Comparing the effectiveness of active and reactive mattresses in pressure injury healing: a pilot study.

OBJECTIVE: A feasibility study to test the proposed methodology for a larger randomised control trial was conducted, investigating the comparative effectiveness of the two types of pressure management support surfaces with regards to healing pressure injuries (PI). A secondary objective was to provide insights into the user acceptability of the two types of pressure management support surfaces. METHOD: A randomised control feasibility study was conducted in a community health setting in Canberra, Australia. Patients aged ≥65 years with an existing Stage 2 PI who slept in a bed were eligible. Participants were randomised to either the active mattress group or the reactive mattress group for use on their bed. All participants received standard wound care by community nursing staff and were provided an air-flotation cushion for use when not in bed. Photographs were taken and used for blind assessment of wound healing. Secondary information was gathered through a survey regarding user acceptability of the support surfaces and changes in habits regarding PI prevention strategies. RESULTS: In total, five patients were recruited, with one passing away prior to mattress allocation. Results were inconclusive with regards to comparative effectiveness and user acceptability due to the small sample size; however, secondary data indicated an increasing implementation of PI prevention strategies. CONCLUSION: This study confirmed the need for further high quality research comparing reactive and active pressure mattresses. Trends indicate the importance of including education on PI prevention strategies to promote changes in behaviour. Changes to the proposed methodology will be made to increase recruitment in the primary study.

Support surfaces for the treatment and prevention of pressure ulcers: a systematic literature review.

OBJECTIVE: Changes in technology have resulted in a lack of clarity regarding the comparative effectiveness between active and reactive support surfaces in the prevention and treatment of pressure ulcers (PUs). The purpose of this literature review was to evaluate the comparative effectiveness of active and reactive mattresses for prevention and treatment of PUs. METHOD: A literature search was completed using CINAHL, Medline Plus, Scopus, Cochrane Library and PubMed databases, as well as reference lists. A temporal limiter was placed excluding studies published before 2000 due to changes in care standards and support surface technology. RESULTS: Of the 33 articles included, nine were systematic/literature reviews and 24 were randomised controlled trials (RCTs). There was a consensus that pressure mattresses are an effective prevention and treatment strategy, however comparisons of the two types were often inconclusive or conflicting. Studies were conducted in acute, sub-acute or residential facilities, with no studies in a domiciliary setting. The majority of studies were rated as moderate quality with significant methodological limitations. CONCLUSION: Further research is needed to investigate the use of support surfaces in a domiciliary setting with an appropriate methodology aimed at minimising the limitations described in the existing literature.

Systemic low-grade inflammation in post-traumatic stress disorder: a systematic review.

Studies examining post-traumatic stress disorder (PTSD) have either emphasized a relationship between PTSD and a systemically pro-inflammatory state or identified a link between PTSD and chronic disease. The aim of this study was to evaluate the evidence for a relationship between individuals with PTSD and systemic low-grade inflammation that has been proposed to underlie chronic disease development in this population. The authors conducted a systematic review of the literature (January 2006 to April 2017) in accordance with the PRISMA statement in the following four databases: PubMed, MEDLINE, PsycINFO, and SPORTDiscus with Full Text. The search strategy was limited to articles published in peer-reviewed journals and to human studies. Nine studies measuring systemic inflammation and discussing its role in chronic disease development were selected for inclusion in this review. The association between markers of systemic inflammation and PTSD was evaluated by the measurement of a variety of systemic inflammatory markers including acute-phase proteins, complement proteins, pro- and anti-inflammatory cytokines, natural killer cells, and white blood cells. In general, systemic inflammatory biomarkers were elevated across the studies in the PTSD groups. There is evidence that PTSD is underpinned by the presence of a systemic low-grade inflammatory state. This inflammation may be the mechanism associated with increased risk for chronic disease in the PTSD population. From this, future research should focus on interventions that help to reduce inflammation, such as exercise.

To embed or not to embed? A longitudinal study exploring the impact of curriculum design on the evidence-based practice profiles of UK pre-registration nursing students.

