Trivalent and quadrivalent seasonal influenza vaccine in adults aged 60 and older: a systematic review and network meta-analysis.

OBJECTIVES: To compare the efficacy of influenza vaccines of any valency for adults 60 years and older. DESIGN AND SETTING: Systematic review with network meta-analysis (NMA) of randomised controlled trials (RCTs). MEDLINE, EMBASE, JBI Evidence-Based Practice (EBP) Database, PsycINFO, and Cochrane Evidence -Based Medicine database were searched from inception to 20 June 20, 2022. Two reviewers screened, abstracted, and appraised articles (Cochrane Risk of Bias (ROB) 2.0 tool) independently. We assessed certainty of findings using Confidence in Network Meta-Analysis and Grading of Recommendations, Assessment, Development and Evaluations approaches. We performed random-effects meta-analysis and network meta-analysis (NMA), and estimated odds ratios (ORs) for dichotomous outcomes and incidence rate ratios (IRRs) for count outcomes along with their corresponding 95% confidence intervals (CIs) and prediction intervals. PARTICIPANTS: Older adults (≥60 years old) receiving an influenza vaccine licensed in Canada or the USA (vs placebo, no vaccine, or any other licensed vaccine), at any dose. MAIN OUTCOME MEASURES: Laboratory-confirmed influenza (LCI) and influenza-like illness (ILI). Secondary outcomes were the number of vascular adverse events, hospitalisation for acute respiratory infection (ARI) and ILI, inpatient hospitalisation, emergency room (ER) visit for ILI, outpatient visit, and mortality, among others. RESULTS: We included 41 RCTs and 15 companion reports comprising 8 vaccine types and 206 032 participants. Vaccines may prevent LCI compared with placebo, with high-dose trivalent inactivated influenza vaccine (IIV3-HD) (NMA: 9 RCTs, 52 202 participants, OR 0.23, 95% confidence interval (CI) (0.11 to 0.51), low certainty of evidence) and recombinant influenza vaccine (RIV) (OR 0.25, 95%CI (0.08 to 0.73), low certainty of evidence) among the most efficacious vaccines. Standard dose trivalent IIV3 (IIV3-SD) may prevent ILI compared with placebo, but the result was imprecise (meta-analysis: 2 RCTs, 854 participants, OR 0.39, 95%CI (0.15 to 1.02), low certainty of evidence). Any HD was associated with prevention of ILI compared with placebo (NMA: 9 RCTs, 65 658 participants, OR 0.38, 95%CI (0.15 to 0.93)). Adjuvanted quadrivalent IIV (IIV4-Adj) may be associated with the least vascular adverse events, but the results were very uncertain (NMA: eight 8 RCTs, 57 677 participants, IRR 0.18, 95%CI (0.07 to 0.43), very low certainty of evidence). RIV on all-cause mortality may be comparable to placebo (NMA: 20 RCTs, 140 577 participants, OR 1.01, 95%CI (0.23 to 4.49), low certainty of evidence). CONCLUSIONS: This systematic review demonstrated efficacy associated with IIV3-HD and RIV vaccines in protecting older persons against LCI. RIV vaccine may reduce all-cause mortality when compared with other vaccines, but the evidence is uncertain. Differences in efficacy between influenza vaccines remain uncertain with very low to moderate certainty of evidence. PROSPERO REGISTRATION NUMBER: CRD42020177357.

Staff Perceptions of the Impact of the COVID-19 Pandemic on Older Adults Living in a Residential Long-Term Care Facility.

