formal carers providing end-of-life care and bereavement support to people with intellectual disabilities have unmet learning needs

    2017-12-19T05:54:40-08:00

    Commentary on: Lord A, Field S, Smith IC. The experiences of staff who support people with intellectual disability on issues about death, dying and bereavement: a metasynthesis. J Appl Res Intellect Disabil 2017;30:1007–21.

    Implications for practice and research

  • Unmet learning needs exist among staff supporting people with intellectual disabilities at end of life and in bereavement, which should be addressed within care settings.

  • There is evidence that partnership working between intellectual disability and palliative care services can enable the end-of-life care needs of people with intellectual disabilities to be more effectively assessed and addressed.

  • Further studies are required to explore staff experiences in supporting people with intellectual disabilities in these sensitive issues.

  • Context

    Research studies evidence that staff in both intellectual disability and palliative care services lack confidence, knowledge and skills in addressing the end-of-life care support needs of people with intellectual disabilities1...




    Young people with an intellectual disability experience poorer physical and mental health during transition to adulthood

    2017-12-19T05:54:40-08:00

    Commentary on: Young-Southward G, Rydzewska E, Philo C, et al. Physical and mental health of young people with and without intellectual disabilities: cross-sectional analysis of a whole country population. J Intellect Disabil Res 2017;61:984–93.

    Implications for practice and research

  • Younger people with intellectual disability experience much poorer health and an increased risk of a mental health condition during transition to adulthood than those in the general population. This underscores their need for comprehensive healthcare and proactive mental illness detection and treatment during transition.

  • Longitudinal studies of health-related outcomes are needed for younger people with intellectual disabilities. Future research could explore the impact of preventative strategies such as targeted mental health initiatives on the emergence of mental health conditions in younger people with intellectual disability during transition.

  • Context

    People with intellectual disability face multiple physical and mental health disadvantages across the lifespan.1 Limited research has examined...




    Oral contraceptives do not appear to present long-term cancer harms and may even provide protection against some cancers

    2017-12-19T05:54:40-08:00

    Commentary on: Iverson L, Sivasubramaniam S, Lee AJ, et al. Lifetime cancer risks and combined oral contraceptives: the Royal College of General Practitioners’ oral contraceptive study. Am J Obstet Gynecol 2017;216:580:e1–9.

    Implications for practice and research

  • Nurses and nurse practitioners who prescribe combined oral contraceptive (COCs) and counsel patients about COCs are in a position to ensure balanced discussion as they improve patient knowledge of known benefits and risks.

  • Prescribers presenting health teaching should have an equal focus on the benefits and risks.

  • Future research should include side-by-side comparisons of COCs and other types of fertility control (ie, long-acting reversible contraceptives and/or vaginal rings) to provide women with the evidence needed to make informed choices about this important aspect of their day-to-day life.

  • Context

    Combined oral contraceptives (COCs) have been on the market over 50 years, and generations of women have chosen to control their...




    Healthcare professionals should be mindful that victims and victim-bullies may have additional health needs associated with risk-taking behaviour

    2017-12-19T05:54:40-08:00

    Commentary on: Kritsotakis G, Papanikolaou M, Androulakis E, et al. Associations of bullying and cyberbullying with substance use and sexual risk taking in young adults. J Nurs Scholarsh 2017;49:360–70.

    Implications for practice and research

  • The effects of bullying and cyberbullying can be linked to a number of health risk behaviours. Education and healthcare professionals need to include prevention and intervention strategies within educational curricula, building on replacing maladaptive coping strategies with adaptive responses.

  • Future research should explore the adaptive and maladaptive coping mechanisms employed by victims and victim-bullies during the transition to adulthood and how this impacts on their relationships.

  • Context

    The effects of traditional bullying on children and adolescent health and well-being is widely recognised; these include low self-esteem, anxiety, depression, social isolation, self-harm and suicidal thoughts.1 More recently, research has explored cyberbullying and there is now a growing body of evidence that...




    Automated telephone communication systems may have the potential to play a positive role in healthcare

    2017-12-19T05:54:40-08:00

    Commentary on: Posadzki P, Mastellos N, Ryan R, et al. Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database Syst Rev 2016;12:CD009921.

    Implications for practice and research

  • Automated telephone communication systems (ATCS) have the potential to play a positive role in healthcare, but practical matters should be considered before implementation.

  • Further evidence is needed to counter the variable and often low-quality evidence available to date, which limits the extent to which ATCS can be safely implemented across populations.

  • Context

    Recent years have seen communication technologies promoted as a route to improve access for patients and save resources in healthcare systems under strain.1 One such development is ATCS that are used instead of—or in conjunction with—telephone communication between patients and healthcare professionals. Rather than person-to-person communication, ATCS use computer-to-person communication to deliver voice messages to patients and/or collect...




    Personality and interpersonal behaviour may impact on burnout in nurses

    2017-12-19T05:54:40-08:00

    Commentary on: Geuens N, Van Bogaert P, Franck E. Vulnerability to burnout within the nursing workforce-The role of personality and interpersonal behaviour. J Clin Nurs 2017;26:4622–33.

    Implications for practice and research

  • Personality characteristics are an important vulnerability factor to consider when exploring the generation of burnout.

