Comparación entre la primera y la sexta ola de la pandemia por el coronavirus SARS-COV-2 en pacientes con enfermedad inmunomediada / Comparison of the first and sixth waves of the SARS-COV-2 coronavirus pandemic in patients with immune-mediated disease

Introducción: Las últimas evidencias revelan que la infección por COVID-19 no tienen peor pronóstico en los pacientes con enfermedades inflamatorias inmunomediadas (EIMI), aunque desarrollan menor respuesta a la vacunación. Objetivo: Comparar la incidencia de COVID-19 y características clínicas en pacientes con EIMI entre la primera y sexta olas. Método: Estudio observacional prospectivo de 2 cohortes de pacientes con EIMI diagnosticados de COVID-19. Primera cohorte: marzo-mayo de 2020; segunda cohorte: diciembre/2021 a febrero/2022. Se recogieron variables sociodemográficas y clínicas, y en la segunda cohorte el estado de vacunación contra la COVID-19. El análisis estadístico estableció las diferencias de las características y la evolución clínica entre ambas cohortes. Resultados: De un total de 1.627 pacientes en seguimiento, contrajeron COVID-19 durante la primera ola 77 (4,60%) y 184 en la sexta (11,3%). En la sexta hubo menos hospitalizaciones, ingresos en cuidados intensivos y fallecimientos que en la primera (p=0,000) y 180 pacientes (97,8%) tenían al menos una dosis de vacuna. Conclusión: La detección precoz y la vacunación han evitado la aparición de complicaciones graves.(AU)

Introduction: Recent evidence shows that COVID-19 infection does not have a worse prognosis in patients with immune-mediated inflammatory diseases (IMID), although they develop a worse response to vaccination. Objective:To compare the incidence of COVID-19 and clinical features in patients with IMID between the first and sixth waves. Method: Prospective observational study of two cohorts of IMID patients diagnosed with COVID-19. First cohort March to May 2020, and second cohort December/2021 to February/2022. Sociodemographic and clinical variables were collected and, in the second cohort, COVID-19 vaccination status. Statistical analysis established differences in characteristics and clinical course between the two cohorts. Results: In total, 1627 patients were followed up, of whom 77 (4.60%) contracted COVID-19 during the first wave and 184 in the sixth wave (11.3%). In the sixth wave, there were fewer hospitalisations, intensive care unit admissions, and deaths than in the first wave (P=.000) and 180 patients (97.8%) had at least one dose of vaccine. Conclusion: Early detection and vaccination have prevented the occurrence of serious complications.(AU)

Establishment and implementation of a nurse-led interdisciplinary management strategy for central line maintenance: A single-center experience.

Objectives: This study aimed to establish and implement an interdisciplinary management strategy led by senior nurses via a vascular access specialist team (VAST) at a teaching hospital. Methods: In 2021, the hospital established and implemented a nurse-led VAST management strategy to improve the quality of clinical central line maintenance. The VAST comprised senior nurses specialized in intravenous therapy, ultrasound/radiology technologists, medical doctors with central venous catheterization certificates, central line maintenance nurses, and administrative coordinators. The management strategy mainly included systemic on-the-job training for VAST members, the establishment of an interdisciplinary central line emergency "green channel," the formation of a VAST-based, nurse-led standardized clinical rounding system, and the standardization of central line self-care instructions for patients. During the pre- (July 2020 to April 2021) and post- (May 2021 to May 2022) of the implementation the interdisciplinary management strategy, overall patients' self-care ability, the success rate of catheterization at first time, central line management compliance rate, and patients' satisfaction with catheter maintenance were investigated and compared. Results: The results showed the score self-care ability was increased from 74.75 ± 18.4 (pre-VAST) to 99.10 ± 23.65 (post- VAST); the success rate for catheterization at first time was improved to 100% (225/225), compared to 92.9% (209/225) at pre-VAST; the central line management compliance rate was also increased to 99.6% (224/225) at post-VAST from 93.3% (210/225) at pre-VAST. A patient satisfaction survey on catheter maintenance showed improvements in all five indicators were compared to the pre- VAST (P < 0.05). Conclusions: The nurse-led VAST interdisciplinary strategy can effectively improve the quality of clinical central line management and should be used to reinforce clinical catheterization and maintenance of central lines.

