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BACKGROUND: New Zealand is one of the last high-income countries in the world experiencing significant rates of rheumatic fever. Nurses play a crucial role in rheumatic fever prevention; however, little is understood as to how nurses can best achieve this. AIM: To explore nursing practices that optimise rheumatic fever prevention. DESIGN: An integrative review. METHODS: Four electronic databases (CINAHL, SCOPUS, Medline via, and Ovid) were searched for peer-reviewed empirical articles published from 2013 to 2023. Grey literature (guidelines/reports) was also sourced. Critical appraisal was applied using the Mixed-Methods Appraisal Tools and the Joanna Briggs Critical Appraisal checklist. Qualitative Research in Psychology, 3(2), 77-101, thematic analysis method was used to generate themes. RESULTS: Seven research articles and three national reports were included. Four themes-in-depth nursing knowledge and improving prophylaxis adherence, cultural competency, and therapeutic nurse-patient relationships-were found. CONCLUSION: While nursing knowledge and ways to improve injection adherence are essential, being culturally receptive and developing therapeutic relationships are equally important. Without strong and trusting relationships, it is difficult to deliver care required for prevention success. IMPLICATIONS TO CARE: When working with vulnerable populations it is important to be culturally receptive in all interactions with patients and their families. IMPACT: New Zealand has high rates of rheumatic fever, especially among vulnerable populations such as Pacific Islanders and Maori. Nurses are often frontline primary care providers who, when skilled with the right tools, can help reduce the prevalence of this disease. REPORTING METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow chart. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution was required for this research.
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Fiebre Reumática , Humanos , Fiebre Reumática/prevención & control , Nueva Zelanda , Femenino , Masculino , Adulto , Relaciones Enfermero-Paciente , Persona de Mediana Edad , Rol de la EnfermeraRESUMEN
AIM: To explore the moral emotions that frontline nurses navigated in endeavouring to ensure a 'good death' for hospital patients and care home residents during the first wave of the COVID-19 pandemic. BACKGROUND: Under normal circumstances, frontline staff are focused on clinical ethics, which foreground what is best for individuals and families. Public health crises such as a pandemic require staff to adapt rapidly to focus on what benefits communities, at times compromising individual well-being and autonomy. Visitor restrictions when people were dying provided vivid exemplars of this ethical shift and the moral emotions nurses encountered with the requirement to implement this change. METHODS: Twenty-nine interviews were conducted with nurses in direct clinical care roles. Data were analysed thematically informed by the theoretical concepts of a good death and moral emotions. RESULTS: The data set highlighted that moral emotions such as sympathy, empathy, distress and guilt were integral to the decisions participants described in striving for a good palliative experience. Four themes were identified in the data analysis: nurses as gatekeepers; ethical tensions and rule bending; nurses as proxy family members; separation and sacrifice. CONCLUSIONS: Participants reflected on morally compromising situations and highlighted agency through emotionally satisfying workarounds and collegial deliberations that enabled them to believe that they were party to painful but morally justifiable decisions. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Nurses are required to implement national policy changes that may disrupt notions of best practice and therefore be experienced as a moral wrong. In navigating the moral emotions accompanying this shift, nurses benefit from compassionate leadership and ethics education to support team cohesion enabling nurses to prevail. PUBLIC CONTRIBUTION: Twenty-nine frontline registered nurses participated in the qualitative interviews that inform this study. REPORTING METHOD: The study adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.
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COVID-19 , Enfermeras y Enfermeros , Humanos , Pandemias , Salud Pública , COVID-19/epidemiología , Principios Morales , Investigación Cualitativa , EmocionesRESUMEN
OBJECTIVE: To identify trends in complaints received by the Health and Disability Commissioner (HDC) about aged residential care (ARC) facilities in order to learn from and implement positive changes in care. METHODS: A case study of 24 deidentified publicly available HDC cases across three large New Zealand ARC organisations was completed. Cross-case analysis first involved analysis of each case individually and then compared all cases using inductive thematic analysis with the intention of drawing a single set of conclusions. RESULTS: The speed at which the events occurred was contributory to the complaint, with 58% of the cases being rapid in nature and with sepsis being the predominant contributing factor to rapid decline and death. Six main diagnoses were indicators of deterioration: nutrition/hydration was indicated in 22% of the cases, followed by sepsis 17%, wounds 17%, UTI/renal issues 15%, falls 15% and respiratory issues 15%. CONCLUSIONS: Trends in Health and Disability complaints across multiple organisations can become a powerful tool for widespread quality improvement. This review highlights that the speed of deterioration triggered many complaints, especially in cases of sepsis which is possibly overlooked as a contributing problem. Also, that nutrition/hydration was indicated in many complaints and is an important condition-indicator. Trends in complaints are not generalisable to all large organisations; however, they can be applied to individual facilities.
