Uncontrolled chronic pain is one of the barriers preventing older people from achieving active ageing. Effective pain management can enhance their mobility, increasing the happiness level and thus the quality of life.

Exploratory cross-sectional study.

Cognitively intact community-dwelling older persons aged over 60 in Hong Kong were invited for a 20–25-minute interview.

A total of 173 participants were recruited, with a mean age of 73·2. The average pain intensity was 3·97 ± 1·80. Oral analgesic drugs were used by 47·1% of participants, and 86·0% used nonpharmacological methods to relieve pain. Compared with participants free of chronic pain, participants with pain had lower happiness levels (p < 0·05). In addition, levels of mobility (p < 0·05) and physical quality of life (p < 0·05) were lower for older people with pain. Pain intensity was negatively correlated with physical quality of life (p < 0·05) and self-efficacy (p < 0·05), and positively correlated with mystery (p < 0·05), permanence (p < 0·05) and self-blame (p < 0·05) in pain belief.

It was noted that nonpharmacological methods were commonly used by older persons as pain relief and that older persons with pain were less happy, less mobile and had a poorer quality of life as compared to their counterparts without pain.

It is important to educate community-dwelling older persons on methods of pain management and to maintain their physical and psychological well-being in order to engage them in the community and lead a healthy and happy ageing.

While the effectiveness of cardiac rehabilitation is long established, more studies are needed to examine the combined effectiveness of this multicomponent intervention and the factors that influence this in the changed profile of patients currently attending cardiac rehabilitation.

The study was a longitudinal retrospective study of patients following a six- or eight-week Phase III cardiac rehabilitation programme.

The study recruited 154 patients. Functional capacity, anxiety, depression, weight, waist circumference and BMI were assessed at the beginning and end of cardiac rehabilitation. t-tests were used to assess changes over time, and multivariate regression analysis was used to determine the influence of factors on these changes.

Significant improvements were seen in functional capacity, waist circumference, weight and BMI, but not in depression and anxiety. Multivariate analysis revealed that being younger and less fit was associated with greater improvements in functional capacity while reason for referral, gender, depression or BMI did not influence improvements in functional capacity. Models testing the influence of the factors on BMI, anxiety and depression were not significant.

Cardiac rehabilitation is still an effective method to instigate changes in cardiac risk factors despite the changes in patients profile attending programmes.

Continued encouragement of the historically less typical patients to participate in cardiac rehabilitation is needed as reason for referral, gender, depression or BMI did not influence improvements in functional capacity. Despite psychosocial components within the programme, no significant improvements were observed over cardiac rehabilitation in depression or anxiety. While effectiveness was observed, there is room for further optimisation of practice and research by employing and documenting clearly the use of behavioural techniques.

Point-of-care tests are usually carried out by nurses. They are used in many healthcare units. Through training, nurses are able to improve their competence in performing point-of-care testing.

Systematic review.

A literature search of electronic data was undertaken in autumn 2011 using CINAHL, The Cochrane Library, Medline (Ovid) and Scopus databases.

From the available literature, six specific initiatives were analysed. The studies were performed on three continents and in five healthcare settings. The three interventions were related to glucose point-of-care testing. The training approaches involved seven aspects. The interventions were diverse, broad and multifaceted, but they appeared to be successful. The strength of the interventions lay in the involvement of laboratory staff. Quantitative synthesis of the data was not undertaken because of different designs for the studies.

Training can improve nurses' competence, and many methods are available. There are very few studies of training nurses in point-of-care testing, although in-depth descriptions of interventions in different settings would be valuable.

Nurses can be trained using a variety of methods in different healthcare settings. To save resources, especially in large hospitals and sparsely populated areas, distance learning is worth considering. However if training is delivered with the support of laboratory professionals, nurses subsequently perform good-quality point-of-care testing.

Chronic obstructive pulmonary disease is a chronic illness that can lead to poor nutritional status due to an increased energy requirements related to laboured breathing. Inadequate nutritional intake has often been described in this patient group. Nutritional support for patients with chronic obstructive pulmonary disease who suffer from nutritional problems is essential, both for their sense of well-being and for their survival with chronic obstructive pulmonary disease.

The study design was descriptive and comparative.

Quantitative data collection was carried out among 81 patients with chronic obstructive pulmonary disease (47 women and 34 men) with an average age of 65 years (SD 3·5). The Mini Nutritional Assessment was used to assess nutritional status.

Participants who lived alone had worse nutritional status than those who did not live alone, and female participants had worse nutritional status than their male counterparts. No significant correlation was found between pulmonary function and nutritional status.

This study contributes knowledge of a potential correlation between nutritional status, gender and marital status in patients with chronic obstructive pulmonary disease. Women with chronic obstructive pulmonary disease may be at an increased risk of malnutrition. Despite the previous results showing malnutrition and underweight to be common, the present study found that many of the participants were overweight, which may reflect a global health trend regardless of disease.

Early identification of patients at risk of malnutrition is important. Registered nurses should be aware that patients with chronic obstructive pulmonary disease who are female or who live alone may be at an increased risk of nutritional problems. Patients with chronic obstructive pulmonary disease must be offered information and support for individually adapted measures at an early stage in order to avoid nutritional problems, regardless of under- and overweight.

Concern about attracting and retaining registered nurses is a continuing workforce issue in parts of Asia and throughout the world.

Qualitative interviews with recent nursing graduates.

Seventeen face-to-face interviews took place using a structured schedule of 23 questions. Data were coded and analysed by hand to determine clusters of interest and develop themes.

Four broad topics emerged: (1) skills and qualities graduates consider central to nursing; (2) the support they received during the transition from graduate to novice practitioner and that which continues; (3) elements they value in nursing role models and leaders; and (4) the ward characteristics that will encourage them to remain in nursing and develop a career. Interviewees expressed concerns about retention-related issues, making suggestions for improvements. Unique findings focus on the blaming culture that many respondents consider they are working in, and the system whereby they are not free to access postgraduate studies until a specific time frame has elapsed, and when they do pursue further studies, they are bonded to the auspicing hospital/health service.

Responses unique to this research are the explicit concerns about a blaming culture, and complaints about rigid rules (bonding system) that virtually prevent an individual from accessing postgraduate studies independent of the hospital system. Interviewees strongly resent the bonding system that indentures them to that place of work.

Quality health care is dependent on a well-educated, sustainable and skilled nursing workforce. Recognition of the concerns of newly graduated nurses in relation to nursing skill acquisition, workplace support issues and career concerns can assist in ensuring these issues are adequately addressed and in turn contribute to a stronger, more stable and competent nursing workforce.

Accurate patient assessment is imperative to determine the status and needs of the patient and the delivery of appropriate patient care. Nurses must be highly skilled in conducting timely and accurate patient assessments to overcome environmental obstacles and deliver quality and safe patient care. A structured approach to patient assessment is widely accepted in everyday clinical practice, yet little is known about the impact structured patient assessment frameworks have on patient care.

Integrative review.

An electronic database search was conducted using Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System, PubMed and ProQuest Dissertations and Theses. The reference sections of textbooks and journal articles on patient assessment were manually searched for further studies. A comprehensive peer review screening process was undertaken. Research studies were selected that evaluated the impact structured patient assessment frameworks have on patient care. Studies were included if frameworks were designed for use by paramedics, nurses or medical practitioners working in prehospital or acute in-hospital settings.

Twelve studies met the inclusion criteria. There were no studies that evaluate the impact of a generic nursing assessment framework on patient care. The use of a structured patient assessment framework improved clinician performance of patient assessment. Limited evidence was found to support other aspects of patient care including documentation, communication, care implementation, patient and clinician satisfaction, and patient outcomes.

Structured patient assessment frameworks enhance clinician performance of patient assessment and hold the potential to improve patient care and outcomes; however, further research is required to address these evidence gaps, particularly in nursing.

Acute care clinicians should consider using structured patient assessment frameworks in clinical practice to enhance their performance of patient assessment.

Patient-controlled intravenous analgesia has been used most commonly for management of postoperative pain. Although it can be very effective in management of postoperative pain, patients still complained of many adverse reactions.

A quasi-experimental study design was used.

Seventy female participants were recruited for each group and were randomly assigned to one of the pain management methods. Data regarding pain level, adverse reactions experienced and level of satisfaction with pain management methods during a 48-hour postoperative period were collected. Calculation of cost for each pain management method was based on the cost of the device, drugs for both analgesics and antiemetics, and time spent by nurses for both pain management methods. Frequencies, percentages and means of the data were calculated, and chi-squared test and t-test were performed for homogeneity.

Mean postoperative pain levels at 2, 6 and 12 hour were significantly lower in patients who used patient-controlled analgesic compared with patients who received intravenous injection; however, after that, there was no significant difference between the two methods. The cost for pain management was much higher for patients who used patient-controlled analgesic; however, satisfaction level with pain control was lower than that for patients who received intravenous injection.

For patients who underwent total hysterectomy, patient-controlled analgesia was not cost-effective for management of postoperative pain for 48 hour, compared with conventional intravenous injection.

For nurses caring for patients with pain, adaptation of diverse methods of pain management that will increase patients' satisfaction with pain management as well as lower the cost and occurrence of adverse reactions should be considered.

Breastfeeding is endorsed by the World Health Organisation as a key health promotion strategy, and yet many women in Australia cease breastfeeding (either fully or partially) before the recommended time frame of six months. Engaging with and interviewing families is a well-established research strategy, but interviewing the family as a whole has rarely been used as a part of breastfeeding research.

A component of a study, conducted in Sydney, Australia, was to use ‘family conversations’ to ascertain the views and beliefs that are held by those in the first-time mother's social network and how these impact on her experience of mothering and associated decision-making.

Being able to balance the needs of the researcher and the research participants is an important challenge that is a core component of conducting ethical research.

This paper highlights the viability of ‘family conversations’ as a data collection method for midwifery and nursing research and the need for midwives and child and family health nurses to more actively engage with a woman's support network with education and other strategies to assist in creating an environment for new mothers that is conducive to the continuation of breastfeeding and thriving as a mother.

Fatigue is a complex multidimensional symptom experienced by patients with varying diagnoses. Limited details are available on the nature of nursing interventions to manage fatigue, which preclude fidelity of implementation in day-to-day practice.

Literature review.

Multiple databases were searched for publications reporting on the evaluation of nurse-delivered interventions for the management of fatigue. Data were extracted on study and intervention characteristics and results pertaining to the effects of the intervention on fatigue.

The studies (n = 16) evaluated eight interventions: psycho-education, cognitive behavioural therapy, exercise, acupressure, relaxation, distraction, energy conservation and activity management, and a combination of exercise, education and support.

Psycho-education was evaluated in several studies and demonstrated effectiveness when delivered in both acute and community settings.

This review focused on interventions that are within the scope of nursing practice for the management of fatigue. The findings provide nurses with an overview of the effectiveness of interventions they may use in their day-to-day practice to help patients manage fatigue. A detailed description of interventions found effective is provided to assist nurses in translating evidence into practice.

In palliative care settings, nurses and the terminally ill person's family members interact very closely with each other. It is important for nurses to work with families to ensure that the care of the terminally ill person is optimised.

A qualitative design using grounded theory methods was used to describe how nurses engaged with families and the challenges they faced.

Twenty-two nurses from home care and inpatient palliative care settings across Malaysia participated in this study. Data were collected through seven interviews and eight focus group discussions conducted between 2007–2009.

The main problem identified by nurses was the different expectations to patient care with families. The participants used the core process of Engaging with families to resolve these differences and implemented strategies described as Preparing families for palliative care, Modifying care and Staying engaged to promote greater consistency and quality of care. When participants were able to resolve their different expectations with families, these resulted in positive outcomes, described as Harmony. However, negative outcomes of participants not being able to resolve their different expectations with families were Disharmony.

This study highlights the importance of engaging and supporting families of the terminally ill as well as providing a guide that may be used by nurses and carers to better respond to families' needs and concerns.

The study draws attention to the need for formal palliative care education, inclusive of family care, to enable nurses to provide the terminally ill person and their family effective and appropriate care.

Fatigue, characterised by tiredness, weakness or lack of energy, involves physical, cognitive and emotional aspects. Its aetiology is not well defined and the prevalence ranges from 30–70% in women with breast cancer, reaching up to 80% when they are undergoing radiotherapy. This is one of the most frequent side effects of radiotherapy, and it may interfere with self-esteem, social activities and quality of life.

Literature systematic review.

A search for studies published from 2000–2010 was carried out in Pubmed, Scielo and Bireme databases, using the descriptors fatigue and radiotherapy and their correlates in Portuguese.

We selected 12 articles of 1085 found. The number of studies involving breast cancer was higher than those related to gynaecological cancer. Functional Assessment of Cancer Therapy-Fatigue was the most used scale specifically for the evaluation of fatigue. Pretreatment fatigue level may be an important risk factor to aggravate it during radiotherapy and decrease the quality of life. Five studies proposed interventions, all of them involving non-pharmacological therapies: cognitive-behavioural therapy associated with hypnosis, moderate-intensity physical exercises, stretching programmes, yoga and polarity therapy. The studies showed good results in relation to fatigue, physical and psychological aspects, and quality of life.

Early detection of fatigue, using appropriate scales, is relevant to propose suitable treatments and achieve better clinical conditions, adherence and continuity of radiotherapy treatment, aiming to ensure more effective responses.

Fatigue is a frequent symptom in patients undergoing radiotherapy. It may become a factor that limits or prevents the continuity of radiotherapy and therefore should be diagnosed in the initial appointments, so that it can be properly treated.

Promoting oral health is an important nursing role for patients with diabetes, especially in disadvantaged areas. However, limited research has been carried out on the relationship between numbers of remaining teeth, diabetes-related biomarkers and personal oral hygiene among diabetic rural residents.

A cross-sectional, descriptive design with a simple random sample was used.

This study was part of a longitudinal cohort study of health promotion for preventing diabetic foot among rural community diabetic residents. It was carried out in 18 western coastal and inland districts of Chiayi County in central Taiwan. In total, 703 participants were enrolled in this study.

The findings indicated that a high percentage of the participants (26%) had no remaining natural teeth. Nearly three quarters (74%) had fewer than 20 natural teeth. After controlling for the potential confounding factors, multivariate analysis demonstrated that the factors determining numbers of remaining teeth were age (p < 0·001), education (p < 0·001), using dental floss (p = 0·003), ankle brachial pressure index (p = 0·028), waist circumference (p = 0·024) and HbA1C (p = 0·033).

Except for some unmodifiable factors, the factors most significantly associated with numbers of remaining teeth were less tooth-brushing with dental floss, abnormal ankle brachial pressure and poor glycemic control.

This study highlights the importance of nursing intervention in oral hygiene for patients with type 2 diabetes. It is necessary to initiate oral health promotion activities when diabetes is first diagnosed, especially for older diabetic residents of rural or coastal areas who are poorly educated.

Literature reveals that knowledge exists concerning the nature of dignity. Literature is scant on how health personnel think the reasons may be when patients do not maintain their dignity or how caregivers might improve and strengthen their concern in preserving and promoting the patients' dignity in a rehabilitation context.

The study was explorative and descriptive, with content analysis of gathered empirical data.

Qualitative focus group interviews with representatives from the staff at three different rehabilitation centres were carried out. Professionals within different occupations were represented at the meeting: nurses, ergonomists, physiotherapists, psychologists, medical doctors, social workers, auxiliary nurses and speech therapists.

Dignity is promoted when the patient himself becomes an active agent, when the patient's feelings and thoughts are respected, when the family of the patient is included and listened to, when the patient is free to make critical comment, when members of staff are able to cope with the patient's disabilities and when the aesthetic environment is attended to and enhanced. Dignity is not promoted when health personnel override or dominate patients, when health personnel focus merely on the patient's diagnosis and not the sick person and when health personnel and/or relatives try to impose their own values.

The staff working in institutions to rehabilitate patients with head injuries and multiple sclerosis must be aware and sensitive to the importance of maintaining and supporting the patient's dignity and self-respect.

The results from this project confirm the importance of acknowledging the patient's self-worth as a human being, unconditionally. This might be essential in promoting and preserving the patients' dignity.

Children continue to experience moderate to severe pain postoperatively. Unrelieved pain has short- and long-term undesirable consequences. Thus, it is important to ensure pain is managed effectively. Little research has explored children's and parents' perceptions of pain management.

Exploratory study.

Children (n = 8) were interviewed about their perceptions of pain care using the draw-and-write technique or a semi-structured format and asked to rate the worst pain experienced postoperatively on a numerical scale. Parents (n = 10) were asked to complete the Information About Pain questionnaire. Data were collected in 2011.

Most children experienced moderate to severe pain postoperatively. Children reported being asked about their pain, receiving pain medication and using non-pharmacological methods of pain relief. A lack of preoperative preparation was evident for some children. Most parents indicated they had received information on their child's pain management. Generally, participants were satisfied with care.

Participants appeared satisfied with the care provided despite experiencing moderate to severe pain. This may be attributable to beliefs that nurses would do everything they could to relieve pain and that some pain is to be expected postsurgery.

Children are still experiencing moderate to severe pain postoperatively. Given the possible short- and long-term consequences of unrelieved pain, this is of concern. Knowledge translation models may support the use of evidence in practice, and setting a pain goal with parents and children may help improve care.

One in four older people who visits a General Practitioner suffers from depression. Depression is a concern for 15% of all older home-care service clients. Detecting and managing depression in older people is highlighted as a key role of nurses. A literature review has been conducted to investigate collaborative models of care, aimed at ensuring low-threshold access to care and exploring the scope of nurse practice within these models.

Literature review comprising 14 studies and reviews.

Three different collaborative care programmes (Collaborative Care Model, Community Mental Health Team and Psychogeriatric Assessment and Treatment in City Housing programme) were identified. In all programmes, the essential aspects were complex and multifaceted interventions, provided by a variety of healthcare professionals, but the access to care differed. All studies described the role of nurses differently and with wide variations.

Despite a broad scope of practice, nurses play a pivotal role within the different models of care. Nurses have to have the educational background and expertise in mental health issues to recognise depression and eventually be able to provide more comprehensive interventions to alleviate depression in older people.

Collaboration is needed to meet the needs of older people with depression. New forms of work divisions are pivotal to achieve this objective.

The majority of studies focus on examining the relationships between the late-treatment side effects and quality of life in gynaecological cancer survivors. As a result, there is insufficient information about what are the correlations between psychosocial factors and quality of life in gynaecological cancer survivors.

Cross-sectional study.

The quality of life of the 85 gynaecological cancer patients who had completed active treatments for at least six months was compared with the 85 age-matched women without cancer history. Measures included SF-12 Health Surveys, Medical Outcomes Study Sleep Scale, Beck Depression Inventory-II, State-Trait Anxiety Inventory, Sexual Activity Questionnaire and Experiences in Close Relationships-Revised.

There were no significant differences in the quality of life between gynaecological cancer survivors and noncancer women. However, higher attachment-related anxiety in close relationship was the main factor associated with the lower physical quality of life in the gynaecological cancer survivor group. In contrast, older ages were correlated with lower physical quality of life in noncancer women. Anxiety level was the main factor associated with lower mental quality of life for both groups.

Different from noncancer women, the psychosocial factor of insecure attachment in close relationships was the main factor associated with physical quality of life for gynaecological cancer survivors. Anxiety status was the common factor correlated with mental quality of life for cancer and noncancer women.

Developing psychosocial interventions focusing on secure attachment in close relationships and anxiety management could improve physical and mental components of quality of life among gynaecological cancer survivors.

In studies conducted to prevent the bruising associated with the subcutaneous injection of heparin, it is observed that bruising cannot be prevented completely; however, there is a decrease in frequencies and sizes of bruising. There is no study aimed at accelerating the bruising recovery.

Quasi-experimental.

Thirty-three patients, who were treated for heparin and had bruising in the injection site, were included in the study. One of their upper arms with bruising was considered as the experimental arm, and the other upper arm with bruising was considered as the control arm. ‘Local dry heat pack’ application was performed on the bruising area in the experimental arm 72 hours after the heparin injection. As the bruising areas in the other upper arm were considered as the control arm, no application was performed. The sizes of bruising areas were drawn on the transparent film and determined as square centimetre.

The size of bruising areas was 3·21 ± 3·78 cm² in the experimental arm and 5·22 ± 4·45 cm² in the control arm 120 hours after the injections. The difference between the bruising sizes of the experimental and control arms was statistically significant.

It was observed that ‘local dry heat pack’ application had a positive effect on the recovery of bruising, associated with the subcutaneous injection of heparin.

The acceleration of bruising recovery will enable decreasing patients' anxieties, improving their body image and increasing their adherence to therapy.

Capacity assessment is of significant priority within health care as a finding of incapacity is a vehicle for the removal of many of an individual's fundamental rights. Despite there being many instruments and tools available to aid health professionals in the assessment of patient capacity, there are no standardised guidelines from professional bodies that inform the assessment of mental capacity.