Comparison of the first and sixth waves of the SARS-COV-2 coronavirus pandemic in patients with immune-mediated disease.

INTRODUCTION: Recent evidence shows that COVID-19 infection does not have a worse prognosis in patients with immune-mediated inflammatory diseases (IMID), although they develop a worse response to vaccination. OBJECTIVE: To compare the incidence of COVID-19 and clinical features in patients with IMID between the first and sixth waves. METHOD: Prospective observational study of two cohorts of IMID patients diagnosed with COVID-19. First cohort March to May 2020, and second cohort December/2021 to February/2022. Sociodemographic and clinical variables were collected and, in the second cohort, COVID-19 vaccination status. Statistical analysis established differences in characteristics and clinical course between the two cohorts. RESULTS: In total, 1627 patients were followed up, of whom 77 (4.60%) contracted COVID-19 during the first wave and 184 in the sixth wave (11.3%). In the sixth wave, there were fewer hospitalisations, intensive care unit admissions, and deaths than in the first wave (p=.000) and 180 patients (97.8%) had at least one dose of vaccine. CONCLUSION: Early detection and vaccination have prevented the occurrence of serious complications.

[Comparison of the first and sixth waves of the SARS-COV-2 coronavirus pandemic in patients with immune-mediated disease.] / Comparación entre la primera y la sexta ola de la pandemia por el coronavirus SARS-COV-2 en pacientes con enfermedad inmunomediada.

Recent evidence shows that COVID-19 infection does not have a worse prognosis in patients with immune-mediated inflammatory diseases (IMID), although they develop a worse response to vaccination.Objective To compare the incidence of COVID-19 and clinical features in patients with IMID between the first and sixth waves.Method Prospective observational study of two cohorts of IMID patients diagnosed with COVID-19. First cohort March to May 2020, and second cohort December/2021 to February/2022.Sociodemographic and clinical variables were collected and, in the second cohort, COVID-19 vaccination status. Statistical analysis established differences in characteristics and clinical course between the two cohorts.Results In total, 1627 patients were followed up, of whom 77 (4.60%) contracted COVID-19 during the first wave and 184 in the sixth wave (11.3%). In the sixth wave, there were fewer hospitalisations, intensive care unit admissions, and deaths than in the first wave (p=.000) and 180 patients (97.8%) had at least one dose of vaccine.Conclusion Early detection and vaccination have prevented the occurrence of serious complications.

Association between the Nursing Practice Environment and Safety Perception with Patient Safety Culture during COVID-19.

AIMS: In this study, we aimed to identify the relationship between nursing practice environments (NPEs) and safety perceptions with patient safety culture (PSC) during COVID-19. DESIGN: We conducted a quantitative, non-experimental, correlational, and cross-sectional study. We interviewed 211 nurses from Peru using two scales: PES-NWI and HSOPSC. We used the Shapiro-Wilk test and Spearman's coefficient and estimated two regression models. RESULTS: NPE was reported as favorable by 45.5% of the participants, and PSC was reported as neutral by 61.1%. Safety perception, the workplace, and NPE predict PSC. All NPE factors were correlated with PSC. However, safety perception, support of nurses subscale, the nurse manager's ability, and leadership were predictors of PSC. CONCLUSION: To promote a safe work culture, health institutions should foster leadership that prioritizes safety, strengthens managers' abilities, encourages interprofessional collaboration, and considers nurses' feedback for constant improvement.

Nursing practice and teleconsultations in a pandemic context: A mixed-methods study.

