Role transition of newly graduated nurses from nursing students to registered nurses: A qualitative systematic review.

BACKGROUND: The transition experience of newly graduated registered nurses is highly stressful and associated with high attrition rates. OBJECTIVES AND DESIGN: This qualitative systematic review aims to consolidate the available evidence on the experiences of newly graduated registered nurses' role transition from nursing students to registered nurses. DATA SOURCES: English language research published between 2010 and 2022 was searched using PubMed, CINAHL, Scopus, Embase, PsycInfo and ProQuest Dissertations and Thesis databases. REVIEW METHODS: Data were extracted using a data extraction form and appraised using the Critical Appraisal Skills Programme (CASP) tool for published studies or the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for unpublished studies or grey literature, respectively. RESULTS: The review included 25 studies and the meta-synthesis identified four themes: (a) Knowledge deficit, (b) Overwhelming clinical practise, (c) Importance of workplace support, and (d) Meaning of "being a nurse". CONCLUSIONS: Newly graduated registered nurses experienced facing knowledge deficits in the clinical setting and felt overwhelmed with work, especially for newly graduated registered nurses during the Covid-19 pandemic. Support from colleagues was invaluable, and they wished for better support through standardised transition programs. Despite nursing being mentally and physically exhausting, many newly graduated registered nurses regarded their profession satisfying and meaningful, however some eventually resigned. Understanding the transition experiences of newly graduated registered nurses can provide valuable insights on how to facilitate their transition and in turn decrease attrition rates, and ensure safe care for the patients and that public healthcare needs are met.

Effectiveness of continuous glucose monitoring in maintaining glycaemic control among people with type 1 diabetes mellitus: a systematic review of randomised controlled trials and meta-analysis.

AIMS/HYPOTHESIS: The aim of this work was to assess the effectiveness of continuous glucose monitoring (CGM) vs self-monitoring of blood glucose (SMBG) in maintaining glycaemic control among people with type 1 diabetes mellitus. METHODS: Cochrane Library, PubMed, Embase, CINAHL, Scopus, trial registries and grey literature were searched from 9 June 2011 until 22 December 2020 for RCTs comparing CGM intervention against SMBG control among the non-pregnant individuals with type 1 diabetes mellitus of all ages and both sexes on multiple daily injections or continuous subcutaneous insulin infusion with HbA1c levels, severe hypoglycaemia and diabetic ketoacidosis (DKA) as outcomes. Studies also included any individual or caregiver-led CGM systems. Studies involving GlucoWatch were excluded. Risk of bias was appraised with Cochrane risk of bias tool. Meta-analysis and meta-regression were performed using Review Manager software and R software, respectively. Heterogeneity was evaluated using χ2 and I2 statistics. Overall effects and certainty of evidence were evaluated using Z statistic and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) software. RESULTS: Twenty-two studies, involving 2188 individuals with type 1 diabetes, were identified. Most studies had low risk of bias. Meta-analysis of 21 studies involving 2149 individuals revealed that CGM significantly decreased HbA1c levels compared with SMBG (mean difference -2.46 mmol/mol [-0.23%] [95% CI -3.83, -1.08], Z = 3.50, p=0.0005), with larger effects experienced among higher baseline HbA1c >64 mmol/mol (>8%) individuals (mean difference -4.67 mmol/mol [-0.43%] [95% CI -6.04, -3.30], Z = 6.69, p<0.00001). However, CGM had no influence on the number of severe hypoglycaemia (p=0.13) and DKA events (p=0.88). Certainty of evidence was moderate. CONCLUSIONS/INTERPRETATION: CGM is superior to SMBG in improving glycaemic control among individuals with type 1 diabetes in the community, especially in those with uncontrolled glycaemia. Individuals with type 1 diabetes with HbA1c >64 mmol/mol (>8%) are most likely to benefit from CGM. Current findings could not confer a concrete conclusion on the effectiveness of CGM on DKA outcome as DKA incidences were rare. Current evidence is also limited to outpatient settings. Future research should evaluate the accuracy of CGM and the effectiveness of CGM across different age groups and insulin regimens as these remain unclear in this paper. PROSPERO REGISTRATION: Registration no. CRD42020207042. FUNDING: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

The Experiences and Support Needs of Women With Gestational Breast Cancer in Singapore: A Descriptive Qualitative Study.