BACKGROUND: The use of Evidence-Based Practice (EBP) is increasingly emphasized within healthcare. However, little research has focused on nurses' pre-registration training; particularly regarding the impact of curriculum-design on learning EBP. OBJECTIVES: This study compared the impact of embedding EBP throughout the curriculum, with modular-based teaching, on pre-registration nursing students' EBP profiles. DESIGN: A longitudinal panel study. SETTINGS AND PARTICIPANTS: A convenience sample of fifty-six pre-registration nursing students (55.4% studying an embedded EBP-curriculum and 44.6% studying a modular EBP-curriculum), were recruited from a UK University between 2011 and 2014. METHODS: Participants completed the Student Evidence-Based Practice Questionnaire (S-EBPQ) in the first, second and third year of their course. This questionnaire measures four EBP domains: frequency of use, attitude, knowledge and skills in retrieving and reviewing evidence, and knowledge and skills in applying and sharing evidence. RESULTS: Two-way mixed between-within Analyses of Variance revealed significant improvements across all domains, except attitude (which remained broadly positive across all years), for both curriculum-groups. No significant differences in this improvement were identified between the two curricula overall. However, the direction and rate of change of scores on the retrieving and applying subscales (but not frequency of use) for the two groups differed across time; specifically those on the embedded curriculum showed a dip in scores on these subscales in year 2. This appeared to be related to associated features of the course such as the timing of placements and delivery of theory. CONCLUSIONS: Taking a modular or embedded approach to EBP may have little impact on students' final EBP profiles. However, careful consideration should be given to the timing of related course features which may play a key role in students' perceptions of their knowledge and skills in its application. Further research should explore how curriculum-design might build on students' initial positive attitudes towards EBP and its use in their practice.

Nurses' resilience and the emotional labour of nursing work: An integrative review of empirical literature.

BACKGROUND: The emotional labour of nursing work involves managing the emotional demands of relating with patients, families and colleagues. Building nurses' resilience is an important strategy in mitigating the stress and burnout that may be caused by ongoing exposure to these demands. Understandings of resilience in the context of emotional labour in nursing, however, are limited. OBJECTIVES: To investigate the state of knowledge on resilience in the context of emotional labour in nursing. DESIGN: Integrative literature review. DATA SOURCES: CINAHL, Medline, Scopus, and PsycINFO electronic databases were searched for abstracts published between 2005 and 2015 and written in English. Reference lists were hand searched. REVIEW METHODS: Whittemore and Knafl's integrative review method was used to guide this review. The constant comparative method was used to analyze and synthesize data from 27 peer-reviewed quantitative and qualitative articles. Methodological quality of included studies was assessed using the Mixed Methods Assessment Tool. RESULTS: Emotional labour is a facet of all aspects of nursing work and nurse-patient/family/collegial interactions. Emotional dissonance arising from surface acting in emotional labour can lead to stress and burnout. Resilience can be a protective process for the negative effects of emotional labour. Several resilience interventions have been designed to strengthen nurses' individual resources and reduce the negative effects of workplace stress; however they do not specifically address emotional labour. Inclusion of emotional labour-mitigating strategies is recommended for future resilience interventions. CONCLUSION: Resilience is a significant intervention that can build nurses' resources and address the effects of emotional dissonance in nursing work. There is a need for further investigation of the relationship between resilience and emotional labour in nursing, and robust evaluation of the impact of resilience interventions that address emotional labour.

Supporting completion of an online continuing professional development programme for newly qualified practitioners: A qualitative evaluation.

BACKGROUND: Development programmes to support newly qualified practitioners gain confidence in their first professional role often show varied levels of engagement, due to competing priorities and demands. In Scotland, the Flying Start NHS® programme uses a structured programme of online and work-based learning with associated mentoring, to support individuals through an often difficult transition to become capable, confident practitioners. Whilst the programme was generally well received, the factors leading to widely varying completion rates between professions and organisations were not well understood. AIM: The aim of this study was to identify the factors leading to successful completion of Flying Start, a transition programme for newly qualified practitioners. METHOD: A qualitative approach was adopted to gather data from two groups of participants. Semi-structured telephone interviews were conducted with strategic and management level participants (n=23), from five health boards in Scotland. Semi-structured interviews (n=22) and focus groups (n=11) were conducted with practitioners within 6months either side of completing the programme. The interviews were transcribed and analysed using framework analysis. RESULTS: Three key themes relating to successful completion emerged from the analysis: Management and Delivery; Content and Material; Participation and Completion. Factors leading to successful completion were identified at programme, organisational and individual levels. These included clear communication and signposting, up-to-date and relevant content, links with continuing professional development frameworks, effective leadership, mentor and peer support, setting clear standards for assessment, and facilitating appropriate IT access. CONCLUSIONS: A strong strategic commitment to embedding a development programme for newly qualified practitioners can ensure that the necessary support is available to encourage timely completion. The mentor's role - to provide face-to-face support - is identified as a key factor in completion and is achieved through setting attainable targets, monitoring progress, and providing motivation. However organisational structures that facilitate the mentoring relationship are also necessary.