Integrative review.

Primary studies of instruments or tools concerning assessment of patient capacity to consent to treatment, published in English in peer-reviewed journals between January 2005–December 2010, were included in the review. Review papers of capacity assessment instruments were included for years including and prior to 2006.

Nineteen instruments were found which assess patient capacity to consent. Key themes were identified in terms of capacity domains assessed, psychometric properties, instrument implementation, patient populations studied and instrument versus clinician judgement.

Despite a plethora of capacity assessment instruments and tools available, only a small number of instruments were found to have demonstrated both reliability and validity. Further research is required to improve the validity of existing capacity assessment instruments.

Increased attention to patient rights and autonomy arguably places a considerable burden on healthcare professionals to facilitate capacity assessments across a continuum of health care. Despite a plethora of capacity assessment instruments and tools being available to healthcare professionals, a comprehensive assessment requires time and is often difficult in the acute care setting. A strictly formulaic approach to the assessment of capacity is unlikely to capture specific individual nuances; therefore, capacity assessment instruments should support, but not replace, experienced clinical judgement.

Executive function is an important contributor to functional independence as it consists of cognitive processes needed for decision-making, planning, organising and behavioural monitoring. Impairment in this domain is common in heart failure patients and associated with reduced performance of instrumental activities of daily living in many medical and neurological populations. However, the contribution of executive functions to functional independence and healthy lifestyle choices in heart failure patients has not been fully examined.

Cross-sectional analyses.

One hundred and seventy-five heart failure patients completed a neuropsychological battery and echocardiogram. Participants also completed the Lawton–Brody Instrumental Activities of Daily Living Scale and reported current cigarette use.

Hierarchical regressions revealed that reduced executive function was independently associated with worse instrumental activity of daily living performance with a specific association for decreased ability to manage medications. Partial correlations showed that executive dysfunction was associated with current cigarette use.

Our findings suggest that executive dysfunction is associated with poorer functional independence and contributes to unhealthy behaviours in heart failure. Future studies should examine whether heart failure patients benefit from formal organisation schema (i.e. pill organisers) to maintain independence.

Screening of executive function in heart failure patients may provide key insight into their ability to perform daily tasks, including the management of treatment recommendations.

In recent years, several intermediate units have been established to improve the clinical pathway from hospital to home for older patients.

Qualitative study.

Data were obtained from interviews with eight patients and 16 healthcare providers working in the unit and from observations in six multidisciplinary meetings and six report meetings in the unit. Transcripts of interviews and field notes were analysed using a method for systematic text condensation.

Care performed as a balance between relational, practical and moral aspects seems to be important to render good service to patients and to ensure the providers’ job satisfaction. Most patients experienced their stay in the unit as positive. The providers highlighted ‘suitable patients’, an appropriate physical environment and communicating computer systems as significant factors for performing treatment and for providing nursing and rehabilitation in a caring manner.

When environmental and organisational conditions exert pressure on the working situation, care as a practical activity seems to be prioritised at the expense of the two other aspects. The findings indicate that unfavourable environmental and organisational conditions impede patients' recovery process and thereby a good clinical pathway.

To recruit, support and retain a multidisciplinary staff to the best interest of patients, it seems to be important to perform care work as a balance between relational, practical and moral activities.

Sexual health care is an important component of holistic health care. Nurses' personal sexual knowledge and attitudes are shown to influence provision of sexual health care.

This is a descriptive, cross-sectional study.

We selected 146 senior nursing students by convenience sampling from nursing schools in two medical universities in central Taiwan. Data were collected using the Nursing Attitudes on Sexual Health Care scale developed based on the ‘Permission/Limited Information/Specific Suggestions/Intensive Therapy’ model. Higher scores indicated more positive attitudes.

Participants' mean age was 22·15 years. Mean total Nursing Attitudes on Sexual Health Care scores ranged from 45–75 (61·40 ± 10·17). Nursing students' most positive attitudes towards Permission/Limited Information/Specific Suggestions/Intensive Therapy sexual healthcare interventions were at the Permission level, and least positive attitudes were at levels of Specific Suggestion and Intensive Therapy. The top three positive items were as follows: accept patients' expression of sexual concerns, initiate discussions and encourage patients to talk. Male nursing students had negative attitudes towards sexual healthcare interventions, which became more positive as age increased, especially at the Limited Information level.

Nursing students had different attitudes towards different levels of sexual health care in the Permission/Limited Information/Specific Suggestions/Intensive Therapy model. Attitudes were associated with age and gender. The Nursing Attitudes on Sexual Health Care scale is useful and reliable for identifying nurses' attitudes towards providing sexual health care.

The Permission/Limited Information/Specific Suggestions/Intensive Therapy-based Nursing Attitudes on Sexual Health Care scale helps to identify nurses' attitudes. A better understanding of nurses' attitudes towards provisional sexual health care will provide information needed to develop appropriate education programmes to improve delivery of sexual health care.

The C-PNWE scale was translated and revised from the PNWE scale. The least of perfection is that the development of C-PNWE ignored that the psychometric properties of the PNWE instrument were established of critical care nurses and further application and testing of the PNWE in various patient care settings were recommended.

This is a cross-sectional design. Nurses from different departments of a hospital were sampled by convenience sampling and investigated by self-administrated questionnaire.

Data obtained through questionnaires were analysed by descriptive statistical analyses and profile analyses using the Statistical Package for the Social Sciences (SPSS) Chinese version 17.0 software.

The coincident and level profile analyses indicated that these groups can merge into one group, and the profile of measurement result of this merged group would not exhibit flatness. Among six dimensions of C-PNWE scale, the Staffing and Resource Adequacy got the lowest average score. Among 41 items, ‘Opportunity for staff nurse to participate in policy decisions’ got the lowest mean.

The C-PNWE scale shows good psychometric properties and can be used to explore nurses' perspectives of the nursing practice environment in China. And the situation of nurses' perceived working environment in China needs further study.

Shaping nursing practice environments to promote desired outcomes requires valid and reliable measures to assess practice environments prior to, during and following efforts to implement change. The C-PNWE scale can be a useful measurement tool for administrators to improve the nursing work environment in China.

Increasingly, hospital nurses are urged to promote patients' health and meet their needs. Yet, internationally, little is known about how patients themselves understand health promotion, and no Jordanian study has been undertaken in this area.

A qualitative design was used.

Focus group discussions (n = 4) were undertaken with hospital patients. All discussions were digitally recorded, transcribed verbatim and analysed using qualitative thematic analysis.

Three images of health promotion emerged. These include health promotion as having adequate health knowledge, economic independency and good environment. It was also found that gender and spirituality affected patients' conceptualisations.

Hospital patients' understanding and expectations of health promotion are complex and go beyond the disease management approach. Therefore, if health promotion is to meet patients' needs and operate at empowerment and socio-economic levels, the images identified in this article should be considered. The study limitations and recommendations for practice and future research are also outlined.

There is a need for a framework of health promotion that integrates patients' beliefs in general and particularly those related to religion and gender roles within the daily philosophy of care. Having achieved this, hospital nurses will be able to deliver culturally competent and wide-reaching health promotion.

Up to 83% of intensive care unit patients experience delirium. In addition to increased risk of mortality, morbidity and cognitive impairment, the experience itself is unpleasant. A number of studies have focused on memories associated with delirium, but the association between delirium, memories and health-related quality needs further investigation.

We used an observational multicentre design with telephone interviews.

Adult intensive care unit patients (n = 360) were consecutively recruited and interviewed using the intensive care unit-Memory Tool one week after intensive care unit. Interviews were repeated after two and six months and supplemented with Short Form-36 and the Barthel Index.

Delirium was detected in 60% of the patients in our study, and delirious patients had significantly fewer factual memories and more memories of delusion than nondelirious patients up to six months postintensive care unit discharge. Delirium, memories and intensive care unit diaries with follow-up did not affect health-related quality of life and healthcare dependency. Memories of delusions might have an impact on patients assessed as nondelirious.

More than half of the patients in intensive care unit experience delirium, which is associated with fewer factual memories and more memories of delusions. Short Form-36 might not be sensitive to delirium-related outcomes. Future research should include the development of better assessment tools to determine the long-term consequences of intensive care unit delirium.

We recommend regular assessment to prevent, detect and treat delirium. We also recommend an intensive care unit follow-up programme providing an opportunity for postintensive care unit patients, particularly previously delirious patients, to discuss their memories and experiences with intensive care unit professionals.

This article reports on a qualitative follow-up study to a whole-population survey investigating the under-reporting of violence within one learning disability service. The survey had identified a pronounced level of under-reporting but suggested an unexpected degree of complexity around the issue, which warranted further study.

A qualitative research design was employed.

Semi-structured interviews were conducted with 22 professionals working in learning disability services; data were subsequently transcribed verbatim and subject to stringent thematic analysis.

The findings confirmed that the decision to report an incident or not was complicated by professional interpretation of violence. Three themes were produced by the analysis: the reality of violence, change over time and (zero) tolerance.

The study indicates that both experience of violence and ways of understanding it in relation to learning disability are shared across professional groups, although nurses are both more inured and generally more accepting of it. The study suggests that the relationship between learning disability nurses and service users with a propensity for violence is complicated by issues of professional background and concerns about the pertinence of zero tolerance.

The availability of effective protocols and procedures is important, but services need also to acknowledge the more ambiguous aspects of the therapeutic relationship to fully understand under-reporting of service user violence in the context of learning disability.

Over 50% of adults diagnosed with a terminal illness and the majority of people who have cancer, prefer to be cared for and to die in their own home. Despite this, most deaths occur in hospital. Increasing the options available for patients, including their place of care and death is central to current UK policy initiatives. Hospice at home services aim to support patients to remain at home, yet there are wide variations in the design of services and delivery. A hospice at home service was developed to provide various components (accompanied transfer home, crisis intervention and hospice aides) that could be tailored to meet the individual needs of patients.

An evaluation study.

Data were collected from 75 health care professionals. District nurses participated in one focus group (13) and 31 completed an electronic survey. Palliative care specialist nurses participated in a focus group (9). One hospital discharge co-ordinator and two general practitioners participated in semi-structured interviews and a further 19 general practitioners completed the electronic survey.

Health care professionals reported the impact and value of each of the components of the service, as helping to support patients to remain at home, by individually tailoring care. They also positively reported that support for family carers appeared to enable them to continue coping, rapid access to the service was suggested to contribute to faster hospital discharges and the crisis intervention service was identified as helping patients remain in their own home, where they wanted to be.

Health care professionals perceived that the additional individualised support provided by this service contributed to enabling patients to continue be cared for and to die at home in their place of choice.

This service offers various components of a hospice at home service, enabling a tailor made package to meet individual and local area needs. Developing an individually tailored package of care appears to be able to meet specific needs.

Despite numerous initiatives aimed at teaching blood pressure measurement techniques, many healthcare providers measure blood pressures incorrectly.

Descriptive, cohort design.

Medical assistants and licensed practical nurses were asked to complete a questionnaire on TPB variables. These nursing staff's patients had their blood pressures measured and completed a survey about techniques used to measure their blood pressure. We correlated nursing staff's responses on the TBP questionnaire with their intention to measure an accurate blood pressure and with the difference between their actual blood pressure measurement and a second measurement taken by a researcher immediately after the clinic visit. Patients' perceptions of MAs' and LPNs' blood pressure measurement techniques were examined descriptively.

Perceived control and social norm predicted intention to measure an accurate blood pressure, with a negative relationship between knowledge and intention. Consistent with the TPB, intention was the only significant predictor of blood pressure measurement accuracy.

Theory of planned behavior constructs predicted the healthcare providers' intention to measure blood pressure accurately and intention predicted the actual accuracy of systolic blood pressure measurement. However, participants' knowledge about blood pressure measurement had an unexpected negative relationship with their intentions.

These findings have important implications for nursing education departments and organisations which traditionally invest significant time and effort in annual competency training focused on knowledge enhancement by staff. This study suggests that a better strategy might involve efforts to enhance providers' intention to change, particularly by changing social norms or increasing perceived control of the behaviour by nursing staff.

Discharge planning commenced at admission by nurses plays a key role in improving patient outcomes,but policies in place to maintain effective discharge planning are often not followed by nurses.

This is a descriptive study.

Nurses (n = 64) working in acute wards undertook a self-report survey of discharge planning understanding, adherence and barriers.

Adherence to discharge planning policy is low (23%), despite a general awareness of the reduced quality of patient outcomes that may result. The most common barriers to discharge planning identified were lack of time and patient factors. Further contradictions occurred in that nurses understood the importance of discharge planning, yet did not comply with discharge planning policies.

Nurses require additional encouragement and support in complying with discharge planning policies, and discharge planning policies should be adapted to better handle unpredictable illness trajectories.

Completion of discharge planning is important for the safe transition of patients from one care setting to the next. Before a systematic approach to discharge planning can be implemented, a greater understanding of nurses' discharge planning practice in acute care wards is required. Greater incorporation of discharge planning activities into nurses' daily practice may also occur if nurses are involved in the development and implementation of the discharge processes and then provided with education and regular feedback on monthly audit results.

Children undergoing surgery often experience anxiety, which may lead to negative health outcomes, such as increased pain, feeding difficulties and sleeping problems. Education of children about their condition according to their individual needs may be correlated with reduced anxiety.

Systematic review.

A database search in MEDLINE, PsycInfo, Cochrane Library and CINAHL was carried out during February 2011. Using the PICOS acronym, the query was organised into a searchable foreground question: the studies should evaluate (Objective) the effects of education (Intervention) compared with the standard preparation (Control) for children aged 2–12 years old undergoing elective surgeries (Population). The results would be based on randomised controlled studies (Study design). In total, 475 articles were yielded, from which 45 full-text articles were assessed for eligibility, and finally, 16 studies were included in the review.

In 12 of the 16 studies, children in the education groups reported lower anxiety scores. In two studies, no statistically significant effect of education was reported on anxiety. Moreover, education had an age-related effect in two studies, by being more effective to children older than four to six years and having a negative effect on younger children's anxiety. Parents of children in the education groups experienced lower anxiety.

Education seems to be especially effective in the reduction in older children's anxiety and to have a negative effect on younger children's anxiety.

Education can be incorporated into the care provided to children aged four to six years or older undergoing elective surgical procedures, according to their individualised needs.

A major complication of abdominal surgical procedures is paralytic ileus which results in patient discomfort, prolonged length of hospital stay and increased cost of treatment.

Prospective randomised case–control study.

Women who underwent abdominal gynaecological surgery for benign disorders under general anaesthesia were randomised into eight groups according to different combinations of interventions consisting of chewing gum, early oral hydration and early mobilisation. The effects of these interventions on the time of first bowel sounds, first passage of flatus and first defecation following abdominal gynaecologic surgery were investigated. The data were analysed using chi-square tests, t-test for independent samples, Tukey's HSD test, pairwise comparison test, one-way analysis of variance.

It was found that the time when bowel sounds were heard was shorter, the time first passage of flatus was shorter and first defecation occurred earlier in the 1st group of women who chew gum, were hydrated orally and were mobilised early after surgery than the other groups. It was also determined that these periods were longest in the women who did not receive any intervention and received the routine hospital care when compared with other groups. Duration of hospital stay was shorter in the women who chew gum, were hydrated orally and were mobilised early than the other groups.

Early oral feeding, early mobilisation and chewing gum are effective methods in terms of preventing paralytic ileus following abdominal gynaecological surgery, improving patient comfort and shortening the duration of hospitalisation.

Nurses may cause early recovery, improve the patient comfort, prevent paralytic ileus and shorten the duration of hospitalisation after gynaecologic abdominal surgery by recommending gum chewing, early mobilisation and early hydration.

Patients describe the use of the bedpan often as uncomfortable and painful, and nurses mention difficulties using standard-sized bedpans for obese patients or removing a bedpan without soiling the bed. Although the bedpan is still regularly used in hospitals, there are few empirical studies that confirm these experiences.

A descriptive quantitative research design.

A convenience sample of 78 patients was recruited, and data were collected using a standardised questionnaire (German version of the Bedpan Ongemak Schaal). Descriptive statistics were used to analyse frequency (scale A) and extent of inconvenient experiences (scale B). Internal consistency of the scales was tested using Cronbach's alpha.

A major finding of the study was that most patients felt dependent on other persons and no autonomous movement was possible on the bedpan. Patients were frequently confronted with pain, inconvenient characteristics of the bedpan (e.g. coldness, hardness), uncomfortable positions and hygiene inconveniences (e.g. wet backside, fear that urination may miss the bedpan).

As the bedpan is still regularly used in acute care hospitals, innovations in bedpan models are necessary to address the problems. But there are also several courses of action nurses should consider when caring for patients who are dependent on the bedpan.

The discomfort of the bedpan, the feeling of dependency and embarrassment could lead to undesirable patient reactions, such as avoidance of fluid intake or leaving the bed. If nurses know the reasons for this behaviour, they could meet these problems with empathetic understanding.

Effective ward leadership has been recognised as vital to the quality of care, resource management and interprofessional working. However, there is evidence that, at present, front-line nurse leaders are ill equipped to lead effectively and lack confidence in their ability to do so.

The project aimed to provide a tailored programme for ward managers to develop their portfolio of skills to perform this pivotal role. The course contained two key elements: an integrated teaching programme to enhance leadership knowledge and skills and action learning to facilitate application to individual's own leadership practice. Both were underpinned by a change project where each individual indentified, undertook and evaluated an innovation in practice.

Twenty-two ward managers completed the leadership programme. Participants completed semi-structured questionnaires after each taught module. Action learning was evaluated through a combined structured and semi-structured questionnaire.

All participants evaluated the programme as increasing their repertoire of leadership skills. Following completion of the programme, ward managers continue to work together as an evolving community of practice.

Ward managers' development is enhanced by a programme integrating theory, action learning and completion of a ward-based project.

Ward managers cannot be effectively developed in isolation. Leadership development is best supported where the organisation is also committed to developing. A leadership development programme that incorporates knowledge from within the organisation with external expertise can be an effective method to enhance front-line clinical leadership.

Since the advent of New Public Management in many Western countries, patient participation in healthcare decision-making has been considered to be a best practice. A common notion is that well-educated and well-informed public want to choose their own treatments and providers and want to ask questions about the quality of their health services.

Survey.

A self-report-measuring instrument was designed and administered to 620 healthcare professionals. Items were developed, validated and tested by 451 nurses and physicians working in six surgical wards in a University Hospital in Norway.

A 16-item scale with the following four dimensions was developed: information dissemination, formulation of options, integration of information and control. Factor analysis procedures and reliability testing were performed. A one-way, between-groups analysis of variance was conducted to compare doctors' and nurses' opinions on four dimensions of patient participation in surgical treatment decision-making.

This article shows that patient participation in surgical treatment decision-making can be measured by a 16-item scale and four distinct dimensions. The analysis demonstrated a reasonable level of construct validity and reliability. Nurses and physicians have a positive attitude towards patient participation overall, but the two groups differ in the extent to which they accept the idea of patient participation in treatment decision-making.

The instrument can be a tool for managers and healthcare professionals in the implementation of patient participation in clinical practice. Data from the instrument can be useful to identify health services being provided and what areas that could strengthen patient participation.

Handover is a fundamental component of clinical practice and is essential to ensure safe patient care. Research indicates a number of problems with this process, with high variability in the type of information provided. Despite the reported deficits with handover practices internationally, guidelines and standardised tools for its conduct and evaluation are scarce. Further work is required to develop an instrument that measures the effectiveness of handover in a valid and reliable way.

Secondary analysis of data collected between 2006–2008 from nurses working on 24 wards across a large Australian healthcare service.

A sample of 299 nurses completed the survey that included 20 self-report items which evaluated the effectiveness of handover. Data were analysed using exploratory factor analysis and confirmatory factor analysis supported by structural equation modelling.

Analyses resulted in a 14-item Handover Evaluation Scale with three subscales: (1) quality of information (six items), (2) interaction and support (five items) and (3) efficiency (three items). A fourth subscale, patient involvement (three items), was removed from the scale as it was not a good measure of handover.

The scale is a self-report, valid and reliable measure of the handover process. It provides a useful tool for monitoring and evaluating handover processes in health organisations, and it is recommended for use and further development.

Monitoring handover is an important quality assurance process that is required to meet healthcare standards. This reliable and valid scale can be used in practice to monitor the quality of handover and provide information that can form the basis of education and training packages and guidelines to improve handover policies and processes.

The MAI measures of maternal affectionate attachment. This scale displays the most appropriate indicators associated with attachment and has been widely adopted in different fields for measuring maternal–infant attachment.

Cross-sectional survey design.

