Enhancing palliative care for advanced cancer patients: evaluating implementation and impact of a virtual nurse-led symptom monitoring and telehealth initiative.

BACKGROUND: As a result of the COVID-19 pandemic, we implemented a novel nurse-led symptom monitoring and virtual telehealth program for patients with advanced cancer on palliative care. AIMS: To evaluate the reach, effectiveness, adoption, implementation, maintenance and acceptability of our program. METHODS: This was a prospective study carried out in a cohort of patients with advanced cancer over the period of 3rd June 2020 to 22nd October 2021. Demographic characteristics, cancer diagnosis, and functional status of patients were collected upon recruitment. Patients were asked to complete a patient-reported outcome measure (the Integrated Palliative Care Outcome Scale, IPOS) prior to the first palliative care consult and subsequently every week for the duration of their participation in the program (12 weeks). The IPOS measures the severity of physical symptoms, emotional concerns, information, and financial needs. Participants' utilization of healthcare services by participants 3 months before, during and 3 months after the telemedicine program was reviewed. At the end of the program, a client satisfaction questionnaire (CSQ-4) to survey participants' experience with the telehealth program and their willingness to pay for this program was administered. RESULTS: Reach: The recruitment to adoption ratio of the program was 0.71. Acceptability:: Participants expressed satisfactory experience. EFFECTIVENESS: We noted that the severity of patients' symptoms and number of emergency department visits decreased over time with nurse support. Adoption: we received referrals from 23 oncologists, yielding an adoption rate of 70%. IMPLEMENTATION: Of the 99 patients recruited for the program, 88.9% of them managed to complete their initial video consults as planned. 16% of them failed to complete the program due to factors such as patient demising. Maintenance: The declining rate of IPOS completion throughout the study period (98.9% at week 1 to 60.8% at week 12) demonstrated the difficulties in sustaining regular administration of self-reported patient outcome measures. CONCLUSION: The telemedicine program was effective and acceptable. We noted challenges in sustaining the administration of patient reported outcome measures over time. Further studies on how we can improve the sustainability of symptom monitoring in a telehealth program for patients with advanced illnesses, under palliative care, should be conducted.

CONTRIBUTIONS TO THE LITERATURE: • A virtual, nurse-led telehealth symptom monitoring service for patients with advanced cancer under palliative care, has acceptable reach, adoption from oncologists, is effective and could be implemented satisfactorily in the Asian population. • However, there are challenges in sustaining the regular reporting of patient reported outcome measures over time. • The use of the REAIM framework in this study has helped guide the evaluation of programs and helped generate areas for future studies.

Effectiveness of nurse-led self-care interventions on quality of life, social support, depression and anxiety among people living with HIV: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: People living with HIV often face challenges related to quality of life, mental health, and social support. Nurse-led self-care interventions have been proposed as a means to address these issues, but their overall effectiveness needs systematic evaluation. OBJECTIVES: To systematically review and meta-analyze the effectiveness of nurse-led self-care interventions on quality of life, social support, depression, and anxiety among people living with HIV. DESIGN: A systematic review and meta-analysis of randomized controlled trials. METHODS: A systematic search of PubMed, EMBASE, Web of Science (Core Collection), Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Scopus, and PsycINFO (Ovid) was conducted for articles from inception to May 2024. Two authors independently screened studies and extracted data. Randomized controlled trials that investigated the effects of nurse-led self-care interventions on the quality of life, social support, depression, and anxiety in people living with HIV, published in English, were included. The quality of the included studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials. Meta-analyses were conducted using Review Manager 5.3 and Stata17, and the certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: Nineteen randomized controlled trials published between 2003 and 2024 were included. The meta-analysis showed that compared to the control group, nurse-led self-care interventions significantly improved quality of life (SMD = 0.45, 95 % CI: 0.07 to 0.84, P < 0.05) and reduced depression (SMD = -0.46, 95 % CI: -0.75 to -0.17, P < 0.001; RR = 0.80, 95 % CI: 0.68 to 0.94, P < 0.05). The impact on social support was not statistically significant (SMD = -0.02, 95 % CI: -0.25 to 0.22, P = 0.89). Only two studies reported beneficial effects on anxiety, indicating a need for further high-quality research. CONCLUSION: Nurse-led self-care interventions effectively improve the quality of life and reduce depression in people living with HIV, but current evidence shows these interventions have little impact on social support. The evidence regarding anxiety is limited, indicating a need for more rigorous research to explore the potential benefits of these interventions for anxiety in people living with HIV. These findings support the inclusion of nurse-led self-care interventions in routine HIV care to enhance the well-being of people living with HIV. REGISTRATION NUMBER: (PROSPERO): CRD42024548592.

