Integrated Virtual Care for Irritable Bowel Syndrome: A Qualitative Study.

Irritable bowel syndrome (IBS) is a condition that affects approximately one in 10 people in the United States (Defrees & Bailey, 2017). Despite the high prevalence of IBS, the medical community struggles to effectively understand, diagnose, and treat this disorder (Ankersen et al., 2021). In recent years, an increasing number of health-tech companies have emerged to offer integrated treatment of IBS via telemedicine. This pilot study explores the patient experience of virtual, multidisciplinary IBS care through a U.S.-based company, Oshi Health. Semistructured interviews were conducted followed by thematic analysis to identify commonalities between patient experience and perspective (Van Manen, 2014). Overarching themes were identified as follows: loss of the grocer, a broken system, and the power of self-trust. Although several limitations exist, including small sample size, the study offers insight into the experience of telemedicine services for IBS and provides a framework for future research.

The Role of Serum NT-proBNP for Predicting Left Ventricular Systolic Dysfunction in Hospitalized Patients in Sri Lanka.

Background/aims: Only a few studies have addressed the role of NT-proBNP in identifying Left Ventricular Systolic Dysfunction (LVSD) in South Asian populations. Therefore, the current study was aimed at assessing the use of serum NT-proBNP in predicting LVSD in a hospitalized population in Sri Lanka. Methods: A random sample of 278 individuals referred for echocardiography at a major Teaching Hospital consented for venous blood samples to be collected for serum NT-proBNP assay by sandwich ELISA. Based on the ejection fraction (LVEF) and fractional shortening (FS), participants were differentiated as LVSD (LVEF<50%, FS≤ 29%) and non-LVSD individuals (LVEF>60%). According to inclusion/exclusion criteria, the final study sample consisted of 100 LVSD patients and 41 non-LVSD individuals. Results: The mean ages of the LVSD and non-LVSD groups were 69.1 (±6.2 years) and 71.4 (±2.4 years) (p=0.066) respectively. The median NT-proBNP value (with IQR) among LVSD patients (528.2 pg/mL,355.2-924.2) was comparatively higher than that of non-LVSD individuals (207.3 pg/mL,177.5-343.0). Strong correlations of NT-proBNP level with LVEF (Spearman rho= -0.84, p<0.001) and FS (rho= -0.81, p<0.001) suggested that serum NT-proBNP concentration increases in parallel to deteriorating left ventricular functions. The AUROC of serum NT-proBNP for differentiating LVSD was 0.859 (95% CI:0.79 - 0.92) and the optimal cut-off level for predicting LVSD was 265pg/mL, with 90% sensitivity and 70% specificity. Conclusion: Current Sri Lankan study revealed a considerable correlation of serum NT-proBNP level with LVSD and utilizing such an assay for screening will facilitate adequate evidence to rule-out LVSD among high-risk residents.

An exploration into registered nurses' knowledge of adult fever in Scotland: A mixed method study.

BACKGROUND: Fever may be a result of many causes, infective or non-infective. Nurses' fever management can be affected by their knowledge and beliefs and also by patients' beliefs. Consequently, an understanding of fever is vital in the diagnosis, treatment and follow-up of various ailments and diseases. Greater knowledge of fever will guide more accurate assessments of the epidemiology of fever and its management. OBJECTIVES: This study explored nurses' knowledge in the context of fever and identified factors that affected this knowledge acquisition. METHODS: A mixed methods approach was used with a validated questionnaire designed to gather information about nurses' knowledge of fever. This was followed up by semi-structured interviews to explore factors associated with the acquisition of fever knowledge. The online survey was distributed to registered nurses in Scotland. RESULTS: A total of 177 questionnaires were completed. The questionnaires were scored with a correct answer 1 point, while a wrong answer -1 point. The mean total score in the knowledge section was 0.47. Only 49.2 % of participants scored above 0. The stepwise linear regression demonstrated working experience in critical care unit, acute care unit and the role of nurse practitioner together could predict 10 % of the total knowledge score (P < 0.05). Through analysis of associations and qualitative data, it was found that many factors had contributed to the nurses' knowledge about fever, specifically educational content, individual confidence and the Sepsis Six bundle. CONCLUSIONS: Considerable misconceptions were found to exist in the nurses' understanding of fever. Only a few factors were found to be associated with the total knowledge score. It was highlighted that the due to the strong influence of the Sepsis Six bundle, participants often assumed a direct causal connection between fever and infectious disease or sepsis. The study result indicated a concern in nurses' acquisition of fever knowledge. TWEETABLE ABSTRACT: Misconceptions from foundational learning were found in nurses' understanding of fever. However, the Sepsis 6 was found to impact their current knowledge of fever.

