Understanding how to facilitate continence for people with dementia in acute hospital settings: a mixed methods systematic review and thematic synthesis.

BACKGROUND: People living with dementia (PLWD) are at significant risk of developing urinary and/or faecal incontinence and are also at risk of functional incontinence or being labelled as being incontinent. Despite the growing population of PLWD and importance of continence care, little is known about the appropriate management, organisation, and interactional strategies for PLWD admitted to acute hospitals. This mixed methods systematic review and thematic synthesis sought to identify successful strategies across all care settings that could then be used to inform innovations in continence care for PLWD in the acute hospital setting. METHODS: In phase 1, a scoping search of two electronic databases (MEDLINE and PsycINFO) and a consultation with stakeholders was undertaken. Findings were presented to the project steering group and two priority areas for phase 2 were identified which were communication and individualised care plans. In phase 2, eight databases and relevant UK government and other organisational websites were searched for English language citations from inception to August 2020. Critical appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT Version 11). Thematic synthesis was employed and the strength of synthesised findings for the intervention studies was assessed using the GRADE approach and the confidence in synthesised qualitative and survey findings was assessed using the CERQual approach. RESULTS: In phase 1, 1348 citations were found and 75 included. In phase 2, 6247 citations were found, 14 research studies and 14 policy and guidance documents were included. The quality of studies varied. Material was synthesised into three overarching syntheses which were: communication this is dignified, person-centred and respectful; communication during outpatients apointments and delivering individualised continence care. CONCLUSIONS: Recognising that PLWD are not always able to communicate their continence needs verbally is important. Incorporating interpersonal and communication skills into the context of continence care within training for those working with this patient group is crucial for continence to be maintained during an acute admission. Continence care in the acute setting should be tailored to the individual and be developed in partnership with staff and caregivers. TRIAL REGISTRATION: PROSPERO: CRD42018119495 .

A realist evaluation of a safe medication administration education programme.

BACKGROUND: Continuing professional education (CPE) for nurses is deemed an essential component to develop, maintain and update professional skills. However, there is little empirical evidence of its effectiveness or factors which may influence its application into practice. OBJECTIVE: This paper explores a continuing professional education programme on the safe administration of medication and how new knowledge and skills are transferred into clinical practice. DESIGN: Realist evaluation provided the framework for this study. Realist evaluation stresses the need to evaluate programmes within "context," and to ask what "mechanisms" are acting to produce which "outcomes." This realist evaluation had four distinct stages. Firstly, theories were built as conjectured CMO configurations (Stage 1 and 2), then these cCMO were tested (Stage 3) and they were then refined (Stage 4). METHODS: Data was collected through document analysis and interviews (9) to build and refine CMOs. The conjectured CMOs were tested by clinical observation, interview (7), analysis of further documents and analysis of data from reported critical incidents and nursing care metric measurements. RESULTS: This study has shown the significant role of the ward manager in the application of new learning from the education programme to practice. Local leadership was found to enable a patient safety culture and the adoption of a quality improvement approach. The multi-disciplinary team at both organisation and local level was also found to be a significant context for the application of the education programme into practice. Reasoning skills and receptivity to change were identified to be key mechanisms which were enabled within the described contexts. CONCLUSION: The findings from this study should inform policy and practice on the factors required to ensure learning from CPE is applied in practice. The realist evaluation framework should be applied when evaluating CPE programmes as the rationale for such programmes is to maintain and improve patient care.

A Community Hospital NICU Developmental Care Partner Program: Feasibility and Association With Decreased Nurse Burnout Without Increased Infant Infection Rates.

BACKGROUND: Volunteers can provide staff-directed sensory inputs to infants hospitalized in the NICU, but research on volunteer programs is limited. PURPOSE: To evaluate the feasibility of a developmental care partner (DCP) program in a level III NICU and determine its relationship with provider burnout and infant infection rates. METHODS: DCPs were trained to provide sensory input to infants, based on the behavioral cues observed by the occupational therapists and nursing staff, in medically stable infants. Feasibility was assessed by documenting the process of training and utilizing volunteers, as well as tracking duration and frequency of DCP visits. Staff burnout measures were assessed using the Maslach Burnout Inventory Human Services Survey (MBI-HSS) before and after implementation. Infant infection rates before and after the introduction of volunteers were compared. RESULTS: Seventy-two volunteers were interested, and 25 (35%) completed the DCP competencies and provided sensory exposures to 54 neonates, who were visited an average of 8 times (range 1-15). Twelve (48%) DCPs did once-per-week visits, and 9 (36%) did at least 50 contact hours. MBI-HSS scores for staff emotional exhaustion (P < .001) and depersonalization (P < .006) were lower after DCP implementation. There were no differences in infant infection rates before and after DCP implementation (Fisher exact P = 1.000). IMPLICATIONS FOR PRACTICE: Volunteer-based DCP programs may be feasible to implement in community hospitals and could help reduce staff emotional exhaustion and depersonalization without increasing the incidence of infant infections. IMPLICATIONS FOR RESEARCH: Future research on NICU volunteer programs with larger sample sizes and different infant populations is warranted.

