Telehealth care and remote monitoring strategies in heart failure patients: A systematic review and meta-analysis.

BACKGROUND: Heart failure (HF) is a cardiac clinical syndrome that involves complex pathological aetiologies. It represents a growing public health issue and affects a significant number of people worldwide. OBJECTIVES: To synthesize evidence related to the impact of telemonitoring strategies on mortality and hospital readmissions of heart failure patients. METHODS: A systematic literature review was conducted using PubMed, Scopus, CINAHL, IEEE Xplore Digital Library, Engineering Source, and INSPEC. To be included, studies had to be in English or Italian and involve heart failure patients of any NYHA class, receiving care through any telecare, remote monitoring, telemonitoring, or telehealth programmes. Articles had to contain data on both mortality and number of patients who underwent rehospitalizations during follow-ups. To explore the effectiveness of telemonitoring strategies in reducing both one-year all-cause mortality and one-year rehospitalizations, studies were synthesized through meta-analyses, while those excluded from meta-analyses were summarized narratively. RESULTS: Sixty-one studies were included in the review. Narrative synthesis of data suggests a trend towards a reduction in deaths among monitored patients, but the number of rehospitalized patients was higher in this group. Meta-analysis of studies reporting one-year all-cause mortality outlined the protective power of care models based on telemonitoring in reducing one-year all-cause mortality. Meta-analysis of studies reporting the number of rehospitalized patients in one-year outlined that telemonitoring is effective in reducing the number of rehospitalized patients when compared with usual care strategies. CONCLUSION: Evidence from this review confirms the benefits of telemonitoring in reducing mortality and rehospitalizations of HF patients. Further research is needed to reduce the heterogeneity of the studies.

Nursing Diagnosis Accuracy in Nursing Education: Clinical Decision Support System Compared With Paper-Based Documentation-A Before and After Study.

Computer-based technologies have been widely used in nursing education, although the best educational modality to improve documentation and nursing diagnostic accuracy using electronic health records is still under investigation. It is important to address this gap and seek an effective way to address increased accuracy around nursing diagnoses identification. Nursing diagnoses are judgments that represent a synthesis of data collected by the nurse and used to guide interventions and to achieve desirable patients' outcomes. This current investigation is aimed at comparing the nursing diagnostic accuracy, satisfaction, and usability of a computerized system versus a traditional paper-based approach. A total of 66 nursing students solved three validated clinical scenarios using the NANDA-International terminologies traditional paper-based approach and then the computer-based Clinical Decision Support System. Study findings indicated a significantly higher nursing diagnostic accuracy ( P < .001) in solving cancer and stroke clinical scenarios, whereas there was no significant difference in acute myocardial infarction scenario. The use of the electronic system increased the number of correct diagnostic indicators ( P < .05); however, the level of students' satisfaction was similar. The usability scores highlighted the need to make the electronic documentation systems more user-friendly.

Impact of standardized nursing terminologies on patient and organizational outcomes: A systematic review and meta-analysis.

AIMS: To explore the impact of 12 American Nurses Association recognized standardized nursing terminologies (SNTs) on patient and organizational outcomes. BACKGROUND: Previous studies reported an effect of SNTs on outcomes, but no previous frameworks nor meta-analyses were found. DESIGN: Systematic review and meta-analyses. REVIEW METHODS: PubMed, Scopus, CINAHL, and OpenGrey databases were last consulted in July 2021. All abstracts and full texts were screened independently by two researchers. The review included primary quantitative studies that reported an association between recognized SNTs and outcomes. Two reviewers independently assessed the risk of bias and certainty of evidence for each meta-analyzed outcome using the "Grading of Recommendations, Assessment, Development and Evaluation" (GRADE) approach. RESULTS: Fifty-three reports were included. NANDA-NIC-NOC and Omaha System were the most frequently reported SNTs used in the studies. Risk of bias in randomized controlled trials and not-randomized controlled trials ranged from high to unclear, this risk was low in cross-sectional studies. The number of nursing diagnoses NANDA-I moderately correlated with the intensive care unit length of stay (r = 0.38; 95% CI = 0.31-0.44). Using the Omaha System nurse-led transitional care program showed a large increase in both knowledge (d = 1.21; 95% CI = 0.97-1.44) and self-efficacy (d = 1.23; 95% CI = 0.97-1.48), while a reduction on the readmission rate (OR = 0.46; 95% CI = 0.09-0.83). Nursing diagnoses were found to be useful predictors for organizational (length of stay) and patients' outcomes (mortality, quality of life). The GRADE indicated that the certainty of evidence was rated from very low to low. CONCLUSIONS: Studies using SNTs demonstrated significant improvement and prediction power in several patients' and organizational outcomes. Further high-quality research is required to increase the certainty of evidence of these relationships. CLINICAL RELEVANCE: SNTs should be considered by healthcare policymakers to improve nursing care and as essential reporting data about patient's nursing complexity to guide reimbursement criteria.

Dose-Response Relationship between High-Fidelity Simulation and Intensive Care Nursing Students' Learning Outcomes: An Italian Multimethod Study.