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Intención , Sepsis , Humanos , Anciano , Nueva Zelanda , Riñón , Estado Nutricional , Sepsis/diagnóstico , Sepsis/terapiaRESUMEN
Objective To identify baseline factors associated with outcomes from an inpatient multidisciplinary pain management program (PMP) located in a bicultural area of Aotearoa New Zealand. Methods A prospective cohort study was undertaken involving 164 people with chronic pain who attended the PMP. Demographic, clinical, and psychosocial measures were obtained at baseline, whereas clinical and psychosocial outcome measures were also obtained at program discharge and 3-month follow up (N = 100). Multivariate analyses were used to determine baseline demographic variables that were associated with outcomes at discharge and follow up. Results Being male and working full-time were associated with poorer outcomes in select measures at discharge. At the 3-month follow up, Maori ethnicity, working full-time, being retired or unemployed, or having chronic widespread pain were associated with poorer outcomes for some measures, whereas those with rheumatoid arthritis had greater self-efficacy. Conclusions Sex, ethnicity, employment status, and patient condition impact clinical outcomes from the program and in the time from discharge to follow up. Program content and/or delivery should be altered to promote more equitable outcomes for all patients in the long term.
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Dolor Crónico , Humanos , Masculino , Femenino , Dolor Crónico/terapia , Estudios Prospectivos , Nueva ZelandaRESUMEN
Introduction Pacific people have an increased risk of hospitalisation if barriers to immunisation against vaccine-preventable diseases are not reduced. This research sought to determine what is known about the barriers to immunisations in Pacific people living in New Zealand and identify ways to reduce these barriers and inform health care. Aim To identify the barriers to immunisation for Pasifika and to identify ways to reduce these barriers and inform health care. Methods An integrative review was undertaken with databases searched for articles published between February 2021 and May 2021. The review follows the five-stage process of problem formulation; literature search; evaluation of data; data analysis and interpretation; and presentation of the results through discussion. Results Twelve studies were included. Three themes were identified: Deprivation, Health Literacy (which covered understanding the importance of immunisation programmes, attitudes and beliefs and communication), and access to health care (including communication accessibility to health professionals and physical access). Discussion This review has identified that barriers such as level of deprivation strongly influences immunisation uptake in Pacific people. The significance of government-led initiatives was shown to improve the rates of immunisation of Pacific children. Pacific people's awareness of immunisation programmes and government campaigns are encouraged to incorporate ethnic-specific strategies in addressing barriers, such as bringing vaccinations to where Pacific people frequent, including churches, community hubs, and venues that parents can easily access.
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Enfermedades Prevenibles por Vacunación , Niño , Humanos , Inmunización , Nueva Zelanda , Padres , Vacunación , Enfermedades Prevenibles por Vacunación/prevención & controlRESUMEN
Objective There is little information on how multidisciplinary pain management programs (MPMPs), the gold-standard treatment for people with chronic non-cancer pain, should be structured or delivered. This study compared outcomes from a 3-week in-patient MPMP between those who attended a group-based program that included 8 h of individual therapy each week and those who attended when the amount of individual therapy had been halved. Methods Participants were patients attending an MPMP with a large component of individual sessions (n = 112; Standard) and patients attending the same MPMP after it switched to predominantly group-based sessions (n = 117; Revised). The Hospital Anxiety and Depression Scale (HADS) and Queen Elizabeth (QE) Health Scale were administered to participants at baseline and discharge. Regression analysis was used to compare outcomes between the two delivery formats. Results There were no significant differences in any outcome measures between the two delivery formats overall. The QE Health Scale (P < 0.001) and HADS depression (P < 0.05) scores were significantly better for patients with rheumatoid arthritis or osteoarthritis who had undertaken the Revised program compared with the Standard program. Conclusions This study provides support that changing the amount of individual therapy within in-patient MPMPs does not change patient outcomes. However, there is evidence that those with rheumatoid arthritis and osteoarthritis respond better to a more group-based approach, suggesting that different populations may be suited to different delivery formats. What is known about the topic? Studies have shown mixed results as to whether group- or individual-based rehabilitation programs are more effective. Previous systematic reviews on physiotherapy- or psychological-based interventions have concluded that individual and group approaches are generally equivalent in terms of patient outcomes. MPMPs are trending towards more group-based delivery of content; however, it is unknown whether the equivalence of efficacy between group and individual formats extends to a chronic pain population receiving multidisciplinary care. What does this paper add? This research specifically adds to the knowledge that almost exclusive group delivery of therapy is just as effective as a program with more individual components in a population of patients participating in an MPMP. There is some evidence that those with rheumatoid arthritis and osteoarthritis in the almost exclusive group delivery program had better outcomes than those in the program with more individual components, indicating that specific conditions may benefit more from a group approach. What are the implications for practitioners? Practitioners can be confident that group delivery is just as effective as individual delivery of program components in an MPMP. Thus, decisions regarding the delivery format can be based on factors such as practical considerations, cost or patient and clinician preference.