Effectiveness of a nurse-led family empowerment program to improve the quality of life among pregnant adolescents: A randomized controlled trial.

OBJECTIVE: The present study examined the effects of a nurse-led family empowerment program on the quality of life of Palestinian pregnant adolescents. METHODS: This was a randomized controlled trial with a two-group pre-/post-test design. The sample consisted of 58 pregnant adolescents recruited from six governmental primary health care clinics in Palestine. Participants were randomly allocated in equal numbers to either the control group (n = 29), which received routine care, or the experimental group (n = 29), which received both routine care and the study program. Data collection instruments included a demographic form and the WHO Quality of Life-BREF (WHOQoL-BREF). Data were collected twice: at 32 or 33 weeks' gestation to establish a baseline and at 36 or 37 weeks' gestation post-test. Statistical analyses were performed and included descriptive statistics, chi-square and t-tests. RESULTS: The study findings indicated a significant increase in the mean quality of life scores of the experimental group in the post-test compared to the pre-test (P < 0.001). Additionally, pregnant adolescents in the experimental group demonstrated significantly higher post-test QoL scores than those in the control group (P < 0.001). CONCLUSION: The nurse-led family empowerment program emerges as a viable and efficacious alternative intervention for improving the quality of life among Palestinian pregnant adolescents. CLINICALTRIALS: The study was registered with the NIH U.S. National Library of Medicine ClinicalTrials.gov on 01/09/2021 with the registration code NCT05031130. It can be accessed via this link: https://classic. CLINICALTRIALS: gov/ct2/show/NCT05031130.

Patient evaluation of Klick, a technology-enabled, nurse-delivered HIV outpatient pathway.

OBJECTIVES: Klick is a clinic-specific, digitally supported outpatient pathway of care for people living with HIV (PLWH). It involves a smartphone application (app) for PLWH to self-manage their care, navigate access to the clinic and communicate with their healthcare provider. We present a patient evaluation of Klick. METHODS: Patients use Klick to book/reschedule appointments, view laboratory results, request medication, access remote nurse-delivered consultations and communicate with clinicians. In October 2022, Klick was evaluated by PLWH through a questionnaire and interviews. RESULTS: Between August 2020 and April 2024, 5859 patients had registered to use Klick; during April 2024 alone, 2509 (43%) used Klick. In October 2022, 1661 PLWH were invited to complete surveys, of whom 362 (22%) responded. These respondents were 95% (340/358) male and 84% (298/354) white, and 63% (227/359) were in the age range 41-60 years. Respondents felt Klick was easy to use (average score 4.3/5), and 92% thought having a clinic-specific app was important/very important. Respondents valued the following app features as important/very important - online booking (93%); viewable results (94%); prescription requests (90%) - and rated their experience of using them highly - 91% for e-booking and 91% for viewable results. A total of 93% said they would recommend Klick to friends and 82% rated Klick as above average/excellent. CONCLUSIONS: PLWH reported high levels of satisfaction using a clinic-specific mHealth app to manage their HIV care and demonstrated sustained active use. Klick was rated easy to use, as helping to meet healthcare needs and as providing a superior experience for some aspects of care. Other HIV clinics or services managing chronic conditions could benefit from the adoption of personalized digital solutions to enhance patient care.

Clinical Outcomes of a Nurse-Delivered, Technology-Enabled HIV Outpatient Model.

We evaluated Klick, a nurse-led, digitally enabled model of HIV outpatient care, launched in 2020. Klick's smartphone app offers online booking, remote nurse-led consultations, and results. An audit of Klick nurse-led consultations was conducted against BHIVA monitoring guidelines, and nurses were interviewed about their experience. Of 40 Klick patients audited, 4 of 5 BHIVA standards were met: 100% had documented co-medications, smoking history, blood pressure, and viral load data, and 89% received a cardiovascular risk calculation (Targets 97%-90%-90%-90%-90%). Compared to national BHIVA audit findings, Klick performed better across 22 of 24 comparable measures. Nurses safely managed a cohort comprising some complexity (eg, co-morbidities, polypharmacy); no cases were escalated off the pathway, and all were virologically suppressed. Using a digitally supported model, nurses effectively provided safe care to HIV-positive patients with predominantly stable health, enabling consultants to focus on more complex caseloads. Care was comprehensive and person-centered and obtained better outcomes compared to previous national audits.