AIM: To explore the use and implementation of teleconsultations by primary care nurses in the context of the COVID-19 pandemic. BACKGROUND: Teleconsultation use increased rapidly during the COVID-19 pandemic. Its implementation has been documented for physicians and specialists, but knowledge is still limited in nursing practice. DESIGN: A sequential mixed-methods study. METHODS: Phase 1: A cross-sectional e-survey with 98 nurses (64 nurse clinicians [NCs] and 34 nurse practitioners [NPs]) was conducted in 2020 in 48 teaching primary care clinics in Quebec (Canada). Phase 2: Semi-structured interviews with four NCs and six NPs were conducted in 2021 in three primary care clinics. This study adheres to STROBE and COREQ guidelines. RESULTS: During the pandemic, telephone was the principal teleconsultation modality used by NPs and NCs compared to other teleconsultation modalities (text messages, email and video). The only variable associated with a higher likelihood of using teleconsultations was type of professional (NCs). Video consultation was almost absent from the modalities used. The majority of participants reported several facilitators to using teleconsultations in their work (e.g. web platforms and work-family balance) and for patients (e.g. rapid access). Some barriers to utilisation were identified (e.g. lack of physical resources) for successful integration of teleconsultations at the organisational, technological and systemic levels. Participants also reported positive (e.g. assessment of cognitive deficiency) and negative (e.g. rural population) impacts of using teleconsultations during a pandemic that made the use of teleconsultations complex. CONCLUSION: This study highlights the potential for nurses to use teleconsultations in primary care practice and suggests concrete solutions to encourage their implementation after the pandemic. RELEVANCE TO CLINICAL PRACTICE: Findings emphasize the need for updated nursing education, easy-to-use technology and the strengthening of policies for the sustainable use of teleconsultations in primary health care. IMPLICATIONS FOR THE PROFESSION: This study could promote the sustainable use of teleconsultations in nursing practice. REPORTING METHOD: The study adhered to relevant EQUATOR guidelines; the STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies were used for reporting. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution, as the study focused on the use of teleconsultation among health professionals, specifically primary care nurses.

Quality of work-life and coping strategies of nurse educators and clinicians in COVID-19: A cross-sectional study.

The study compared perceived differences in Quality of Work-Life (QoWL) among nurse clinicians and educators and coping strategies used by nurses. DESIGN: A cross-sectional study. METHODS: From August and November 2020, the study measured the QoWL and coping strategies of 360 nurses with two scales using a multi-stage sampling technique. The data were analysed with descriptive, Pearson correlation and multivariate linear regression analyses. RESULTS: Quality of Work-Life was generally low among nurses; nurse educators, however, had better QoWL than clinical nurses. Age, salary and nature of work predicted the QoWL of nurses. Work-family segmentation, seeking assistance, open communication and recreational activities were employed by most nurses to cope with challenges. With the rate of workload and work-related stress associated with COVID-19, nurse leaders must advocate for evidence-based coping strategies to deal with work and family life stress.

Advanced practice nurse capabilities: A mixed methods systematic review.

BACKGROUND: Global health challenges demand the optimal use of nurses' professional competence and capability. Competencies related to the roles of advanced practice nurses have been developed, but research on these nurses' capabilities remains limited. AIM: To summarise and compare the literature on the capabilities of advanced practice nurses and the dimensions of these capabilities. METHODS: We carried out a mixed methods systematic review, using CINAHL, PubMed, and Scopus to search literature published between 1998 and 2021. The quality of the selected articles was evaluated with the JBI Critical Appraisal Tools. We employed abductive content analysis, including deductive and inductive analysis. The reporting was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement. RESULTS: Eleven articles out of 357 met the inclusion criteria. We identified all five dimensions of Hase and Davis's (1999) capability framework: can apply competencies in familiar as well as unfamiliar situations, is creative, has a high degree of self-efficacy, knows how to learn, and works well in teams. Additionally, we found a new dimension of capability: identifies factors affecting the scope of practice. LIMITATIONS: This mixed methods systematic review was conducted about a little-studied topic. Because country-specific differences exist and consensus on advanced practice nursing roles is lacking, the concept of advanced practice nurse capabilities cannot be directly generalised. CONCLUSIONS: Capability is a requirement and a necessity in the performance of advanced practice nurses. Identifying and defining the dimensions of advanced practice nurses' capabilities will lead the way in developing the roles, education, and capability assessments of advanced practice nurses. Identification of advanced practice nurses' capability will facilitate role understanding, visibility, and implementation in health care services. This can improve the quality and accessibility of care and improve the cost-effectiveness of the use of health care professionals.