  • A better understanding of individual factors associated with burnout could allow the development of bespoke prevention programmes.

  • Individual-directed and organisation-directed interventions can be combined to cope with this problem.

  • Context

    Much has been said about the negative impact of burnout on nurses’ health, but the causes of this phenomenon are still unclear. Shimizutani and colleagues1 found that neuroticism was related to burnout, and a systematic review by Khamisa et al2 regarding this question concluded that, in a broad perspective, burnout, job satisfaction and general health are related.

    This study sought to identify the influence of personality...




    Paediatric intensive care nurses report higher empathy but also higher burnout than other health professionals

    2017-12-19T05:54:40-08:00

    Commentary on: Latimer M, Jackson PL, Eugène F, et al. Empathy in paediatric intensive care nurses part 1: behavioural and psychological correlates. J Adv Nurs 2017;73:2676–85.

    Implications for practice and research

  • Intensive care nurses should be provided with advice on how to care for their own psychological well-being at work given their regular exposure to traumatic events.

  • Further research could establish whether the associations found between exposure to patients’ pain, staff distress and overestimation of pain apply to other nursing groups.

  • Context

    A recent increase in the number of publications on the high prevalence of burnout and moral distress in health professionals in general, and in critical care staff in particular, has led to a call for more research into the mechanisms by which burnout arises and into interventions to increase resilience in the workplace.1 In this study, the associations between exposure to...




    Effective dietary recommendations could help to prevent age-related cognitive decline

    2017-12-19T05:54:40-08:00

    Commentary on: McEvoy CT, Guyer H, Langa KM, et al. Neuroprotective diets are associated with better cognitive function: the health and retirement study. J Am Geriatr Soc 2017;65:1857–62.

    Implications for practice and research

  • Effective dietary recommendations to prevent age-related cognitive decline have important public health implications given the high prevalence and large burden of dementia.

  • More prospective studies and clinical trials are needed to further elucidate the role of dietary patterns against neurodegeneration during ageing and to find the most optimal dietary pattern.

  • Context

    Dementia is one of the grand challenges of the 21st century. Since no curative therapy is available yet, prevention by lifestyle factors such as diet is of utmost importance. Therefore, effective dietary strategies that can slow down cognitive decline and reduce the incidence of dementia need to be identified. The Mediterranean diet (MedDiet) has been associated with slower cognitive decline and a...




    Commitment to patient-centred experiences at both the organisation and clinician level optimises empowerment of hospitalised older adults with advanced disease

    2017-12-19T05:54:40-08:00

    Commentary on: Selman LE, Daveson BA, Smith M, et al. How empowering is hospital care for older people with advanced disease? Barriers and facilitators from a cross-national ethnography in England, Ireland and the USA. Age Ageing 2017;46:300–9.

    Implications for practice and research

  • Commitment to patient-centred experiences at both the organisation and clinician level ensuring inclusion of the older adult through two-way communication and information exchanges optimises patient empowerment.

  • Future research should explore academic and community hospitals with innovative models of care delivery and their impact on empowerment.

  • Context

    This research aligns with current evidence and further supports the importance of patient empowerment in hospitalised older adults with advanced disease to enable greater autonomy and healthcare control. The research by Selman et al reports on a component of a larger study and provides new evidence regarding facilitators and barriers in the acute care sector to...




    Telephone-based collaborative care is an effective approach for treating anxiety in primary care patients

    2017-12-19T05:54:40-08:00

    Commentary on: Rollman BL, Belnap BH, Mazumdar S, et al. Telephone-delivered stepped collaborative care for treating anxiety in primary care: a randomized controlled trial. J Gen Intern Med 2017;32:245–55.

    Implications for practice and research

  • Telephone-based stepped collaborative care yields lasting improvements in anxiety and mood for primary care patients with generalised anxiety disorder and/or panic disorder.

  • Research is needed to determine which collaborative care intervention components are most beneficial to which subgroups of patients.

  • Context

    Collaborative care (CC) or care management involves longitudinal monitoring plus pharmacological and/or behavioural interventions based on evidence-based, stepped care treatment protocols.1 CC is delivered by a care manager (often a registered nurse) working in close collaboration with a primary care provider (PCP) and mental health specialist (often a psychiatrist). Whereas CC for depression in primary care has strong empirical support, CC for anxiety has not been studied extensively.




    People who face the bereavement of a partner with dementia have poorer mental health than those whose partners are dying from other diseases

    2017-12-19T05:54:40-08:00

    Commentary on: Shah SM, Carey IM, Harris T, et al. The mental health and mortality impact of death of a partner with dementia. Int J Geriatr Psychiatry 2016;31:929–37.

    Implications for practice and research

  • As caring for a partner with dementia has a negative impact on caregivers’ health, supportive interventions need to be offered to active caregivers.

  • Patients with dementia are less likely to receive palliative care, so these services need to be made more accessible to patients with dementia and their caregivers.

  • Comparisons between dementia bereaved partners and non-dementia bereaved groups need to be extended to other bereavement-related health problems, including complicated grief.

  • Context

    It has been consistently documented that caring for a family member with dementia is associated with multiple health impairments. Coping with predeath grief, providing end-of-life care and experiencing the death of the care recipient are particularly stressful, but the...


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