Background: The best application modality of high-fidelity simulation in graduate critical care nursing courses is still rarely investigated in nursing research. This is an important issue since advanced nursing skills are necessary to effectively respond to critically ill patients' care needs. The aim of the study was to examine the influence of a modified teaching model based on multiple exposures to high-fidelity simulations on both the learning outcomes and the perceptions of graduate students enrolled in a critical care nursing course. Methods: A multimethod study involving a sample of graduate critical care nursing students was conducted. A theoretical teaching model focused on multiple exposures to high-fidelity simulations is currently applied as a teaching method in an Italian critical care nursing course. According to the Kirkpatrick model for evaluating training programs, the performance, self-efficacy, and self-confidence in managing critically ill patients were considered learning outcomes, while satisfaction with learning and students' lived experiences during the experimental phases were considered students' perceptions. Results: Multiple exposures to high-fidelity simulations significantly improved performance, self-efficacy, and self-confidence in managing virtual critically ill patients' care needs. The satisfaction level was high, while lived experiences of participants were positive and allowed for better explanation of quantitative results of this study. Conclusions: Multiple exposures to high-fidelity simulations can be considered a valuable teaching method that can improve the learning outcomes of graduate nurses enrolled in an intensive care course.

Detailed data about a forty-year systematic review and meta-analysis on nursing student academic outcomes.

Data were extracted from observational studies describing undergraduate nursing students' academic outcomes that were included in a systematic review and meta-analysis conducted in 2019 and updated in 2020 [1]. Data were extracted by two researchers independently through a previously tested electronic spreadsheet; any disagreement about data extraction was discussed with a third author. Extracted data were studies' general information, characteristics (i.e., country, study design, involved centers, number of cohort of students involved, duration (years) and denomination of the program attended, sample (N), sociodemographic characteristics of the sample, and methods utilized for data collection), and data related to the research question(s) of the review, i.e., nursing students' academic outcomes occurrence and associated factors. Raw data for each included study are reported, along with meta-analyses that were performed using ProMeta free software utilizing Odds Ratio (OR) and Cohen's d as principal effect sizes. The random-effect model was used for all studies, while the level of heterogeneity was explored and quantified through the Cochran's Q-test and I2 , respectively. Substantial or considerable heterogeneity (i.e., I2 ≥ 50%) was explored through a subgroup analysis based on the study design, when feasible [2]. A sensitivity analysis was also performed to detect the possible influence of single studies on meta-analyses results [2]. Publication bias was assessed through funnel plots and the testsf for their asymmetry, i.e., Begg and Mazumdar's rank correlation and Egger's linear regression method [2]. These data provide for an updated state of the art about nursing students' outcomes and associated factors. Therefore, they could ease future literature summaries about the topic, other than allow a comparison of the literature with future research results.

The lived experiences of intensive care nursing students exposed to a new model of high-fidelity simulation training: a phenomenological study.

BACKGROUND: In postgraduate intensive care nursing courses, high-fidelity simulation is useful to prepare students to guarantee safe and quality care of critically ill patients. Surprisingly, this issue has not attracted sufficient attention in the literature, and it is not clear whether the linear application of the traditional high-fidelity simulation method based on prebriefing, the simulation session and debriefing, can serve as empirical reference in postgraduate students' education. The aim of this study was to investigate the lived experiences of postgraduate students receiving multiple exposures to an innovative high-fidelity simulation design based on Kolb's Experiential Learning Theory. METHODS: A phenomenological study was conducted at an Italian University involving a purposive sample of 15 nursing students attending the postgraduate intensive care course. Audio-recorded face-to-face in-depth interviews were held by a researcher in a dedicated room complemented with non-verbal communication outlined in the field notes. Thematic analysis was used to analyse the transcribed data. RESULTS: Three themes and ten categories were derived from the data analysis. The themes included pragmatic learning experience, the emotional path, and confidence. CONCLUSIONS: Multiple exposure to high-fidelity simulation was lived as a pragmatic learning experience enhancing the students' ability to apply theory into practice. This novel approach also contributed to the transition from negative to positive feelings and improved students' confidence about technical and non-technical skills when caring for a critically ill patient.

Evaluating the interchangeability of infrared and digital devices with the traditional mercury thermometer in hospitalized pediatric patients: an observational study.

Gradual replacement of the mercury thermometers with alternative devices is ongoing around the world in a bid to protect human health and the environment from the adverse effects of mercury. However, to reduce the risks of misdiagnosis, unnecessary treatments, and omission of care in pediatric populations, more evidence on the reliability of alternative thermometers is needed. The aim of this comparative observational study was to detect any differences in temperature measurements between the use of the axillary mercury thermometer and the alternative techniques. Temperature values in degree Celsius (°C) were measured in a group of Albanian children aged up to 14 years using mercury and digital axillary thermometers, as well as forehead and tympanic infrared thermometers. The digital axillary device, compared with the mercury one, showed no clinically significant difference in the mean values (- 0.04 ± 0.29 °C) and the narrowest 95% level of agreement (+ 0.53 °C to - 0.62 °C) in the paired comparisons. For cut-off point of 37.5 °C, the digital axillary thermometer showed the highest levels of sensitivity (72.5%) and specificity (99.1%) in detecting fever. This study indicates that the digital axillary thermometer may be the better option since it adequately balances accuracy, safety, and children's comfort.