The study was carried out in two clinics. From the accessible population of 507 samples, a simple random sampling method of selection was used to randomly choose 200 names of mothers at 4–8 months after delivery using a computer. One hundred and eighty-one mothers agreed to participate in the study. The Chinese version of the MAI (CMAI) was developed in five stages: translation, review, back-translation, a review by a panel of specialists and a pilot test. Regarding the reliability of the CMAI, a test of correlations between the subscales and the entire scale was performed consecutively. With respect to the validity of the MAI, exploratory factor analyses, a test of relationships between items and subscales, and an analysis of concurrent criterion-related validity were conducted.

The CMAI contains four factors in its structure. The CMAI and its subscales possess good internal consistency; the Cronbach's α coefficient was 0·94. In addition, the Pearson product-moment correlation coefficient between the CMAI and the Maternal–Fetal Attachment Inventory (MFAI) and between the CMAI and the Maternal–Infant Attachment Inventory (MIAI) was 0·38 and 0·5, respectively. This suggests significant medium and high respective correlations between the CMAI and these two scales. One major limitation of this study is that participants were recruited from two clinics located in central Taiwan.

The CMAI possesses acceptable reliability and validity for use in measuring the levels of attachment and affectional ties between mothers and their infants.

The CMAI provides further evidence of the applicability of the CMAI in clinical maternity care services.

Supportive professional practice environments are particularly important to nurses’ satisfaction with their work and the quality of patient care provided. Hence, research that examines nurse practitioners practice implications and barriers in today's healthcare system is essential.

A descriptive-correlational design using survey methodology. A nonprobability sample of convenience was used. The outcome measures were: The Misener Nurse Practitioner Job Satisfaction Scale and two investigator-developed surveys.

Participants expressed dissatisfaction with professional and monetary recognition, assertive influence, administrative support and collegial relationships.

Interaction of subscale factors on overall job satisfaction and demographic survey findings has important implications for health administrators and nurse practitioners in similar organisations.

Stakeholders in healthcare milieus need to be fully engaged in the redesign of the American healthcare system heeding the recommendations of the Institute of Medicine to provide safer health systems to the public. By doing this, issues related to frustration by nurse practitioners related to job satisfaction will be addressed. The need for cooperation, participation, collaboration and instrumental communication are essential in the delivery of safe, quality patient care. A better understanding of intrinsic professional rewards needs to be learned by nurse practitioners who want to seek professional satisfaction and engage in the survival and growth of the profession. Nurse practitioners armed with this translational information have viable agenda items that can be negotiated into extrinsic rewards.

Recruitment is crucial to the success of research projects. Effective recruitment leads to effective retention, an increased pool of data and in-time completion of projects. Robust evidence indicates that recruitment remains a challenge in many clinical trials.

Discursive article.

The complexity of recruitment is mandated based on the findings from a literature review that summarises common threats to successful recruitment. Nursing theories and models that incorporate recruitment are critically reviewed before recruiting, and its planning is related to existing complex intervention methodology.

Threats to sufficient recruitment are inherent in the planning of studies, the recruiting process and triadic relationships between institutions, recruiter and participants. Existing nursing theories and models address important recruitment issues but do not account for all aspects that jeopardise sufficient recruitment. Hence, available frameworks for complex intervention planning and evaluation are useful to guide recruitment and its planning as an umbrella methodology.

Using complex intervention methodology for recruitment and its planning enhances a nurse researcher's awareness of the challenges and pitfalls recruitment poses and may translate to improved recruitment rates and overall success of clinical trials.

Although implantable cardioverter defibrillator has become a well-established therapy for people experiencing potentially lethal dysrhythmias, implantable cardioverter defibrillator patients may have physical and psychosocial problems due to the implantation. Applying a planning education and follow-up programme to implantable cardioverter defibrillator-implanted patients may prevent the need for more intensive treatment during the postimplantation period.

A mixed methods design that used both qualitative and quantitative data collections and analysis was used for this study.

The study was performed in the cardiology department in Turkey between 2009–2010. The data were collected using the ‘Semi-Structured Interview Form’, ‘Form for Assessment of Patients’ Knowledge Level about implantable cardioverter defibrillator’, ‘Spielberger's State-Trait Anxiety Inventory’, ‘Beck Depression Inventory II’ and ‘The Short-Form 36 Health Survey’. All forms were completed at the beginning of the study and at six months. The study included 27 patients in the experimental group and 27 patients in the control group.

The results showed that the patients were living with various physical and psychosocial problems and insufficient knowledge regarding the implantable cardioverter defibrillator. Education and follow-up programme increased knowledge levels, decreased anxiety and depression scores and improved several subscales of quality of life in the experimental group patients.

It was recommended that education and follow-up programme be used for patients scheduled to undergo implantable cardioverter defibrillator implantation, starting before implantation and continuing thereafter, to help patients adapt to a life with implantable cardioverter defibrillator.

Planned education and follow-up programme conducted by nurses may improve the knowledge levels and quality of life, anxiety and depression scores of the implantable cardioverter defibrillator-implanted patients.

Men receiving treatments for localised prostate cancer experience symptoms of urinary incontinence, urinary obstruction/irritation, bowel difficulties and sexual dysfunction. Understanding patients' symptom experiences and identifying strategies that they use to manage these symptoms are imperative for symptom management planning.

A descriptive, cross-sectional study was conducted with a sample of 53 men, who were within three months of the initiation of their treatment.

The Symptom Indexes and the Strategy and Effectiveness of Symptom Self-Management questionnaires were used to measure symptoms, symptom distress and symptom self-management. Descriptive statistics, t-tests, correlations and multiple regressions were used to analyse the data.

Symptoms were significantly correlated with symptom-related distress (r = 0·67, p < 0·01). Frequency of symptoms was significantly associated with symptom self-management strategies for urinary (β = 0·50, p < 0·01), bowel (β = 0·71, p < 0·01) and sexual problems (β = 0·28, p = 0·05). The most effective strategies were as follows: pads and doing Kegel exercise for managing urinary problems, rest and endurance for bowel symptoms, and expressing feelings and finding alternative ways to express affection for management of sexual dysfunction.

Assessing symptom self-management among men with newly diagnosed prostate cancer can help healthcare providers develop strategies that will enhance health-related quality of life.

Results provide information on effective strategies that patients with prostate cancer found to reduce their symptoms. The strategies used provide a foundation for developing and testing interventions for personalised symptom management.

The prevention and treatment of pressure ulcers has generally become the responsibility of the nursing staff; this has resulted in studies of nurses' knowledge of this task, although few studies include physicians in their analysis.

Cross-sectional survey conducted in North Girona (Province) Primary Care Services from February to April 2010.

The study questionnaire had three sections: sociodemographic data, questions about division of responsibility for the care of patients with pressure ulcers or at risk of developing them, and 36 statements based on the recommendations in clinical practice guidelines provided by well-recognised national and international institutions.

Eighty-one nurses (64·8%) and 46 physicians (36·8%) responded to this study. Nurses had greater responsibility for the care of pressure ulcers, made greater use of medical prescriptions to obtain supplies if not available in the primary care centre, were more familiar with the site's clinical practice guidelines on the topic and showed better adherence to their recommendations. Nurses also had better knowledge than the participating physicians of the use of medications and healthcare products to heal or to prevent pressure ulcers.

Nurses had sufficient knowledge and more appropriate skills than the participating physicians for the prescription of medications and healthcare products for the prevention and treatment of pressure ulcers.

The data demonstrated that nurses have sufficient knowledge and skill to provide wound care and could safely write these prescriptions, although Spanish law permitting nurse prescription is not fully implemented.

The majority of research in nursing is descriptive and exploratory in nature. There is an increasing professional and political demand for nurses to develop and provide evidence to support their practices. Nurses need to explore current practice and develop and test interventions to provide the evidence required for safe practice.

A literature review using a systematic approach.

The review was carried out using four databases: CINAHL, PubMed, PsycINFO and BNI (2000–2011), and the search was limited to ‘brief interventions’ and complex intervention development (January 2000–September 2011). Included papers reported on guidelines for intervention development or ‘how’ an intervention was developed.

Six papers reported on guidelines for developing interventions. There are many similarities between the guidelines with a similar pattern of guideline development in Europe and the USA. The only guideline reported to have been used in the development of interventions is the Medical Research Council framework (MRC) (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000), with 9 of 14 papers that describe the development of an intervention reporting the use of this guideline. The other five papers did not mention the use of any guideline or framework.

The MRC (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000) framework appears to be the most widely used guideline reported for developing complex interventions. Although the updated MRC (Developing and Evaluating Complex Interventions, 2008) framework adds considerably to the original MRC (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000) framework, other guidelines contribute additional guidance which can inform the development of nursing interventions. These additional guidelines are presented in a model for developing complex interventions for nursing.

The model will help nurses planning to develop nursing interventions as it provides additional and nursing-specific guidance to the MRC (Developing and Evaluating Complex Interventions, 2008) framework for the development of complex interventions for nursing practice.

Cancer is more prevalent in older age. Evidence suggests that older people's pain is generally under-recognised and under treated. Pain is a significant concern for many people living and dying with cancer and may be of particular concern for older people who may have complex biopsychosocial needs. There is mounting evidence that older people and their families experience high level of unmet need generally and suboptimal pain in particular.

Narrative literature review.

A comprehensive search of five electronic databases was undertaken between the years 1996–2010 inclusive. Inclusion criteria were primary research papers relating older peoples' experiences of cancer pain, incorporating the verbal report or narrative account of experience of cancer.

Seventeen papers met the criteria for inclusion in the review. Three major themes emerged from the literature: (1) emotional experience identified by older people with cancer pain, (2) effects of pain on life and living, and (3) how communication affects the experience or expression of cancer pain including subthemes of validating, trust and cultural effects on the communication of pain.

There is limited research about older people's cancer pain from the perspective of the person experiencing the pain. This review highlights the need for further research into living and dying with cancer pain which incorporates the unique and individual experience of older people.

Understanding the complexity and nature of older people's cancer pain experience should inform appropriate effective care that improves quality of life and promotes independence and dignity. Culturally sensitive training in communication may enhance understanding of the needs of older people with cancer pain.

In view of the growing number of adults with chronic diseases and a lack of resources in health care, it would be valuable for healthcare professionals to know which factors result in good-quality counselling for such individuals.

The study used a cross-sectional, descriptive design.

Data were collected from chronically ill adults (n = 106) in northern Finland and were analysed using logistic regression.

Counselling implementation was perceived to be of good quality if it was preplanned (odds ratio = 24·07) and patient-centred (odds ratio = 16·03) and if interaction during counselling (odds ratio = 13·27) was good. Counselling about social support (odds ratio = 14·78), preplanned counselling (odds ratio = 9·69), counselling about the results of investigations (odds ratio = 7·84) and counselling about disease progression (odds ratio = 7·66) were statistically significant predictors of the content being considered good quality. The effects of counselling on disease treatment (odds ratio = 11·33), patient-centred counselling (odds ratio = 9·75) and counselling about the effects of attitudes (odds ratio = 9·52) were statistically significant predictors of highly beneficial counselling. Counselling about the effects of disease treatment (odds ratio = 9·71) and interaction during counselling (odds ratio = 4·91) predicted the quality of counselling materials and methods.

The results could be used to help healthcare professionals to ensure good-quality counselling by highlighting the areas that are most important to meet the expectations of chronically ill adults.

The results can be used to develop the quality of chronically ill adults' counselling as well as to educate staff to focus better on chronically ill patients' counselling because it is necessary to develop new ways to offer more patient-centred counselling in order to address patients' needs and fit care to patients' lifestyles.

Healthcare professionals, with particular regard to nurses, are exposed to several job stressors that can adversely affect both their mental and physical health and also decrease work engagement. Work engagement can be considered as the positive opposite of burnout, and it is characterised by energy, involvement and professional efficacy.

A cross-sectional survey research was conducted with self-report questionnaires.

The Maslach Burnout Inventory–General Survey, the Areas of Worklife Scale and four scales from the Occupational Stress Indicator were administered to a sample of 198 hospital staff (registered nurses, nurse aides, physicians and physiotherapists), of which 110 participated in the study.

The most significant predictors of energy were workload, mental health and job satisfaction; the best predictors of involvement were community, workload, mental health and job satisfaction; professional efficacy was best predicted by values and job satisfaction. In relation to the second aim, physiotherapists had the highest levels of occupational stress and disengagement from their work, while nurse aides were the most work-engaged and job-satisfied professional category, with positive perceptions of the work environment.

Both organisational and personal factors were found to be significantly associated with work engagement. In this study, physiotherapists were the category with the highest risk of work-related psychological problems, whereas nurse aides had the lowest risk.

Interventions aimed at improving clinical practice and psychological health of nurses and hospital staff should focus on workload, workers' personal expectations and job satisfaction.

Supporting undergraduate nursing students with disabilities has gained further momentum because of amendments to the Disability Discrimination Act in 2009. Providers of higher education must now ensure proactive steps to prevent discrimination against students with a disability are implemented to assist in course progression. Simulation allows for the impact of a student's disability to be assessed and informs the determination of reasonable adjustments to be implemented. Further suitable adjustments can then be determined in a safe environment and evaluated prior to scheduled placement. Auditing in this manner, offers a risk management strategy for all while maintaining the academic integrity of the program.

Discursive.

Low, medium and high fidelity simulation activities critically analysed and their application to support undergraduate nursing students with disabilities assessed.

With advancing technology and new pedagogical approaches simulation as a learning strategy can play a significant role. In this role, simulation supports undergraduate nursing students with disabilities to meet course requirements, while offering higher education providers an important risk management strategy.

The discussion recommends simulation is used to inform the determination of reasonable adjustments for undergraduate nursing students with disabilities as an effective, contemporary curriculum practice. Adoption of simulation, in this way, will meet three imperatives: comply with current legislative requirements, embrace advances in learning technologies and embed one of the six principles of inclusive curriculum. Achieving these imperatives is likely to increase accessibility for all students and offer students with a disability a supportive learning experience.

Provides capacity to systematically assess, monitor, evaluate and support students with a disability. The students' reasonable adjustments can be determined prior to attending clinical practice to minimise risks and ensure the safety of all.

Falls risk is a predominant concern when nursing older people, especially those in residential aged care. Fall-related injuries, specifically pertaining to the hip, yield a high cost to the individual both physically and psychologically. Accordingly, hip protectors are argued in related literature as a form of protection against such injuries.

A database search as per a specified search strategy was conducted for quantitative research publications and randomised control trials.

English language publications were sought from the year 2000–2011. Searches were made, using specific combinations of keywords, in the following databases: MEDLINE via OvidSP, CINAHL via EBSCOHost, Ageline via OvidSP, Cochrane Library, The Joanna Briggs Institute and Google Scholar.

Six articles were selected for review. Methodological quality of the research publications collated varied, and the use of hip protectors was deemed inconclusive. Compliance was raised as a prevailing issue.

The problem of fall-related injuries is significant. Whilst some evidence is inconclusive, the use of hip protectors is recommended as best practice.

The issue of compliance, however, was identified to affect the use of appliances in residential aged care. Addressing compliance issues must be tackled if hip protectors are to be part of a resident-centred approach.

Incontinence is a known complication of DM2 with impact on women's lives. Less is known about incontinence problem among Emirati women with DM2.

A cross-sectional survey design using probability sampling approach was employed to assess urinary incontinence in Emirati women with DM2.

A total of 300 women with DM2, aged 20–65 years, were recruited from six healthcare centres. Data were collected over an 18-month period. A standardised incontinence questionnaire was used to assess type and frequency of incontinence within the past 12 months. Presence of weekly incontinence was the main outcome.

Of the 300 women, 188 (63%) reported any incontinence, of which 48% had at least weekly episode. Both stress (n = 154, 51·3%) and urge (n = 181, 60·3%) were reported by participants, with 48 (31·1%) reporting at least weekly stress and 85 (46·9%) expressing at least weekly urge incontinence. Diabetes duration was a significant risk factor for any, stress and urge incontinence followed by age for only any and stress incontinence. BMI was a risk factor for urge incontinence. Women perceived incontinence as bothersome, disturbing their social activities and daily prayers.

The prevalence of incontinence in Emirati women with DM2 is higher than that reported by women in other cultures. Risk factors identified were DM2 duration, age and obesity. Emirati women found incontinence to be a bothersome problem influencing their daily lives and prayers.

Nurses in general practice should be alert to the incontinence problem by considering it as part of the routine diabetes evaluation of women, especially of those with longer duration of diabetes, obese and older. Cultural knowledge, sensitivity and individualised treatment plans need to be adopted by nurses working in the UAE to encourage the reporting of incontinence by Emirati Muslim women with DM2.

Oral hygiene has an impact on the clinical outcomes and well-being of critically ill patients.

A descriptive, cross-sectional design was used.

The study was conducted in the intensive care unit of a private hospital located in Istanbul. The study sample consisted of 60 patients treated in the intensive care unit for five consecutive days. Oral assessments were conducted once per day every morning for five days. The oral assessments were performed using the Oral Assessment Tool and Oral Assessment Checklist.

The oral hygiene status and the health of the oral mucus membranes improved over the consecutive five-day assessments, and the routine oral care provided by nurses in the intensive care unit was effective in preventing oral mucus membrane-related complications.

The frequency of oral care and oral moistening should be determined according to the patient's condition and the presence of risk factors for oral complications. Oral mucus membranes should be assessed closely and systematically in all critically ill patients who are mechanically ventilated, are receiving oxygen therapy, are undergoing invasive procedures, have a history of chronic health problems or are receiving enteral or parenteral nutrition.

To prevent infections or complications during intensive care treatment, it is important for nurses working in critical care units to develop and implement oral care assessments and evidence-based oral care protocols.

A structured literature review using Cumulative Index to Nursing and Allied Health Literature, Pubmed, Proquest, Google scholar, Meditext database and a hand search of critical care journals via identified search terms for relevant articles published between 2000 and 2010.

Thirty studies were included in the review either undertaken in the Intensive Care Unit or conducted with critical care staff using different methods of inquiry. The studies were related to family needs; family involvement in routine care; and family involvement during resuscitation and other invasive procedures. The studies revealed that family members ranked both the need for assurance and the need for information as the most important. They also perceived their important needs as being unmet, and identified the nurses as the best staff to meet these needs, followed by the doctors. The studies demonstrate that both family members and healthcare providers have positive attitudes towards family involvement in routine care. However, family members and healthcare providers had significantly different views of family involvement during resuscitation and other invasive procedures.

Meeting Intensive Care Unit family needs can be achieved by supporting and involving families in the care of the critically ill family member. More emphasis should be placed on identifying the family needs in relation to the influence of cultural values and religion held by the family members and the organisational climate and culture of the working area in the Intensive Care Unit.

Structural empowerment can be defined as the actual rather than perceived ability to make autonomous decisions within an organisation. Given the paucity of research on the subject, this study helps to close the gap by identifying factors that affect nurse aide empowerment, that is, decision-making among nurse aides.

The data for the study come from self-administered questionnaires distributed to direct-care workers (nurse aides) in 11 nursing homes in a southern state in the USA. Ordinary least square regression models were estimated to analyse the effects of demographic predictors, personal factors (competency, emotional exhaustion and positive attitude) and structural characteristics (coworker and supervisor support, information availability and shared governance) on nurse aide decision-making.

Findings suggest race among demographic predictors, emotional exhaustion among personal characteristics, and supervisor support, and shared governance among structural factors, significantly affect nurse aide decision-making.

It is important to explore race as one of the central determinants of structural empowerment among nurse aides. In addition, the nature and type of emotional exhaustion that propels decision-making needs to be further examined.

The study shows the importance of shared governance and supervisor support for fostering nurse aide empowerment.

Prior research has suggested that pain is a major concern for people with arthritis. However, studies systematically investigating pain experiences and self-management status of arthritis patients are scarce in mainland China.

Descriptive survey.

Participants (n = 197) aged 45 and over, diagnosed with either osteoarthritis or rheumatoid arthritis, and experiencing persistent pain were administered three self-report questionnaires: the Demographic Data Questionnaire, the Brief Pain Inventory and the Pain Management Inventory.

The mean of the overall pain intensity was 5·6 (SD = 1·3). The median of number of pain sites was 7·0 (QR = 7·0) and the overall pain interference was 6·0 (QR = 2·6). Most participants experienced moderate to severe pain and interference. The current methods used for managing pain were perceived as only moderately effective. The sample used a median of 4·0 (QR = 3·0) self-management methods. Most often used were prescribed medicine, massage, heat and activity pacing. Methods perceived as most helpful included prescribed medicine, over-the-counter medicine, hot baths and heat. Persons with rheumatoid arthritis had significantly more pain sites, higher pain intensity and greater number of pain management methods used compared to those with osteoarthritis.

Pain management is a significant problem in this population. The findings highlight the importance of helping the individual to identify and appropriately use a variety of self-management methods, selecting the appropriate method(s) at any one time.

Healthcare providers are urged to develop appropriate interventions on pain management tailored to arthritis patients in mainland China.