BACKGROUND: Gestational breast cancer is diagnosed during pregnancy or within the first postpartum year. There is a lack of studies on the experiences of ethnically diverse Asian women with gestational breast cancer. OBJECTIVE: The aim of this study was to explore the experiences of Asian women with gestational breast cancer so necessary support can be rendered. METHODS: This qualitative descriptive study used purposive sampling to recruit 7 women with gestational breast cancer who were following up at the breast center of a tertiary women's hospital in Singapore. Semistructured, individual, face-to-face, audio-recorded interviews were used to explore the in-depth experiences of these women. Data were transcribed verbatim and analyzed using thematic analysis. RESULTS: Three main themes emerged from the thematic analysis: (1) being a sick woman, (2) juggling between being a mother and a patient, and (3) seeking normalcy. Women had to contend with disruptive changes from gestational breast cancer, both emotionally and physically. They were constantly distressed by their altered body images, and family support was vital to help these women cope with their treatments. Alternative support sources included healthcare professionals and the Internet. CONCLUSION: Gestational breast cancer experiences varied based on the women's encounter perceptions and existing support. Their experiences may be improved through further support to mediate their coping efforts. Future quantitative and qualitative research should explore and evaluate the various aspects of the long-term disease and psychosocial effects of gestational breast cancer. IMPLICATIONS FOR PRACTICE: Hospitals should include support strategies in antenatal classes and postnatal workshops to lessen disruptions of the motherhood experiences.

Diabetes-Related Emotional Distress among Children/Adolescents and Their Parents: A Descriptive Cross-Sectional Study.

Childhood diabetes is a rising concern as the overall annual increase in diabetes among children/adolescents is estimated to be around 3% over the past decade. Diabetes management places children/adolescents and their parents at greater risks of psychological distress. This study aims to measure the levels of diabetes-related emotional distress in children/adolescents with diabetes and their caregiving parents and to identify associations between sociodemographic characteristics and clinical variables in Singapore. A cross-sectional study was conducted using validated questionnaires. Ninety-two parent-child/adolescent dyads completed self-reported questionnaires. Elevated levels of diabetes-related distress were found in both children/adolescents with diabetes and their parents. Female children/adolescents with diabetes, low-income households, and less-educated parents of children/adolescents with diabetes were more susceptible to diabetes-related distress. It is important for healthcare professionals to educate less-educated parents in the management of their children's/adolescents' diabetes. Greater financial assistance should be provided to low-income households that may not have access to advanced diabetes treatments.

Caregiver Stress, Coping Strategies, and Support Needs of Mothers Caring for their Children Who Are Undergoing Active Cancer Treatments.

The diagnosis of childhood cancer not only affects the life of the child but also impacts the lives of the caregivers as well. This study aims to explore the caregiving stress, coping strategies, and support needs of mothers caring for children/adolescents with cancer during the active treatment phase. Individual semi-structured interviews were conducted, and two authors independently and thematically analyzed data. Caregiving mothers went through a process of emotional changes and a change in lifestyles when their children were diagnosed with cancer and undergoing treatments. It is important to ensure that caregiving mothers of children/adolescents with cancer are well supported by family, friends, and healthcare professionals. Healthcare professionals can develop informational booklets on cancer treatment protocols and work together with mothers. Parent support groups and plans for psychoeducational and spiritual care programs for mothers as forms of informational and emotional support may also be established.

Factors affecting Pap smear uptake in a maternity hospital: A descriptive cross-sectional study.