Sexuality as taboo: using interpretative phenomenological analysis and a Foucauldian lens to explore fathers' practices in talking to their children about puberty, relationships and reproduction.

BACKGROUND: Fathers can play an important role in their children's learning about relationships and sexuality but we know very little about the father's lived experience in this regard. AIM: To explore eight fathers' perceptions and experiences of discussing puberty, relationships and reproduction with their 10-year-old children. METHODS: The paper commences with a genealogical analysis of the history of sex education in England from the Public Health Act of 1848 to the present day. Interpretative phenomenological analysis (IPA) was used as both a methodology and a method. Face-to-face interviews were conducted with each father and results were analysed ideographically, followed by analysis across the group. Interpretations were developed using a Foucauldian lens of governmentality and biopower. FINDINGS: The paper explores how synthesis of IPA with a Foucauldian lens revealed significant tensions between the fathers' cognitions, accounts and behaviours, which were underpinned by an enduring perception of sexuality as taboo. CONCLUSION: By providing a contextualised understanding of the fathers' practices, this study demonstrates that a more informed approach to health promotion strategy can be achieved and the implications for nursing are explored.

Men's perceptions of the impact of the physical consequences of a radical prostatectomy on their quality of life: a qualitative systematic review.

OBJECTIVE: To identify men's perceptions of the impact of the physical consequences of a radical prostatectomy on their quality of life. INTRODUCTION: Prostate cancer is the most common male cancer and second most common cause of cancer death of men in the Western world. Compared to other prostate cancer treatments, trials report worse urinary incontinence and sexual function and similar bowel function among men with prostate-specific antigen detected prostate cancer who underwent radicalized prostatectomy. INCLUSION CRITERIA: This review included men of all ages and nationalities who had undergone a radical prostatectomy as treatment for any stage of prostate cancer. It considered studies that investigated:Any setting where the topic was addressed with participants meeting the inclusion criteria was included. The review considered studies that focused on qualitative data including, but not limited to: phenomenology, grounded theory, ethnography and action research. Studies were included if they reported results relating to one or more of the phenomena of interest. Studies not written in English were excluded. METHODS: The search strategy aimed to find published studies from six databases from database inception to November 2017. Methodological quality of studies was independently assessed by two reviewers using the standardized JBI Critical Appraisal Checklist for Qualitative Research. For data extraction, the standardized Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI) data extraction tool was used. A meta-aggregation was undertaken and the final synthesis of the findings was reached through discussion. Results are presented as five aggregated qualitative syntheses. RESULTS: Nineteen qualitative studies were included in the review. The five synthesized findings were: CONCLUSIONS:: Urinary incontinence and erectile dysfunction are significant side-effects of radical prostatectomy which have a negative impact on men's quality of life for which they feel ill prepared, and physical and psychosocial support is essential.

Physical therapy and exercise interventions in Huntington's disease: a mixed methods systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The review seeks to evaluate the effectiveness of physical therapy and exercise interventions in Huntington's disease (HD). The review question is: What is the effectiveness of physiotherapy and therapeutic exercise interventions in people with HD, and what are patients', families' and caregivers' perceptions of these interventions?The specific objectives are:This mixed methods review seeks to develop an aggregated synthesis of quantitative, qualitative and narrative systematic reviews on physiotherapy and exercise interventions in HD, in an attempt to derive conclusions and recommendations useful for clinical practice and policy decision-making.

The silencing effects of the childhood innocence ideal: the perceptions and practices of fathers in educating their children about sexuality.

This study employed Interpretative Phenomenological Analysis to explore eight fathers' perceptions and practices in talking to their ten year old children about puberty, relationships and reproduction. The fathers participated in face to face interviews which were analysed idiographically initially, followed by analysis at the group level. Interpretations were then developed through critical application of a Foucauldian lens of governmentality and biopower. The results revealed a tension between the fathers' cognitions, accounts and behaviours. Their practices were largely characterised by silence yet they reported positive attitudes towards children's sexuality education and perceived themselves as equipped and willing to take on the role of sexuality educator. They also reported enjoying open relationships with their children. Interpretations centred on contradictions and conflict between the majority of the fathers' aspirations and the compelling nature of the childhood innocence discourse as a technology of governmentality. Whilst all of the fathers felt that it was in their children's interests to learn about sexuality, all but one adhered to hegemonic protective discourses and unquestioningly integrated their normalising effects into their fathering practices which, it is argued, may paradoxically render their children more vulnerable both now and in the future.

Acquired pharmaco-dynamic opioid tolerance: a concept analysis.