Service evaluation: A grey area of research?

The National Health Service in the United Kingdom categorises research and research-like activities in five ways, such as 'service evaluation', 'clinical audit', 'surveillance', 'usual practice' and 'research'. Only activities classified as 'research' require review by the Research Ethics Committees. It is argued, in this position paper, that the current governance of research and research-like activities does not provide sufficient ethical oversight for projects classified as 'service evaluation'. The distinction between the categories of 'research' and 'service evaluation' can be a grey area. A considerable percentage of studies are considered as non-research and therefore not eligible to be reviewed by the Research Ethics Committee, which scrutinises research proposals rigorously to ensure they conform to established ethical standards, protecting research participants from harm, preserving their rights and providing reassurance to the public. This article explores the ethical discomfort potentially inherent in the activity currently labelled as 'service evaluation'.

The challenge of the biosciences in nurse education: A literature review.

AIMS AND OBJECTIVES: To review relevant literature that addresses the challenges of the biosciences in nurse education. More precisely, the review aims to explore the literature, concerning students' learning, learning contexts and methodological issues and identify any significant gaps. BACKGROUND: Knowledge of anatomy, physiology and biochemistry is essential for the understanding of human beings and for full appreciation of the concepts of illness and disease. The current status would seem to be that the required competencies within bioscience subjects are difficult to acquire and students have high rates of failure. DESIGN: Integrative review. METHODS: The research was performed on CINAHL, ERIC, Medline and British Nursing Index databases in a period from 2013-2017. Descriptive analytical methods were used for the initial research trawl. FINDINGS: The search strategy resulted in 23 papers. The results of this review shed light on certain deficiencies in the research field looking at the biosciences in nurse education. There is a distinct lack of intervention studies and, thereby, knowledge of how best to support students' learning in effective ways. Of note is that there are no field study approaches identified in the review sample. CONCLUSION: Many of the papers are single studies and course evaluations which may be seen as too narrow and inadequate as perspective. Students appear satisfied with the courses in the biosciences, but there seems to be no correlation between satisfaction and achievement. RELEVANCE TO CLINICAL PRACTICE: Understanding and being able to give coherent rationales for the bioscience content in the nursing curricula are crucial and must be established in relation to its relevance to the dynamic nature of patient care, technological advances and demographic realities. Only on that basis can the primacy of this content be seen as relevant to the aspiring student nurse.

Using Data Mining Strategies in Clinical Decision Making: A Literature Review.

Several data-mining models have been embedded in the clinical environment to improve decision making and patient safety. Consequently, it is crucial to survey the principal data-mining strategies currently used in clinical decision making and to determine the disadvantages and advantages of using these strategies in data mining in clinical decision making. A literature review was conducted, which identified 21 relevant articles. The article findings showed that multiple models of data mining were used in clinical decision making. Although data mining is efficient and accurate, the models are limited with respect to disease and condition.

The role of massage therapy in the relief of cancer pain.

Massage is increasingly being considered as a means of relieving the pain many cancer patients experience. This article aims to investigate current evidence relating to the safety and effectiveness of using massage to help treat this group of patients.

Nitric oxide and nursing: a review.

AIMS AND OBJECTIVES: This paper, therefore, aimed to review published literature in this area of pharmacological exploitation, to look at the therapeutic applications and clinical relevance and, by so doing, provide an accessible source for nurses to gain insight into the role of nitric oxide in the clinical setting. BACKGROUND: Nitric oxide is a chemical mediator fundamental in the maintenance of adequate tissue perfusion and effective cardiovascular function; a major endogenous regulator of vascular tone. The use of nitrates are well established as pharmacological agents but it is only recently that it has been recognized that they act as a source of nitric oxide. Although widely addressed within the medical literature, there appears to be a paucity of nursing literature that explores either its physiological action, or its relevance to nursing practice. CONCLUSIONS: This literature review provides an overview of the use of nitric oxide and its implications for nursing practice and patient outcomes. RELEVANCE TO CLINICAL PRACTICE: Knowledge of nitric oxide and its action is pertinent to nurses across diverse specialities. It helps in understanding the principles of many nitrogen-derived medications which nurses administer to their patients on a daily basis. In terms of oral medication, this is demonstrated by greater insights into the action of nitrates, the appreciation of surprising developments in medications such as sildenafil and the development of new drug opportunities such as nitric oxide-non-steroidal anti-inflammatory drugs. Equally, the use of inhaled nitric oxide therapy in adult and neonatal critical care units appears to be an increasingly valuable source of treatment. A particular research challenge is found in the attempt at nitric oxide inhibition in the management of septic shock. The authors argue that understanding such esoteric areas of therapeutic developments is increasingly to be part of the repertoire of knowledge and skills for nurses in the 21st century.