AIM: To understand factors that influence women's decisions to go for Pap smears. BACKGROUND: Globally, cervical cancer is the fourth most common cancer among women. In Singapore, cervical cancer is on the rise and has been found to be the eighth highest cause of death among women. Research has shown that regular screening for cervical cancer with Pap smear reduces cervical cancer-related mortality. However, Pap smear awareness is still limited and its uptake in Singapore is highly opportunistic, requiring the need for a deeper understanding of the factors that influence Pap smear uptake among women in Singapore. DESIGN: A descriptive cross-sectional study design was used. METHODS: Convenience sampling was used to recruit 350 participants (postnatal women of at least 21 years old) from a local maternity hospital. Data were collected using validated questionnaires. Logistic regression was used to analyse the data. RESULTS: Demographic factors, such as age, ethnicity and religion, as well as women's beliefs about the effectiveness of Pap smear in detecting cervical cancer, the desire to discover health problems early and considering Pap smear to be painful, were found to be factors significantly influencing Pap smear uptake. Healthcare professionals need to be mindful of these factors to address women's needs to encourage women to go for Pap smears. CONCLUSION: Various factors were found to influence Pap smear uptake. Future interventions can take these factors into account for increasing Pap smear awareness.

Effectiveness of the Neonatal Discharge Program for Very Low-Birth-Weight Infants on Parental Efficacy and Psychological Distress.

This pilot study aimed to (i) evaluate the effectiveness of a neonatal discharge program, (ii) identify relationships between parent and infant factors and parental efficacy and psychological distress, and (iii) identify ways to improve the neonatal discharge program. A quasiexperimental 1-group pretest/posttest design was used. Through consecutive sampling, 42 participants were recruited. Data were collected using self-report questionnaires. Self-administering instruments gathered data on parental efficacy and psychological distress as well as feedback and recommendations on the intervention. A significant increase in parental efficacy and a reduction in psychological distress were observed from pre- to postdischarge intervention. Significant relationships were found between parental efficacy and infants' gestational age, birth weight, gender, and participants' level of education, and a significant relationship was found between psychological distress and number of children from previous pregnancies. Moreover, an Internet-based program, in addition to the face-to-face teaching, was identified as a preferred option to aid in information retention. It is important to evaluate and enhance the neonatal discharge program to suit the parents of today while providing them with informational and emotional support. Future studies should explore parental coping and the long-term effects of their infant's birth and the intervention.

A Qualitative Study on Midwives' Perceptions of Physiologic Birth in Singapore.

Midwives are advocates for parturients, and their actions and attitudes can influence a woman's experience during childbirth. Hence, it is valuable to examine midwives' perceptions of physiologic birth in an obstetric-led environment. A descriptive, qualitative study design was utilized. Semistructured face-to-face interviews were conducted with 10 registered midwives from the birthing suite of a public hospital in Singapore. Data were analyzed using thematic analysis. Three major themes were (1) perceptions of physiologic birth, (2) perceived facilitators of physiologic birth, and (3) perceived barriers to physiologic birth. Interestingly, senior midwives in this study experienced more negative outcomes with physiologic birth, resulting in apprehension and reduced confidence levels. This study contributed to the understanding of midwives' perceptions regarding facilitators and barriers to physiologic birth. Factors such as supporting birthing team and antepartum education could be useful in supporting physiologic birth. However, advanced age of some of the midwives was found in this study to be a barrier to physiologic birth.

Experiences of adolescents living with cancer: A descriptive qualitative study.

This study aimed to explore the experiences of adolescents from Singapore, aged 10-18 years old, living with cancer and their perceptions on how their psychosocial outcomes can be improved. A descriptive qualitative study design was used. Convenience sampling was used to recruit 10 participants from a pediatric oncology ward in a Singapore hospital. Individual semi-structured interviews were conducted. Thematic analysis was used to analyze the data. Five major themes emerged: (1) experience of physical symptoms, (2) emotional response to their condition, (3) changes in social dynamics, and (4) falling behind in academics. The psychosocial outcomes of Singaporean adolescents with cancer could be improved by thorough pain assessments and creating a more conducive hospital environment.