Outcomes and challenges of successful clinical nurse specialist role implementation: Participatory action research.

AIM: To describe the clinical nurse specialist role and its outcomes and challenges. DESIGN: Participatory Action Research conducted in Finland between the fall of 2017 and the end of 2018. METHODS: A core participatory action research team (n = 10) led the design, implementation and evaluation of the research. Multiple data collection methods were used. The study is reported using the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) guidelines for participatory action research. RESULTS: The clinical nurse specialist used most of the time in clinical patient care followed by clinical nursing leadership and scholarship activities. Outcomes of successful implementation led to increased visibility of nursing expertise, development, integration and quality assurance of nursing processes and practice, and promotion of knowledge translation and unit and collaborator cooperation. Furthermore, role challenges were also recognized.

Role of the teenage and young adult blood and marrow stem-cell transplant clinical nurse specialist.

This article explores the role of the teenage and young adult (TYA) blood and marrow stem-cell transplant clinical nurse specialist (CNS) from the author's perspective, and the challenges of developing a novel role. The article aims to provide insight into the role, and review the benefits of the CNS to patient care, thus highlighting the value of developing such a role within other stem-cell transplant centres in the UK.

Percepción de los pacientes hospitalizados respecto del cuidado de enfermería

Resumen: Introducción: La atención humanizada requiere la interacción entre los conocimientos científicos y los valores, generando la necesidad de particularizar los cuidados, siendo esta una actividad esencial en enfermería. Objetivo: Analizar la percepción que tienen los usuarios hospitalizados respecto del cuidado humanizado que reciben por parte de las profesionales de enfermería. Metodología: Se desarrolló una investigación de tipo cuantitativa, descriptiva, correlacional y de corte transversal, que incluyó a los usuarios hospitalizados en los Servicios Clínicos de Medicina, Cirugía, Pensionado y representantes legales de pacientes menores de 18 años en Pediatría, de un hospital público ubicado en el sur de Chile, con una muestra de 377 participantes. Posterior a aplicación de consentimiento informado, se aplicó una caracterización sociodemográfica y el instrumento Percepción de Comportamientos de Cuidado Humanizado de Enfermería - versión 3, con adaptación transcultural para la población chilena, el cual fue complementado con otros datos pertinentes a los objetivos de la investigación. Resultados: Se encontró que las personas participantes en su mayoría reconocieron al profesional de enfermería por el uniforme, y pese a existir algunas diferencias en cada servicio, refirieron satisfacción con el cuidado recibido (84,6 %). Aspectos como la edad, el tiempo de hospitalización y el reconocimiento del personal de enfermería, evidenciaron relación estadística con la satisfacción. Conclusiones: Se requiere implementar estrategias para fortalecer la percepción del cuidado humanizado de enfermería, siendo estos aspectos una contribución para la construcción de un clima y cultura organizacional que evidencien esta perspectiva de cuidado.

Resumo: Introdução: Uma atenção humanizada requer a interação entre saberes científicos e valores, gerando a necessidade de particularização ou cuidado, sendo essa uma atividade essencial na enfermagem. Objetivo: Analisar a percepção que os usuários hospitalizados têm sobre o atendimento humanizado que recebem dos profissionais de enfermagem. Método: Es uma investigação quantitativa, descritiva, correlacional e transversal, que incluiu os usuários hospitalizados nos Serviços de Medicina, Cirurgia, Pensionista e representantes legais de pacientes menores de 18 anos em Pediatria, de um hospital público localizado no sul do Chile, com uma amostra de 377 participantes, Após a aplicação do consentimento informado, foi aplicada uma caracterização sociodemográfica e foi aplicado o instrumento Percepção de Comportamentos de Assistência Humanizada de Enfermagem - versão 3, com adaptação transcultural para a população chilena, ou que foi complementado com outros dados pertinentes aos objetivos da pesquisa. Resultados: Verificou-se que os participantes, em sua maioria, reconheciam ou profissionais de enfermagem pelo uniforme e, apesar da existência de algumas diferenças em cada Serviço, relatam sentir-se satisfeitos com o atendimento recebido (84,6 %). Aspectos como a idade, tempo de internação e reconhecimento da equipe de enfermagem apresentam relação estatística com a satisfação. Conclusões: É necessário implementar estratégias que fortaleçam a percepção do cuidado humanizado de enfermagem, sendo esses aspectos uma contribuição para a construção de um clima e cultura organizacional que demonstrem essa perspectiva de cuidado.