Older adults residing in long-term care facilities (LTCFs) were an at-risk group during the coronavirus disease 2019 (COVID-19) pandemic. Actions to prevent transmission in LTCFs included visitation restrictions, suspension of group activities, and isolating residents in their rooms. Despite these measures, this vulnerable cohort experienced high levels of infection and mortality. The current article reports RNs' and health care assistants' perceptions of the impact of COVID-19 on residents in a LTCF. Using a descriptive qualitative design, semi-structured interviews, which were conducted with seven RNs and four health care assistants, were thematically analyzed. Three themes emerged: Impact on Daily Routine, Disruption to Relationships With Staff, and Vulnerability. Staff perceived residents were negatively impacted physically, emotionally, and socially as a direct consequence of COVID-19 and by strategies introduced to protect them contracting the virus. It is recommended that the long-term impact of the COVID-19 pandemic on this cohort be evaluated from the perspective of all stakeholders (i.e., residents, staff, and families) using a longitudinal research design. [Journal of Gerontological Nursing, 49(10), 44-50.].

Experiences of a Nursing Team Working in a Residential Care Facility for Older Adults During the COVID-19 Pandemic.

Experiences of staff working in residential long-term care facilities (LTCFs) during the coronavirus disease 2019 (COVID-19) pandemic are likely to differ from that of staff working in acute hospitals. The aim of the current study was to describe the experiences of the nursing team supporting frail older adults with high medical and care needs living in a LTCF. Using a descriptive qualitative design, data were gathered via one-to-one semi-structured interviews and thematically analyzed. Four themes emerged: Providing Care During COVID-19, Impact of COVID-19 on Staff, Organizational Management of COVID-19, and Training and Education. Visitation restrictions and staff shortages impacted all aspects of work life. Staff reported increased stress and exhaustion with COVID-19 infection resulting in long-term health issues. It is important to learn from these experiences to inform and empower staff to manage future outbreaks of infectious diseases. [Journal of Gerontological Nursing, 49(3), 40-46.].

Prevalence of tobacco smoking among European migrants residing in EU 15 countries: a quantitative systematic review protocol.

OBJECTIVES: The objective of this systematic review is to summarize the prevalence of tobacco smoking in European migrants residing in EU 15 countries. INTRODUCTION: Most of the migration within the World Health Organization European Region is intracontinental. The prevalence of smoking varies greatly across the European Region. Migrants may choose to adopt the smoking behaviors of their host countries or retain the smoking behaviors of their countries of origin. Several studies have identified the high prevalence of smoking of some migrant groups in comparison to their host countries, but no systematic reviews have been completed on intracontinental migrants within the European Region. INCLUSION CRITERIA: Epidemiological studies, which include data on the prevalence of tobacco smoking in European migrants aged ≥ 15 years of age living in the following EU 15 countries host countries for ≥ 1 year: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, and the United Kingdom. METHODS: MEDLINE, Embase, CINAHL, PsycINFO, ASSIA, and Web of Science will be searched to identify published studies. General gray literature (eg, Open Grey) as well as gray literature for migrants (Migrant Health Research Portal) and tobacco will be searched. The JBI methodology for systematic reviews of prevalence will be used in this review. Data synthesis will use meta-analysis where appropriate and narrative synthesis.

Prioritising key motivators and challenges influencing informal carers' decisions for participating in randomised trials: An embedded Study Within A before and after Trial (SWAT 55).

Background: Family members, or others, often assume the role of informal (unpaid) carers of people with chronic illnesses. Care-giving, however, can impact profoundly on the quality of life of carers and can cause carer worry, stress and guilt. Implementing interventions that positively affect the lives of carers is important; however, carers as a group are often difficult to reach. We embedded a study within a pilot-feasibility trial of a mindfulness based intervention to determine and prioritise the key motivators and challenges influencing informal carers' decisions for participating in a trial. Methods: We used a multi-method approach involving interviews with participants from a ' host trial' and data from systematic reviews to develop a survey that was distributed to informal carers in Ireland. The survey consisted of 28 motivator and 17 challenge statements. Participants rated how important they thought each statement was when deciding to take part in a trial on a 5-point Likert Scale. Mean scores and standard deviations were calculated for each statement and arranged in descending order to provide the priority lists. Results: Thirty-six carers responded to the survey. Helping to create awareness about carers was the top ranked motivator, followed by four study design statements related to the time at which the study occurs, the study location, format of delivery and venue. The least important motivator related to how carers were invited to take part in a study. Difficulties in planning due to the caring role emerged as the most important challenge, followed by being unable to leave the care recipient on his/her own. Conclusions: Insight into decision-making for research participation will assist trial developers tailor trial processes for informal carer populations. We recommend that trialists should consider these motivators and challenges when designing future trials involving informal carers so as to enhance trial feasibility and success.