Acute care nurse practitioners provide safe and effective care to patients. There is limited evidence of the effects of acute care nurse practitioner roles on healthcare teams, and many of the findings are contradictory. Research is lacking to describe how nurse practitioners affect perceptions of team effectiveness.

A descriptive multiple-case study undertaken in two university-affiliated teaching hospitals in Canada.

Data were collected from March–May 2009. Data sources included interviews (n = 59), time and motion study, non-participant observations, documents and field notes. Interviews were conducted individually or in groups using a semi-structured interview guide. Data were analysed within and across the cases to identify similarities and differences in perceptions of team effectiveness.

Team members believed the nurse practitioners improved the team's effectiveness. They identified six team processes they believed were improved by the addition of the nurse practitioners to the teams. The processes included decision-making, communication, cohesion, care coordination, problem-solving and focus on patients and families.

The study contributes to our understanding of how nurse practitioners affect perceptions of team effectiveness. Improved team communication and care coordination were believed to be particularly important. Nurse practitioner can facilitate patient- and family-centred care in healthcare teams.

Nurse practitioners improve perceptions of team effectiveness. Further work is needed in different contexts and with patients and families to determine their perceptions of team effectiveness.

The nurse practitioner role was believed to be particularly important to improve team communication and care coordination. This constitutes an added value of acute care nurse practitioners roles in healthcare teams. Nurse practitioner roles contribute to patient-centred care and can improve the quality and safety of the care provided to patients and families.

Several prior studies have assessed the ability of exercise training to improve functional capacity and produce beneficial effects on mortality and physical capacity in patients with cardiovascular disease.

A non-randomised six-month prospective longitudinal study.

This study consisted of 41 patients (59–83 years old) with mild hypertension and/or stable angina pectoris. The home-based daily activity and heart rate variability were measured at the start of the study (BASE) and six months after the start of the study (6MoA). At 6MoA, the active mass increased in 23 patients (the IC group), while it decreased in the remaining 18 patients (the DC group).

There were significant increases in the high-frequency component in the IC group between the data at BASE and 6MoA. There were significant decreases in the low frequency to high-frequency ratio (low frequency/high-frequency) during sleep in the IC group between the data at BASE and 6MoA. The active mass was classified into life activities and walk activities in terms of intensity of activity. In a multivariate model, increased life activitiesrevealed a trend towards an association with increased high-frequency.

In patients with mild hypertension and/or stable angina pectoris, an increase in active mass improved heart rate variability outcomes with increased high-frequency and decreased low frequency/high-frequency during sleep. To increase life activitiesmight improve heart rate variability and prognosis in patients.

This study demonstrated that the potential importance of low-intensity daily activities in patients with mild hypertension and/or stable angina pectoris.

Noise-induced hearing loss represents a significant risk factor for injury, disability and death in agricultural populations due to an inability to receive sensory information that can indicate dangerous situations. Despite the availability of hearing protection devices, rates of utilisation remain low, while rates of noise-induced hearing loss are high within the agricultural youth population.

Comprehensive review of the literature.

Electronic database searches were conducted to identify research studies of hearing protection interventions for youth living or working on farms.

Three intervention studies were identified as meeting the review criteria, with additional reanalysis studies based on the original intervention studies. The intervention studies demonstrated increased use of hearing protection devices among youth who received the interventions compared to the control groups although audiometry testing results were not improved as a result of the intervention.

The findings of this review highlight the need for additional research into the effectiveness of hearing protection device use as a noise-induced hearing loss preventative measure in youth who live or work on farms and the creation of effective interventions to increase hearing protection device use and decrease Noise-induced hearing loss risk.

It is recommended that nurses be educated in the areas of health promotion relevant to farming communities to be able to effectively meet their rural clients' needs in relation to noise-induced hearing loss. Working with youth, families, and schools, as well as developing community partnerships, can facilitate the dissemination of hearing protection promotion.

High-risk types of human papillomavirus are a key aetiologic factor behind cervical cancer. Recently, human papillomavirus vaccination is considered an effective approach to prevent vaccine-specific typed human papillomavirus-related cervical cancer in women. However, several controversial issues still arise about routine administration of human papillomavirus vaccines, and the literature on young women's protection against human papillomavirus-related cervical cancer is limited.

A descriptive qualitative design categorised responses into themes.

Sixteen sexually active college women (aged 20–22 years) were recruited via purposive and snow-ball sampling in Southern Taiwan. Every participant underwent an in-depth interview which was audio-recorded and fully transcribed. Analysis of the interview material was inductive and followed a thematic analysis approach. Procedures to confirm confidentiality, credibility and consistency were considered.

This article provides an insight into the college women's experiences in the obstacles to and striving towards breakthroughs of human papillomavirus-related cervical cancer prevention. The obstacles include inadequate health literacy, financial difficulty, negative medical experiences and gender myths. The striving towards breakthroughs consists in self-protection and knowledge support.

College women experience difficulties with human papillomavirus-related cervical cancer prevention. They desire to have a publicly funded human papillomavirus immunisation programme, friendly medical environments, sufficient knowledge and open-minded society to maintain their health. Such reflection information is helpful to design effective human papillomavirus-related cervical cancer prevention campaigns.

Young women do not know how to protect against human papillomavirus infection, although human papillomavirus-related cervical cancer prevention methods are definite. This study provides useful information for health care professionals to assess the intervention education and health care to develop a thorough human papillomavirus-related cervical cancer programme. To have control of human papillomavirus-related cervical cancer for young women, personal health care management, prophylactic medicine and Pap tests should be integrated into human papillomavirus-related cervical cancer campaigns.

While tools exist for testing reasons for living among English-speaking individuals, none are available to assess Chinese-speaking older adults' motivation for living.

This study had three steps: cross-sectional survey to collect data on instrument items, instrument development and psychometric testing.

Participants were 247 older male residents of five veterans' homes, including 22 who had attempted suicide in the previous three months and 225 non-suicide attempters. The Chinese-language instrument, Motivations for Living Inventory, was developed based on individual interviews with older male residents of nursing homes and veterans' homes, focus groups with workers at nursing and veterans' homes, the literature and the authors' clinical experiences. The resulting Inventory was examined by content validity, construct validity, criterion-related validity, internal consistency reliability and test–retest reliability.

The inventory had good content validity index (1·00). Factor analysis yielded a five-factor solution, accounting for 82·02% of the variance. Veterans' home male residents who had not attempted suicide tended to have higher scores than residents who had attempted suicide in the previous three months across the global inventory and all its subscales, indicating good criterion validity. Inventory reliability (Cronbach's α for the total scale was 0·86 and for subscales ranged from 0·80–0·94) and intraclass correlation coefficient (0·81) was satisfactory.

The Chinese-language Motivations for Living Inventory can be completed in five to seven minutes and is perceived as easy to complete. Moreover, the inventory yielded highly acceptable parameters of validity and reliability.

The Chinese-language Motivations for Living Inventory can be used to assess reasons for living in Chinese-speaking, institutionalised older male adults.

LVAD are becoming a standard option to improve the quality of life for patients with advanced heart failure. Past research focused on technology issues and survival rates, but limited research has addressed the effect of LVADs on patients' perceptions of self. Orem's theory of self-care provides a framework to investigate how patients manage threats to self-concept to safely live with such a device.

Hermeneutic phenomenology based on van Manen's method.

Data were collected using semi-structured interviews. Data saturation was achieved with nine participants (seven men; two women), 31–70 years of age who lived with a LVAD at home for at least three months. Thematic analysis was ongoing, and final themes were consensually validated.

Two themes constructed from the data were consistent with the requisite of modifying self-concept. First, Having a LVAD means living. Participants described they ‘feel alive again’, and they ‘had the rest of [their] lives that they didn't have before’. The second theme: A desire to be ‘normal’ in public, arose from participants descriptions of how the LVAD brought unwanted attention to them and that their appearance was ‘shocking’ to others.

Participants accepted the LVAD as necessary to live making it easier for them to modify their self-concept and accept the changes to their bodies and daily lives. Attaining a sense of normalcy was more difficult in public and required additional lifestyle modifications.

Findings advance self-care knowledge in LVAD management and can heighten nurses' awareness about self-concept as a vital component for maintenance of health and well-being.

Diaper dermatitis is the most common dermatological condition in newborns who are cared for in the neonatal intensive care unit. Recently, there are several kinds of complementary skincare methods suggested for newborns, such as sunflower oil, human breast milk, etc. Also, some chemical formulations are still being used in many neonatal intensive care units.

Randomised controlled, prospective, experimental.

This study was carried out with a population including term and preterm newborns who developed diaper rash while being treated in the neonatal intensive care unit of a university hospital in Istanbul between February–October 2010. On completion of the research, a total of 63 newborns from human breast milk (n = 30) and barrier cream (n = 33) groups were contacted.

Genders, mean gestation weeks, feeding method, antibiotic use, diaper area cleansing methods, diaper brands and prelesion scores of newborns in both groups were found to be comparable (p > 0·05). There was no statistically significant difference (p = 0.294) between the groups in terms of mean number of clinical improvement days, but postlesion score of the barrier cream group was statistically significantly lower (p = 0·002) than the human breast milk group.

Barrier cream delivers more effective results than treatment with human breast milk, particularly in the treatment of newborns with moderate to severe dermatitis in the result of the study.

This study will shed light on nursing care of skin for newborns who are treated in neonatal intensive care unit.

Systematic review is defined as a scientific research method that synthesises high-quality scientific knowledge on a given topic. The number of such reviews in nursing science has increased dramatically during recent years, but their methodological quality has not previously been assessed.

A review of the literature using a narrative approach.

Ranked impact factor scores for nursing journals were obtained from the Journal Citation Report database of the Institute of Scientific Information (ISI Web of Knowledge). All issues from the years 2009 and 2010 of the top 10 ranked journals were included. CINAHL and MEDLINE databases were searched to locate studies using the search terms ‘systematic review’ and ‘systematic literature review’. A total of 39 eligible studies were identified. Their methodological quality was evaluated through the specific criteria of quality assessment, description of synthesis and strengths and weaknesses reported in the included studies.

Most of the eligible systematic reviews included several different designs or types of quantitative study. The majority included a quality assessment, and a total of 17 different criteria were identified. The method of synthesis was mentioned in about half of the reviews, the most common being narrative synthesis. The weaknesses of reviews were discussed, while strengths were rarely highlighted.

The methodological quality of the systematic reviews examined varied considerably, although they were all published in nursing journals with a high-impact factor.

Despite the fact that systematic reviews are considered the most robust source of research evidence, they vary in methodological quality. This point is important to consider in clinical practice when applying the results to patient care.

Dementia is an increasing illness in the world. Dementia affects not only the person with dementia but also the relatives. There is a lack of knowledge about the experience of being a relative to a dementia-suffering person.

Twenty-one stories from relatives were included in this study, and these stories were analysed by employing Kirsti Malterud's method ‘systematic text condensation’. The relatives were divided into four groups: sons, husbands, daughters and wives.

Eight themes were identified in their stories, two in each of the four groups. From these eight themes, it was identified that they all experienced change, grief and negative personal sentiments. However, differences were also found, one of them being that the sons found it easier to adapt to new roles during the course of the illness, while the daughters found it more difficult. The husbands experienced being attacked by the people around them, while the wives were found to submit their dementia-suffering husbands to physical abuse. The wives also suffered from self-criticism.

The similarities between the four groups are more significant than the differences. Sons, husbands, daughters and wives of a person suffering from dementia should be considered on an equal basis in terms of their experiences of grief, change and personal negative sentiments.

Relatives play a significant role in the well-being of their parent or spouse suffering from dementia. Therefore, professionals need to focus on both relatives and patient when they meet a person with dementia in clinical practice.

Measuring the quality of pain management interventions is complex. Intermittent audits do not accurately capture the results of quality improvement initiatives. The failure rate for one intervention, epidural analgesia, is approximately 30% in everyday practice, so it is an important area for improvement. Continuous measurement and analysis are required to understand the multiple factors involved in providing effective pain relief.

Process control and quality improvement

Routine prospectively acquired data collection started in 2006. Patients were asked about their pain and side effects of treatment. Statistical Process Control methods were applied for continuous data analysis. A multidisciplinary group worked together to identify reasons for variation in the data and instigated ideas for improvement. The key measure for improvement was a reduction in the percentage of patients with an epidural in severe pain.

The baseline control charts illustrated the recorded variation in the rate of several processes and outcomes for 293 surgical patients. The mean visual analogue pain score (VNRS) was four. There was no special cause variation when data were stratified by surgeons, clinical area or patients who had experienced pain before surgery. Fifty-seven per cent of patients were hypotensive on the first day after surgery. We were able to demonstrate a significant improvement in the failure rate of epidurals as the project continued with quality improvement interventions.

Statistical Process Control is a useful tool for measuring and improving the quality of pain management.

The applications of Statistical Process Control methods offer the potential to learn more about the process of change and outcomes in an Acute Pain Service both locally and nationally. We have been able to develop measures for improvement and benchmarking in routine care that has led to the establishment of a national pain registry.

Depression is considered the most frequent mental disorder among the older population. Specifically, the depression rate among nursing home patients is three to four times higher than among community-dwelling older people, and a large overlap of anxiety is found. Therefore, identifying nursing strategies to prevent and decrease anxiety and depression is of great importance for nursing home patients' well-being. Nurse–patient interaction is described as a fundamental resource for meaning in life, dignity and thriving among nursing home patients.

The study employed a cross-sectional design. The data were collected in 2008 and 2009 in 44 different nursing homes from 250 nursing home patients who met the inclusion criteria.

A sample of 202 cognitively intact nursing home patients responded to the Nurse–Patient Interaction Scale and the Hospital Anxiety and Depression Scale. A structural equation model of the hypothesised relationships was tested by means of Lisrel 8.8 (Scientific Software International Inc., Lincolnwood, IL, USA).

The SEM model tested demonstrated significant direct relationships and total effects of nurse–patient interaction on depression and a mediated influence on anxiety.

Nurse–patient interaction influences depression, as well as anxiety, mediated by depression. Hence, nurse–patient interaction might be an important resource in relation to patients' mental health.

Nurse–patient interaction is an essential factor of quality of care, perceived by long-term nursing home patients. Facilitating nurses' communicating and interactive skills and competence might prevent and decrease depression and anxiety among cognitively intact nursing home patients.

Childhood obesity is a worldwide health problem that leads to serious metabolic and physiological consequences. An effective intervention to manage obesity is essential. Motivational interviewing is designed to resolve ambivalence, enhance intrinsic motivation and promote confidence in a person's ability to make behaviour changes. It has shown promise in the adult obesity literature as effecting positive health behaviour changes. Motivational interviewing has also been proposed as an effective method for improving the weight loss of obese children.

A pre–post quasi-experimental design with repeated measures was used.

The study was conducted in four primary schools over an 11-month period in 2010–2011. Obese children (n = 185) were screened from 791 school children studying the equivalent to UK grades 5 and 6 and were divided into three groups: motivational interviewing, motivational interviewing+ and a control group. The motivational interviewing group (n = 70) children were provided with motivational interviewing counselling; the motivational interviewing+ group (n = 66) children were provided with motivational interviewing counselling while telephone consultation was provided for their parents; and the control group did not receive any intervention (n = 49).

Children in both the motivational interviewing and motivational interviewing+ groups showed significant improvement in their weight-related behaviour and obesity-related anthropometric measures from the baseline to the end of the 14-week intervention, while the control group had significant deterioration in their anthropometric measures.

Motivational interviewing appears to be a promising intervention for promoting weight loss in obese children. Motivational interviewing counselling may be extended to obese children of different age groups.

This study indicates that motivational interviewing is a useful method for improving behaviour changes in eating, physical activity and weight loss for obese children, suggesting the benefits of such intervention.

One woman dies every seven minutes, at the same time, one-quarter of all maternal death worldwide is being caused by PPH. The aim of United Nations Fifth Millennium Development Goal 5 is to lower MMR by three quarters between 1990–2015.

Narrative literature review.

Study articles from 1996–2012 were searched in electronic databases MEDLINE, Cochrane, PubMED, Google's scholar and manual searches. Combinations of the following search words were used: post-partum haemorrhage/bleeding, sub-Saharan Africa/rural areas, antenatal/obstetric care/maternal mortality/skilled care at birth/maternity care/health survey. 125 article abstracts were read, and 50 full articles used in this review.

Every day about 800 women died due to birth complications in 2010: of the 800 maternal deaths worldwide, 440 occurred in sub-Saharan Africa with PPH being the main cause. Common causes of PPH are related to failure of the healthcare system, inaccurate estimation of blood loss after delivery and lack of skills to prevent and manage PPH.

Special attention is needed with emphasis on regular attendance of antenatal clinic, proper information concerning pregnancy and delivery, skills to accurate estimate blood loss, and prevention and management of PPH.

PPH is the leading cause of MMR in areas where essential care and skilled health attendants are limited. Basic Emergency Obstetric Care and arrangements for timely referral to the big hospital with facilities must be practiced everywhere.

This review may help to remind health workers and the government that maternal mortality due to PPH is still higher and more interventions are needed.

Distress, clinical anxiety and depression are evident in patients with cancer, leading to poor psychosocial and quality-of-life outcomes.

Instrument development study with norm-referenced measurements.

Content validity was determined by expert review. Cronbach's α was used to assess internal consistency reliability and product-moment correlations were conducted. Exploratory factor analysis measured validity of items using varimax rotation method. Criterion-related validity testing used the Perceived Stress Scale and the convergent validity test of construct validity used the Hospital Anxiety and Depression Scale. A total of 125 women pathologically diagnosed with breast cancer were interviewed on the day prior to initial breast surgery.

After testing, the Newly Diagnosed Breast Cancer Stress Scale consisted of four main factors with 17 items with acceptable reliability and good validity, and its length and time to complete the questionnaire were appropriate. Internal consistency reliability of the scale was shown by Cronbach's α = 0·84, the criterion validity of Perceived Stress Scale-10 was r = 0·46 (p < 0·001), the convergent validity of Hospital Anxiety and Depression Scale-14 was r = 0·57 (p < 0·001) for anxiety and r = 0·35 (p < 0·001) for depression.

The Newly Diagnosed Breast Cancer Stress Scale has acceptable reliability and good validity to measure stress in newly diagnosed patients with breast cancer.

The Newly Diagnosed Breast Cancer Stress Scale can provide healthcare workers with an instrument to better identify stress levels in newly diagnosed breast cancer patients and provide valuable information when defining psychosocial care interventions.

Diabetes treatment is a critical concern worldwide. However, studies on self-care behaviour, social support and quality of life based on diabetes patients' diverse regimens are few.

This study was a cross-sectional design.

We enroled 127 outpatients aged over 40 years who visited a metabolism clinic at a medical centre in Southern Taiwan. The Self-care Behaviour Scale, Social Support Scale and Quality of Life Scale were used to collect data.

The results indicated that patients with a combined regimen of taking-medicine-while-dieting-with-regular exercise had the highest score at the levels of social support, self-care behaviour and quality of life.

The study results could offer evidence-based knowledge for healthcare professionals to guide and promote social support, self-care behaviour and quality of life for people diagnosed with type 2 diabetes.

These findings will help healthcare professionals to establish appropriate nursing strategies for type 2 diabetes patients who need to exercise regularly as part of their daily care to enhance their self-care behaviour, social support and quality of life.

Nurses play an important part in managing sedation because the prescription is usually given verbally directly from the cardiologist who is performing the procedure and typically, an anaesthetist is not present.

A qualitative exploratory design was employed.

Semi-structured interviews with 23 nurses from 16 cardiac catheterisation laboratories across four states in Australia and also New Zealand were conducted. Data analysis followed the guide developed by Braun and Clark to identify the main themes.

Major themes emerged from analysis regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements.

The most critical issue identified in this study is that current guidelines, which are meant to apply regardless of the clinical setting, are not practical for the cardiac catheterisation laboratory due to a lack of access to anaesthetists. Furthermore, this study has demonstrated that nurses hold concerns about the legitimacy of their practice in situations when they are required to perform tasks outside of clinical practice guidelines. To address nurses' concerns, it is proposed that new guidelines could be developed, which address the unique circumstances in which sedation is used in the cardiac catheterisation laboratory.

Nurses need to possess advanced knowledge and skills in monitoring for the adverse effects of sedation. Several challenges impact on nurses' ability to monitor patients during procedural sedation and analgesia. Preprocedural patient education about what to expect from sedation is essential.

Statistics suggest that adolescents are not always making safe sexual health decisions. It is essential to develop an understanding of preferred sources of information and support to structure health and education services so that adolescents develop skills and knowledge to make safer choices.

A cross-sectional survey design.

A wide-ranging questionnaire was developed using validated questions, drawn from similar adolescent lifestyle surveys and adapted with guidance from an advisory group; 2036 13–16-year-olds responded. Two questions, reporting information sources adolescents find useful and sources of approachable support, are considered here.

