The integrative review: updated methodology

Exploring parental knowledge, care-seeking, and support strategies for neonatal illness: an integrative review of the African Great Lakes region

BACKGROUND

Sub-Saharan Africa shoulders much of the global burden of neonatal mortality. Quality postnatal care is often lacking due to availability, accessibility, mistrust of health systems, and socio-economic barriers, yet delays in care-seeking contribute to avoidable neonatal deaths. Research highlights the urgent need for improved health education about neonatal illness; however, contextual factors are rarely considered, and few interventions have been implemented.

OBJECTIVES

To critically examine the literature on parents' knowledge of neonatal illness and care-seeking behaviour and evaluate interventions supporting parental understanding in sub-Saharan African Great Lakes countries.

METHODS

Systematic searches were conducted in CINAHL, MEDLINE, Global Health, the Cochrane Library, and thesis repositories. Studies meeting inclusion criteria were critically analysed using Whittemore and Knafl's framework, and quality was assessed with Hawker et al.'s tool, following PRISMA guidelines.

RESULTS

Seventy studies (48 quantitative, 14 qualitative, eight mixed methods) were reviewed. The first theme, "poor knowledge of neonatal illness", showed parents struggled to recognise illness, with knowledge affected by maternity and socio-economic factors. The second theme, "sub-optimal healthcare-seeking behaviour", highlighted delayed care-seeking due to cultural, social, and economic factors. Finally, "strategies to support parents' understanding" emphasised the roles of community workers, health education phone calls, SMS, and videos, and neonatal monitoring systems.

CONCLUSIONS

Parental knowledge of neonatal illness is generally low, and care-seeking is influenced by beliefs, trust in healthcare, and logistical challenges. While community health workers and multi-media interventions appear effective, health education efforts must address contextual barriers and beliefs to improve recognition and care-seeking for neonatal illness.

The Same but Different?: A Systematic Review of the Impact of Selection and Collider Bias on Internal Validity

BACKGROUND

Recent work conceptually unifying selection and collider-restriction bias as threats to internal validity implies that their impact on observed associations should similarly align. We reviewed epidemiologic literature to summarize existing knowledge about the impact of selection and collider bias.

METHODS

We systematically searched for peer-reviewed, methodologic articles and general epidemiology textbooks published in English from 1 January 2000 to 12 July 2024. We included sources that focused on internal validity and discussed the magnitude or direction of selection or collider bias. We abstracted conclusions about the likely magnitude and direction of bias, which stratum or strata are affected when restricting analyses to a subset, and the conditions under which the consequences of bias were evaluated.

RESULTS

We retained 33 of 5508 identified articles and 12 of 205 textbooks for data abstraction. Overall, we found that collider bias articles conveyed its impact as minimal while selection bias sources described variable effects. We also observed that most collider bias sources evaluated bias under the sharp null (assuming no relationship between the exposure and outcome) and found differences between how selection and collider bias sources discussed the role of interaction and the strata affected.

CONCLUSIONS

Although collider-restriction and selection bias affecting internal validity are considered theoretically equivalent, conclusions differ about their consequences for study results. Investigating collider bias not under the sharp null and considering the role of both multiplicative and additive interaction between the causes of a collider may improve our ability to predict and quantify its impact on internal validity.

Nurses' learning about professional interpersonal communication: Findings from an integrative review

BACKGROUND

Effective communication, a cognitive and social skill, is pivotal in quality care delivery. It is important to explore how nurses learn about communication during their program of study, and more importantly the substance of what they have learnt regarding communicating with patients. This is of value given the changing context of health care, society and contemporary nursing.

AIM

To explore learning and teaching practices of professional, interpersonal communication and the associated outcomes for student learning during pre-registration education.

DESIGN

Integrative review.

DATA SOURCES

Four databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Proquest and Scopus, were searched January 2000 through to December 2020. A subsequent rapid review of literature 2020 to 2023 was guided by Dobbin's method.