Telephone interventions, delivered by healthcare professionals, for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses.

BACKGROUND: Maintaining care for ill persons in the community is heavily dependent on support from unpaid caregivers. Many caregivers, however, find themselves in a caring role for which they are ill prepared and may require professional support. The telephone is an easily accessible method of providing support irrespective of geographical location. OBJECTIVES: The objective of this review was to evaluate the effectiveness of telephone support interventions, delivered by healthcare professionals, when compared to usual care or non-telephone-based support interventions for providing education and psychosocial support for informal caregivers of people with acute and chronic diagnosed illnesses, and to evaluate the cost-effectiveness of telephone interventions in this population. SEARCH METHODS: We searched the following databases from inception to 16 November 2018: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; PsycINFO; ProQuest Dissertations and Theses A&I; and CINAHL Complete. We also searched 11 caregiver-specific websites, three conference links, and two clinical trial registries. SELECTION CRITERIA: We included randomised controlled trials (RCTs) (including cluster-RCTs) and quasi-RCTs. We excluded cross-over trials because of the high risk of carry-over effects from one intervention to another. DATA COLLECTION AND ANALYSIS: Two authors independently screened citations against the review's inclusion criteria, extracted data, and assessed the included studies using the Cochrane 'Risk of bias' tool. The review's prespecified primary (quality of life and burden) and secondary outcomes (skill acquisition, psychological health, knowledge, health status and well-being, family functioning, satisfaction, and economic outcomes), where reported, were assessed at the end of intervention delivery and at short-term (≤ 3 months), medium-term (> 3 to ≤ 6 months) and longer-term time points (> 6 to 12 months) following the intervention. Where possible, meta-analyses were conducted, otherwise results were reported narratively. MAIN RESULTS: We included 21 randomised studies involving 1,690 caregivers; 19 studies compared telephone support interventions and usual care, of which 18 contributed data to the analyses. Two studies compared telephone and non-telephone professional support interventions. Caregiver ages ranged from 19 years to 87 years across studies. The majority of participants were female (> 70.53%), with two trials including females only. Most caregivers were family members, educated beyond secondary or high school level or had the equivalent in years of education. All caregivers were based in the community. Overall risk of bias was high for most studies.The results demonstrated that there is probably little or no difference between telephone support interventions and usual care for the primary outcome of quality of life at the end of intervention (SMD -0.02, 95% CI -0.24 to 0.19, 4 studies, 364 caregivers) (moderate-certainty evidence) or burden at the end of intervention (SMD -0.11, 95% CI -0.30 to 0.07, 9 studies, 788 caregivers) (low-certainty evidence). For one study where quality of life at the end of intervention was reported narratively, the findings indicated that a telephone support intervention may result in slightly higher quality of life, compared with usual care. Two further studies on caregiver burden were reported narratively; one reported that telephone support interventions may decrease burden, the other reported no change in the intervention group, compared with usual care.We are uncertain about the effects of telephone support interventions on caregiver depression at the end of intervention (SMD -0.37, 95% CI -0.70 to -0.05, 9 studies, 792 caregivers) due to very low-certainty evidence for this outcome. Depression was reported narratively for three studies. One reported that the intervention may reduce caregiver depression at the end of intervention, but this effect was not sustained at short-term follow-up. The other two studies reported there may be little or no difference between telephone support and usual care for depression at the end of intervention. Six studies measured satisfaction with the intervention but did not report comparative data. All six reported high satisfaction scores with the intervention. No adverse events, including suicide or suicide ideation, were measured or reported by any of the included studies.Our analysis indicated that caregiver anxiety may be slightly reduced (MD -6.0, 95% CI -11.68 to -0.32, 1 study, 61 caregivers) and preparedness to care slightly improved (SMD 0.37, 95% CI 0.09 to 0.64, 2 studies, 208 caregivers) at the end of intervention, following telephone-only support interventions compared to usual care. Findings indicated there may be little or no difference between telephone support interventions and usual care for all of the following outcomes at the end of intervention: problem-solving, social activity, caregiver competence, coping, stress, knowledge, physical health, self-efficacy, family functioning, and satisfaction with supports (practical or social). There may also be little or no effect of telephone support interventions for quality of life and burden at short-term follow-up or for burden and depression at medium-term follow-up.Litttle or no difference was found between groups for any of the reported outcomes in studies comparing telephone and non-telephone professional support interventions. We are uncertain as to the effects of telephone support interventions compared to non-telephone support interventions for caregiver burden and depression at the end of intervention. No study reported on quality of life or satisfaction with the intervention and no adverse events were reported or noted in the two studies reporting on this comparison. AUTHORS' CONCLUSIONS: Although our review indicated slight benefit may exist for telephone support interventions on some outcomes (e.g. anxiety and preparedness to care at the end of intervention), for most outcomes, including the primary outcomes, telephone-only interventions may have little or no effect on caregiver outcomes compared to usual care. The findings of the review were mainly based on studies with overall high risk of bias, and few participants. Further high-quality trials, with larger sample sizes are required.