Adolescents find informal sources more useful and experience higher levels of comfort accessing informal support especially from their best friends and mothers. Of formal provision, school-based sources are preferred; however, sexual health information seeking is gendered and changes across year groups. The range of sexual health information sources adolescents access increases with age, and how they access these information sources changes as sexual activity increases and the information becomes more relevant.

The findings support the targeting of sexual health provision in relation to age and gender and suggest a youth-focused approach to formal provision, including outreach working and a collaborative relationship with adolescents and parents.

The findings contribute to an understanding of sources of information and support preferred by adolescents. In particular, they need to reconsider how services external to the school may be developed so they are youth-focused and approachable. Nurses need to consider how best to work in partnership with adolescents and their families to disseminate accurate information and develop relevant services.

Critical thinking and creativity are crucial in nursing education. The teaching approach of problem-based learning can help to reduce the difficulties of nurturing problem-solving skills. However, there is little in the literature on how to improve the effectiveness of a problem-based learning lesson by designing appropriate and innovative activities such as composing songs, writing poems and using role plays.

Exploratory qualitative study.

A sample of 100 students participated in seven semi-structured focus groups, of which two were innovative groups and five were standard groups, adopting three activities in problem-based learning, namely composing songs, writing poems and performing role plays. The data were analysed using thematic analysis.

There are three themes extracted from the conversations: ‘students’ perceptions of problem-based learning', ‘students’ perceptions of creative thinking' and ‘students’ perceptions of critical thinking'. Participants generally agreed that critical thinking is more important than creativity in problem-based learning and clinical practice. Participants in the innovative groups perceived a significantly closer relationship between critical thinking and nursing care, and between creativity and nursing care than the standard groups.

Both standard and innovative groups agreed that problem-based learning could significantly increase their critical thinking and problem-solving skills. Further, by composing songs, writing poems and using role plays, the innovative groups had significantly increased their awareness of the relationship among critical thinking, creativity and nursing care.

Nursing educators should include more types of creative activities than it often does in conventional problem-based learning classes. The results could help nurse educators design an appropriate curriculum for preparing professional and ethical nurses for future clinical practice.

There is an increasing interest in the potential for telemonitoring to support the home-based management of patients with chronic heart failure. However, little is known about the views of patients and professionals on the use of telemonitoring in this context. A chronic heart failure telemonitoring service was set-up by NHS Lothian, Scotland, to evaluate the intervention.

A qualitative design was adopted to explore the views of patients and professionals participating in the service.

Semi-structured interviews were undertaken with 18 patients (61% male, mean age 75 years) and five professionals participating at different time points in this new service. Interviews were audio recorded, coded and thematically analysed using the Framework approach.

Five main themes were identified: ‘information, support and reassurance’; ‘compliance and dependence’; ‘changes and challenges’; ‘determining the criteria for patient applicability to telemonitoring’; and ‘continuity of care’.

Patients and professionals considered telemonitoring useful in the management of chronic heart failure, although with some caveats. Telemonitoring was popular with patients because they felt reassurance arising from what was perceived as continuous practitioner surveillance. Professionals expressed concern regarding perceived patient dependence on practitioner support. Increased workload was also a concern. Both groups acknowledged the need for improved technology and changes to service provision in order to better meet the intended objectives of the service.

Although popular with patients, professionals emphasised the importance of case selection and adequate training and support, both for patients and themselves, in order to maximise the expected benefits of the service, particularly with regard to enabling self-management.

In the United States, women account for approximately one in four new HIV infections. Despite the effectiveness of consistent condom use, women often confront biological, cultural and psychosocial barriers that limit their ability to engage in condom-use.

Cross-sectional, quantitative study.

Participants (N = 90) were recruited from a domestic violence shelter, a domestic violence support organisation and an obstetrics/gynaecology clinic in Philadelphia, PA. Data were collected by questionnaires to assess women's condom-use intentions, actual condom-use behaviour, sexual partner risk factors, experience of IPV, level of sexual relationship power and perceptions of monogamy.

Fifty-eight per cent of participants (n = 52) indicated a difference between their preference and intentions to use condoms vs. their actual use, with 62% (n = 32) using condoms less frequently than they would like. Significant differences in condom use emerged for women with low vs. high sexual relationship power and women who reported being in a monogamous relationship vs. those who did not. Of particular concern, a majority of these relationships were with high-risk partners, further increasing women's already elevated risk of acquiring HIV.

Condom use is a multifaceted issue, particularly in sexual relationships involving power differentials and perceived monogamy. Condom use was complicated by women's own preferences, sexual relationship power differentials and by the perceived exclusivity of the relationship with their sexual partners.

These findings have important implications for nurses as they are uniquely positioned to facilitate HIV risk reduction among their patients through the discussion of sexual health issues and barriers to negotiating condom use that women may confront.

Numerous studies have documented the impact of trauma centre level, trauma centre verification, volume per centre and per surgeon or resource availability on outcomes among trauma patients. However, there continues to be debated about whether trauma care is comparable by these trauma centre characteristics.

Systematic review.

Eligible studies were identified via electronic database searches, footnote chasing and contact with clinical experts. Quality of selected studies was assessed in terms of internal and external validity using 14 questions. Two reviewers independently examined titles, abstracts and whether each met the predefined criteria.

A total of 50 studies which met criteria were selected. Ten of 17 articles showed that level I trauma centres had better patient outcomes than level II centres. The achievement of trauma centre verification by American College of Surgeons or State was beneficial to decreasing mortality and length of stay in 9 of 11 studies. High trauma admission volume was beneficial in 8 of 16 studies. The volume per trauma surgeon did not contribute to better patient outcomes in 4 of 5 studies. The availability of in-house trauma surgeon was beneficial to lower mortality and shorter length of stay in only 2 of 9 studies.

This review supports that achieving the trauma centre verification by American College of Surgeons or State is definitely beneficial to patient outcomes. However, the benefit of level I centres compared with level II centres, and volume of annual trauma patients to outcomes is still debating. Further prospective study examining this relationship is required.

Understanding which characteristics of trauma centre provides the best prospect for improved outcomes depending on patient need and resource availability would allow further appreciation of the processes that foster such enhancement.

We have only limited information about the effect of mobility function improvement on the HRQoL several years after THR. We have recently found that after THR postoperative health awareness is influenced mainly by cardiovascular diseases, but the effects of the movement parameters on the subsequent feelings of well-being were not examined.

Retrospective longitudinal study.

This study involved 109 patients who had had THR. The patients' health status and objective and subjective mobility function at the time of operation and five years later were evaluated using questionnaires (including EQ-5D and WOMAC scores) and the hospital database.

All components of EQ-5D and WOMAC had significantly improved by Year 5 in patients who experienced a complete recovery after the operation, but not the mobility and pain components of EQ-5D for those patients who felt an improvement only in their subjective mobility function. The surgeon-assessed parameters and use of walking aids showed a similar distribution in patients who considered themselves to be healthy or only moderately sick five years after THR.

Successful THR significantly improves the feeling of well-being and the mobility function of patients even five years after the operation. In individual cases, however, other subjective and objective factors, but not the mobility function, have a major influence on the HRQoL.

Five years after successful THR, nursing care has to focus not only on the further improvement of the mobility but on strengthening the subjective feeling of the patient's well-being and health.

Caregivers of persons with dementias experience poorer sleep in comparison with non-caregivers, and poor sleep is related to negative health outcomes. The reasons for caregivers' poor sleep are complex, and it is known that the night-time behaviours of the persons with dementia contribute to caregiver sleep disruption. However, the frequency of behavioural and psychological symptoms of dementia has hitherto not been sufficiently explored as a contributing factor to poor caregiver sleep.

A non-experimental cross-sectional design.

Eighty caregivers completed questionnaires on the frequency of behavioural and psychological symptoms of the persons with dementia, the Dementia Severity Rating Scale, the Pittsburgh Sleep Quality Index and the Center for Epidemiologic Studies Depression Scale.

Poor sleep was reported with awakenings by the persons with dementia occurring for more than half of the caregivers. The frequency of behaviours and symptoms did not make a unique contribution to the variance of caregivers' global sleep. The frequency of behaviours, and specifically of agitation and apathy, contributed to the variance in subjective sleep quality, as defined by the caregivers' appraisal of their sleep.

The findings demonstrate the relationship between (1) daytime and night-time behaviours of persons with dementias and (2) their caregivers' sleep quality and emphasise the complexity of the factors that contribute to caregiver sleep quality.

These findings suggest that nurses should be cognizant of the relationship between daytime behaviours of the persons with dementia and the caregivers' appraisal of their sleep, realising that appraising one's sleep as poor can be a contributing factor to perpetuating sleep problems. Interventions aimed at helping the caregiver manage the persons with dementia's agitation or the caregiver's emotional response to persons with dementia apathy may improve caregivers' perception of their sleep.

AT is a patient-centred approach used to explore patient attitudes, beliefs and discrepancy toward medications that aimed to enhance patients' medication-taking behaviour.

Qualitative analysis of semi-structured interviews with patients who had completed an AT intervention.

A convenience sample of 10 hypertensive patients who received AT as part of an exploratory randomised controlled trial (ISRCTN99494659) were included. Thematic analysis of semi-structured interviews exploring patient's views and experiences of AT was used.

Five major themes of AT emerged; modifying attitudes and beliefs, positive impact on self efficacy, therapist motivation, positive impact on well-being and a well-designed intervention.

patients' views about the benefit of AT were entirely consistent with our proposed mechanism of action for this intervention; that is by improving patient's beliefs and attitudes regarding taking drugs, and finding solutions to barriers that prevent adherence, patients become more complaint with their medication which in turn has a positive impact on clinical outcomes [i.e. blood pressure, hypertension complication (stroke, myocardial infarction, and recurrent hospitalisation)].

Exploring patients' experience with AT and recognising these five elements help in tailoring a new effective strategy according to individual needs for enhancing adherence to prescribed drugs.

Patients with coronary artery diseases must perform the health behaviour to prevent recurrent cardiac events. It has been already well known that self-efficacy is a vital factor in both initiating and maintaining health behaviours.

Descriptive correlational and cross-sectional survey design.

Subjects were interviewed using structured study questionnaires. The data collected were statistically analysed by descriptive statistics and inferential statistics including the t-test, anova, Tukey's test, Pearson's correlation and hierarchical multiple regression analysis to determine the predictors of cardiac self-efficacy.

A convenience sample of 214 patients with coronary artery diseases was included. The mean age of subjects was 60·71 ± 10·07 years, and three-fourths were men. The overall model significantly explained 15·8% of variance in cardiac self-efficacy. Among predictors, occupation, diagnosis, body mass index, experience of receiving patient education and awareness of risk factors had statistically significant influences on cardiac self-efficacy.

Rather than disease knowledge, factors related to subject's perception were more likely to associate with cardiac self-efficacy. These findings might provide a theoretical basis to develop nursing interventions for enhancing cardiac self-efficacy of patients with coronary artery diseases.

Clinical nurses taking care of patients with coronary artery diseases should consider the patients' perception on their coronary artery diseases including experience of receiving patient education, and awareness of risk factors in encouraging the cardiac self-efficacy to promote the health behaviours for the secondary prevention of coronary artery diseases.

Although quality of life has been a focus of concern in mental health care, data are lacking on what life is like and what factors are related to an individual's quality of life after a suicide attempt.

A cross-sectional, descriptive design was used.

Participants comprised a convenience sample of 103 individuals who had attempted suicide within the previous three months and received follow-up care from one suicide-prevention centre in northern Taiwan. Participants were assessed for depression and quality of life using the Beck Depression Inventory, Taiwan version and the World Health Organisation Quality of Life Instrument-BREF, Taiwan version, respectively.

Almost half the participants (n = 49) had severe depression and one-third of them (n = 30) reattempted suicide while receiving follow-up care. Depression and quality-of-life scores were statistically significantly inversely correlated. participants' quality-of-life scores were most associated with their depressive level, reattempting suicide during suicidal follow-up care, high educational level and older age.

The present study indicates that factors associated with quality of life decreased more in individuals with moderate/severe depression than in those with mild depression. In addition, individuals who reattempted suicide during follow-up care were more likely to suffer from poor life quality.

Mental health professionals should include frequent evaluation of depressive status and quality of life in follow-up care for patients who have recently attempted suicide. Particularly, mental health professionals must treat suicidal individuals with a high tendency to reattempt suicide by establishing trust with them and allowing them to narrate their painful experiences during follow-up care.

The optimal period for weight loss is six months postpartum. However, most women cannot return to their pre-pregnancy fitness level within that period of time.

A quasi-experimental one-group pretest–post-test design was carried out.

A convenience sampling method was used to recruit 28 women at 2–6 months postpartum. The ‘Yoga and Pilates Exercise Programme for Postpartum Woman’ was designed for this study and was delivered in group sessions once a week for three months (12 times total) for 60 minutes each time by a professional coach. Of the participants, 23 completed the entire program. The participants' body composition and levels of depression and fatigue were measured before and after the programme to identify differences.

Women in the high-score group showed a significant decrease of 6·71 ± 5·71 points (t = 3·113, p = 0·021) in the depression score after participating in the exercise programme. No significant difference was found for the level of fatigue before and after the exercise programme (p > 0·05). Significant reductions in the participants' body weight, body fat percentage, fat mass and basic metabolic rate were observed after the exercise programme (p < 0·001).

These physical activities benefited the physical and mental health of postpartum women and enhanced their quality of life.

It is worthwhile promoting a yoga and Pilates exercise programme for postpartum women in communities.

Consumer perspective literature indicates approval and dissatisfaction with certain aspects of the inpatient experience, and there is a limited understanding of what consumers perceive to be effective nursing practice.

The design of this study was qualitative, the data being interpreted with a thematic analysis.

This study sought the perspectives of eight (n = 8) recovered consumers through semi-structured interviews.

Nurses were considered highly influential over the inpatient experience. The findings of this study are characterised by three overall themes regarding nursing practice: (1) ensuring weight gain, (2) maintaining a therapeutic milieu, and (3) the nursing relationship.

Consumers have clear perspectives of how nurses effectively ensure weight gain and how nurses ensure a positive inpatient experience. The quality of relationships between consumers and nurses had implications for both weight gain and the perceived quality of the inpatient experience. By relying on the strength of positive, thoughtful and well-timed interactions, nurses may contribute to productive physical outcomes and a positive inpatient experience. Consumers indicated that motivation to adhere to care was derived from strong relationships with nurses. Ensuring both weight gain and a positive experience involves achieving a productive ‘balance of restrictions’. Consumers also valued nurses that created a comfortable and productive environment.

This study indicates that the process of weight gain may be enhanced when accompanied by a process of therapeutic engagement. Therapeutic alliance may be an effective way for nurses to ensure weight gain and an enhanced inpatient experience. Therapeutically beneficial relationships may enhance treatment and possibly enhance outcomes for consumers.

The repeatability and precision of readings from IR thermometers for professional use were questioned in the past, but in recent years, these types of thermometers have been technologically improved, so their ability to replicate standard temperature readings reliably should be re-examined.

Febrile and afebrile children were recruited from the emergency department, overflow treatment areas and the paediatric intensive care unit of a large hospital in Argentina. Each child had a randomised sequence of seven temperature readings, including three from the ear, three from the forehead or behind the ear and one reference oral or rectal reading.

Temperature readings were taken with the ThermoScan PRO 4000, the Temporal Scanner TAT-5000 and the monitor mode of SureTemp^® Plus, a widely used professional-grade contact thermometer, for reference.

Of 205 children, 46% were febrile, per reference thermometer readings. While mean ThermoScan PRO 4000 febrile measurements did not differ significantly from reference, mean Temporal Scanner TAT-5000 febrile measurements were significantly lower (by a mean of 0·42 °C) than the reference. Overall bias of the ThermoScan PRO 4000 was significantly lower than that of the Temporal Scanner TAT-5000; repeatability was 1·5 times higher, and overall false-negative rate was about a third that of Temporal Scanner TAT-5000, when compared to the reference.

This study indicates that the ThermoScan PRO 4000 provides measurements closer to those of a professional-grade contact thermometer when compared to the Temporal Scanner TAT-5000.

The odds of misclassifying a febrile child as non-febrile were about threefold higher with the Temporal Scanner TAT-5000 temporal artery thermometer than with the ThermoScan^® PRO 4000 ear thermometer.

Hospitalised patients in the United States who experience cardiopulmonary arrest seldom recover. Most of these patients show signs of clinical deterioration prior to cardiopulmonary arrest. RRTs have been shown to decrease the incidence of cardiopulmonary arrest by bringing needed resources to unstable patients. Despite the evidence in support of the activation of RRTs, nurses do not always use this resource. Nurses' decisions to activate or not to activate the RRT are not clearly understood.

We used a qualitative design for this study.

A purposive sample of 15 medical/surgical nurses was recruited from a small medical centre in the Midwest. Researchers used semistructured, open-ended questions to elicit subject responses regarding facilitators and barriers to activating RRTs.

Themes emerged and were categorised as facilitators and barriers to calling the RRT. Facilitators and barriers were then subdivided into distinct subthemes: RRT characteristics and unit culture. The expertise of the RRT members and support and encouragement from nursing unit colleagues and leaders emerged as two potential facilitators. Communication of the RRT members and calling the physician first emerged as two potential barriers. We also identified educational factors that were not clearly facilitators or barriers to calling the RRT.

Further study is needed using quantitative designs with larger sample sizes.

Nurses can build upon knowledge of facilitators and barriers related to RRT characteristics and nursing unit culture.

Coping strategies for living with ALS have already been investigated. However, there is a lack of studies on how people with the disease find meaning and what helps and hinders this.

A qualitative descriptive study.

Fourteen individual interviews were performed in Spring 2007. The interviews were analysed by qualitative content analysis.

Two themes emerged to illuminate the complex life situation of the interviewees: experiences of anxiety over life and death and finding meaning despite the illness. It became clear that the uncertain journey towards death was more frightened than death itself. Despite the incurable disease, which brought feelings of life and death anxiety, physical loss, unfairness, guilt, shame and existential loneliness, they also found meaning in life, which strengthened their will to live. Meaning was found through their family and friends, the act of giving and receiving help, the feeling of having a life of their own and accepting the present. The perspective of life was transferred to a deeper view where material things and quarrels were no longer in focus.

Despite the disease, the participants found meaning in life which strengthened their will to live.

The balance between anxiety over life and death and finding meaning in life indicates the importance of support through the whole disease process. Both disease-specific problems and existential questions must be tackled. Nurses and other professionals need to be aware of the patients' existential qualms. There is a need to focus on what is important for the individual, and emphasis must be placed on where that person can find meaning.

Prevailing knowledge about women's sexual problems has prioritised the material body. Particular attention is given to the importance of penetrative sexual intercourse, orgasm and the reproductive imperative, which fail to take account of contextual factors that contribute to women's experiences of sexual problems.

Qualitative in-depth interview study.

Individual in-depth interviews conducted with 23 women aged 23–72 years, recruited from members of the general public and a psychosexual clinic.

The findings suggest that sexual problems are bodily experienced and socially and psychologically mediated. Women's views were influenced by the relational context of their experiences. At the same time, their views were deeply embedded within a patriarchal framework to make sense of their own sexual functioning and satisfaction.

This study presents a challenge in the drive to medicalise women's sexual problems via the female sexual dysfunction label. It problematises the current diagnostic criteria for sexual problems outlined in the Diagnostic and Statistical Manual, which presupposes a highly individualised framework and favours a more nuanced approach.

Rather than adopting or eschewing an entirely medical or psychosocial model, women presenting with sexual problems should be seen by a clinician whose assessment is holistic and takes into account relational, cultural, psychosocial and health-related concerns.

Patients with chronic obstructive pulmonary disease are often troubled by acute exacerbation and must learn how to prevent this.

A two-group, pretest–post-test experimental design was used in this study.

Data were collected between January–July 2008. Sixty-four participants were randomly assigned either to an intervention (n = 33) or to a comparison (n = 31) group. Both groups were assessed on four separate occasions, namely pretest, post-test 1 (5th week), post-test 2 (9th week) and post-test 3 (13th week). The intervention group received a four-week self-regulation protocol. The comparison group received the self-regulation guidebook only. The Borg Dyspnea Scale, the Symptom Distress Scale, the Pulmonary Functional Status Scale, the chronic obstructive pulmonary disease Self-Efficacy Scale and the peak expiratory flow were used to measure differences between pretest and post-test values.

On the 5th, 9th and 13th weeks after the self-regulation protocol intervention, we found significantly better scores in the four scales in the intervention group compared to those in the comparison group. On the 9th and 13th weeks, there was a significantly greater peak expiratory flow in the intervention group. The intervention group also showed a lower rate of unscheduled physician visits because of acute exacerbation than the comparison group.

The findings indicate that the self-regulation protocol developed in this study could significantly assist participants to control their individual symptoms and avoid acute exacerbation.