AIM: To report an analysis of the concept of acquired pharmaco-dynamic opioid tolerance. BACKGROUND: Acquired pharmaco-dynamic opioid tolerance is a complex and poorly understood phenomenon associated with strong opioid therapy for managing pain. Critical review of the concept provides greater clarification of the attributes, assisting healthcare professionals in addressing pain and functional management of patients, particularly those with non-malignant pain. DESIGN: Concept analysis. DATA SOURCES: A systematic literature search was undertaken using electronic data bases: CINAHL, British Nursing Index, EMBase, Medline, Pubmed and AMED. All literature reviewed was in English and published between 1976 and 2012. The key search terms were 'chronic non-malignant pain', 'strong opioid therapy' and 'development of acquired pharmaco-dynamic opioid tolerance'; all possible variant terms were also searched. METHOD: The Walker and Avant approach was used to guide the concept analysis. RESULTS: The concept analysis revealed four empirical referents: plasticity, drug administration, reduced analgesic efficacy and increased drug dosing. Tachyphylexia was identified as a borderline case, opioid induced hyperalgesia as a related case and pseudo-tolerance as a contrary case. The antecedent is administration of an opioid analgesic drug and the consequences, increasing opioid drug dose to maintain analgesic effect. CONCLUSION: Untangling the antecedents, empirical referents and consequences of tolerance help healthcare professionals understand its complexities. Improved knowledge may ultimately influence patient outcomes through the construction of better monitoring systems. This concept analysis may also provide insights for policy change and give empirical direction for future research.

A baseline study of anticoagulant management in UK hospitals.

OBJECTIVES: To undertake a baseline study of the management of anticoagulants in order to allow later comparison of the impact of the National Patient Safety Agency (NPSA) patient safety alert (including a new patient held record) published in April 2007. METHODS: A multimethod study comprising semistructured interviews in 20 acute trusts and a telephone/email survey of general practitioners (GPs). RESULTS: The authors found a high degree of consensus concerning a number of problems in the management of anticoagulation services. Consultant haematologists and chief pharmacists expressed concern about the level of competence of junior medical and nursing staff and the quality of patient discharge from general inpatient wards. Patients were regularly discharged before being stabilised on Warfarin, pre-discharge information was not always given, patient-held records were not reliably completed nor follow-up arrangements made. At the ward level, there was some confusion about the responsibility for completing the yellow book on discharge and little awareness of the role of GPs in providing a monitoring service. GPs were largely dissatisfied with the quality of discharge information. CONCLUSION: The baseline data present a significant cause for concern in the management of warfarin prior to the publication of the NPSA safety alert.

Safe practice for patients receiving anticoagulant therapy.

Venous thrombolembolism, although largely preventable, continues to be a major cause of death in hospitalised patients. The anticoagulant drugs used to prevent and treat this condition require careful and knowlegeable management. Nurses working in acute and community settings have an important role in this process.

Making patients safer: nurses' responses to patient safety alerts.

AIM: This paper is a report of a study to determine whether action required by patient safety alerts was effectively taken. BACKGROUND: Over the last 10 years, there has been a growing awareness of the number of patients unintentionally harmed in the course of their treatment. Safety alerts are designed to reduce the incidence of adverse events by removing these predisposing factors. METHOD: A multi-method study was carried out in 20 acute, two mental health, four ambulance and 15 primary care provider organizations in the United Kingdom in 2006-2007 using surveys, interviews with senior managers and front-line staff, collection of documentary evidence and equipment audit. The implementation of three safety alerts for nursing action is reported. FINDINGS: Most staff were aware of the dangers posed by gloves to staff with latex allergy, but only 20% were aware of the types of common equipment that posed a danger to sensitive patients. Almost 40% of nurses were unable to give a correct acidity value to allow nasogastric feeding to commence. One alert, on needle-free intravascular connectors, was distributed in only a few organizations as the term used was unfamiliar at all levels of the organization. CONCLUSION: Healthcare providers have succeeded in setting up successful systems to disseminate alerts to middle management level, but there is evidence that implementation of recommendations by nurses is sub-optimal.

The discipline of improvement: something old, something new?

In response to calls to improve the efficacy of health care services, there is an increasing focus on the processes of achieving a continuous improvement of services and practices. One specific response is that of the NHS Modernization Agency and National Health Service University in relation to the Discipline of Improvement in Health and Social Care. This paper draws on a study that explored the underpinning knowledge base of the Discipline of Improvement and focuses on describing the framework that was developed. The two-dimensional framework is composed of five primary categories, which cross-link to 11 competencies. The study concludes that the Discipline of Improvement draws together a group of ideas that together cohere to form a distinctive model to aid the improvement of health care. While some of these ideas are well-established, the way in which the Discipline of Improvement makes connections between them offers something new to our understanding of change in the complex world of health care provision, and to nursing management.