The redundancy of positivism as a paradigm for nursing research.

New nursing researchers are faced with a smorgasbord of competing methodologies. Sometimes, they are encouraged to adopt the research paradigms beloved of their senior colleagues. This is a problem if those paradigms are no longer of contemporary methodological relevance. The aim of this paper was to provide clarity about current research paradigms. It seeks to interrogate the continuing viability of positivism as a guiding paradigm for nursing research. It does this by critically analysing the methodological literature. Five major paradigms are addressed: the positivist; the interpretivist/constructivist; the transformative; the realist; and the postpositivist. Acceptance of interpretivist, transformative or realist approaches necessarily entails wholesale rejection of positivism, while acceptance of postpositivism involves its partial rejection. Postpositivism has superseded positivism as the guiding paradigm of the scientific method. The incorporation in randomized controlled trials of postpositivist assumptions indicates that even on the methodological territory that it once claimed as its own, positivism has been rendered redundant as an appropriate paradigm for contemporary nursing research.

Intensive care nurses' opinions and current practice in relation to delirium in the intensive care setting.

BACKGROUND: Delirium is a frequently encountered syndrome that negatively impacts on the well-being of the critically ill patient. Although international guidelines promote delirium monitoring, little is known regarding Irish intensive care (ICU) nurses' opinions and current practice in relation to delirium monitoring. AIM: To ascertain ICU nurses' opinions on delirium among the critically ill and establish if delirium monitoring is part of current practice in the Republic of Ireland. METHODS: A descriptive quantitative survey design was employed, utilising a self-report questionnaire. Participants were registered nurses selected using convenience sampling from two of the largest and leading teaching hospitals in the Republic of Ireland. The overall response rate was 70% (n=151/216). FINDINGS: The majority of participants 143 (95%) recognised delirium as a serious problem and 93% considered delirium to be an under-diagnosed syndrome that requires active medical intervention. Only 17.9% reported screening for delirium and 4% ranked delirium important to monitor in the ICU setting. The majority of participants never attended a lecture (79%) or read an article (68%) pertaining to delirium. CONCLUSION: The findings provide further evidence of the theory practice gap that is likely to exist internationally in settings where best practice guidelines on the management of delirium in the ICU setting are not implemented.

A systematic review of systematic reviews on interventions for caregivers of people with chronic conditions.