REVIEW METHOD

Whittemore and Knafl's framework guided this review. It included 1. problem identification, 2. literature search, 3. data evaluation, 4. data analysis, and 5.

PRESENTATION

The PRISMA protocol informed screening of literature. The quality of included articles was assessed using the Mixed Method Appraisal Tool (MMAT).

RESULTS

Of the initial eligible 46 articles critiqued, 26 remained; A rapid review found one further article. Twenty-seven articles were included in the final analysis. We derived a comprehensive understanding of curricula that included conceptual approaches, teaching techniques, student outcomes, and novel innovations. Conceptional approaches described self-efficacy based on Bandura's social learning theory. Teaching techniques to advance social and active learning though varied, were dominantly active experiential learning. Student outcomes were forthcoming across all described modes of learning and teaching that involved good education practices that actively engaged learners. Finally, we specifically identified novel practices that included immersion, repetition of deliberate practice, scaffolding and coaching. The specific unique contribution of these practices was the capacity to acknowledge and embrace existing innate student capacities.

CONCLUSION

Current literature advocates students learning of professional communication is forthcoming from appropriately designed courses. Research and evaluation of student learning remains rudimentary. The contribution of factors such as students' life skills and innate communication ability to their learning of professional interpersonal communication is largely absent. Further research is needed regarding the best focus for learning and teaching of professional interpersonal communication.

Identifying the landscape and contribution of advanced nurse practitioners in supporting healthcare provision in Ireland in the 21st century: An integrative review

Background

In Ireland the role of advanced nurse practitioner has developed significantly since 2001. This evolution is rooted in the growing recognition of the need for highly skilled nursing professionals to address complex healthcare demands and improve patient outcomes.

Objective

To scope the landscape and identify the effect of advanced nurse practitioners on healthcare provision in Ireland.

Design

A systematic search of eight academic databases (CINAHL, Embase, PsycINFO, Scopus, Medline and Academic Search Complete, Cochrane, Web of Science) relevant to nursing and health care were performed.

Settings

Nursing care environment.

Participants

Advanced nurse practitioners delivering care.

Methods

A pre-defined systematic search of eight academic databases was conducted, and two reviewers screened each study against the inclusion criteria. Additional hand-searching of the reference lists (backward chaining) and citations (forward chaining) of papers that met the inclusion criteria was conducted. The methodological details of each paper were extracted and assessed for quality and rigour utilising the Mixed Methods Appraisal Tool and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for appraising grey literature. Data were mapped and analysed onto the six domains of advanced nurse practitioner practice, and the review was reported in line with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

Results

All papers included in this review spanned across the last 20 years. In total, 45 papers met the inclusion criteria: quantitative (n = 11), qualitative (n = 15), mixed methods (n = 4), and discussion/clinical cases (n = 15) papers. Advanced nurse practitioners in Ireland contribute substantial impacts on management and team competence, clinical-decision making, leadership and professional scholarship, professional values and conduct, communication and interpersonal competence, and knowledge and cognitive competence domains. Advanced nurse practitioners in Ireland enhance healthcare outcomes through expertise, coordination, and patient-centred approaches, emphasising their critical role in healthcare delivery and system improvements.

Conclusions

We have highlighted the active role advanced nurse practitioners play in enhancing patient care, improving management and team coordination, and advancing professional scholarship. These insights have provided a foundation for future research and policy development to optimise the advanced nurse practitioner role.

The Efficacy of Psycho-Educational Interventions to Optimize Women's Sleep in Pregnancy: An Integrative Review

BACKGROUND

Poor sleep in pregnancy is associated with several adverse maternal and infant outcomes. Psychoeducational interventions may offer a safe and acceptable first-line intervention to help with sleep disturbances.

AIM

To identify and review studies that examined the effect of psycho-educational interventions on sleep in pregnancy and to identify moderators in the treatment effects of the interventions.