Effectiveness of nurse-led intervention on weight reduction among adults in urban Puducherry - A randomized controlled pilot trial.

BACKGROUND: The recent spike in the incidence of type 2 diabetes is most likely caused by the obvious rise in the prevalence of overweight and obesity. The risk of developing noncommunicable illnesses can be prevented and reduced with even modest weight loss. This study was conducted with the aim of evaluating the effectiveness of a nurse-led intervention (NLI) strategy on weight reduction among adults in urban Puducherry. MATERIALS AND METHODS: A two-arm, parallel-group, randomized controlled study with an open label was conducted with obese adults in urban areas of Puducherry, namely Nesavalar colony and Govindanpet, from November 2022 to February 2023. Totally, 88 obese adults were randomized using a simple random sampling method to either the NLI arm or the general care (GC) arm. WHO STEPS (version 3.2) questionnaire was adopted to gather baseline and end line data. NLI arm participants received NLI and GC arm participants received GC from urban primary health center. In statistical analysis, the proportion was used to summarize categorical variables. The parametric and nonparametric tests were applied based on the variable type and normality of the data. Multiple linear regressions were used with outcome changes in weight in the NLI arm. RESULTS: At 16 weeks, the NLI arm lost a mean weight of - 2.58 kg and the GC arm gained 0.38 kg with a mean difference in weight of 2.96 between arms. A significant reduction was found (P < 0.001) in weight, waist circumference, body mass index, and also found significant improvement in cholesterol profile and thyroid stimulating hormone. CONCLUSION: This community-based NLI study is effective for weight reduction in urban Puducherry and it lowers the risk of developing noncommunicable diseases among adults. Due to the larger size of the geographical area and the more number of clusters, a stringent follow-up plan and extra manpower must be created for the main study.

Implementation of a Quality Improvement Learning Collaborative to Support Implementation of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain: Case Study from Nurse-Led Clinics.

PURPOSE: The authors describe a case study of a quality improvement initiative to implement the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain2 ("2016 CDC Guideline") into nurse-led primary care practices in central Appalachia. DESIGN: In this controlled pre-post quality improvement study, a policy change, an electronic health record form, and supporting education were implemented. Knowledge change and quality improvement metrics were measured before and after implementation. DATA SOURCES: The data comprised pre- and post-knowledge survey and quality improvement metrics from the electronic health record. RESULTS: After the implementation of the chronic pain intake form and supporting training and education, marked improvements in documentation and completion of the 2016 CDC Guideline and Tennessee Clinical Practice Guideline-concordant activities were observed, suggesting an increase in compliance with guidelines. CONCLUSIONS: Quality improvement efforts that focus on opioid management best practices may be effective at enhancing 2016 CDC Guideline-concordant care in clinics, including nurse-led ones. Similar strategies could be trialed to ensure the 2022 CDC Clinical Practice Guideline recommendations for opioid and pain management are adopted effectively. PRACTICE IMPLICATIONS: Interventions to improve opioid and pain management through quality improvement efforts require policy changes, clinician and patient education, and electronic record tools.

Post-hoc analysis of two gout remission definitions in a two-year randomized controlled trial of nurse-led versus usual gout care.

OBJECTIVE: To compare the performance of the 2016 preliminary gout remission definition and a simplified gout remission definition in a clinical trial of nurse-led gout care. METHODS: Data from a 2-year parallel arm, non-blinded, randomised controlled trial of 517 community-derived people with gout were analyzed. Participants were assigned 1:1 to receive nurse-led care or general practitioner usual care. Remission was defined using the 2016 preliminary gout remission definition and a simplified gout remission definition without patient reported outcomes. Binary logistic regression was used to compare intervention groups. General linear models were used to compare Gout Impact Scale (GIS) scores between those in remission and those not in remission using either definition. RESULTS: Participants in the nurse-led care group were more likely to achieve remission using either definition; at Year 2 the odds ratio was 7.92 [95 % CI 4.86-12.92] using the 2016 preliminary definition and 11.88 [95 % CI 7.49-18.84] using the simplified definition. For all participants, the 2016 preliminary definition was fulfilled by 9.9 % at Year 1 and 28.4 % at Year 2, p < 0.001 and the simplified definition was fulfilled by 17.6 % at Year 1 and 42.7 % at Year 2, p < 0.001. People in remission using either definition had better gout outcomes assessed using the GIS, including greater control over their gout. CONCLUSION: Both definitions discriminated between the intervention groups and showed high construct validity. The simplified definition identified more people as being in gout remission at Year 1 and Year 2. The simplified definition is a feasible and valid option for defining gout remission.