AIM: To evaluate the effectiveness of interventions to support caregivers of people with selected chronic conditions. BACKGROUND: Informal caregivers provide millions of care hours each week contributing to significant healthcare savings. Despite much research evaluating a range of interventions for caregivers, their impact remains unclear. DESIGN: A systematic review of systematic reviews of interventions to support caregivers of people with selected chronic conditions. DATA SOURCES: The electronic databases of PubMed, CINAHL, British Nursing Index, PsycINFO, Social Science Index (January 1990-May 2014) and The Cochrane Library (Issue 6, June 2014), were searched using Medical Subject Heading and index term combinations of the keywords caregiver, systematic review, intervention and named chronic conditions. REVIEW METHODS: Papers were included if they reported a systematic review of interventions for caregivers of people with chronic conditions. The methodological quality of the included reviews was independently assessed by two reviewers using R-AMSTAR. Data were independently extracted by two reviewers using a pre-designed data extraction form. Narrative synthesis of review findings was used to present the results. RESULTS: Eight systematic reviews were included. There was evidence that education and support programme interventions improved caregiver quality of life. Information-giving interventions improved caregiver knowledge for stroke caregivers. CONCLUSION: Education, support and information-giving interventions warrant further investigation across caregiver groups. A large-scale funded programme for caregiver research is required to ensure that studies are of high quality to inform service development across settings.

Measuring job satisfaction of advanced nurse practitioners and advanced midwife practitioners in the Republic of Ireland: a survey.

AIM: To describe the level of job satisfaction of advanced nurse practitioners (ANP) and advanced midwife practitioners in the Republic of Ireland (RoI). BACKGROUND: Job satisfaction is related to productivity, performance, turnover and health, and thus is a challenge for nursing and healthcare organisations. METHOD: Job satisfaction data were collected from 47 ANPs using the Misener Nurse Practitioner Job Satisfaction Scale. RESULTS: High levels of global job satisfaction were reported. All ANPs reported satisfaction with autonomy, sense of accomplishment, challenge, social interaction and status in the organisation. Lower levels of job satisfaction were attributed to the amount of involvement in research (55%), opportunities to receive compensation for services provided outside normal working hours (55%), the amount (44%) and the quality of administrative support (51%), and the opportunity to negotiate bonuses and resources in return for productivity (36%). CONCLUSION: Advanced nurse practitioners in RoI have high levels of job satisfaction with areas relating to clinical practice but are dissatisfied with areas that lead to empowerment within organisations. Efforts to improve the negotiating and leadership skills of ANPs may improve job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Enhancing inter-professional collegial relationships and improving managerial recognition of the role within nursing are key areas to be targeted to promote job satisfaction of ANPs.

Developing complex interventions for nursing: a critical review of key guidelines.

AIMS AND OBJECTIVES: To identify the most comprehensive approach to developing complex interventions for nursing research and practice. BACKGROUND: The majority of research in nursing is descriptive and exploratory in nature. There is an increasing professional and political demand for nurses to develop and provide evidence to support their practices. Nurses need to explore current practice and develop and test interventions to provide the evidence required for safe practice. DESIGN: A literature review using a systematic approach. METHODS: The review was carried out using four databases: CINAHL, PubMed, PsycINFO and BNI (2000-2011), and the search was limited to 'brief interventions' and complex intervention development (January 2000-September 2011). Included papers reported on guidelines for intervention development or 'how' an intervention was developed. RESULTS: Six papers reported on guidelines for developing interventions. There are many similarities between the guidelines with a similar pattern of guideline development in Europe and the USA. The only guideline reported to have been used in the development of interventions is the Medical Research Council framework (MRC) (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000), with 9 of 14 papers that describe the development of an intervention reporting the use of this guideline. The other five papers did not mention the use of any guideline or framework. CONCLUSIONS: The MRC (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000) framework appears to be the most widely used guideline reported for developing complex interventions. Although the updated MRC (Developing and Evaluating Complex Interventions, 2008) framework adds considerably to the original MRC (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000) framework, other guidelines contribute additional guidance which can inform the development of nursing interventions. These additional guidelines are presented in a model for developing complex interventions for nursing. RELEVANCE TO CLINICAL PRACTICE: The model will help nurses planning to develop nursing interventions as it provides additional and nursing-specific guidance to the MRC (Developing and Evaluating Complex Interventions, 2008) framework for the development of complex interventions for nursing practice.