Abstract: Introduction: Humanized care requires the interaction between scientific knowledge and values, generating the need to particularize care, which is an essential activity in nursing. Objective: To analyze the perception of hospitalized users regarding the humanized care they receive from nursing professionals. Methodology: A quantitative, descriptive, correlational, and cross-sectional research was carried out, which included hospitalized users in the Clinical Services of Medicine, Surgery, Private, and legal representatives of patients under 18 years of age in Pediatrics, of a public hospital located in the south of Chile, with a sample of 377 participants. After the application of informed consent, it was applied a sociodemographic characterization as well as the instrument Perception of Humanized Nursing Care Behaviors - Version 3, with transcultural adaptation for the Chilean population, which was complemented with other data pertinent to the objectives of the research. Results: It was found that most of the participants recognized the nursing professional by the uniform, and despite some differences in each service, they reported satisfaction with the care received (84.6%). Aspects such as age, length of hospitalization and recognition of the nursing staff showed a statistical relation with satisfaction. Conclusions: It is necessary to implement strategies to strengthen the perception of humanized nursing care, being these aspects a contribution to the construction of an organizational climate and culture that evidences this perspective of care.

The life history narrative of clinical nurses with more than 30 years of experience.

BACKGROUND: The nurses with long-term careers in clinical settings shows a clear declining trend. Recording the specific period in Korea's nursing history is also important from a historical perspective. The aim of this study was to analyze the life history narrative of clinical nurses who have been in service for more than 30 years and to explore the strength and structure of their experience that enabled them to retain their long-term careers. METHODS: This study conducted qualitative research with a life history narrative. For data collection, biographical-narrative interview through in-depth personal interviews with six participants. The participants were clinical nurses who had worked at a general hospital for more than 30 years. The interviews were conducted in three sessions per participant, each session lasting 90-180 min. Qualitative thematic analysis was used to analyze the data. RESULTS: The narrative of their life stories were analyzed by dividing them into "Dimensions," "Turnings" and "Adaptations". The dimensions were categorized into individual and career dimensions. Turning points were empirical and environmental conditions that posed a threat to their career retention as nurse clinicians. Adaptations were illustrated individual methods and social interactions. Twenty-four themes were derived from the 94 thematic statements. After the abstract, four comprehensive categories emerged. The core theme for retaining long-term careers, with "Finding value in myself" comprising four themes: "acknowledgement and support from families," "healthy relationship at work," "trusting myself'," and "accumulation of small achievements." CONCLUSIONS: The life narratives of participants reveal a close connection with and relationship between the changes in the social aspects, the fields of healthcare and nursing, their individual predispositions, family recognition, and organizational support at that time in Korea. The healthy interpersonal relationships in work place are the most important condition in maintaining the long-term work of nurses. The experience of nurses in one era may not be able to represent experiences in another era, so an in-depth study exploring the social context seems to be necessary. There is a need for policies and changes in the field that can keep the lives of professional women working as nurses proudly.

The training needs of critical care nurses: A psychometric analysis.