It's all about relationships: Developing nurse-led primary health care in rural communities.

The role of nurses in leading the design and delivery of primary health care services to address health inequities is growing in prominence, specifically in rural Australia. However, limited evidence exists to inform nurse-led primary health care in this context. Based on a focus group with nursing executives and semi-structured interviews with registered nurses we describe nurse experiences of leading the design of a primary health care service in rural Australia and nurse transition to and practice in this service. Nurse experiences were analysed using reflexive thematic analysis. The study reveals the centrality of relational integration in service design and nurse acquisition of relational practice as it relates to nurse to care recipient and nurse to nurse relationships. Tensions between primary health care nurses and their peers, and resultant de-valuing of primary health care practice, are described. The acquisition of nurse professional agency draws attention to investments required to position nurses to lead and sustain care innovations external to hospital settings. The authors propose that relational approaches may provide nurses with the opportunity to reframe their leadership and service contributions towards community literate primary health care provision and provide a pathway to professional emancipation from constrained practice expectations.

Brief Risk Communication for Emergency Department Patients With Sustained Asymptomatic Hypertension.

INTRODUCTION: Sustained asymptomatic hypertension in ED patients is a powerful predictor of chronic uncontrolled hypertension. In this study, we assess the feasibility of using a storyboard video and communicating real-time cardiovascular imaging results on blood pressure control and primary care engagement. METHODS: This was a prospective observational exploratory sub-study. Following Institutional Review Board approval (#18-00197), 20 English-speaking adults in an urban emergency department with an initial blood pressure ≥160/100 mm Hg and a second blood pressure ≥140/90 mm Hg were enrolled. Patients watched a 60-second storyboard video about uncontrolled hypertension in the ED setting, featuring racially and ethnically diverse avatars. They then received a real-time bedside echocardiogram. Emergency nurses communicated the echocardiogram results using a standard script and advised follow-up within 2 weeks after discharge. Patient characteristics, blood pressure control, primary care engagement, and acceptability of the intervention were assessed at baseline, 12 weeks, and 24 weeks post-discharge. RESULTS: All 20 enrolled patients (mean age 55, 70% female, and 95% from underrepresented groups [30% Black, 50% Hispanic, and 15% Black and Hispanic]) exhibited subclinical heart disease on echocardiograms. Blood pressure control improved from baseline (systolic 166 mm Hg, diastolic 97 mm Hg) to 24 weeks (systolic 137 mm Hg, diastolic 78 mm Hg). Seventy percent of patients engaged with primary care post-discharge, and the intervention had high acceptability (94.8% approval). DISCUSSION: The Brief Risk Communication for ED patientswith sustained asymptomatic hypertension study demonstrates the feasibility and acceptability of using a brief video and real-time cardiovascular imaging for risk communication in the emergency department. Future research will build on these findings with a larger, more comprehensive study.

Effect of nurse-Led psychosocial intervention on body image distress and treatment compliance among patients undergoing treatment of cancer: A randomized controlled trial.

BACKGROUND: Dissatisfaction with one's physique is the most common issue among cancer patients, and it is correlated with stress, anxiety, and hopelessness. The current study aimed to assess how the Nurse-Led short psychosocial intervention affected cancer patients' body image distress and treatment compliance. MATERIALS AND METHODS: 67 patients above 18 years of age and undergoing cancer treatment were enrolled in the study through complete enumeration sampling. The individuals were divided into experimental and control groups using simple randomization. A nurse-led brief psychosocial intervention program was implemented for 15 days for the experimental group while the control group was on standard treatment. The intervention's effects were measured on the 15th day using a structured body image distress scale and self-structured treatment compliance scale. The consolidated norms of reporting trials (CONSORT) statement was used to perform the study. Utilizing SPSS, descriptive and inferential statistics were performed to analyze the data. RESULTS: Post-intervention on the 15th day of the program revealed a reduction in Body image distress (Mean, SD and P value; 2.73, 1.72 (experimental), 4.90 ± 2.23 (control) and <0.001). The program also resulted in improved treatment compliance (Mean, SD and P value; 3.66, 2.23 and (experimental) and 5.83, 1.62; and <0.001). CONCLUSION: According to the study's findings, nurses are essential to the care of cancer patients. Nurse-led intervention can be an effective strategy to address these psychological issues and concerns.