Multiple sclerosis: living the reality.

Multiple sclerosis (MS) is a highly variable and unpredictable disease and is considered one of the most life-altering diagnoses a person can receive (Holland and Madonna, 2005). The hallmark of this disorder is its unpredictability. This article explores the journey one individual (ML) takes from the time that seemingly trivial symptoms took on a new and disturbing meaning to the point where, as someone newly diagnosed with MS, the potential challenges of the journey ahead have to be viewed with realism, optimism, and meaning.

Parental responses to health care services for children with chronic conditions and their families: a comparison between Hong Kong and Scotland.

Families caring for a chronically-ill child are known to experience a significant degree of stress that often is not fully understood by health professionals. The purpose of this study was to examine, cross culturally, the experience of families caring for children with chronic conditions both in terms of the impact on their lives and the nature of the support received. The responsibility of caring for a child with a chronic condition had considerable impact on family life in both groups, with the disturbance to harmony possibly being felt more keenly in the Hong Kong group. Effective communication with parents was seen in both countries as key for effective practice. Expectations of health services differed between cultures. Implications can be drawn for the design of future health services addressing the specific health needs of families with children with chronic illness.

The causes of cancer-related fatigue and approaches to its treatment.

Despite the evidence that patients with cancer experience fatigue as a symptom of their condition or as a consequence of treatment, there is no uniform definition of the term, making it difficult to identify the causes. Patients also lack professional support to help them cope. This paper describes the potential causes of fatigue and provides some management solutions.

The challenge of spiritual care in a multi-faith society experienced as a Christian nurse.

BACKGROUND: Understanding the spiritual dimension of holistic nursing care is arguably regaining its centrality in the assessment of patient well being in whatever area of care. However it is argued that we are still far from having a universal agreement as to what is meant by the concept of spirituality. AIMS AND OBJECTIVES: This paper aims to explore some of the definitions and models of spirituality and determine what is meant by spiritual needs. Taking the perspective of a Christian nurse, the potential tension between the nature of spiritual care and evidence-based professionalism is explored. CONCLUSION: The exploration reveals the challenges faced by a nurse who wishes to administer this spiritual care and holds a personal commitment to the Christian faith. RELEVANCE TO CLINICAL PRACTICE: Acknowledging and debating the challenge of spiritual care is arguably the first step towards meeting optimally this need in our patients. The dilemma that may need to be further explored within the context of nursing care is how a nurse, holding and operating within one particular belief (e.g. Christianity) can offer the ideal of spiritual care to patients who hold other, quite different beliefs.

Chronic fatigue syndrome: the nurse's role.

BACKGROUND: Chronic fatigue syndrome (CFS), a disorder of no proven cause, is characterised by extended periods of extreme, debilitating fatigue and related symptoms. This article discusses this distressing disorder and identifies the needs of those who have it. The authors suggest that the nurse could fulfil the role of key professional carer, interacting with the individual with CFS to co-ordinate care and form the pivotal therapeutic relationship. CONCLUSION: CFS remains a chronic illness of uncertain cause and prognosis. For those with CFS, care priorities involve validation, information and advocacy, a therapeutic relationship and co-ordinated care. The particular philosophy of care held by nurses makes them potentially ideal co-ordinators of care for those with CFS.

Wound cleansing: the evidence for the techniques and solutions used.

Nurses are constantly urged to back up their practice with research-based evidence. In the field of tissue viability and wound cleansing, however, it can be difficult to evaluate the research and expert opinion published. In this paper, the authors summarise the evidence on wound cleansing techniques, choice of equipment and cleansing agents in the ward setting.

The classification, grading and staging of cancer development.

Many patients see cancer as one disease whereas it is a collection of diseases with several common features. This month's study paper looks at the biology of cancer and explores the classification and staging of its complex disease processes. Such information is useful for all nurses, who frequently care for patients undergoing tests for cancer or receiving treatment.

Responding to the information needs of patients with cancer.

Cancer care has progressed from the days when doctors alone chose treatments for cancer patients and decided what information to give them. Patients are now more involved in their own care and information-giving has become a priority for nurses. However, achieving the right balance in information provision for individual patients is a challenge.