BACKGROUND/OBJECTIVE: Nurses develop the care methods they learn through specific training and this enables them to provide care in a safe, effective and efficient manner. Intensive Care Units (ICU), as complex areas in terms of care, require nurses with specific training. Due to this fact, we set ourselves the objective to validate a questionnaire that detects the training needs of intensive care nurses in Spain. METHODS: A cross-sectional descriptive study, using an electronic questionnaire, adapted and validated through the Delphi technique, in 85 ICUs in Spain, for which a psychometric analysis is conducted. To explore the dimensions and determine the factorial structure, an Exploratory Factor Analysis (EFA) and a Confirmatory Factor Analysis (CFA) were carried out. Internal consistency was determined through ordinal alpha. The statistical treatment was carried out using the statistical programmes Factor Analysis 10.9.02 and IBM AMOS version 24. RESULTS: A total of 568 Spanish intensive care nurses, randomly divided into two samples, participated in the study. The EFA presented a factorial solution with suitable values for both the Kaiser-Meyer-Olsen Index and Bartlett's Sphericity. In the CFA, the model fit achieved close to ideal values with a Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) close to values of 0.9. The values of individual reliability, internal consistency and average variance extracted were appropriate for this type of analysis. CONCLUSION: The dimensions detected are close to the construct that encompasses the training needs of ICU nurses. The analyses carried out indicate that there are reasonable realities for incorporating these dimensions into the field of nursing training. This study opens the possibility of incorporating new items to adjust the model to improve the explanatory variables. Our findings help us to understand the dimensions that the training programmes should incorporate.

The psychological outcomes of COVID-19 affected the pandemic-after risk perceptions of nurse clinicians: a latent profile analysis.

Background: Risk perception among nurses after the COVID-19 pandemic is a crucial factor affecting their attitudes and willingness to work in clinics. Those with poor psychological status could perceive risks sensitively as fears or threats that are discouraging. This article aimed to determine whether psychological outcomes, including post-traumatic stress disorder (PTSD), depression, anxiety, and insomnia, following the COVID-19 pandemic were differentially related to the risk perceptions of nurses working in clinics and increased perceived risk. Method: The participants were 668 nurse clinicians from five local hospitals. Risk perceptions and psychological outcomes were measured by adapted questionnaires via the Internet. Latent profile analysis (LPA) identified subgroups of individuals who showed similar profiles regarding the perceived risks in nursing. Multinomial regression and probit regression were used to examine the extent to which sociodemographic and psychological outcomes predicted class membership. Results: LPA revealed four classes: groups with low-, mild-, moderate-, and high-level risk perceptions. Membership of the high-level risk perception class was predicted by the severity of psychological outcomes. Anxiety significantly accounted for a moderate increase in risk perceptions, while the symptoms of insomnia, depression, and PTSD accelerated the increase to the high level of risk perception class. Conclusions: By classifying groups of nurse clinicians sharing similar profiles regarding risk perceptions and then exploring associated predictors, this study shows the psychological outcomes after COVID-19 significantly impacted pandemic-associated risk perceptions and suggests intervening in nurses' psychological outcomes while simultaneously focusing on work-related worries is important following the outbreak of COVID-19.

Compasión y competencia cultural: experiencias de equipos de enfermería en dos hospitales de Bogotá / Compassion and cultural competence: experiences of nursing teams in two hospitals in Bogotá

Justificación: En Bogotá confluyen poblaciones culturalmente diversas, por lo cual la compasión y la competencia cultural resultan desafiantes para reconocer el sufrimiento, comprenderlo y aliviarlo mediante intervenciones culturalmente apropiadas y aceptables. Objetivo principal: Describir las experiencias de equipos de enfermería de dos hospitales de Bogotá sobre la compasión y el cuidado a personas culturalmente diversas. Metodología: Estudio cualitativo descriptivo, participaron 28 auxiliares y profesionales de enfermería de dos hospitales de Bogotá; se desarrollaron entrevistas semiestructuradas grabadas en audio y analizadas temáticamente. Resultados principales: Emergieron dos temas: (1) El cuidado culturalmente competente y compasivo se refleja en pequeños actos; (2) El cotidiano del cuidado y la superación de barreras. Conclusión principal: Las experiencias sobre compasión y competencia cultural son múltiples, se expresan a través de pequeños actos, que pueden resultar especialmente valiosos para los sujetos de cuidado. Sin embargo, el contexto impone barreras a ser enfrentadas para el cuidado a personas culturalmente diversas.(AU)