Potential donor family behaviours, experiences and decisions following implementation of the Organ Donation (Deemed Consent) Act 2019 in England: A qualitative study.

BACKGROUND: In May 2020, England implemented "deemed consent" legislation, to make it easier for individuals to donate their organs and convey their decision when alive. Families are supposed to support the decision but can still override it if they disagree. We aimed to learn more about this changed role when families were approached about organ donation. METHODS: A qualitative study using semi-structured interviews with families, feedback from nurses, comparisons with audit data, and public involvement. We used framework analysis with a health systems perspective and utilitarian theory to explore if the law worked. FINDINGS: 103 participants were interviewed representing 83 potential donation cases. In 31/83 (37%) cases donation was fully supported, in 41/83 (49%) cases families supported retrieval of some organs, tissues and procedures, and in 11/83 (13%) cases families declined completely. Themes explaining why the law was not (yet) working included: Understanding and agreeing the family's role, confusion about deemed consent, not supporting the deceased expressed decisions, organ donation as too much of a harm, the different experiences of donation pathways, transition from end-of-life to organ donation discussions, experiences of 'consent', paperwork and processes. Families frequently questioned if their relative wanted to have a surgery rather than supporting the person who died to save lives. CONCLUSION: Families use the unique experience of their relative dying in intensive care to create alternate narratives whereby the outcome satisfies their own utility and not necessarily those of the potential donor. New public ongoing media campaigns crafted to be more supportive of organ donation as a benefit to transplant recipients could help families overcome the many difficulties they encounter at the bedside. IMPLICATIONS FOR CLINICAL PRACTICE: The soft opt-out policy has not empowered nurses to help families at their most vulnerable to increase their support for and consent to deceased organ donation.

Caregiver Burden in Bladder Cancer Patients with Urinary Diversion Post-Radical Cystectomy and the Need for Comprehensive Nursing Education: A Narrative Literature.

Background: Bladder cancer ranks seventh in global cancer prevalence. Radical cystectomy and urinary diversion are standard for muscle-invasive bladder cancer. Family caregivers shoulder a substantial care burden, affecting their own quality of life, with repercussions extending to patients' health-related quality of life (HRQOL). Objective: This narrative review aims to highlight the major concerns perceived by the caregivers and efficacy of nurse-led interventions in alleviating their concerns and improving HRQOL. Methods: A systematic search of the PubMed, CINAHL, and Science Direct databases was carried out to identify studies published in the last 5 years (from Jan 2018 to Aug 2023) that have evaluated the concerns and problems of caregivers attending bladder cancer patients with urinary diversion. Additionally, studies evaluating the efficacy of nurse-led interventions in alleviating these concerns were also searched. Results: Overall, 6 studies involving 933 BC patients with UD and 1042 caregivers were identified as suitable for inclusion in this narrative literature review. Major concerns identified included psychological well-being, medical assistance needs, and peer support. Significant psychological impact was evident in the caregivers which operated in a dyadic manner. Nurse-led stoma education programs have demonstrated potential in enhancing caregivers' quality of life, although they remain restricted. Conclusion: Emphasizing caregivers' role and program effectiveness is critical. Our review addresses these gaps, focusing on caregivers' concerns and the impact of nursing education for improved patient outcomes. Implications for Practice: Holistic and collaborative approach could enhance the overall well-being and quality of life of bladder cancer patients and their caregivers.

Feasibility of a nurse-led, mHealth-assisted, and team-based collaborative care model for heart failure care in India: Findings from a multi-stakeholder qualitative study.