METHODS

An integrative review methodology was used. A comprehensive search in five electronic databases retrieved 1250 articles. Eligible studies (n = 12) were assessed for methodological quality according to the "QualSyst" rapid appraisal tool. Data were extracted and recorded using a modified Covidence form. Quantitative data were summarized in a meta-analysis or narrative synthesis. Qualitative data were narratively reported.

FINDINGS

Twelve studies with three different sleep interventions: Cognitive Behavioral Therapy for Insomnia (CBT-I), Sleep Healthy Education (SHE) and relaxation training were included. Given the variation in study methodologies and interventions, only quantitative results from RCT trials using CBT-I were summarized in the meta-analysis. CBT-I was found to be statistically significant in improving sleep quality in pregnancy (Standard Mean Difference = -0.78; 95% CI = -1.01, -0.54, p < 0.001). Few studies reported the efficacy of SHE and relaxation training. Potential moderators had no effect on the measured sleep quality outcome. Overall, psychoeducational interventions were acceptable to participants during pregnancy.

CONCLUSION

There is insufficient evidence on which to base the recommendations about the effectiveness of all psychoeducational interventions to improve sleep. Based on the available literature, CBT-I is an evidence-based intervention to improve sleep quality in pregnancy.

Healthcare professionals' perceptions of risk management on pregnancy and childbirth: An integrative review

BACKGROUND

Risk management in maternity care aims to reduce incidents and harm to women and babies, contributing to quality care. However, there is growing concern that risk management policies may lead to unnecessary interventions during pregnancy and childbirth, resulting in both short- and long-term morbidity for women and their babies.

AIM

To evaluate healthcare professionals' perceptions of the effect of risk management on pregnancy and childbirth.

METHODS

A five-stage methodological framework was utilised in this review. A comprehensive integrative review was undertaken using a computer-assisted database approach including CINAHL, EMBASE, MEDLINE (Pubmed), PsycINFO and Scopus from 2016-2024. This review is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews (PRISMA-ScR).

FINDINGS

The review identified five papers from four different countries. Two overarching themes were generated: The impact of the dominant medical model on risk management and decision-making in maternity care and the differences and similarities in healthcare professional's perceptions of risk management. The increasing medicalisation of pregnancy and childbirth shifts healthcare professionals' focus towards documentation and administrative tasks, driven by liability fears, rather than addressing clinical risks and providing woman-centred care.

CONCLUSION

Complex factors influence risk management in maternity care. Risk management is affecting the way healthcare professionals think and operate. This review reveals that the medical model significantly shapes healthcare professionals' perceptions of risk management, often undermining midwives' autonomy and impacting decision-making in pregnancy and childbirth. Education and training are essential to restore midwives' autonomous roles, ensuring that women receive the most appropriate, safest and highest quality of care.

Constructing critical care nursing expertise: An integrative literature review

BACKGROUND

The lack of internationally uniform educational regulations and constantly intensifying competence requirements creates the need to enhance the understanding of the educational practices supporting the construction of critical care nursing competence.

AIMS

The aim of this review was to synthesise evidence on critical care nursing competency requirements and to learn more about the educational practices supporting the development of critical care nursing competence.

DESIGN

Integrative review.

METHODS

A systematic literature search was conducted in CINAHL, Scopus, and PubMed, focusing on peer reviewed studies of critical care nursing competence requirements. The review was guided by Cooper's method. Data evaluation was performed using the Joanna Briggs Institute Critical Appraisal Tools. Thematic analysis was used in the analysis and the PRISMA checklist for systematic reviews in reporting.

RESULTS

15 studies of quantitative, qualitative and mixed methods/Delphi research were included in the review. The development of competence in critical care nursing can be enhanced by supporting nurses' personal performance and by supporting the active, continuous and progressive achievement of core critical care nursing competencies.