Introduction: Culturally diverse populations converge in Bogotá, making compassion and cultural competence challenging to recognize suffering, understand it, and alleviate it through culturally appropriate and acceptable interventions. Objective: To describe the experiences of nursing teams from two hospitals in Bogotá regarding compassion and care for culturally diverse people. Methods: Qualitative descriptive study, 28 auxiliary and professional nurses from two hospitals in Bogotá participated; semi-structured interviews were audio-recorded and analyzed thematically. Results: Two themes emerged: (1) Culturally competent and compassionate care is reflected in small acts; (2) The quotidian of care and overcoming barriers. Conclusions: Experiences of compassion and cultural competence are multiple, expressed through small acts, which can be especially valuable to care subjects. However, the context imposes barriers to be faced in caring for culturally diverse people.(AU)

Informing and Supporting the New Clinical Nurse Specialist Prescriber.

Advanced practice registered nurses (APRNs) in the United States are trained to diagnose and treat disease and illness, hence, to prescribe. Of the APRN roles, the clinical nurse specialist (CNS) is the least likely to prescribe. Prescribing is one of many advanced care interventions performed by CNSs, but the statutes regarding prescriptive authority are constantly changing. The purpose of this article is to inform and support the new CNS prescriber. The article reviews CNS prescribing, credentialing and privileging, safety strategies, and educational considerations that influence CNS prescribing and offers current recommendations for new CNS prescribers. Clinical nurse specialist prescribing can enhance the patient care experience and fill unmet prescriptive needs for patients. Overall, more reports on the outcomes of CNS prescribing are urgently needed, specifically, publications on CNS prescribing in acute care, where most CNSs practice.

Adjuvant immunotherapy recommendations for stage III melanoma: physician and nurse interviews.

BACKGROUND: Adjuvant immunotherapy is revolutionising care for patients with resected stage III and IV melanoma. However, immunotherapy may be associated with toxicity, making treatment decisions complicated. This study aimed to identify factors physicians and nurses considered regarding adjuvant immunotherapy for melanoma. METHODS: In-depth interviews were conducted with physicians (medical oncologists, surgeons and dermatologists) and nurses managing patients with resected stage III melanoma at three Australian tertiary melanoma centres between July 2019 and March 2020. Factors considered regarding adjuvant immunotherapy were explored. Recruitment continued until data saturation and thematic analysis was undertaken. RESULTS: Twenty-five physicians and nurses, aged 28-68 years, 60% females, including eleven (44%) medical oncologists, eight (32%) surgeons, five (20%) nurses, and one (4%) dermatologist were interviewed. Over half the sample managed five or more new resected stage III patients per month who could be eligible for adjuvant immunotherapy. Three themes about adjuvant immunotherapy recommendations emerged: [1] clinical and patient factors, [2] treatment information provision, and [3] individual physician/nurse factors. Melanoma sub-stage and an individual patient's therapy risk/benefit profile were primary considerations. Secondary factors included uncertainty about adjuvant immunotherapy's effectiveness and their views about treatment burden patients might consider acceptable. CONCLUSIONS: Patients' disease sub-stage and their treatment risk versus benefit drove the melanoma health care professionals' adjuvant immunotherapy endorsement. Findings clarify clinician preferences and values, aiding clinical communication with patients and facilitating clinical decision-making about management options for resected stage III melanoma.

Fatiga por compasión y factores relacionados en enfermeras de cuidados intensivos: un estudio multicéntrico / Compassion fatigue and related factors in intensive care nurses: a multicentre study