The role of the clinical nurse specialist in MS: a literature review.

The purpose of this review was to determine the role of nurse specialists in multiple sclerosis (NSMS) in providing care for carers of people with multiple sclerosis (PwMS). The databases searched from inception to April 2010 include: CINAHL, PsycINFO, British Nursing Index, PubMed, AMED, Nursing and Allied Health Source, Academic Search Complete, Cochrane Library Database, Web of Knowledge, Ovid Nursing Database, Social Science Index, and Joanna Briggs Institute. Eighteen articles were included in the review. However, only three research-based articles were found that evaluated the role of the NSMS. The remaining articles were discussion-based and provided insight into the contribution of the NSMS to service provision. The review highlights the continuing lack of research evaluating the impact of the role of the nurse specialist in multiple sclerosis and in particular, the lack of recognition of the support role that nurse specialists provide for carers of PwMS.

The use of teaching portfolios to promote excellence and scholarship in nurse education.

Achieving excellence in nurse education and demonstrating scholarship in teaching is a challenge for nurse educators who find themselves torn between maintaining high standards in nurse education and their own need for recognition and promotion in an environment that primarily favours research and publications over excellence in teaching. The use of a teaching portfolio is a way to display excellence in nurse education and to provide a public display of teaching scholarship. While not a new concept in nursing education, it has some originality in its application to practising nurse educators. However, the requirement for and guidelines on the development of a portfolio for nurse educators (other than those undertaking educational training) has been little explored. The aim of this paper is to explore the concept of a teaching portfolio as a vehicle to demonstrate excellence and scholarship among seasoned nurse educators. The process of developing a teaching portfolio at one university setting is outlined, so that other teachers are enlightened to the potential benefits of this activity.

The needs of carers of people with multiple sclerosis: a literature review.

People with multiple sclerosis depend heavily upon their families and other informal carers as they receive limited support from health-care professionals or health-care services. Adopting the carer role results in a life-changing experience, which may bring rewards and challenges to the carer. This paper reviews the research addressing the experiences of carers of people with multiple sclerosis published between 2002 and 2007 building upon an earlier review. The literature suggests that carers have needs across various domains and that spouses/partners have particular needs. Much of the evidence has limited generalizibility although the geographical spread of the evidence indicates considerable consistency of need. The review describes ongoing carer needs which require supportive care and provides the basis for the development and testing of carer interventions for use by health-care professionals.

The experiences of patients and relatives/significant others of overcrowding in accident and emergency in Ireland: a qualitative descriptive study.

Overcrowding in Accident and Emergency Departments (A&E) in Ireland has reached crisis proportions since the dawning of the new millennium. Although this phenomenon is not unique to Ireland and many authors have suggested causes and management strategies to deal with these crises, little appears to have been written regarding the experiences of patients or their families waiting in the A&E. The aim of this qualitative descriptive study was to describe the experiences of patients and/or their relatives/significant others who had spent 12 h or more in A&E awaiting admission to hospital. Four patients and three relatives/significant others volunteered to participate in the study. Participants described the A&E departments as resembling a disaster zone or a hospital scene from a third world country. Descriptions portrayed an environment that was overcrowded, dirty and lacking in resources. Participants were generally positive in their attitudes towards the care they received, but some descriptions appeared to suggest that the quality of care was not always ideal. Recommendations from participants included reduced waiting times with a maximum of 6 h from admission to transfer or discharge; better communications systems with perhaps a liaison person who could advise them about the expected duration of stay in A&E and what was happening regarding their care; and better privacy and security within the departments.