CONCLUSION

To develop the best practices to meet the nursing care requirements of critically ill hospital patients, it is important to consider the personal characteristics of nurses' and support their professional self-confidence. Practices entailing the acquisition of extensive clinical experience, the completion of postgraduate critical care nursing education and the independent study of critical care nursing content are recommended. The development of expertise seems consistent when core competencies are achieved progressively upon the critical care nursing competence base to specialised and advanced competency levels.

Mental Health Factors and Lifestyle Adherence After Myocardial Infarction: An Integrative Review

BACKGROUND

Engaging in healthy lifestyle behaviors following myocardial infarction can improve clinical health outcomes and lower cardiovascular risk factors among patients. However, adhering to a healthy lifestyle after having a myocardial infarction can be challenging, especially for those experiencing poor mental health.

OBJECTIVE

Based on a conceptual model derived from Lazarus and Folkman's Theory of Stress and Coping and the Health Belief Model, this integrative review focuses on mental health factors associated with adherence to healthy lifestyle behaviors post-myocardial infarction.

METHODS

Whittemore and Knafl's integrative review method was used to search and select relevant literature from the EMBASE, PubMed, CINAHL, Scopus, and PsycINFO databases between 2013 and 2023.

RESULTS

A total of 35 articles were included in the review. Based on the Johns Hopkins Nursing Evidence-Based Practice Model criteria, 34 studies were of good quality (B). Mental health factors related to healthy lifestyle behaviors after myocardial infarction included the following: (1) personality factors and coping (eg, neuroticism, agreeableness, and optimism); (2) psychological symptoms (i.e., depression, anxiety, and fear); (3) appraisal (ie, illness perception); (4) health beliefs (ie, susceptibility, severity, benefits, barriers, cues to action, and self-efficacy); and (5) motivation. Social support and demographic characteristics were also related to adherence to healthy lifestyle behaviors.

CONCLUSIONS

This review highlights the role of mental health factors in adhering to healthy lifestyle behaviors among persons with myocardial infarction. Comprehensive theoretically based approaches are needed to develop future interventions for promoting healthy lifestyle behaviors in individuals post-myocardial infarction.

The role of the physiotherapist in the assessment and management of blunt mechanism chest wall injury: A systematic integrative review and narrative synthesis

BACKGROUND

Blunt mechanism chest wall injury (CWI) is a common traumatic presentation to acute hospitals globally and it is associated with high levels of mortality and morbidity. The role of the physiotherapist in the management of this injured population needs clearer definition.

AIM

To synthesise existing evidence relating to the 'work' of physiotherapists in the assessment, management and evaluation of patients with blunt mechanism CWI.

DESIGN

A systematic integrative review of relevant literature with a narrative synthesis.

DATA SOURCES

Embase (Ovid), MEDLINE (Ovid), CINAHL Plus with Full Text (EBSCO), Cochrane Central Register of Controlled Trials (Wiley), PEDro (Physiotherapy Evidence Database), AMED (Ovid). Further searches for grey literature and hand searches were applied. Databases were searched from their inception to December 2024. Analysis and data integration was undertaken through narrative synthesis following a process of thematic coding.

RESULTS

From 7433 identified papers, 92 were included in the final evidence synthesis. Fifty were full published empirical studies, 14 were evidence reviews, 19 were conference abstracts, three were case presentations and six were opinion pieces. Analysis identified the broad scope of clinical care provided by physiotherapists covering (i) initial assessment and emergency care; (ii) acute care priorities and care planning; (iii) patient education and optimising patient self-management; and (iv) post-acute care and follow-up.

CONCLUSION

There is a need for a more standardised approach to the care provided to this patient group. Clinicians need to acquire and develop formal competencies and capacities and knowledge in a more structured approach.

Interventions to Improve the Sleep of Nurses: An Integrative Review

BACKGROUND

Adequate sleep is critical for nurses, affecting their physical, emotional, and occupational health. Nurses suffer from higher levels of sleep disorders than the national average, especially night-shift nurses, with rates as high as 61%. Irregular work/sleep patterns and occupational stress are the main contributors to inadequate sleep for nurses. Not only does this issue impact nurses, but insufficient sleep has been linked to billions of dollars lost due to decreased productivity and medical errors.