Objetivo: Determinar los niveles de fatiga por compasión y sus factores relacionados en profesionales de enfermería de tres Unidades de Cuidado Intensivo de la ciudad de Bucaramanga. Material y métodos: Estudio correlacional de corte transversal realizado entre febrero del 2018 y febrero del 2020. Se utilizó un muestreo a conveniencia. Se aplicó el cuestionario de Calidad de vida para profesionales ProQOL (Professional Quality of Life Scale). Resultados: En general se encontró según las pautas de la escala niveles inferiores al promedio de satisfacción por compasión 45.71% (n=32), niveles medios de Burnout: 56.34% (n=40) y niveles medios de trauma por compasión: 49.30% (n=35). No se encontraron diferencias significativas en relación a factores sociodemográficos. Conclusiones: Se encontraron bajos niveles de satisfacción por compasión lo que incrementa el riesgo de fatiga por compasión. No se hallaron diferencias significativas en relación a los años de experiencia laboral, la edad, el género, los años de experiencia o el estado civil (AU)

Objective: To determine the levels of compassion fatigue and its Related factors in nursing professionals from three Units Intensive Care. Material and methods: Cross-sectional correlational study carried out between February 2018 and February 2020. A sampling at convenience. The Quality of life questionnaire for professionals ProQOL (Professional Quality of Life Scale) was applied. Results: In general, it was found according to the scale guidelines lower than average levels of compassion satisfaction 45.71% (n = 32), mean levels of Burnout: 56.34% (n = 40) and mean levels of compassion trauma: 49.30% (n = 35). Significant differences were not found in relation to sociodemographic factors. Conclusions: Low levels of satisfaction were found for compassion, which increases the risk of compassion fatigue. No significant differences were found in relation to the years of work experience, age, gender, years of experience, or civil status (AU)

Clinical nurse specialist role implementation structures, processes and outcomes: Participatory action research.

AIM: To develop, implement and evaluate the clinical nurse specialist's role within a specialist medical healthcare hospital. A secondary aim was to assess the feasibility of the 'Clinical Nurse Specialist Conceptualisation, Implementation, and Evaluation framework' in the role implementation. BACKGROUND: Implementation of advanced practice nursing roles is an increasing practice around the globe; however, the implementation of these roles is multidimensional, complex process. Clear implementation strategies are needed. DESIGN: Participatory action research was conducted in Finland between 2017-2018. METHODS: The researchers adopted an outsider approach to work with staff, considered as co-researchers, within two participating units. A combination of several methods, such as focus group interviews, action-learning groups and researcher reflective field journal, was used to gather data. The 'Clinical Nurse Specialist Conceptualisation, Implementation, and Evaluation framework' was used to structure the processes undertaken, and the Donabedian structure, process and outcome model was used to structure and analyse the results. The study was reported using the EQUATOR guideline for participatory action research. RESULTS: The results demonstrated the complexity of the role implementation process. Four implementation themes of need analysis, role design, role implementation and role evaluation were examined and described through their structures, processes and outcomes. The 'Clinical Nurse Specialist Conceptualisation, Implementation and Evaluation framework' was validated for its appropriateness guiding the role implementation process. CONCLUSIONS: Role implementation is a complex process which structured, practical guidelines may facilitate. The examined framework may facilitate the role implementation process conducted within organisations. RELEVANCE TO CLINICAL PRACTICE: This research provides complimentary information for individuals and organisations aiming to develop a clinical nurse specialist or other advanced practice nursing roles. Furthermore, we describe a participatory action research process, which offers the means for self-reflection and planning of purposeful actions to improve the conditions of clinical practice.

An advanced practice nurse-led delirium consultation service reduces delirium severity and length of stay in orthopedic patients: A nonrandomized posttest only evaluation study.

PURPOSE: Delirium is an acute neuropsychiatric disorder and is a common and serious complication during hospitalization for older people. This study evaluated the value of an advanced practice nurse (APN)-led delirium consultation service on patient outcomes DESIGN AND METHODS: This was a retrospective chart review of 137 patients over 65 years, hospitalized between 2012 and 2015 in a tertiary care setting in Switzerland, who underwent orthopedic surgery and experienced delirium. FINDINGS: Of the 137 eligible patients, 53 received the delirium consultation service and 84 received the standard care. The group receiving "early" delirium consultation experienced significantly reduced delirium severity over the course of time and the shortest length of stay. PRACTICE IMPLICATIONS: The APN-led delirium consultation service had a positive effect on patient outcomes.