Background: Heart failure (HF) management is often challenging due to poor adherence to GDMT and self-care. Continuous monitoring of patients by a dedicated care manager may enhance adherence to self-care and treatment and prevent hospitalisations. For the adoption and acceptance of a collaborative care model (CCM) for HF management in Indian settings, understanding the perspectives of all stakeholders regarding its various components and feasibility is needed. Therefore, we aimed to obtain perceptions of potential challenges to care and suggestions on multiple components of the proposed CCM in managing HF and its feasibility. Methods: In-depth interviews were done among HF patients, caregivers, nurses, and cardiologists from private, co-operative, and public sector tertiary care hospital settings that cater to HF patients in Kerala, India. An in-depth interview guide was used to elicit the data. Data were analysed using Python QualCoder version 2.2. We used a framework method for the analysis of data. Results: A total of 22 in-depth interviews were conducted. We found that the existing care for HF in many settings was inadequate for continuous engagement with the patients. Non-adherence to treatment and other self-care measures, was noted as a major challenge to HF care. Healthcare providers and patients felt nurses were better at leading collaborative care. However, various barriers, including technical and technological, and the apprehensions of nurses in leading the CCM were identified. The stakeholders also identified the mHealth-assisted CCM as a potential tool to save money. The stakeholders also appreciated the role of nurses in creating confidence in patients. Conclusions: A nurse-led, mHealth-assisted, and team-based collaborative care was recognised as an excellent step to improve patient adherence. Effective implementation of it could reduce hospitalisations and improve patients' ability to manage their HF symptoms.

Heart failure (HF) management requires continuous monitoring of patients by a dedicated care manager to improve adherence to self-care and treatment and prevent hospitalisations. In this study, we aimed to obtain perceptions of patients, carers, cardiologist and nurses on the current challenges to HF care. We also elicited the feasibility of a proposed nurse-led team based collaborative care model in managing HF with mHealth assistance and their suggestions on various components in the model. By interviewing 22 heart failure stakeholders we found the various individual, system level challenges in HF care. Non-adherence to treatment and other self-care measures, was mentioned as a major challenge to HF care. To address the challenges, healthcare providers and patients felt nurses can lead the collaborative care. The stakeholders also identified the mHealth-assisted collaborative care model (CCM) can save money by avoiding unnecessary travel for the patients. While the stakeholders appreciated the role of nurses in creating confidence in patients, they also highlighted the challenges in implementing the intervention. In order to overcome these challenges, training nurses on the basics of HF medications, their side effects, and contraindications was suggested. The stakeholders also mentioned various technical and technological barriers in the use of mHealth application.

Propelling Nurse-Led Structured Intervention to Enhance Self-Care among Patients with Chronic Heart Failure (PROACT-HF): A Cluster Randomized Controlled Trial Study Protocol.

BACKGROUND: Heart Failure (HF) is a common chronic disease that has a high readmission rate and is associated with worsening symptoms and major financial impacts. Disease management implemented during or after an HF hospitalization has been shown to reduce hospitalization and mortality rates. Particularly for outpatients, it is necessary to provide self-care interventions. Structured nurse-led support such as timely follow-ups, including phone calls, is beneficial for improving self-care assessments. Evidence for nurse-led support has been investigated but is less than conclusive. The aim of this study is to compare the effectiveness of a nurse-led structured intervention for outpatients with chronic HF against the usual medical care in terms of self-care behaviors and occurrence of symptom exacerbation or rehospitalization. METHODS AND ANALYSIS: This is a cluster-randomized controlled trial. A total of 40 facilities with certified HF nurses will be allocated to two-arm clusters at a 1:1 ratio, randomly to the intervention or usual care arms. A total of 210 participants will be assigned from the hospital. Participants will be adults aged 18 years or older diagnosed with chronic HF who are classified as Stage C according to the ACCF/AHA Heart Failure staging system. In the intervention group, patients will receive structured nursing support. This begins with weekly support, including phone calls, for the first month, then transitions to monthly support thereafter. The aim is to ensure the stability of their living conditions, promote medication adherence, and encourage self-management. In the control group, patients will receive the usual care. Primary outcomes will assess the improvement or continuation of self-care behavior as measured by changes in EHFScBS (European Heart Failure Self-Care Behavior Scale) scores. Secondary outcomes include occurrence of readmission within 30 days, 3 months, 6 months, and 1 year after discharge, duration of home care until readmission, and blood levels of BNP and NT-proBNP.

Effects of nurse-led interventions on the physical and mental health among pre-frail or frail older adults: A systematic review.