An integrative literature review on midwives' perceptions on the facilitators and barriers of physiological birth.

AIM: To present a synthesis and summary of midwives' perceptions on the facilitators and barriers of physiological birth. BACKGROUND: Medicalisation of birth has transformed and dictated how birthing should take place since the 20th century. Midwives' perceptions on their role within this medicalised environment have not been well documented. DESIGN: An integrative literature review. DATA SOURCES AND REVIEW METHODS: Primary research articles published in English from the period of 2004 to 2015 were included in this review. The Joanna Briggs Institute's critical appraisal forms were used to appraise the quality of the articles. Data were identified from CINAHL, PubMed, PsycINFO, ScienceDirect, and Scopus. RESULTS: Eighteen articles were reviewed. Lack of knowledge due to inadequate training, existing obstetrician-led practices, and midwives' negative perceptions of physiological birth were identified as barriers in the literature. Facilitators like shared decision-making, women's preferences, teamwork, institutional support, and midwives' positive perceptions of physiological birth promoted physiological birth. Most of the studies were conducted in Western countries. CONCLUSION: Midwives face barriers and facilitators when promoting physiological birth during their clinical practise. Future studies exploring midwives' perceptions of physiological birth are needed, especially in Asia where cultural and organizational factors may differ from Western countries.

Application of cabbage leaves compared to gel packs for mothers with breast engorgement: Randomised controlled trial.

BACKGROUND: The effects of cold cabbage leaves and cold gel packs on breast engorgement management have been inconclusive. No studies have compared the effects of these methods on breast engorgement using a rigorous design. OBJECTIVES: To examine the effectiveness of cold cabbage leaves and cold gel packs application on pain, hardness, and temperature due to breast engorgement, the duration of breastfeeding and satisfaction. DESIGN: A randomised controlled three-group pre-test and repeated post-test study. SETTING: A private maternal and children's hospital in Singapore. PARTICIPANTS: Mothers (n=227) with breast engorgement within 14days after delivery. METHODS: The mothers were randomly assigned into either cold cabbage leaves, cold gel packs, or the control group. Pain, hardness of breasts, and body temperature were measured before treatment. Two sets of post-test assessments were conducted at 30min, 1h, and 2h after the first and second application. The duration of breastfeeding was measured up to 6 months. IBM SPSS 23.0 was used to analyse the data. RESULTS: Mothers in the cabbage leaves and gel packs groups had significant reductions in pain at all post-intervention time points compared to the control group, starting from 30min after the first application of cabbage leaves (mean difference=-0.38, p=0.016) or gel packs (mean difference=-0.39, p=0.013). When compared to the control group, mothers in the cabbage leaves group had significant reductions in the hardness of breasts at all post-intervention time points, and mothers in the gel packs group had significant reductions in the hardness of breasts at two time points (1h and 2h after the first and second application, respectively). Mothers in the cabbage leaves group had significant reductions in pain (mean difference=-0.53, p=0.005) and hardness of breasts (mean difference=-0.35, p=0.003) at 2h after the second application compared to those in the gel packs group. Both interventions had no impact on body temperature. There was no significant difference in the durations of breastfeeding for mothers among the three groups at 3-month and 6-month follow-up. More mothers were very satisfied/satisfied with the breast engorgement care provided in the cabbage leaves group compared to the other groups. CONCLUSION: While cold cabbage leaves and cold gel packs can relieve pain and hardness in breast engorgement, the former had better effect, which can be recommended to postnatal mothers to manage breast engorgement.

Perceptions of Parents With Preterm Infants Hospitalized in Singaporean Neonatal Intensive Care Unit.