Healthcare professionals could apply the protocol developed in this study to assist patients to learn the strategies of self-regulation to prevent their acute exacerbation symptoms.

The recruitment and retention of an adequate number of registered nurses is a continuing workforce issue in Singapore and other major cities.

Survey of recent nursing graduates.

Recent nursing graduates from the Bachelor programme (n = 147) were sent an individual survey; a response rate of 54% was achieved.

Findings show that nurses rated their self-concept in a positive manner and were most satisfied (moderately to very) with helping patients and providing effective care, and the level of patient involvement. They were least satisfied (moderately to only a little) with prestige among the general medical community and the general public, hours of work, lifestyle factors and research opportunities. The following four factors were identified as significant impediments to career development; lack of support in the work place; perceived insufficient clinical career development opportunities; excessive work hours; and limited access to merit-based places in further education.

Suggestions made to overcome perceived career development barriers are as follows: broad multifactorial healthcare system changes; decreased and more flexible working hours; and fairer access to further clinical and higher education.

Results highlight the value clinical nurses place on having access to career development opportunities, merit-based further education and work place supports. These factors also have the potential to influence patient care and impact on the retention of nurses in their present job and satisfaction with their nursing career.

Although nurse practitioners in Australia have prescriptive authority, little is known about which specific medications nurse practitioners are prescribing and how frequently they do so.

Descriptive electronic survey.

A total of 209 nurse practitioners reported current prescribing practices. Medications reported were categorised according to the Australian Medicines Handbook major drug classifications and frequencies presented.

Seventy-eight per cent of respondents reported prescribing medications as part of their Nurse Practitioner practice. In total, participants reported prescribing 234 separate medications from most Australian Medicines Handbook major drug classifications. Medications from the classification anti-infective drugs were most frequently prescribed followed by medications from analgesic, psychotropic, cardiovascular, musculoskeletal, genitourinary and gastrointestinal classifications.

The majority of nurse practitioners in Australia prescribe medications in their clinical practice, although the proportion of nurse practitioners prescribing has not changed significantly in the past four years. The medications prescribed are comparable with those most frequently prescribed by all prescribers in Australia and highlight the diversity in scope of practice among nurse practitioners.

Findings highlight the importance of Nurse Practitioner's a capacity to prescribe wide variety of medications, especially in practice areas such acute, primary and emergency care. The unique role nurse practitioners in relation to management of patients with infective processes and patients requiring pain relief is highlighted. Insight into current Nurse Practitioner prescribing trends informs future Nurse Practitioner curricular and future continuing education programmes. Findings give unique insight for future service planning, especially service providers considering introducing nurse practitioners to their service. The finding that nurse practitioners prescribing patterns are similar to other non-nurse practitioner prescribers in Australia highlights the potential for service providers to introduce new models of care that are Nurse Practitioner lead.

The role of haemodialysis nurses in renal anaemia management has evolved through the implementation of nurse-driven protocols, addressing the trend of exceeding haemoglobin targets and rising costs of erythropoietin-stimulating agents.

Retrospective, non-equivalent case control group design.

The sample was from three haemodialysis units in a control group (n = 64) and three haemodialysis units in a protocol group (n = 43). The protocol group used a nurse-driven renal anaemia management protocol, while the control group used a traditional physician-driven approach to renal anaemia management. All retrospective data were obtained from a provincial renal database. Data were analysed using chi-square tests and t-tests. Patient outcomes examined were haemoglobin levels, transferrin saturation levels, erythropoietin-stimulating agents use and intravenous iron use. Cost comparisons were determined using average use of erythropoietin-stimulating agents and intravenous iron.

Control and protocol groups reached haemoglobin target levels. In the protocol group, 75% reached transferrin saturation target levels in comparison with 25% of the control group. Use and costs for iron was higher in the control group, while use and costs for erythropoietin was higher in the protocol group. The higher usage of erythropoietin-stimulating agents was potentially related to comorbid conditions amongst the protocol group.

A nurse-driven protocol approach to renal anaemia management was as effective as the physician-driven approach in reaching haemoglobin and transferrin saturation levels. Further examination of the use and dosing of erythropoietin-stimulating agents and intravenous iron, their impact on haemoglobin levels related to patient comorbidities and subsequent cost effectiveness of protocols is required.

Using a nurse-driven protocol in practice supports the independent nursing role while contributing to safe patient outcomes.

Intensive care sedation practices have undergone significant changes. Patients, where possible, are now managed on lighter levels of sedation, often achieved through the performance of sedation holds (SHs). The performance of SHs is normally carried out by the bedside nurse but compliance is reported to be poor. There has been little exploration of the nurses' experiences of these changes and the implications of SHs and subsequent wakefulness on their delivery of care.

Following ethical approval, 16 intensive care nurses, experienced and inexperienced, from within a general intensive care unit.

A Heideggerian phenomenological approach was used. Data collection consisted of interviews guided by an aide memoir and a framework adapted from Van Manen informed the analysis.

The findings reveal new insights into the world of the intensive care nurse in the light of the changes to sedation management. They demonstrate that there have been unforeseen outcomes from well-intentioned initiatives to improve the quality of patients' care. There were implications from the changes introduced for the nurses care delivery. The main themes that emerged were ‘working priorities’ and ‘unintended consequences’, in turn revealing embedded tensions between evidence-based targets and holistic care.

Intensive care nurses find that the current approach to the changes in sedation management can threaten their professional obligation and personal desire to provide holistic care. The ‘targeted’ approach by healthcare organisations is perceived to militate against the patient-centred care they want to deliver.

Sedation management is complex and needs further consideration particularly the potential constraints ‘target-led’ care has on nursing practice.

The literature presents the concept of shared decision-making as a complex process characterised by a partnership between the healthcare provider and the patient, which is participatory and action oriented with education and negotiation leading to agreement. Few studies have been carried out to explore and describe the events that make up the experiences of shared decision-making in home-care from the nurse's perspective.

A qualitative descriptive study was implemented.

Semi structured interviews were performed with 10 home-care nurses who were asked to reflect on a time in their practice when they were involved in a shared decision-making process with their patient. All data were analysed using Colaizzi's method.

The following Themes were uncovered: Begin where the patient is; Education for shared decision-making; The village and shared decision-making; and Whose decision is it? Each of the four Themes contained Subthemes.

The findings of this study present shared decision-making as a complex, multidimensional and fluid process. A thorough understanding of shared decision-making is essential within the multiple contexts in which care is delivered.

Nurses in clinical practice need to know and understand the events of the experience of shared decision-making. A more comprehensive understanding of these facts can assist home-care nurses in their practice with regard to the application of shared decision-making.

There is a need for competence assessment scales in intensive care nursing practice and education. The nursing care performed in the intensive care unit is special by its nature and needs to be assessed as such. At this moment, however, there is no tested, reliable and valid scale in this field.

A multi-phase, multi-method development and psychometric testing of the scale was conducted.

The scale was developed in three phases. First, following a literature review and Delphi study, the items were created. Second, the scale was pilot tested twice by nursing students (n₁ = 18, n₂ = 56) and intensive care nurses (n₁ = 12, n₂ = 54), and revisions were made. Third, reliability and construct validity were tested by graduating nursing students (n = 139) and intensive care nurses (n = 431).

The Intensive and Critical Care Nursing Competence Scale (ICCN-CS-1) is a self-assessment test consisting of 144 items. Basic competence is divided into patient-related clinical competence and general professional competence. In addition, basic competence is comprised of knowledge base, skill base, attitude and value base and experience base. ICCN-CS-1 is a reliable and tolerably valid scale.

The ICCN-CS-1 is a promising scale for use among nursing students and nurses. Future research is needed to evaluate its construct validity further and to assess its suitability for completion during intensive care unit's orientation programmes and nursing students' clinical practice in an intensive care unit.

The ICCN-CS-1 can be used for basic competence assessment in professional development discussions in intensive care units, in mentor evaluation situations during nursing students' clinical practice and in intensive care nursing education.

Proper psychosocial adjustment is important for patients with end-stage renal disease to cope with multiple stressors of their disease and to balance their lives within the restrictions imposed by peritoneal dialysis treatment. Knowledge on psychosocial adjustment in patients receiving long-term peritoneal dialysis has been limited.

The study was based on a predictive correlational design.

One hundred peritoneal dialysis patients were recruited from outpatient peritoneal dialysis clinics of a general hospital in Taipei, Taiwan. Data were collected with the study questionnaires, including the Physical Symptom Distress Scale, the Social Support Scale and the Psychosocial Adjustment to Illness Scale – self-report.

The mean score on the Psychosocial Adjustment to Illness Scale was 359·7 (SD = 40·0), indicating that these participants were moderately struggling in adjusting to their illness. Symptom distress, family social support and financial status explained 38·3% of the variance in psychosocial adjustment (F_3,96 = 21·5, p < 0·001).

The level of psychosocial adjustment in peritoneal dialysis patients is suboptimal. Overall, the patients with high physical symptom distress, weak family social support and poor financial status reported deficient psychosocial adjustment to their illness.

The findings of this study are relevant to the understanding of preconditions that enable peritoneal dialysis patients to successfully adjust to the disease and its diverse consequences. Patients with insufficient income, higher symptom distress and less family social support have a greater risk of psychosocial maladjustment. Medical professionals may use these variables to identify higher risk groups for early intensive intervention.

Enteral nutrition is preferred for feeding patients in the intensive care unit who are unable to have oral nutrition. Interruption to feeding is likely to be a major contributor to patients not receiving their prescribed nutrition goals.

Prospective before (May–November 2009) and after (March–September 2010) study.

Patients admitted to the intensive care unit (except cardiac surgery) and who were eligible to receive enteral nutrition were enrolled. After gaining Ethics Committee approval, baseline data were collected to identify interruptions to enteral nutrition. Nurse-led multidisciplinary teams developed interventions to target specific reasons for interruption. Change champions implemented the improvements after staff were provided with an education package. Postintervention data were then collected.

Six hundred and fifty-three patients received enteral nutrition with the majority (88%) fed within 48 hours. Considering the first 28 days of feeding for patients fed longer than 24 hours (505 patients), the number of interruptions for patients who had an interruption decreased from 907–662. Interruptions due to gastrointestinal issues decreased (14 vs 10%), while those due to airway issues, enteral nutrition delivery system problems and other interruptions were similar before-and-after the practice change. Time lost to feeding because of interruptions was similar between groups.

Targeted strategies to enteral feeding practice resulted in a reduction to the number of interruptions but not the duration of enteral nutrition lost to interruption. Reducing unnecessary interruption of feeding circuits is likely to minimise the risk for splash injury and contamination of feeding sets through less manipulation and interruption to enteral nutrition flow.

Review of practice may reveal opportunities for improvement. Nurse champions can facilitate change processes to improve care.

Pregnant women experience stress originating from a variety of pregnancy-specific issues, including physical symptoms and changes, changes in body image, physiological, social and emotional changes, parenting concerns, changes in relationships with significant others, medical problems, anxiety about labour and delivery, concerns about birth and the baby's health.

A descriptive cross-sectional study.

This study was conducted at a gynaecology clinic of a private hospital in Istanbul, Turkey within a 12-month period. The study sample comprised 522 pregnant women continuing their regular visits for prenatal care. Pregnancy Description Form and Turkish Version of Revised Version of Prenatal Distress Questionnaire [(NUPDQ)-17 Item Version] were used for data collection.

Study sample was moderately distressed. Turkish pregnant women were mostly distressed and concerned about premature delivery, having an unhealthy baby, labour and delivery, feeling tired and having low energy during pregnancy. Prenatal distress in Turkish pregnant women was associated with personal and pregnancy-related characteristics.

This study found that pregnant women need to be supported emotionally, physically and socially. A better understanding of prenatal maternal distress could assist in informing healthcare professionals about the provision of physically, emotionally, socially and behaviourally appropriate support for achieving a healthy pregnancy.

It is crucial for pregnant women to be regularly assessed and educated for dealing successfully with concerns and fears about prenatal period, birth and postnatal period and about difficulties that women may encounter during their pregnancy.

Type 1 diabetes requires lifestyle changes involving diet modification, monitoring blood glucose, counting carbohydrates and administering insulin. Learning self-care and developing positive attitudes can improve glucose management and promote long-term benefits. Therefore, understanding challenges of youth living with type 1 diabetes from their own perspective is an important first step in improving diabetes outcomes for this age group.

Qualitative descriptive design using focus groups to identify the experiences and challenges of children and youth living with type 1 diabetes.

Six focus groups were held over a four-month period in 2010; each participant attended one focus group. A total of 16 children and youth with type 1 diabetes participated. The focus group discussions were audio recorded, transcribed verbatim and analysed for common themes according to qualitative methodology. To assure trustworthiness, investigators independently coded interviews and themes were refined and adjusted until consensus was reached.

Three themes emerged after analysing transcripts from the focus groups that embody challenges children and youth with type 1 diabetes faced: (1) low blood glucose; (2) self-care activities; and (3) feeling different and/or alone.

Data indicated type 1 diabetes is challenging for this age group. These challenges must be addressed to assist youth in learning to manage their disease and promote healthy outcomes.

It is important for nurses to discuss challenges, understand perspectives of this age group, listen to their concerns, work with them to develop strategies promoting health, minimise complications, reduce or eliminate feeling different or alone and assist parents' efforts to be supportive.

Chronic pain is common among older persons. Indeed, motivation for managing pain is poor, and may cause negative consequences. Motivational interviewing maybe effective in treating chronic pain.

Single-blinded randomised control study.

Older persons with chronic pain (n = 56) were recruited from two elderly community centres. They were blinded from the group allocation. The programme was conducted by an motivational interviewing-trained physiotherapist and registered nurses. Participants in the experimental group received an 8-week integrated motivational interviewing and physical exercise programme, while the control group received regular activities in the centre. Motivational interviewing used open-ended questions to encourage participants to express and recognise their pain and behaviours and professional feedback was given accordingly. Pain intensity, pain self-efficacy, anxiety, happiness, depression, mobility and quality of life were measured before and after the motivational interviewing and physical exercise programme. Attendance and compliance rate of the programme was calculated in the experimental group.

Significant improvements in pain intensity, pain self-efficacy, anxiety, happiness and mobility after the motivational interviewing and physical exercise programme (all p < 0·05) for experimental group, while no significant improvement in control group except on the happiness scale. Regarding group differences in the outcome measures, the change scores on pain intensity, state anxiety and depression were significantly better in the experimental group.

Motivational interviewing and physical exercise programme is effective in improving pain, physical mobility, psychological well-being and self-efficacy for community-dwelling older persons with chronic pain.

Motivational interviewing is a feasible counselling technique whose content can be modified based on target group to change maladaptive behaviours, elicit ambivalences and enhance self-efficacy for making changes. Thus, promoting motivational interviewing and physical exercise programme to older persons with pain is effective and important.

Treatment and secondary prevention of diabetes require a complex combination of care components. Patients' education has been accepted to improve diabetes knowledge, self-management and self-efficacy. Psychometrically sound instruments are needed to measure these patient-centred outcomes.

Psychometric instrument validation.

The first phase included a systematic literature review to develop the instruments. Content validity was evaluated using a two-round Delphi procedure involving diabetes experts. The content validity of the instruments was excellent. In a second phase, a convenience sample of 188 diabetic patients in two hospitals in one specific care region in Belgium participated in the psychometric evaluation. The criterion-related validity and internal consistency reliability were evaluated.

The study produced a 21-item knowledge instrument, reflecting knowledge about ‘glycemic control’ and ‘medico-social management aspects’. The self-management instrument included 32 statements, reflecting ‘treatment and compliance’ and ‘general lifestyle’. The self-efficacy instrument included 30 items, reflecting ‘nutrition’, ‘treatment’ and ‘regimen’. The patient satisfaction survey included 36 items, reflecting satisfaction about the relationship among the diabetes specialist, the diabetes educator, podiatrist and dietician.

An instrument set with sound psychometric characteristics was developed to assess knowledge, self-management and self-efficacy of diabetic patients. Future studies should focus on the association between the instrument outcomes and clinical patient outcomes.

The current instrument can support the design of educational interventions and training programmes and reduce inconsistencies in the information that patients receive. Furthermore, the instruments can be used for benchmarking the quality of diabetic patient education.

Little is known about the status and underlying mechanism of poor school outcome as experienced by low birth weight survivors.

This is a secondary data analysis.

The parental study recruited 1104 low birth weight (LBW) infants weighing ≤ 2000 g from three medical centres of Central New Jersey between 1984 and 1987. Seven hundred and seventy-seven infants survived the neonatal period, and their developmental outcomes had been following up regularly until now. The development data of the survivors were used to achieve the research aims. Initial school outcome assessment was carried out in 9-year-old, using the Woodcock-Johnson Academic Achievement Scale. The severity and range of perinatal brain injury was determined by repeated neonatal cranial ultrasound results obtained at 4 hours, 24 hours and 7 days of life.

Seventeen and a half per cent of the sample experienced poor school performance at age 9 as defined by lower than one standard deviation (SD) of average performance score. Children with the most severe injury, PL/VE, had the lowest mathematics (F = 14·54, p = 0·000) and reading (anova results: F = 11·56, p = 0·000) performances. Visual motor function had a significant effect on children's overall school performance (Hotelling's trace value was 0·028, F = 3·414, p = 0·018), as well as subtest scores for reading (p = 0·006) and mathematics (p = 0·036). However, visual motor function was not a mediator in the association of perinatal brain injury and school outcome.

Perinatal brain injury had a significant long-term effect on school outcome.

Low birth weight infants with history of perinatal brain injury need be closely monitored to substantially reduce the rates of poor school outcome and other neurodevelopmental disabilities.

The prevalence of dementia is increasing related to lack of a cure, thus prompting some researchers and clinicians to focus on patient's quality of life.

A cross-sectional study.

A convenience sample of 200 mild-to-moderate dementia patients was obtained in Jinan city and 205 ones in Wakayama city. Then, we measured patient's quality of life and analysed the relation between general demographic information, cognitive function, activities of living, behavioural and psychological symptoms, and the patient's quality of life.

The total score of Dementia Quality of Life in Jinan city was 89·82 ± 15·11; multiple linear regression showed that the influencing factors of quality of life were marital, economics, characteristics, activities of living, hypertension and irritability. And the total score in Wakayama city was 118·30 ± 14·56; the influencing factors were education, body mass index, activities of living and depression.

The total score of Dementia Quality of Life in Jinan city was significantly lower than Wakayama city. The same influencing factor between these two cities was activities of living.

Nurses could implement interventions to focus on many of the patient's influencing factors, so that to improve their mental and physical health, which may slow the disease process and further improve the patient's quality of life. In addition, Chinese government could learn some experience from Japanese government, such as perfect the system of nursing insurance for elderly and introduce professional geriatric nursing talents to provide better service for the elderly.

Structured education programmes are used widely as interventions in randomised controlled trials. However, the process of developing a structured education programme has received little attention relative to that given to evaluating the effectiveness of such programmes. This paper makes explicit the steps followed to develop the SERPS, thereby making a contribution to the methodology of designing and implementing effective structured education programmes.

The approach to designing the SERPS was informed by the Van Meijel et al. (2004) model (Journal of Advanced Nursing 48, 84): (1) problem definition, (2) accumulation of building blocks for intervention design, (3) intervention design and (4) intervention validation.

Grounded theory was used (1) to generate data to shape the ‘building blocks’ for the SERPS and (2) to explore residents, family and staff's experience of using/receiving reminiscence.

Analysis of the pilot data indicated that the programme met its objective of preparing staff to use reminiscence with residents with dementia. Staff were positive both about the SERPS and the use of reminiscence with residents with dementia.

This paper outlines a systematic approach to developing and validating a structured education programme. Participation in a structured education programme is more positive for staff if they are expected to actively implement what they have learnt. Ongoing support during the delivery of the programme is important for successful implementation.

The incorporation of client and professional experience in the design phase is a key strength of this approach to programme design.

Various repositioning methods have been applied in clinical practice in managing malpositioned peripherally inserted central catheters, and many of them are proved effective. However, little publication reviewed on those literatures describing repositioning techniques to malpositioned peripherally inserted central catheters.

Systematic review. The repositioning techniques were classified and concretely described according to different locations of malpositioned peripherally inserted central catheter tips.

Literature and relevant guidelines were reviewed, focusing on malpositioned locations and incidence, as well as repositioning skills to peripherally inserted central venous catheters. Six databases were searched, including MEDLINE, web of science, CINAHL, Cochrane library, Wanfang database and Chinese National Knowledge Infrastructure. The articles (n = 21) were analysed using inductive content analysis.

The malpositioned locations of postplacement peripherally inserted central catheter tips mainly include right atrium, right ventricular, axillary vein, ipsilateral and contralateral internal jugular vein, subclavian vein, brachiocephalic vein, other small venous branches or catheter looped. Repositioning techniques contained automatic reposition, manual repositioning techniques, re-advancing catheters and catheters' replacement according to different malpositioned patterns.