BACKGROUND: Globally, there is an increase in the number of older people living with frailty, thus effective strategies to prevent and manage frailty are of paramount importance. The effects of nurse-led interventions on the physical and mental health of (pre) frail people have not yet been systematically reviewed. METHODS: We searched the PubMed, Web of Science, EMBASE, CINAHL, and the Cochrane Library from inception to 8 May 2024. Eligible studies included randomized controlled trials and quasi-experimental trials reporting the effects of nurse-led interventions on physical and mental health outcomes among (pre) frail people. Two researchers independently extracted trial data and assessed the risk of bias by using the risk of bias tool recommended by the Cochrane Back Review Group and the Methodological Index for Non-Randomized Studies. RESULTS: 14 randomized controlled trials and 6 quasi-experimental studies, encompassing 3943 participants, were included in the review. Nurse-led interventions included function-based care (cognitive behavioral therapy, exercise, and multi-domain intervention), personalized integrated care, and advance care planning. The reported outcomes were multiple with most results showing inconsistencies. Overall, function-based care showed more positive effects on physical outcomes (31/37, 84 %) and mental health (11/12, 92 %). However, the effectiveness of existing personalized integrated care and advance care planning might be limited. CONCLUSIONS: Nurse-led interventions may effectively improve both physical and mental health among (pre) frail older adults, although effectiveness varies by intervention type. Nurses have the potential to play a leading role, both individually and within multidisciplinary teams, in alleviating the rising global burden of frailty. We need more well-designed randomized controlled trials to confirm the effectiveness of nurse-led interventions and identify the most effective type of interventions.

Nurse-led proactive mobile application in symptom management for children with medical complexity: Study protocol for a randomized controlled trial.

AIM: To investigate the effect of a nurse support using a proactive mobile app to enhance parental self-efficacy in symptom management for children with medical complexity. DESIGN: A single-blinded, randomized controlled trial with a two-armed repeated measures design. METHODS: Eligible parents and the children will be recruited from the special schools and non-government offices. They will be randomly assigned either to the intervention or control groups. Subjects in the study group will receive nurse parental support using a symptom management mobile app for 3 months. The control group will receive the usual care that is available in the community. Data will be collected pre-intervention (T1), immediately after the intervention (T2), and three-month after intervention (T3). The primary outcome is parental self-efficacy. The secondary outcomes include child's symptom burden and their health service utilization. Primary outcome will be compared across two groups in T2 and T3 using with control for the pre-test value of parental self-efficacy. Generalized estimating equation (GEE) will be used to address secondary objectives from T1 to T3 with appropriate link function. DISCUSSION: As a result of the successful implementation of this nurse-led symptom management, parental self-efficacy will be enhanced. Both the symptoms reported by the children and their health service utilization will be reduced. Findings of this study will help in service delivery improvements because it maximizes the availability and accessibility of paediatric health service to parents and the children in local communities. IMPACT: The evidence produced in this study will enlarge the knowledge base that supports evidence-based paediatric home nursing service with the use of health technology in symptom management. This evidence will also contribute to the development of other symptom management programs for other paediatric patient groups. TRIAL REGISTRATION: NCT05765643 (ClinicalTrials.gov identifier). PATIENT OR PUBLIC CONTRIBUTION: Parents of children with medical complexity contributed in mobile application development by giving comments on the usability of mobile application. IMPACT WILL BE GENERATED THROUGH THE FOLLOWING BENEFITS: Improve health service delivery: Home nursing service may not be sustainable in a long run in Hong Kong, as the health care system has been facing a serious nursing workforce shortage in recent years. Besides, these services are affected or even suspended during the community outbreak of infectious disease, like recent coronavirus disease pandemic. Nurse parental support in symptom management for the CMC using a proactive mobile health application will help in service delivery improvements because it maximizes the availability and accessibility of paediatric health service to parents and their CMC in local communities. Improve physical and psychological health of parents and their CMC: The success of program implementation will help to increase parental self-efficacy in symptom management for their CMC, as a result of decrease of children's symptom burden. Improve knowledge base: The evidence produced in this study will (1) enlarge the knowledge base that supports evidence-based paediatric community nursing service related to symptom management for the CMC. This evidence will contribute to the development of other symptom management programs for other paediatric patient groups.

"Sustaining NSW Families" as a hybrid face-to-face/virtual program: Experiences of clients and clinicians.