Perceptions of parents with preterm infants who were hospitalized in a Singapore-based neonatal intensive care unit were observed. Convenience sampling method was used to recruit 8 parents of preterm infants. Semistructured face-to-face in-depth interviews were used to collect data between November 2013 and February 2014. Data were analyzed using thematic analysis. Four themes were identified: "negative emotions versus positive emotions," "finding ways forward," "nature of support received from various sources," and "need more informational and professional support." Parents of preterm infants experienced a multitude of emotions that varied from shock and sadness to excitement and anticipation through their babies' birth, hospitalization, and impending discharge. These parents adopted several strategies to cope with their birth and subsequent infant hospitalization. While their neonatal intensive care unit (NICU) experience was perceived as positive for most parents, some suggestions were made to improve on the information provided and professional care. This study provides evidence to health care professionals in addressing parents' negative emotions and coping abilities in practice. Emotional and informational support for parents is important for them to be more competent in coping with the hospitalization of their newborn in the NICU.

Postpartum social support of women in Singapore: A pilot study.

This pilot study aimed to identify the levels of support expected and received by postpartum women in Singapore. Another objective was to compare the different subdomains of social support. A descriptive design was adopted using a self-administered questionnaire comprising demographics and the Postpartum Support Questionnaire. The study took place at a subsidized obstetrics and gynaecology clinic at a restructured hospital in Singapore from the end of December 2009 to the end of February 2010. The 25 participants were 6 to 8 weeks postpartum and had delivered healthy term infants. They were recruited via convenience sampling. Data were analysed using descriptive statistics and inferential statistics. The overall support needs of the participants were met. Only their informational support needs were unmet. Assessing the needs of postpartum women and teaching them how to convey and manage expectations are recommended initiatives for health-care practitioners to consider.

The inter-rater reliability test of the modified Morse Fall Scale among patients ≥ 55 years old in an acute care hospital in Singapore.

A prospective, descriptive study was conducted in an acute care hospital in Singapore to determine the inter-rater reliability of the modified Morse Fall Scale by evaluating the degrees of agreement on the ratings of the individual items and overall score between the 'gold standard' assessor and the facility assessors. One hundred and forty-two subjects were recruited during the 1.5 month data collection period. The simple and weighted κ-values were all > 0.8 except for the item 'effects of medications' (κ and κw = 0.63), and the correlation coefficient (rs = 0.89) was significantly high at a significance level of < 0.001. The modified Morse Fall Scale was shown to be a reliable fall risk assessment tool having a relative high inter-rater reliability level for the overall score and individual items. This study provides evidence-based psychometric support for the clinical application of this tool.

First-time fathers' experiences and needs during pregnancy and childbirth: a descriptive qualitative study.

OBJECTIVES: to explore first-time fathers' experiences and needs during their wives' pregnancy and childbirth in Singapore. DESIGN AND SETTING: a descriptive qualitative was conducted. Participants were recruited from two obstetric wards in a tertiary hospital in Singapore from November to December 2012. Semi-structured, face-to-face interviews were used to collect data and themes from the interviews were generated using thematic analysis. PARTICIPANTS: a purposive sample of 16 first-time fathers aged above 21 years who accompanied their wives throughout pregnancy and childbirth were recruited from the postnatal wards between one to three days after the birth of their children. FINDINGS: four themes emerged from 16 subthemes: (1) Emotional changes experienced; (2) Adaptive and supportive behaviours adopted; (3) Social support received and (4) Suggestions for improvement to the current maternity care. First-time fathers experienced a range of emotions from being happy and excited to feeling shocked and worried and to feeling calm. Adaptive and supportive behaviours were adopted to deal with the pregnancy changes and better support their wives. In the course of their transition to fatherhood, they also received support from their family, friends, workplaces and the health care professionals. Fathers suggested more information, timely, empathetic and professional care be given and a review to the current administrative/logistical policies. CONCLUSIONS: all fathers modified their behaviours for the sake of protecting their wives and unborn children. Support from their family, friends, workplaces and the health care professionals was invaluable and greatly appreciated. IMPLICATIONS FOR PRACTICE: health care professionals can guide and support fathers by providing them with more information and preparing them for the unknown changes. Future studies are needed to develop intervention programme for fathers to improve their experiences and adaptive behaviours.