Development of the Student Evidence-based Practice Questionnaire (S-EBPQ).

BACKGROUND: The assessment of learning and teaching of Evidence-based Practice (EBP) in nursing is an important issue, yet few tools have been developed specifically for use with student nurses. Therefore, the Evidence-based Practice Questionnaire (EBPQ), which has been successfully used to measure EBP in nurses and nurse educators, was revised to develop a Student version (S-EBPQ). OBJECTIVE: The purpose of the study was to develop a student version of the Evidence-based Practice Questionnaire (EBPQ) and test its psychometric properties with a UK undergraduate student population. DESIGN: Instrument development study. PARTICIPANTS AND METHOD: Two hundred and forty-four undergraduate nursing students from an English University were recruited over a three year period to complete the EBPQ. This data was submitted to reliability analysis based on Item Response Theory and Exploratory Factor Analysis to explore construct validity. RESULTS: Principal Component Analysis demonstrated evidence for the S-EBPQ's construct validity, and analyses comparing the subscale scores of students in their first and second years of studies identified evidence for the tool's convergent validity. Descriptive statistics, correlation coefficients and reliability estimates demonstrated evidence for the S-EBPQ's internal reliability, and item facility and discrimination. CONCLUSION: The S-EBPQ appears to be a psychometrically robust measure of EBP use, attitudes, and knowledge and skills (regarding the retrieval and evaluation of evidence, and the application and sharing of EBP). It may therefore provide an effective means of evaluating learning of EBP with undergraduate nursing students.

Social Return on Investment: Valuing health outcomes or promoting economic values?

Interventions and activities that influence health are often concerned with intangible outcomes that are difficult to value despite their potential significance. Social Return on Investment is an evaluation framework that explores all aspects of change and expresses these in comparable terms. It combines qualitative narratives and quantitative measurements with a financial approach to enable outcomes that can otherwise be overlooked or undervalued to be incorporated appropriately. This article presents Social Return on Investment as an effective tool for supporting the development of a holistic appreciation of how interventions impact on the health and well-being of individuals, communities and societies.

Growing well-beings: The positive experience of care farms.

OBJECTIVES: Care farms enable people who are in some way vulnerable to engage with agricultural places and farming activities. This study investigates how this impacts on the health and well-being of service users and explores associated processes and outcomes. DESIGN: A mixed methods design was adopted that allowed for the integration of quantitative measurements of change with qualitative descriptions of this change. A pragmatic approach provided sufficient flexibility to support the investigation of complex contexts. METHODS: A total of 216 service users completed an initial questionnaire, and 137 (63%) of this number provided comparative data in a follow-up questionnaire. Questionnaires contained multiple choice and open-ended questions alongside standardized health and well-being measures requiring Likert-format responses. Semi-structured interviews with 33 service users allowed personal experiences to be detailed. RESULTS: Statistical analysis of well-being measure scores identified significant positive relationships with the length of time people had been attending the care farm. Questionnaire and interview data presented health benefits as being enabled by the farm environment, the positive experience as supporting personal development, and associated social interactions as becoming increasingly influential as time progressed. CONCLUSIONS: The health and well-being outcomes that result from participating at a care farm influence multiple elements of the human condition and apply amongst vulnerable people with a wide range of personal needs. Care farms have access to a potentially unique range of resources that can support many service users in becoming happier and healthier individuals. Statement of contribution What is already known on this subject? Care farming is increasingly practised and is suggested to support the health and well-being of people who are in some way vulnerable. Care farms utilize agricultural spaces and activities to provide benefits that are presented as having relevance to public health and social inclusion agendas. What does this study add? This is the first longitudinal study to include participants with such differing personal needs. Associated outcomes are explored to provide an understanding of how they impact on health. People and place are found to be mutually supportive in facilitating positive change.