Usefulness of administrative databases in identifying the predictive factors of repeated hospitalizations for heart failure.

OBJECTIVES: to investigate heart failure (HF) hospitalizations, the following one-year follow-up, and any possible connection between rehospitalizations due to HF and patients' characteristics derived from administrative databases. DESIGN: retrospective longitudinal design. SETTING AND PARTICIPANTS: the study was conducted analyzing public hospital records of a district in Abruzzo Region (Central Italy), which counts more than 300,000 inhabitants. Patients hospitalized for HF from 01.01.2016 to 31.12.2017 (index event) were included in the study and followed-up for one year. MAIN OUTCOME MEASURES: frequency of repeated hospital admissions, time intervals from the index HF hospitalizations, and causes of readmissions were investigated. RESULTS: a total of 1,587 patients discharged alive after an index hospitalization for HF were included in the study. The mean age of the patients was 79.6 years and the majority of them were females (53.7%). The mean length of stay (LOS) for the index hospitalizations was 8.8 ±6.8 days. During the follow-up period, 336 (21.2%) patients underwent one to four repeated hospitalizations for HF. The first readmission due to HF occurred after a median time of 106.5 days from the index event discharge, and for 20.0% of all cases it occurred within 31 days; 453 patients (28.6%) were readmitted exclusively for other causes, and 67 (4.2%) died out of hospital without any previous HF re-hospitalization. When the outcome was considered as a composite endpoint (out-of-hospital death/HF re-hospitalization), age >=75 (HR 1.737; 95%CI 1.330-2.267), LOS at the index hospitalization >=8 days (HR 1.302; 95%CI 1.066-1.591), and repeated hospitalizations for other causes (HR 1.789; 95%IC 1.465-2.185) were associated with the risk of repeated hospitalizations for HF. CONCLUSIONS: this study shows that about one HF patient out of five experienced at least one re-hospitalization for HF within one year from index hospitalization. In addition to having a longer index hospitalization, these patients were older and frequently suffered from comorbidities which also led to hospitalizations. The results underline the need for a close and careful follow-up after the discharge of old HF patients with multiple pathologies in order to avoid further HF admissions in a short time.

Graduate Student Outcomes Following Critical Care Simulation: An Italian Pilot Study.

ABSTRACT: High-fidelity simulation provides nursing students with the opportunity to learn and achieve competence in a safe context. The aim of the study was to assess learning outcomes following multiple exposures to high-fidelity simulation sessions. The sample consisted of 18 graduate students enrolled in a critical care nursing course. A four-hour high-fidelity simulation experience was conducted, with a four-hour retraining one month after. Group performance, self-efficacy, self-confidence, and satisfaction improved after multiple exposures to high-fidelity simulation. High-fidelity simulation is a valid adjunct to nursing education in the short term and may improve learning when offered at multiple time points.

Examining nursing student academic outcomes: A forty-year systematic review and meta-analysis.

OBJECTIVES: To synthesize the definitions of nursing students' academic outcomes and provide a quantitative synthesis of their associated and predictive factors. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Four scientific databases were searched until January 2020. REVIEW METHODS: Observational studies describing undergraduate nursing students' academic outcomes were included. Studies were analytically synthesized and meta-analyses were performed utilizing the Odds Ratio or Cohen's d as effect sizes. RESULTS: Eighteen studies, published from 1979 to 2018, were included in the review, nine were meta-analyzed. Studies involved 10,024 undergraduate nursing students and were mostly retrospective cohort (55.6%). Students were mostly female (75.4%) with a mean age ranging from 21.3 to 27.0 years. Meta-analysis revealed that being female (OR = 1.65, 95% CI = 1.26 to 2.12), having attended a Classical, Scientific or Academic high school (OR = 1.30, 95% IC = 1.16 to 1.46), and having reported higher final grades at the upper-secondary high school (Cohen's d = 0.42, 95% CI = 0.18 to 0.65) was significantly associated with student's ability to graduate within the regular duration of the program. Sensitivity analyses confirmed meta-analytic results and meta-analyses heterogeneity depended on study design. Contrasting and limited evidence were found for other investigated factors, and for academic outcomes different from graduation within the regular duration of the program. CONCLUSIONS: Despite meta-analytic results, gender and upper-secondary school would be unethical students' entry selection criteria. Final upper-secondary school grades should be considered for this scope and purpose. Conflicting and limited evidence found for other factors, such as students' background, suggested the influence of local contexts on the phenomenon and its investigation. Investigating the role of modifiable individual variables, such as empathy and critical thinking, could contribute to the open debate about students' entry selection strategies. An improvement in methodological quality of future studies is recommended and expected.