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Dolor Crónico , Manejo del Dolor , Analgésicos Opioides , Dolor Crónico/terapia , Humanos , Evaluación de Resultado en la Atención de SaludRESUMEN
AIM: To explore if human resource practices are the key to manage job burnout in nurses. OBJECTIVE: To determine if human resource practices provide more meaningful work to nurses, subsequently leading to enhanced work-life balance and lower job burnout (emotional exhaustion and cynicism). BACKGROUND: Job burnout is a global phenomenon, particularly relevant in the nursing profession due to pressures within the health sector. Job burnout is also a result of nurses not balancing work with their life roles and maintaining meaning in one's work. High-performance systems are tools that hospital human resource departments can use to increase core employee factors that ultimately reduce the risk of job burnout. METHODS: Using cross-sectional data from 114 New Zealand nurses, we tested a path model to distinguish whether human resource practices can influence job burnout, with meaningful work and work-life balance mediating. The data were analysed using structural equation modelling and indirect effects for mediating. This research adhered to the STROBE Statement. RESULTS: Human resource practices are positively related to meaningful work and work-life balance, and meaningful work was positively related to work-life balance and negatively related to cynicism. Finally, work-life balance is negatively related to emotional exhaustion and cynicism. CONCLUSIONS: Given the influence of human resource practices on job burnout is fully mediated by meaningful work and work-life balance, indicating that managing job burnout is best understood via human resource practices enhancing nurses meaning from work and role balance, which subsequently reduces job burnout. RELEVANCE TO CLINICAL PRACTICE: Human resource practices can enhance work factors, such as meaningful work and work-life balance, that can enable nurses to have reduced job burnout. This will help prevent cynicism, exhaustion and will therefore prevent absenteeism, enhance performance and overall aid long-term employment benefitting not only patients but hospitals.
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Agotamiento Profesional , Agotamiento Profesional/psicología , Estudios Transversales , Humanos , Satisfacción en el Trabajo , Nueva Zelanda , Encuestas y Cuestionarios , Equilibrio entre Vida Personal y Laboral , Recursos HumanosRESUMEN
OBJECTIVES: Multidisciplinary pain management programs (PMPs) were established in the 1970s and are widely regarded as the gold standard management for people with chronic, noncancer pain. However, the recommended content of PMPs is not well described. The aim of the study was to determine the most common content and structure of inpatient PMPs, and describe how these have changed over time. METHODS: A mapping review was performed of studies incorporating an inpatient PMP. Information on the content, format, structure, clinicians involved, and outcome measures was extracted. Publications were analyzed across 5 decades from the 1970s to the 2010s. RESULTS: One hundred and four studies were included. All programs included physical therapy and psychology components, and most included education. While the physical therapy component did not change substantially, there was a shift from operant conditioning approaches to more cognitive behavioral methods over time, along with a reduction in active medication withdrawal and family involvement. Involvement of physical therapists, physicians, and psychologists remained high in the programs, but the inclusion of nurses and occupational therapists declined from the 2000s. The outcome measures revealed a shift to assessment of quality of life and general health. DISCUSSION: Some of the content and format of PMPs has evolved over time, largely with developments in psychological approaches, and there is now more of a holistic approach to assessment.