To explore clients' and clinicians' perspectives about the acceptability and perceived outcomes of the Sustaining New South Wales (NSW) Families (SNF) program shifted to a hybrid service delivery model during the COVID-19 pandemic. Mixed methods design comprising cross-sectional online surveys and a focus group. Eighty clients who accessed the SNF service and 12 SNF clinicians. Anonymous client survey comprising questions about perceived benefits and impacts of the hybrid SNF program model, and suggestions for change. Clinician focus group discussion about perceived benefits and challenges of the hybrid SNF model. The hybrid SNF program is a child and family health nursing home visitation program for families with moderate level psychosocial risks. It comprises a mix of face-to-face and virtual telehealth/telephone appointments, delivered during pregnancy and up to 2 years postpartum. Clients reported high levels of satisfaction with the program, and improvements in confidence and decision-making. Clinicians spoke of increased efficiency and flexibility, and capacity for ongoing service provision during the COVID-19 period. Technology access issues were identified as a barrier. Overall, however, both clients and clinicians expressed a preference for face-to-face SNF service provision. While further studies are required to test clinical outcomes, the hybrid SNF model is acceptable to clients and clinicians.

Nurse-led digital health program for home blood pressure monitoring in stroke patients: protocol for a pooled analysis of randomized controlled trials.

Background: Hypertension is a major risk factor for stroke recurrence in stroke patients. Home blood pressure monitoring, facilitated by digital health technologies and led by nurses, may improve blood pressure control in this high-risk population. However, the evidence is not yet conclusive. This study protocol outlines a pooled analysis of the current literatures to evaluate the effectiveness of nurse-led digital health programs for home blood pressure monitoring in stroke patients. Methods and analysis: We will conduct a comprehensive search of some major electronic databases (e.g., PubMed, EMBASE, Cochrane Library, and CINAHL) and trial registries for randomized controlled trials evaluating nurse-led digital health programs for home blood pressure monitoring in stroke patients. Two reviewers will independently screen titles and abstracts, review full-text articles, extract data, and assess risk of bias using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0). The primary outcome measures will be changes in both systolic and diastolic blood pressure from baseline to the end of the intervention period. Secondary outcomes include adherence to the program, patient satisfaction, and stroke recurrence. Data will be pooled and analyzed using meta-analysis techniques, if appropriate. Discussion: This study will provide comprehensive evidence on the effectiveness of nurse-led digital health programs for home blood pressure monitoring in stroke patients. The findings could have substantial implications for clinical practice and health policy, potentially informing the development of guidelines and policies related to hypertension management and stroke prevention. Conclusion: By pooling the results of randomized controlled trials, this study will offer a robust evidence base to inform clinical practice and health policy in the context of stroke patients. Despite potential limitations such as heterogeneity among studies and risk of publication bias, the rigorous methodology and comprehensive approach to data synthesis will ensure the reliability and validity of the findings. The results will be disseminated through a peer-reviewed publication and potentially at relevant conferences. Registration DOI: https://doi.org/10.17605/OSF.IO/59XQA.

The effect of a nurse-led low carbohydrate regimen on anthropometric and laboratory parameters of patients with metabolic syndrome: a quasi-experimental study.

Introduction: Metabolic syndrome is a global health concern. It is a condition that includes a cluster of various risk factors for type 2 diabetes and cardiovascular disease. This quasi-experimental study investigates the effect of a nurse-led low-carbohydrate regimen on anthropometric and laboratory parameters in metabolic syndrome patients. Methods: The study used a quasi-experimental design conducted at the University of Mosul; 128 participants meeting the metabolic syndrome criteria were recruited and divided into the intervention and control groups. The intervention group received personalized counseling and support in implementing a low-carb regime, while the control group received standard advice. The study participants were assessed by anthropometry, and laboratory parameters were evaluated pre- and post-intervention. Statistical data analysis was conducted using IBM-SPSS 27, including chi-square, Fisher's exact test, t-tests, and the Mcnemar test, which were performed to compare the changes within and between groups. Results: The mean age of the participants in the intervention and control groups was 50.72 ± 6.43 years and 49.14 ± 6.89 years, respectively. Compared to the control group, the intervention group experienced a significant positive reduction in anthropometric measures and laboratory parameters, including weight, body mass index (BMI), waist circumference, lipid profiles, and HbA1c. Conclusion: A tangible effect of nurse-led interventions based on low-carbohydrate regimens in managing metabolic syndrome was empirically authenticated. Positive changes were observed in the intervention group regarding anthropometric measures and laboratory parameters. However, future research may require a larger sample size and a longer follow-up to confirm these effects and evaluate long-term metabolic impacts.