What are the support needs of men with multiple sclerosis, and are they being met?

BACKGROUND: Multiple sclerosis (MS) is a chronic, degenerative condition of the central nervous system that can lead to high levels of disability and a range of psychological and social problems. Although considerable research has been conducted on the experience of living with MS and the disease's psychosocial consequences, much of this has focused on women, with the male perspective seldom considered. It is possible, therefore, that men differ from women in how they experience MS and the type of support or interventions that meet their needs. METHODS: A literature review was undertaken to identify the specific support needs of men with MS, describe current support available to men with MS, and evaluate the extent to which these needs are met by current service provision. RESULTS: The literature reviewed suggests that the needs of men with MS are different from those of women in terms of psychological factors such as well-being and mental health and support. CONCLUSIONS: If interventions are to be evidence based, health-care professionals need to take into account the needs, desires, and capabilities of men with MS in the development of services. Further qualitative and quantitative research is required to address the gaps in the evidence base of support needs for men with MS.

The role and nature of evidence: a systematic review of social workers' evidence-based practice orientation, attitudes, and implementation.

Concerns have been raised over the appropriateness of adopting evidence-based practice (EBP) as a framework for practice within social work. In this systematic review the authors aim to synthesise research findings exploring social workers' EBP orientation, attitudes, adoption, knowledge, skills, and perceived EBP barriers and facilitators. Numerous challenges to EBP implementation were identified, including: time management, research accessibility, and misperceptions of the role of evidence in decision making. Colleagues, supervisors, perceived experts, organizational culture, and tailored training were important for social workers' dissemination and utilization of evidence. Social workers may prefer more conversational, face-to-face methods of research dissemination. Implications of the review findings are discussed.

The effects of the Food Dudes Programme on children's intake of unhealthy foods at lunchtime.

AIMS: Although previous research has shown the Food Dudes Programme increases children's lunchtime fruit and vegetable consumption, research has seldom evaluated whether the intervention can decrease the consumption of high-fat and high-sugar foods. This study is the first, independent evaluation of the Food Dudes Programme to explore whether the programme could change children's lunchtime fruit and vegetable consumption and consumption of high-fat and high-sugar foods following the intervention and explore any relationship between these variables. METHODS: The Food Dudes Programme was evaluated in 15 primary schools in the West Midlands, United Kingdom (n = 2,433) at baseline (pre-intervention), and three months and 12 months post-intervention. Consumption was measured across five consecutive days in each school using weighed intake (school-provided meals) and digital photography (home-provided meals). RESULTS: A significant increase in the consumption of lunchtime fruit and vegetables was found at three months for children in the intervention schools, but only for those eating school-supplied lunches. For children consuming school meals, consumption of high-fat and high-sugar foods for children in the intervention and control schools increased over time. No relationship was found between increases in fruit and vegetable consumption and decrease in consumption of high-fat and high-sugar foods following the Food Dudes intervention. CONCLUSIONS: The Food Dudes Programme has a limited effect on decreasing consumption of high-fat and high-sugar foods at lunchtime. Targeting unhealthy food consumption in addition to increasing fruit and vegetable consumption may facilitate this. Restricted access to high-fat and high-sugar foods may also reduce intake; however, this needs to be part of a multi-faceted approach to changing children's dietary patterns involving the whole school community.

Pain and trauma in negative pressure wound therapy: a review.

Negative pressure wound therapy (NPWT) is considered an effective wound treatment, but there are a number of issues that need to be addressed for improvements to be made. This review aimed to explore the literature relating to the pain and skin trauma that may be experienced during NPWT. A literature search was carried out using the following databases: Academic Search Complete, CINAHL, PsychINFO, MEDLINE and PsyARTICLES. A total of 30 articles were reviewed. Studies reported varying levels of pain in patients undergoing NPWT, with certain treatment factors affecting the level of pain, such as the NPWT system and the dressing/filler used. Similarly, although there is much less research exploring NPWT-related trauma, findings suggest that dressing and filler type may impact on whether trauma occurs. However, further research needs to consider the different stages of NPWT and how pain and trauma can be minimised during the whole procedure. As both pain and skin trauma impact on the patient's well-being and on wound healing, it is essential that research further explores the factors that may affect the experience of pain and trauma, so as to inform developments in wound care.