Attitudes and perceived barriers influencing incident reporting by nurses and their correlation with reported incidents: A systematic review.

BACKGROUND: Clinical incident reporting is an integral feature of risk management system in the healthcare sector. By reporting clinical incidents, nurses allow for learning from errors, identification of error patterns and development of error preventive strategies. The need to understand attitudes to reporting, perceived barriers and incident reporting patterns by nurses are the core highlights of this review. OBJECTIVES: INCLUSION CRITERIA: This review considered descriptive quantitative studies that examined nurses' attitudes or perceived barriers towards incident reporting.The participants in this review were nurses working in acute care settings or step-down care settings. Studies that included non-nursing healthcare personnel were excluded.This review considered studies which examined nurses' attitudes towards incident reporting, perceived barriers and incident reporting practices.The outcomes of interest were the attitudes that nurses have towards incident reporting, perceived barriers and the types of reported incidents in correlation with nurses' attitudes and barriers. SEARCH STRATEGY: A three-step search strategy was utilised in this review. An initial limited search of CINAHL and MEDLINE was undertaken. Search strategies were then developed using identified keywords and index terms. Lastly, the reference lists of all identified articles were examined. All searches were limited to studies published in English, between 1991 and 2010. METHODOLOGICAL QUALITY: The studies were independently assessed by two reviewers using the Joanna Briggs Institute Critical Appraisal Checklist for Descriptive/ Case Series studies. DATA EXTRACTION: The reviewers extracted data independently from included studies using the Joanna Briggs Institute Data Extraction Form for Descriptive/ Case Series studies. DATA SYNTHESIS: Due to the descriptive nature of the study designs, statistical pooling was not possible. Therefore, the findings of this systematic review are presented in a narrative summary. MAIN FINDINGS: Fifty-five papers were identified from the searches based on their titles and abstracts. Nine studies were included in this review. Cultural and demographic factors were the most significant factors in affecting nurses' attitudes towards incident reporting. Major perceived barriers included fear, administrative issues, and the reporting process. Also, nurses were more likely to report incidents that caused direct harm, and if reporting was kept anonymous. CONCLUSIONS: This review demonstrated that attitudes of nurses towards incident reporting vary across different study settings, with perceived barriers hindering the reporting process. Using the findings, interventions can be customised to increase reporting rates can be developed to curb the problem of underreporting.A non-punitive culture towards incident reporting has to be cultivated, and nursing authorities should provide frequent positive feedback to staff who reported incidents. Investigating system errors should be the focus rather than individual blame.Further research should target the development and evaluation of strategies to increase rates of incident reporting. Any differences between actual and perceived reporting rates should also be explored.

The effectiveness of cabbage leaf application (treatment) on pain and hardness in breast engorgement and its effect on the duration of breastfeeding.