The most appropriate repositioning techniques should be adopted on the basis of malpositioned locations, direction and length of the malpositioned tip, patients' integrated conditions and available medical equipments to maintain the catheter tip in the best position.

The repositioning techniques described in this review can be applied in clinical practice to ensure the infusion therapy through peripherally inserted central catheter more economical and safe.

The status of psychosocial adaptation is the main influential factor for quality of life. The correlation between psychosocial adaptation and quality of life for various diseases has been studied previously. However, there have been few reports on the impact of psychosocial adaptation on quality of life in people with visual impairments.

Survey.

In this study, subjects with visual impairment (n = 213) were interviewed to assess their demographics, disease-related information, psychosocial adaptation status and quality of life. The psychosocial adaptation questionnaire and quality of life scale for visually impaired patients were used to survey psychosocial adaptation and quality of life. Correlation and multiple stepwise regression analyses were used to study the association of psychosocial adaptation with quality of life in visually impaired patients.

Psychosocial adaptation was significantly associated with quality of life, including the sense of belonging and psychological dimensions. The results also showed that there was statistical significance for the impact of occupational status, payment, monthly income (family), vision classification and psychosocial adaptation on quality of life, and the status of psychosocial adaptation was the main factor affecting the quality of life in people with visual impairments.

It was found that the status of psychosocial adaptation was conspicuously associated with multiple dimensions of quality of life. Therefore, psychosocial adaptation status should be given close attention in clinical care.

Our results could be used to guide nurses in making a plan for health education and nursing that improves the quality of life for the visually impaired.

Injury is a leading cause of preventable mortality and morbidity worldwide, with approximately 10% of hospitalised trauma patients being admitted to intensive care. Intensive care patients experience significant ongoing physical and psychological burden after discharge; however, the patterns of recovery and the subgroups of intensive care patients who experience the greatest burden are not described.

This prospective cohort study was conducted in one tertiary referral hospital in south-east Queensland, Australia.

Following ethics approval, injured patients who required admission to intensive care provided consent. Participants completed questionnaires prior to hospital discharge (n = 123) and one (n = 93) and six months (n = 88) later. Data included demographic and socioeconomic details, pre-injury health, injury characteristics, acute care factors, postacute factors [self-efficacy, illness perception, perceived social support and psychological status as measured by the Kessler Psychological Distress Scale (K10) and the PTSD Civilian Checklist] and health status (SF-36).

All participants required ongoing support from healthcare providers in the six months after discharge from hospital, and approximately half required support services such as accommodation and home modifications. Approximately 20% of participants reported post-traumatic stress symptoms, while approximately half the participants reported psychological distress. Average quality of life scores were significantly below the Australian norms both one and six months postdischarge.

Trauma intensive care patients rely on ongoing healthcare professional and social support services. Compromised health-related quality of life and psychological health persists at six months.

Effective discharge planning and communication across the care continuum is essential to facilitate access to healthcare providers and other support services in the community setting.

Increasing life expectancy and ageing of the population require consideration of the adequacy of home care services and the role of family members as care providers. The older population is a very heterogeneous group because of their variable needs and several disabilities. To ensure the quality of home care, experimental information is needed from clients and their family members.

A survey design with convenience sampling.

The home care client and a family member of his/her answered a questionnaire together, including background questions, the Family Functioning, Health and Social Support instrument and an open question about support received from home care. Statistical methods were used to describe quantitative data, and content analysis was used in analysing the replies to the open question.

Family health was noted as good, and family functioning and overall social support fairly good. An older person's higher basic education, higher age of the family member, better family health and male gender were connected with better social support received. The relationship of the older person and the family member as well as the duration of home care service use had an effect on social support received. The content analysis raised expectations related to time, planning of service, organisational factors and caring practise.

Home care clients' and families' needs for support vary, and therefore, the assessment of needs, care planning and updating are important.

The variable support needs of older people and their family members require flexible and adaptable home services. Cooperation between all participants involved in care would promote the well-being of the older person and the entire family.

Obesity is now considered a chronic low-grade inflammatory process, characterised by alterations in the systemic concentrations of some inflammation markers. Adiponectin, leptin and other inflammatory proteins have been shown to correlate with insulin resistance and the metabolic syndrome in adults.

Cross-sectional study in two groups of obese and normal weight adolescents.

Serum levels of adiponectin, leptin, ceruloplasmin and insulin levels were determined and correlated among them and with anthropometric parameters, blood pressure body mass index and body mass index z-score.

Waist circumference, body mass index and blood pressure values correlated significantly with both homoeostasis model assessment for insulin resistance and insulin levels. Ceruloplasmin also correlated with both parameters with a high level of significance. However, leptin levels did not correlate with either homoeostasis model assessment for insulin resistance or insulin, and adiponectin correlated with homoeostasis model assessment for insulin resistance but not insulin. All inflammation markers studied correlated with the body mass index z-score. These correlations were stronger in the group of obese individuals compared to lean ones.

We found a relationship between insulin resistance and some inflammation in adolescents, which was particularly strong in obese individuals and was associated with the development of metabolic syndrome. Among the inflammation markers studied, ceruloplasmin revealed as a potential string marker of insulin resistance in obese adolescents.

The results obtained in this study imply a significant advance in the field of clinical practice of nursing. The adequate understanding by nursing personnel of the inflammatory processes inherent to obesity constitutes a key factor for the prevention of the disease and its complications in adolescents.

Preoperative teaching is beneficial to surgical patients in alleviating their anxiety and promoting their postoperative recovery. Despite the leading role in patient teaching by nurses, sparse studies have been addressed the consistency between nurses' perceptions and their actual practice of preoperative teaching in surgical wards.

A cross-sectional survey.

Data were collected by using self-reported preoperative teaching questionnaires together with nurse demographic data sheets. Sampling setting was an acute public hospital and all nurses working in surgical wards (n = 100) were approached in the study.

A total of 86 nurses returned the questionnaires. ‘Details of anaesthesia’ was the most prominent preoperative teaching component rated by nurses although their major teaching was pertained to ‘preoperative preparation’. In addition, oral explanation was reported as the most prevalent way of information delivery and internet was the least preferred method. Discrepancies between nurses' perceptions and actual practice were found in this study. Moreover, nurses' time availability, language barriers and tight operation schedules were perceived as top factors affecting the provision of preoperative teaching. Furthermore, nurses' satisfaction with such patient teaching was significantly associated with their professional training and their daily workload in the clinical setting.

Preoperative patient teaching was not fully achieved by nurses in this study, and the results highlighted the conflicting issues related to the implementation process that could be resolved by means of proper planning and management in clinical practice.

Healthcare organisations and nurse managers should periodically review the existing clinical resources so that sufficient preoperative teaching strategies can be provided. Nurses' perceptions and satisfaction towards preoperative teaching can be compared with those of the patients in further studies so that the insights for developing an effective preoperative teaching programme can be more comprehensive.

Telemonitoring is increasingly used to provide structured follow-up. In patients with heart failure it has been shown to reduce mortality. However there is limited knowledge of the extent to which it supports the patient to develop self-care skills.

A qualitative study including interviews with patients at 2 time-points.

Fifteen patients mean age 74, 11 (73%) male, 9 (60%) symptomatic on moderate activity, 6 (40%) symptomatic on mild exertion were interviewed at two time points: firstly following three months of telemonitoring and the second interview following six months of telemonitoring. Thematic analysis of the data was undertaken using constant comparison.

Patients undertook a variety of self-care actions. During the three-month interview technological skills featured highly in patients accounts and they used telemonitoring to facilitate professional monitoring. However, during the six-month interview patients described how they used telemonitoring to support their self-care actions. Such actions were based on the understanding of heart failure that patients developed from their personal experience of symptoms, and their interaction with the telemonitoring and the telemonitoring nurse. We found no difference in self-care actions regardless of patients age, severity of their heart failure, time since diagnosis with heart failure or living alone.

In summary, the majority of patients used telemonitoring daily and developed self-care skills in monitoring their heart failure. Such skills were developed over the six-month time-period of the study.

Our findings suggest how the nurse can help patients to use telemonitoring to develop their understanding of their heart failure and empower them for self- care decision making.

There are expectations that nurse prescribers will prescribe for patients. Nurse prescribers share jurisdiction of prescribing with doctors in the workplace and new divisions of labour must be agreed to enable the nurse to begin prescribing. Little is known about how nurses integrate prescribing in practice but these agreements are potentially important to the organisation of professional work and the delivery of healthcare.

Case study.

Twenty six nurse prescribers were interviewed in case studies of primary and secondary care prescribing. Case data were collected by semi-structured interview and combined with field notes and socio-demographic data in case summaries. Data were organised in nvivo (QSR International Pty Ltd, Doncaster, Victoria, Australia) and subject to manual analysis at single and cross-case level.

Twenty-one of the 26 cases were prescribing. Trust between doctor and nurse and nurse and employer was shown to be necessary for effective integration. There were differences in how prescribing agreements were reached in primary and secondary care. Restrictions were imposed in secondary care. In primary care, nurses made decisions themselves about the medicines they prescribe but frequently asked doctors to check their decisions. Nurses described three approaches to prescribing: as opportunity presents, for specific conditions and for individuals.

Nurse prescribers described three approaches to prescribing and in two approaches the nurse self-restricted prescribing activity. Secondary care prescribers had more employer restrictions than their primary care counterparts. Trust between doctor nurse and nurse employer was shown to be necessary for integration; without trust, the nurse will not prescribe.

Trust in prescribing relationships is necessary for effective integration of nurse prescribing in practice.

Identification of ICU patients' analgesic and sedative needs decreases the risk of complications and the hospital length of stay. Several studies have reported a lack of systematic assessment.

Three assessment tools were implemented in two Norwegian ICUs in a prospective two-site study (April–July 2009). Frequency of pain and sedation documentation, the number of days when a sedation level was prescribed, and the amount of analgesics and sedatives used were documented for 958 ICU days in 139 mechanically ventilated patients. Fifty-five ICU nurses completed a questionnaire on the effects of the assessment tools before and after implementation.

Patients assessed by the tools had a documented pain score 2·5 times daily and a sedation score three times daily. A sedation level was prescribed for 70% of the total patient days. A documented match between prescribed and reported sedation level was achieved for 27% of the days. Combinations of continuous analgesia and sedation were prescribed with wide therapeutic ranges. Significant improvements were seen in the units' assessment and documentation routines scored by the nurses after the implementation of the tools.

Although the tools were well accepted, they were not used as frequently as recommended. The proportion of missing written prescriptions and documentation of sedation levels most likely reflects the nurses' and physicians' poorly defined intentions for the prescribed treatment. The tools applied helped nurses to focus on significant signs and symptoms.

Without well-organised pain treatment and sedation, the risk of oversedation is always present. Our results show that the implementation of tools contributes to a systematic approach of the assessment and treatment of pain and sedation in intensive care.

Patients with diabetes encounter many challenges when making health decisions in their daily lives, as they have access to many different kinds of health information. Health literacy issues are new topics in Chinese society. Without a valid and reliable instrument in Chinese, it is difficult to measure the level of health literacy and promote the concept of health literacy in Chinese societies.

A methodological study with a sample of 137 patients with type 2 diabetes aged 65 years or older.

Chinese Health Literacy Scale for Diabetes was developed with reference to the revised Bloom's taxonomy model. Psychometric tests (content validity, item analysis, construct validity, discriminative ability and test–retest reliability) were conducted. Correlations between Chinese Health Literacy Scale for Diabetes and four relevant measures were tested. Cronbach's alpha and alpha if item deleted were calculated to assess internal consistency.

Cronbach's alpha for Chinese Health Literacy Scale for Diabetes and its four subscales (remembering, understanding, applying and analysing) were 0·884, 0·885, 0·667, 0·654 and 0·717, respectively. The Chinese Health Literacy Scale for Diabetes was significantly correlated with the Diabetic Knowledge Scale (r = 0·398, p < 0·001), the Diabetic Management Self-Efficacy Scale (r = 0·257, p < 0·001), the Preschool and Primary Chinese Literacy Scale (r = 0·822, p < 0·001) and the Chinese Value of Learning Scale (r = 0·303, p < 0·001). It took an average of seven minutes to complete this 34-item instrument.

The findings of this study support the Chinese Health Literacy Scale for Diabetes as a reliable and valid instrument for measuring the health literacy of Chinese patients with diabetes.

We recommend that clinicians use this tool to assess patients' health literacy before conducting any kind of health promotion.

A large part of the obese population attempt to lose weight. Of those who had lost at least 10% of their initial weight, 33·5% regained weight. This weight loss and regain is termed ‘weight cycling’. So far, no available validated instruments exist that are capable of identifying these patients.

A quantitative study for the validation of a questionnaire.

The selected patients received a phone call from the researchers. On that occasion, they answered a questionnaire that contained eight questions about their current weight, their weight at 18 years of age and their history of weight cycling over the past two years. Approximately 20 days after the first phone call, the patients were re-contacted and asked to respond again to the proposed questionnaire. The internal consistency and reliability were examined through a kappa index and a chi-squared test. The questions that showed evidence of reliability and consistency composed the final questionnaire.

The final questionnaire consisted of six questions. An analysis of the test–retest kappa coefficient was moderate or greater for four of the six objective questions. One of the two quantitative questions showed a strong correlation for the test/retest reliability, and the other showed a strong correlation with the gold standard. An analysis of the internal consistency between a composition of questions 5 and 6 with question 4 showed moderate agreement, which increased when it was adjusted for the same cut-off point. The agreement between patients classified as ‘weight cyclers’ was higher than 80% in both tests.

The Questionnaire to Assess Weight Cycling provided evidence of reliability and internal consistency.

Evaluating weight cycling.

Pressure ulcer risk assessment scales are recommended for use in clinical practice. For paediatric patients, 12 instruments are currently described. Empirical evidence about the performance of Glamorgan scale scores in clinical practice is limited.

An observational validation study was conducted on a paediatric cardiac unit of a large university hospital in Germany in April and May 2010.

Children were assessed simultaneously and independently by varying convenience samples of three nurses per assessment situation. Pressure ulcer risk was measured by the Glamorgan scale and a 100 mm Visual Analogue Scale (VAS). Proportions of agreement (p_o), multirater kappa and intraclass correlation coefficients were calculated.

Thirty children were rated by 27 nurses. Median children's age was 5·5 years. Agreement among item scores was high, whereas reliability coefficients of item scores were low. Interrater reliability for the Glamorgan scale sum scores was higher than for VAS scores. Correlation between both scales was moderate.

High agreement among item scores indicates that nurses are able to make precise judgements. The low interrater reliability of item and sum scores indicates that nurses were unable to differentiate the rated children based on their item and sum scores, thus providing little additional clinical relevant information about pressure ulcer risk in this setting.

The Glamorgan scale and the VAS are unable to make clear distinctions in a low-risk setting. Therefore, it is unlikely that the tools in this setting provide additional information for clinical decision making. Both tools are not recommended for daily use.

It is already known that students can experience reality shock on clinical placement and that staff support is crucial for their adaptation to the environment. This process is similar to socialisation theory whereby the newcomer adapts to the workplace.

A multiple case study design (n = 5) was used.

Data were collected using semi-structured interviews (n = 43) and non-participant observation of students implementing skills in clinical practice.

Findings revealed the factors that could facilitate students' implementation of clinical skills were as follows: provision of learning opportunities, staff support and supervision, and students' confidence. Factors that hindered students were reality shock, ‘the gap’ in how skills were taught in the higher education institutions and the clinical setting, and missed learning opportunities. Support from peers in the clinical area and having previous experience of working as a health care assistant, or similar, were the factors that could either positively or negatively impact on students.

Students need to be adequately prepared for the real-life clinical environment. Understanding, through socialisation theory, how students adapt to the workplace can facilitate this process. Facilitating students' learning includes supporting them, developing their confidence and ensuring that they have prior exposure to undertaking clinical skills.

Staff working with students in clinical practice can help facilitate students’ learning and implementing of clinical skills through an understanding of how students adapt and ‘fit in’ to their working environment.

Research demonstrates the burden experienced by informal carers is substantial. There is no available information about the burden placed on community health volunteers, nor is there a scale developed for the purpose of measuring their burden.

An instrument development and psychometric analysis study was undertaken.

Exploratory principal component factor analysis was applied to investigate the internal structure of the new scale.

The initial item pool derived from literature review and experts resulted in 44 items linked to volunteer burden. The final scale includes 20 items with a content validity index of 0·86 and Cronbach's alpha for test (0·82) and retest (0·77). The reliability coefficient of the test–retest results was 0·63 [95%-confidence interval = (0·44, 0·77)]. Principal component analysis identified five underlying factors: Factor 1 items are related to personal and family matters; factor 2 items are related to administrative issues; factor 3 items concern the community support; factor 4 items are related to organisational matters; and factor 5 items concern issues of adequate health promotion delivery.

The 20 item instrument designed to measure the burden on community health volunteers in Taiwan showed good internal consistency, content validity and construct validity. The findings infer that the scale may be an effective measure of the burden experienced by community health volunteers. Further testing of this scale within other countries that make use of community health volunteers is required to confirm the results.

As volunteers play an important role in supporting the work of community health nurses, the new scale provides a means for nurses to assess volunteers' level of burden and develop interventions as required.

Despite international campaigns condemning violence against women, IPV remains a worldwide problem and recent Australian community attitudes demonstrate ongoing beliefs condemning women in abusive relationships. Women experiencing IPV are over-represented in healthcare-seeking populations; however, they are rarely identified as experiencing abuse and are often not provided care directed towards achieving ongoing safety. While women seek empathetic healthcare, disclosure of abuse often results in being judged negatively or blamed.

A grounded theory study drawing on Clarke's (Sage Publications, London, 2005) analytic approach of situational analysis.

Semi-structured interviews conducted with seven women. Data was analysed using nvivo 8 software within a Situational Analysis framework.

Four major categories were identified: Accessing healthcare: challenges and barriers; Care women need vs. care women receive; Discourses of IPV and constructions of self; and Acknowledging IPV: moving on and re-constructing self. Women faced significant challenges in accessing emergency healthcare and healthcare then often lacked empathy. Women created an understanding of self from a world dominated by an abusive partner and needed assistance re-labelling their experiences as IPV. Healthcare professionals who provided empathetic care were instrumental in assisting this process, enhancing women's abilities to explore options for limiting abuse and assisting them to enhance their self-efficacy and reconstruct a positive sense of self.

Healthcare is one of the few avenues women living with IPV have to receive emotional and physical support. Healthcare that ignores psychosocial issues further damages women's sense of self.

Women require timely information and empathetic support from healthcare professionals to assist them in understanding and labelling their experiences as IPV. This enhances women's ability to feel deserving of, and ideally achieve, a life without violence.

Wound care is one of the most major issues for trauma patients at home. Wound infection has been alerted mostly on medical treatment. Little is known about how healthcare education impact patient care of traumatic wound after discharged from emergency department.

A quasi-experimental design was used by using two groups post-test.

Random sampling was used to recruited participants, 89 participants in each group in emergency department at a medical centre in Taiwan. A 25-minute wound care programme was given to patients in the intervention group. A questionnaire was used to evaluate the effectiveness of the programme after 72 hours as patient followed up in out-patient department. The data of wound infection were collected from patient's medical record by followed 2 weeks after injured.

After wound care programme, the knowledge, skills of wounds care, the satisfaction of health education in experimental group are better than the control group (p < 0·05). Wound infection rate in experimental group (9%) is lower than control group (20·2%), and statistically significant (p < 0·05).

The wound care programme could increase the knowledge, skills of wound care of emergency patient and reduce the wound infection rate.

Wound care requites technical knowledge; thus, practical demonstration of teaching and self-practice is more effectiveness for patients in learning their wound care. An appropriated health programme can improve the patients' wound care and care quality.

Delirium is a common syndrome in hospitalised older patients, especially in surgical intensive care units, and the consequences of under-detection can be very serious for older people. Therefore, assessment of the cognitive status of older patients using a valid instrument is important in intensive care units.

A descriptive prospective design was used.

Consecutive non-intubated patients aged 65 and older, admitted to a surgical intensive care unit of an Italian hospital during a seven months period, were assessed for delirium using the NEECHAM scale and the Confusion Assessment Method for intensive care unit, once per shift, for 48 hours after admission. Cohen's kappa coefficient, ROC curve, sensitivity and specificity were estimated. An open ended questionnaire was used to assess user-friendliness of the scale.

A sample of 41 older patients with a mean age of 78·3 years was studied. The kappa coefficient was 0·95. The sensitivity was 99·19%, specificity 95% at cut-off of 25, and the area under the curve was 0·99 (CI 0·99–1·00). Nurses evaluated positively the scale as they were able to collect data during care process in maximum 10 minutes, but experienced problems in rating the appearance behaviour and physiological control items of the scale.