The evidence-based practice profiles of academic and clinical staff involved in pre-registration nursing students' education: a cross sectional survey of US and UK staff.

BACKGROUND: Competency in evidence-based practice (EBP) is a requirement for graduate nurses. Despite a growing body of research exploring the EBP profiles of students, little research has explored the EBP profiles of nurse educators. OBJECTIVES: To explore: the differences/similarities in the EBP profiles of US and UK clinical and academic faculty; the barriers nurse educators experience when teaching EBP; the impact of postgraduate education on EBP profile and; what nurse educators perceive "success" in implementing and teaching EBP to be. DESIGN: A cross-sectional online survey design was employed. SETTINGS: Two Universities delivering undergraduate nursing education in the US and UK, in partnership with large hospital systems, small community hospitals, community settings, and independent sector health organisations. PARTICIPANTS: Eighty-one nurse educators working in academic and clinical contexts in the US and UK (US academic=12, US clinical=17, UK academic=9, UK clinical=43) were recruited opportunistically. METHODS: Participants were emailed a weblink to an online survey, comprising demographic questions, the Evidence-Based Practice Questionnaire and open-ended questions about EBP barriers, facilitators and successes. RESULTS: Quantitative results indicated that academic faculty scored significantly higher on knowledge and skills of EBP, than clinical faculty, but revealed no other significant differences on EBP use or attitudes, or between US and UK professionals. Participants with postgraduate training scored significantly higher on EBP knowledge/skills, but not EBP attitudes or use. Qualitative findings identified key themes relating to EBP barriers and facilitators, including: Evidence-, organisational-, and teaching-related issues. Perceptions of successes in EBP were also described. CONCLUSIONS: Nurse educators working in the UK and US face similar EBP barriers to teaching and implementation, but view it positively and use it frequently. Clinical staff may require extra support to maintain their EBP knowledge and skills in comparison to staff working in academic contexts.

Family-based childhood obesity interventions in the UK: a systematic review of published studies.

Family-based programmes that emphasise lifestyle and behaviour change using psychological principles have been shown to be effective in targeting childhood obesity. While there is some evidence that evaluates UK family-based obesity interventions at a local level, no review to date has addressed this nationally. This review presents the available evidence from UK family-based childhood obesity interventions. Ten articles that met the inclusion criteria were included for review. The majority of programmes reviewed lasted 12 weeks, with only three studies providing follow-up data at 12 months or longer. Change in adiposity may be a short-term benefit of participation in a child weight management programme, but there is insufficient robust evidence to indicate that this benefit is long lasting and many studies were methodologically weak with limited internal validity. There is insufficient evidence to suggest how the inclusion of parents and the wider family may impact on the effectiveness of UK community based weight management programme for children and young people.

Evidence-based practice in physiotherapy: a systematic review of barriers, enablers and interventions.

BACKGROUND: Despite clear benefits of the Evidence-Based Practice (EBP) approach to ensuring quality and consistency of care, its uptake within physiotherapy has been inconsistent. OBJECTIVES: Synthesise the findings of research into EBP barriers, facilitators and interventions in physiotherapy and identify methods of enhancing adoption and implementation. DATA SOURCES: Literature concerning physiotherapists' practice between 2000 and 2012 was systematically searched using: Academic Search Complete, Cumulative Index of Nursing and Allied Health Literature Plus, American Psychological Association databases, Medline, Journal Storage, and Science Direct. Reference lists were searched to identify additional studies. STUDY SELECTION: Thirty-two studies, focusing either on physiotherapists' EBP knowledge, attitudes or implementation, or EBP interventions in physiotherapy were included. DATA EXTRACTION AND SYNTHESIS: One author undertook all data extraction and a second author reviewed to ensure consistency and rigour. Synthesis was organised around the themes of EBP barriers/enablers, attitudes, knowledge/skills, use and interventions. RESULTS: Many physiotherapists hold positive attitudes towards EBP. However, this does not necessarily translate into consistent, high-quality EBP. Many barriers to EBP implementation are apparent, including: lack of time and skills, and misperceptions of EBP. LIMITATIONS: Only studies published in the English language, in peer-reviewed journals were included, thereby introducing possible publication bias. Furthermore, narrative synthesis may be subject to greater confirmation bias. CONCLUSION AND IMPLICATIONS: There is no "one-size fits all" approach to enhancing EBP implementation; assessing organisational culture prior to designing interventions is crucial. Although some interventions appear promising, further research is required to explore the most effective methods of supporting physiotherapists' adoption of EBP.