BACKGROUND: Breast engorgement is a condition that affects breastfeeding mothers early in the postpartum. The discomfort and tenderness as a result of the engorgement is a major contributing factor to the early cessation of breastfeeding. Many treatments for breast engorgement have been attempted and explored. OBJECTIVE: To examine the effectiveness of cabbage leaf treatment on pain and hardness of the engorged breasts of post-partum women and its influence on the duration of breastfeeding in women with breast engorgement. INCLUSION CRITERIA: Postpartum lactating mothers 13 to 50 years of age and of any parity in the first two weeks postpartum with breast engorgement.Cabbage leaf treatment on breast engorgement in reducing pain, hardness and increasing the duration of breastfeeding.Primary outcomes: engorgement, severity of the distention, hardness to touch and pain associated with breast engorgement. Secondary outcome: duration of breastfeeding.Quantitative studies including RCTs, quasi-randomized trials and quasi-experimental studies. SEARCH STRATEGY: Studies in English language from inception of the relevant databases to 2010 were considered for inclusion in this review.The databases searched included: CINAHL, MEDLINE, SCOPUS, EMBASE, Web of Science, Science Direct. The search for unpublished studies included: Google Scholar, Mednar, Proquest. METHODOLOGICAL QUALITY: Studies were assessed by two independent reviewers for methodological validity using standardised critical appraisal tools from the Joanna Briggs Institute. DATA EXTRACTION: Data were extracted using the standardised data extraction tools from the Joanna Briggs Institute. DATA SYNTHESIS: The results were presented in narrative format as the meta-analysis was not appropriate because study methods were heterogeneous. RESULTS: Four studies were included in this review: one RCT and two quasi-randomised studies and one quasi-experimental study. In one RCT after the first cabbage leaf application, fewer mothers were reporting breast engorgement through their second to fourth assessments as compared to the control group. On the second assessment a smaller proportion in the intervention group thought their breasts were engorged (51% vs 57%, p = 0.68). In one study the experimental group receiving cabbage leaf treatment improved from a pre-treatment score of 5.17 (70%) to 3.02 (20%) (p =<0.001). In addition, hot and cold compresses appeared to reduce scores more effectively than cold cabbage leaf (p<0.001). In one study both cabbage leaf and hot and cold compresses interventions decreased numerical pain scores (p≤0.001) and thus pain in breast engorgement. In a study results showed statistically significant reduction in pain scores for both room temperature 2.0 points (37%) and chilled cabbage leaf 2.1 points (38%) (p=0.0001). There was no statistical difference in mean pre and post treatment scores of room temperature and chilled cabbage leaf (p=0.84).In one study pre and post treatment scores using the Bourbonnais scale showed a statistically significant reduction in pain scores: 1.8 points (30%) with cabbage leaf and 2.2 points (39%) with gel packs (p=0.0001). In one study it was found that 18% more mothers who received the cabbage leaf intervention were exclusively breastfeeding at six weeks (p= 0.09). Less mothers had stopped breastfeeding prior to eight days (8.88% vs 24% p= 0.09) and overall duration of breastfeeding was longer in the intervention group (36 vs 30 days, p=0.04). CONCLUSION: Overall results showed that cabbage leaf treatment used on women with breast engorgement did reduce pain, the hardness of the engorged breasts and increased the duration of breast feeding.The current available evidence suggests that cabbage leaf treatment helps reduce pain in breast engorgement and lengthens breastfeeding duration, although some studies have also reported that cabbage leaf treatment is not effective.Cabbage leaf may be useful in the treatment of breast engorgement. The chilled cabbage leaf may be used for breast engorgement in breastfeeding women but there is insufficient evidence to suggest the generalized use of cabbage leaf in protocols for the treatment of breast engorgement.Researchers should aim to achieve more homogeneity across the studies by using similar tools and instruments (preferably validated) to compare the effectiveness of cabbage leaf treatment; measuring similar outcomes (i.e pain scores, breast engorgement scores, duration of breastfeeding).

Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals.

BACKGROUND: Theories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore. METHODS: Nurses were surveyed to identify their perceptions regarding barriers to implementation of clinical practice guidelines in their practice setting. The validated questionnaire, 'Barriers and facilitators assessment instrument', was administered to nurses (n = 1830) working in the medical, surgical, geriatric units, at five acute care hospitals in Singapore. RESULTS: An 80.2% response rate was achieved. The greatest barriers to implementation of clinical practice guidelines reported included: knowledge and motivation, availability of support staff, access to facilities, health status of patients, and, education of staff and patients. CONCLUSION: Numerous barriers to the use of the Fall Prevention Clinical Practice Guideline have been identified. This study has laid the foundation for further research into implementation of clinical practice guidelines in Singapore by identifying barriers to change in acute care settings.