Findings from this study confirm the good diagnostic value and ease of application of the NEECHAM scale with non-ventilated intensive care patients.

The NEECHAM scale can be used to detect delirium during the routine nursing assessment of non-intubated older patients as it requires minimal demand and stress on the patient as well as on the bedside nurse.

Military secondary care nurses are employed within UK National Health Service Trusts to gain clinical experience that will be relevant to their military nursing role.

A two-stage grounded theory study using mixed methods: postal questionnaire survey and in-depth interviews.

In stage one a postal questionnaire was distributed to all serving military nurses. Stage two involved 12 semi-structured interviews. The data from both parts of the study were analysed using grounded theory.

Four categories and one core category were identified, which suggested that participants did not feel fully prepared for deployment. Their feelings of preparedness increased with deployment experience and decreased when the nature of injuries seen on deployment changed. Respondents argued that even when unprepared, they did not feel incompetent. The findings suggest that the peacetime clinical experience gained in the National Health Service did not always develop the necessary competencies to carry out roles as military nurses on deployment. This study highlights the unique role of military nurses. We discuss these findings in the light of the literature on competency and expertise.

The military nurses in this study did not feel fully prepared for deployed operations. We propose a new model for how military nurses could gain relevant experience from their National Health Service placements.

National Health Service clinical placements need to be reassessed regularly to ensure that they are meeting military nurses' clinical requirements. Experiences of nurses returning from deployment could be shared and used as a basis for reflection and learning within National Health Service Trusts and also inform decisions regarding the appropriateness of clinical placements for qualified military nurses.

In the UK the bio-psycho-social model has informed the shape of the National Institute for Health and Clinical Excellence and the Social Care Institute for Excellence ‘dementia’ guideline. However, limited attention has been paid to outlining and describing a physical domain of dementia, a discrepancy that informed the rationale for this study.

A collective case study design was used to address the research aim and objectives.

Case studies from along the trajectory of dementia were provided by an international team of contributors from an inter-disciplinary background comprising nursing (general and mental health), social work and social science.

The team's synthesis and analysis of the six case studies generated five repeating themes with each theme becoming components of a ‘physical’ domain of dementia. The five identified physical components were: (1) physical well-being, (2) physical health and examination, (3) physical care, (4) physical treatment and (5) physical environment.

The development of a bio-psycho-social-physical model of dementia presents a holistic and culturally sensitive approach to understanding the experience of living with dementia, and to providing care and support in a variety of situations and contexts.

The physical domain of dementia has particular relevance to nursing and nursing practice, such as providing physical care at the end-of-life. The interplay between the biological-psychological-social-physical domains of dementia and the trajectory of dementia could form the basis of clinical decision-making and practice.

There is increasing evidence regarding the inadequacy of care for people with learning disabilities in acute care settings. However, few studies have specifically addressed their health, safety and welfare in such contexts.

Four key electronic databases (Medline; PsycINFO; British Nursing Index and archive; Cumulative Index to Nursing and Allied Health Literature) were searched for relevant literature published between 2000 and 2011.

Publications assessed as meeting the inclusion criteria were retrieved in full. Data were extracted regarding methods used; primary aims of the study being reported; and key findings.

Of the 3505 papers identified in the initial search, eight met the inclusion criteria. Analysis revealed six areas of influence on the health, safety and welfare of adults with learning disabilities in acute hospitals: care provision (meeting health and personal needs); communication; staff attitudes; staff knowledge; supporters; and carers (valuing their role); physical environment.

We represent these six areas diagrammatically, as concentric rings. These influence on health, safety and welfare form an inner (direct) layer and an outer (indirect) layer consisting of liaison services and education/training. This new conceptualisation of influences as being multi-layered assists in the identification of similarly multi-layered improvement strategies.

Adults with learning disabilities can exert their own influence on health, safety and welfare and should be supported to make decisions about their own care. More broadly they should be involved with policy development, nurse education and research. This can be achieved through inclusive approaches, for example, inviting people with learning disabilities to input into nursing curricula or to engage in research as coinvestigators.

Adolescent girls prefer engaging in self-care activities for dysmenorrhoea. The Adolescent Dysmenorrhic Self-Care Scale is a reliable and valid scale for measuring the self-care behaviour of adolescent girls with dysmenorrhoea. However, it has not been validated in Hong Kong population.

A cross-sectional design.

In phase one, the Adolescent Dysmenorrhic Self-Care Scale was translated into Chinese-Cantonese and was reviewed by an expert panel for the semantic equivalence and content validity. In phase two, the Chinese-Cantonese version of Adolescent Dysmenorrhic Self-Care Scale was administered to 396 girls with dysmenorrhoea. The construct validity was tested using confirmatory factor analysis and correlated with the Chinese version of the Generalized Self-Efficacy Scale. The reliability was assessed by Cronbach's alpha and test–retest reliability.

Item 13 related to school nurses was deleted because of its poor relevance to the Hong Kong situation. Four items (items 26–29) related to the medical-orientated behaviours were considered by the expert panel as not relevant to the self-care construct in Hong Kong population. Therefore, confirmatory factor analyses were carried out to 39-item Chinese-Cantonese-Adolescent Dysmenorrhic Self-Care Scale (deletion of item 13) and the 35-item Chinese-Cantonese-Adolescent Dysmenorrhic Self-Care Scale (with further deletion of items 26–29). Confirmatory factor analysis did not confirm the 39-item Chinese-Cantonese-Adolescent Dysmenorrhic Self-Care Scale, but the results showed the goodness of fit in the 35-item of Chinese-Cantonese-Adolescent Dysmenorrhic Self-Care Scale (root-mean-square error of approximation = 0·075, standardised root-mean-square residual = 0·078, normed fit index = 0·95, non-normed fit index = 0·96, comparative fit index = 0·96). Significant correlations with Chinese version of the Generalized Self-Efficacy Scale (r = 0·46, p < 0·01) were identified. The Cronbach's alpha of 35-item Chinese-Cantonese-Adolescent Dysmenorrhic Self-Care Scale was 0·94. The intraclass correlation coefficient was 0·93.

The 35-item Chinese-Cantonese-Adolescent Dysmenorrhic Self-Care Scale had satisfactory validity and reliability.

Nurses may use the 35-item Chinese-Cantonese-Adolescent Dysmenorrhic Self-Care Scale in assessing the self-care behaviour of adolescent girls with dysmenorrhoea, so that girls with a low level of self-care behaviour can be identified and appropriate intervention can be provided.

The main studies about the family environment of schizophrenia patients are related to the concept of Expressed Emotion. There is currently no instrument to evaluate this concept in Brazil that is easily applicable and comparable with studies from other countries.

Methodological and cross-sectional research design.

A convenience sample of 130 relatives of schizophrenia outpatients was selected. The translation and cultural adaptation of the instrument involved experts in mental health and experts in the German language and included back translation, semantic evaluation of items and pretesting of the instrument with 30 relatives of schizophrenia outpatients. The psychometric properties of the instrument were studied with another 100 relatives, which fulfilled the requirements for the Brazilian Portuguese version of the instrument. The psychometric properties of the instrument were assessed by construct validity (using an analysis of its key components, comparisons between distinct groups–convergent validity with the Antonovsky's Sense of Coherence Scale) and reliability (checking the internal consistency of its items and its test–retest reproducibility).

The analysis of main components confirmed dimensionality patterns that were comparable between the original and adapted versions. In two domains of the instrument, critical comments and emotional over-involvement had moderate and significant correlations, respectively, with Antonovsky's Sense of Coherence Scale, appropriate values of Cronbach's alpha and strong and significant correlations, respectively, in test–retest reproducibility. We observed significant differences between distinct groups of parents in the category of emotional over-involvement.

We conclude that the Portuguese-adapted version of the Family Questionnaire is valid and reliable for the study sample.

This study provided evidence that the Family Questionnaire is a reliable and valid instrument for assessing expressed emotion. It is easy and practical to use and is acceptable for use in a Brazilian cultural population.

Cancer survivors need to know about nutrition and other lifestyle behaviour changes to help them recover and potentially reduce the risk of the same cancer recurring or a new cancer developing. From this perspective, frontline registered nurses are in a prime position to support cancer survivors who are in their care.

Discursive paper.

On the basis of the international research evidence and a critical analysis of recent policy and practice literature, themes emerged, which illustrate the importance of nutrition, diet and lifestyle advice for cancer survivors. This paper discusses the need for more focused education and greater interprofessional working for quality care delivery.

New professional guidance for emerging frontline nurses indicates they should be able to provide appropriate and more consistent advice on nutritional issues, physical activity and weight management, although more research is needed to understand the right mode of nutrition training. Additionally, interprofessional working needs improving as well as encouraging cancer survivors to respond.

High-quality nutrition education and training is required for nurses working across both the acute and primary care sectors. They require this to effectively monitor and advise patients and to know when, where and from whom they can access more specialist help. Interprofessional collaborative working across multi-centre settings (National Health Service and non-National Health Service) is key to provide the best effective care and support for cancer survivors.

Reconstructing patients' changes in behaviour prior to aggressive incidents may contribute to identify early warning signs specific to the individual patient. The EDP comprises an early intervention strategy suggested by the patient and approved by the nurses. Implementation of EDP may enhance efficient risk assessment and management.

An explorative design was used to review existing records and to monitor frequencies of early warning signs.

Early detection plans of 171 patients from two forensic hospital wards were examined. Frequency distributions were estimated by recording the early warning signs on the FESAI. Rank order correlation analyses were conducted to compare diagnostic subgroups and offender subgroups concerning types and frequencies of warning signs.

The FESAI categories with the highest frequency rank were the following: (1) anger, (2) social withdrawal, (3) superficial contact and (4) non-aggressive antisocial behaviour. There were no significant differences between subgroups of patients concerning the ranks of the four categories of early warning signs.

The results suggest that the FESAI covers very well the wide variety of occurred warning signs reported in the EDPs. No group profiles of warning signs were found to be specific to diagnosis or offence type.

Applying the FESAI to develop individual EDPs appears to be a promising approach to enhance risk assessment and management.

There are conflicting data about the protective effect of anxiolytic medication used in patients after acute myocardial infarction. Examination of the interaction of anxiolytic medication and anxiety level may explain these disparate results.

This was a secondary analysis of existing data from a multisite, prospective study of the impact of anxiety on in-hospital complications in patients with AMI.

Patients were primarily men, Caucasians, with Killip class 1 or 2, from the USA and Australia (n = 156). Anxiety level in the emergency department and intensive care unit and in-hospital complications were collected using self-report measures and medical record review. Logistic regression analyses examined whether the use of anxiolytic medication influenced the relationship between anxiety and in-hospital complications after controlling for demographic and clinical covariates.

In the ED, 31% of participants were very or extremely anxious; anxiolytic medication was given to only 5%. In the intensive care unit, nearly half of participants received anxiolytic medication. There was no association between anxiety level and use of anxiolytic medication. Anxiety was an independent predictor of the probability of in-hospital complications. The administration of anxiolytic medication did not alter the relationship between anxiety and in-hospital complications.

Use of anxiolytics in patients with AMI was not associated with anxiety level and did not reduce the probability of in-hospital complications.

Clinicians need to regularly assess anxiety and treat it appropriately. Regular anxiety assessment may promote appropriate use of anxiolytic medication. Clinical guidelines for the management of patients with an AMI should address anxiety assessment and appropriate use of anxiolytic medication to improve patients' outcomes.

Growing attention is given to the implementation of health promotion activities in mental health care. By improving the understanding of perceptions of patients and mental health nurses, health promotion programmes targeting physical activity and healthy eating can be developed that better meet the patients' needs.

A descriptive qualitative study.

Based on a purposive sampling strategy, three focus groups including 17 mental health nurses and individual interviews with 15 patients were conducted.

Although physical and mental health benefits of physical activity and healthy eating were identified, several barriers to integrate healthy lifestyles into the daily life of patients were reported. Important barriers identified by the patients consisted of lack of energy and motivation as a result of the MD, side effects of psychotropic drug use, and hospitalisation. Lack of time and personal views and attitudes towards health promotion were reported by the mental health nurses as important elements influencing the way in which they integrate health promotion in the care provided. Support from the mental health nurse was considered important by the patients in changing their unhealthy lifestyle behaviour.

The results of the study provide insight into important factors influencing the integration of health promotion activities targeting physical activity and healthy eating in individuals with MD living in sheltered housing.

The information derived from this study is useful and relevant in the design and implementation of health promotion interventions targeting physical activity and healthy eating in people with MD living in sheltered housing.

Few studies analyse the impact of caring for a child with cerebral palsy on the caregivers' quality of life besides mental health. Also, less attention has been paid to the influence of caregiver's personal resources like self-efficacy or coping strategies on how they adjust to the child's illness and the care situation.

Cross-section correlational design.

Sixty two parents of children with cerebral palsy completed measures to assess the quality of life (i.e. physical, environmental and social relationships), mental health (i.e. general mental health, depression and anxiety), self-efficacy and coping strategies.

Parents of children with cerebral palsy had, in general terms, low levels of quality of life and mental health. Self-efficacy was related to most of the outcomes, whereas any of the coping strategies assessed was significantly related to the outcomes.

Quality of life and mental health can be affected in caregivers of children with CP. Personal resources like self-efficacy also need attention as they can help in the understanding of the differences in these outcomes and the design of effective interventions.

Self-efficacy should be a key element in interventions addressed to parents of children with CP to elicit a process of empowerment that can improve the well-being of the family as a whole.

Contemporary management of SUI includes conservative therapy and surgical repair – the choice of treatment modality depends on the severity of symptoms. If conservative treatment fails, surgical correction is necessary. The outcomes of the surgery for SUI and their influence on sexual functions are satisfactory in short-term follow-up.

A total of 50 women diagnosed with SUI according to International Continence Society standards were included in the study. The patients were qualified for surgical procedures such as: transobturator suburethral tape (TOT) (n = 35), Perigee (n = 6) or MiniArc (n = 9).

Sexual functions and behaviours were evaluated prior to the operation and 1–3 years postoperatively in all patient using Female Sexual Function Index (FSFI) and non-validated questions.

The mean time after the operation was 1·96 ± 0·83 years. Postoperatively, all women reported significant reduction of urinary incontinence symptoms. According to DSM-IV criteria, female sexual dysfunctions were diagnosed in 12% of females after the urogenital operation. However, sexual complaints (FSFI scores equal or <26·55 points) without distress were reported by 62% of the patients. The comparison of sexual complaints declared prior to and after the operation showed significant differences in the prevalence of decreased desire, decreased arousal and decreased orgasm frequency. In addition, we documented significant improvement of sexual attractiveness and sexual life evaluation after the SUI operation.

Surgical repair for SUI improves female sexual functions and reduces sexual distress, as observed in a long-term follow-up.

Sexual functions, distress and behaviours in women who underwent surgical repair of SUI; the impact of SUI female quality of life as well as on sexual functions.

Abdominal organ cluster transplantation is used to treat multiple abdominal organ diseases. Delay in monitoring and treatment can lead to graft failure.

A descriptive study.

Data collected from eight patients who underwent abdominal organ cluster transplantation from May 2004–March 2009 in our hospital were retrospectively assessed. The clinical manifestations of graft rejection and variations in characteristics associated with graft function were analysed.

In all eight cases, graft function recovered successfully without rejection during the perioperative period. In one case, liver graft rejection occurred 1·5 months postoperatively, but dose adjustment of the anti-rejection drugs provided symptom relief.

Rejection can be prevented and cured successfully through monitoring and early detection of rejection characteristics by the nursing staff.

With the increase of awareness and knowledge on the clinical observation and nursing care, the rate of transplantation rejection decreased among abdominal cluster transplant patients.

Enhanced recovery after surgery is a standardised, multimodal treatment programme for elective colorectal surgery, leading to faster recovery and shorter hospital stays via interprofessional collaboration. The ERAS concept is initiated for patients a week before surgery when the patient receives detailed information about the care process during a meeting with a nurse.

The study is a qualitative interpretive study based on interviews.

Twelve patients, nine men and three women, were interviewed. The interviews were transcribed verbatim and analysed using interpretive phenomenological analysis (IPA).

The analysis identified and formulated five themes: being seen, security, trust, responsibility and participation. All themes are closely related and illustrate positive and negative sides of the patient's experience. They hang together and form a complete set of experiences: ERAS conversation and its impact on patients' participation.

The results show that patients feel confirmed in the ERAS conversation. Healthcare professionals need to be bonding more information call during hospitalisation. It is important to confirm the patient in order for them to participate and take responsibility. Reliance on caregivers is important for patients to feel safe and to participate in their own care. This study shows that the ERAS conversation was experienced as being structured and individually tailored, but the information must apply to the patients throughout the period of care.

Some shortcomings have been revealed, which should enable improvement in the care of patients. Healthcare professionals need to raise awareness of patients' responsibilities for participation in their own recovery and care. Healthcare professionals and patients need to be aware of each other's responsibilities.

Anxiety and depression after CABG are the most common complications, having a negative impact on the prognosis of heart disease, leading to special needs according to their new physical and mental conditions.

Randomised clinical trial.

This study conducted in Iran, 70 patients undergoing CABG were included and divided into two equal groups, the control group and intervention group. They were followed up for six weeks. An audiotape educational programme was given to the intervention group after surgery in addition to the routine training. But patients in the control group received only routine training. Anxiety and depression were assessed by Hospital Anxiety and Depression Scale, a standardised questionnaire for anxiety and depression. Data were collected before and six weeks after the intervention. For the comparison of mean scores between the groups, the data were analysed in spss, version 16, using independent T-test and paired T-test.

The mean scores obtained in both anxiety and depression dimensions were significantly different between the intervention and control groups.

Audiotape educational programme used by patients undergoing CABG decreases the level of their anxiety and depression after cardiac surgery.

The most significant finding was the importance of audiotape educational programme to meet the needs of the CABG patients, which suggest that patient education through audiotape can be effective in self-care after heart surgery and nurses can use an audiotape containing preparatory information to improve outcomes and reduce anxiety and depression in patients having CABG.

Patients differ in the way that they cope with the time spent waiting for a heart or lung transplant. Patients must already before the transplantation be taught about a new lifestyle, risk factors, medication, food restrictions and exercise, so they can take an active role and responsibility for disease management after transplantation. Little is known about patients' experiences of information and support in these situations.

Qualitative descriptive design.

Sixteen patients (16–67 year) were strategically selected from one transplant centre in Sweden and interviewed six months after heart or lung transplantation. Using content analysis, transcribed data were organised into subcategories that reflected emerging categories.

Three categories that describe patients' experiences of information and support have been identified: ‘Achieving confidence and trust by information and support’, ‘Experiencing a lack of input and understanding’ and ‘Struggling with a life-threatening illness and an insecure future’. Each category consists of different subcategories.

Information and support in connection to heart or lung transplantation are a complex and multifaceted issue involving patient-related, family-related, disease-related and treatment-related factors as well as experiences related to the social situation, the healthcare system and society. Transplant patients are very vulnerable, and a deeper understanding of patients' experiences should help healthcare providers in optimising the care for these very sick patients.

A holistic approach to the patient is necessary in meeting the needs of patients with chronic illness, especially patients with children at home, as well as the needs of their families. An important implication is the necessity to enhance awareness about transplant patients in society in general, in particular in other institutions, by sharing knowledge and by improving cooperation.

The overall efficacy of heart failure programmes has been proven in several meta-analyses. However, the debate continues as to which components are essential in a heart failure programme to improve patient outcomes.

Prospective cohort study of patients participating in heart failure programmes.

Forty-eight of 62 (77%) programmes in Australia participating in a national register of CHF-MPs were evaluated using the HF-IS: derived from a summed and weighted score of each intervention applied by the CHF-MP (27 interventions overall). The CHF-MPs were prospectively categorised as relatively low (HF-IS < 190 – n = 39 programmes & 407 patients) or high (HF-IS ≥ 190 – n = 9 programmes & 166 patients) in complexity. Six-month morbidity and mortality rates in 573 consecutively recruited patients with systolic dysfunction and in New York Heart Association Class II–IV were prospectively examined.

Patients exposed to CHF-MPs with a high HF-IS had a lower rate of unplanned, all-cause hospitalisation (n = 24, 14% vs. n = 102, 25%) compared with CHF-MPs with a low HF-IS within six months. On an adjusted basis, CHF-MPs with a high HF-IS were associated with a reduced risk of unplanned hospitalisation and/or death within six months and remained event-free longer.

High complexity CHF-MPs applying more evidence-based interventions are associated with a higher event-free survival over six months.

The HF-IS is an easy-to-use evidence-based tool to assist programme coordinators to improve the quality of their heart failure programme which may also improve patient outcomes.

Being the relative of a cardiac arrest patient has been described as an unexpected chaotic situation. It is a unique experience because the event was unexpected, but also because of the heart disease and the uncertain neurological impact and outcome.

The design of the study was qualitative.