Motivational interventions in the management of HbA1c levels: a systematic review and meta-analysis.

AIMS: To review the diabetes literature in order to examine the effect of motivational interventions on treatment outcome as measured by changes in glycated haemoglobin. METHODS: Relevant databases were systematically searched for randomised controlled trials in which motivational interventions were examined in relation to treatment outcome in people with type 1 and type 2 diabetes mellitus. RESULTS: The 13 studies identified for review included 1223 participants diagnosed with type 1 diabetes and 1895 participants diagnosed with type 2 diabetes. The analysis showed a 0.17% (95% CI: -0.09, 0.43%) improvement in glycemic control in people who received a motivational intervention compared to a control group, however, the effect was not statistically significant. CONCLUSIONS: The impact of motivational interventions in the management of blood glucose levels appears to be limited. However, due to the small number of studies and issues of heterogeneity caution in interpreting the present findings is advised. Moreover, the unique contribution of motivational interventions may be better assessed by outcomes such as behaviour change and other intermediate outcomes. Further research examining the delivery and focus of motivational interventions in helping people manage their diabetes is recommended. The clinical implications of the present findings are therefore uncertain pending further research.

The reach, transferability, and impact of the Evidence-Based Practice Questionnaire: a methodological and narrative literature review.

BACKGROUND: Since the 1990s, evidence-based practice (EBP) has been increasingly emphasized in nursing, but its implementation is still sometimes met with confusion and resistance. Therefore, identifying factors affecting its implementation is crucial. The Evidence-Based Practice Questionnaire (EBPQ) was published in 2006, addressing a need for a robust measure of nurses' practice of, attitudes toward, and knowledge of EBP. The growing body of professionals using the questionnaire means that a review of its reach, transferability, and impact is timely. AIMS: The aims of this review were threefold: (a) identify the situations in which the EBPQ has been used in both published and unpublished research internationally (Reach); (b) collate the psychometric properties of the EBPQ from the research reviewed (Transferability); and (c) discuss the study's findings to shed new light on issues facing professionals in implementing EBP, and possible future directions for research (Impact). METHODS: Literature searches on studies reported between 2006 and July 2012 inclusive were conducted using the terms "Evidence-Based Practice Questionnaire" and "EBPQ." Green, Johnson and Adams's guidelines for completing narrative literature reviews and Terwee et al.'s framework for reporting questionnaires' psychometric properties were adopted to ensure rigor. FINDINGS: Twenty-seven studies were reviewed in which the EBPQ had been translated into five different languages and used with a variety of professional groups. The questionnaire demonstrated convergent and discriminant validity and good internal reliability. Research adopting the questionnaire identified a range of variables related to EBP implementation, including qualification route and job role. LINKING EVIDENCE TO ACTION: Assessment of organizational culture and workforce training needs prior to developing educational interventions is crucial. The EBPQ has the potential to provide further understanding of these and other issues faced by professionals when implementing EBP.

Automatic and motivational predictors of children's physical activity: integrating habit, the environment, and the Theory of Planned Behavior.

BACKGROUND: Physical activity determinant studies now often include both environmental and sociocognitive factors but few of them acknowledge and explore the mechanisms underlying relevant environmental influences. This study explored environmental correlates of children's self-reported physical activity and potential mediation through the Theory of Planned Behavior (TPB) and habit strength. METHODS: Six hundred and twenty-one pupils aged 9-11 years were recruited from 4 primary schools in the UK. TPB variables, habit strength and environmental variables were assessed at baseline. Self-reported physical activity was assessed 1 week later. RESULTS: Mediation tests revealed that 43% of the association between convenient facilities and intention was mediated through subjective norms (17%) and habit (26%), while 15% of the association between convenient facilities and physical activity was mediated through habit strength alone. A significant direct effect of convenient facilities and resources in the home environment on physical activity was also found. The school environment was not significantly related to children's physical activity intentions or behavior. CONCLUSION: The results suggest that the environment influences children's physical activity both directly and indirectly and that habit strength seems to be the most important mediator for this association.