PURPOSE

This integrative review explores and evaluates existing research on nonpharmacologic interventions designed to improve sleep function and quality for nurses.

METHODS

A systematic search was performed to find research interventions that improved nurses' sleep. CINAHL, Scopus, and OVID Medline databases were searched using the terms (sleep OR circadian rhythm) AND (intervention OR sleep hygiene) AND (nurs*). After the initial search, reference lists and secondary sources were evaluated for potential articles for inclusion.

RESULTS

This review included 33 articles. Interventions included exercise, lighting manipulation, supplements, aromatherapy, education, music therapy, and mindfulness/meditation. All 7 exercise interventions included in this review improved participants' sleep length and quality. Nearly all mindfulness and aromatherapy interventions that promote relaxation and stress reduction were effective. Exposing nurses to bright light did not necessarily correlate with increased sleep but did improve fatigue levels at work.

CONCLUSION

Prioritizing sleep can ensure the health and safety of nurses, and further research is still needed. Health care organizations can positively impact this problem by implementing effective practices to improve the sleep health of nurses.

Public image of nursing: an integrative review of challenges and solutions

INTRODUCTION

The nursing profession, despite comprising the largest segment of the global healthcare workforce, faces a significant challenge: a negative public image. This unfavorable perception adversely impacts recruitment, retention, and job satisfaction. Entrenched stereotypes and cultural biases often erode the profession's credibility and diminish its appeal. This integrative review explores the challenges contributing to this public image issue and identifies potential solutions to enhance it.

METHODS

This integrative review followed the Whittemore and Knafl's (2005) method, encompassing five stages: problem identification, literature search, data evaluation, analysis, and presentation. A comprehensive search of relevant databases, including SID, Irandoc, Magiran, Google Scholar, Web of Science, PubMed, CINAHL, and Scopus, was conducted using the keywords "image," "public," "nurs*," "solutions," and "challenges" covering the period from January 2010 to January 2025. Of the 868 articles initially retrieved, 54 met the inclusion criteria and were assessed using the Mixed Methods Appraisal Tool for inclusion in the final review.

RESULTS

Critical appraisal and synthesis of the selected articles revealed three overarching themes related to the public image of nursing: professional enhancement, professional advancement, and systemic factors. These themes encompassed nine sub-themes.

CONCLUSION

This review demonstrates that the public image of nursing is influenced by both professional and systemic factors, with nurses themselves playing a critical role in shaping perceptions. Improving this image requires a collaborative effort involving nurses, healthcare organizations, and policymakers. Crucially, nurses must cultivate a confident and self-assured professional identity to ensure the public's perception accurately reflects the vital contributions of the nursing profession.

Literature reviews: typology and forensic applications

Secondary research models, such as literature reviews, are designed to summarize existing primary data. Literature reviews serve distinct purposes depending on their methodology and scope. In forensic science, they have been widely used to recover historical information, facilitate bibliometric investigations, compile and compare analytical techniques, promote best practices, and support decision-making. This study presented a comprehensive description of common literature review types, namely (1) narrative, (2) integrative, (3) scoping, (4) systematic (with or without meta-analysis), (5) bibliometric, and (6) umbrella reviews, highlighting their specific characteristics and applications in forensic science. Forensic experts, students, instructors, and research authors and readers must be familiar with the typology and appropriate use of literature reviews to effectively select the most suitable approach for their studies and professional practice. In this context, the goal of academic research, as pursued in the present work, is to strengthen forensic knowledge, enhance theoretical rigor, and ultimately improve practices in the field through education in scientific research methodology.

Scoping review of evidence synthesis: Concepts, types and methods

OBJECTIVES

To systematically explore the concepts, types, and methodologies related to literature reviews and evidence synthesis.

METHODS

We conducted a scoping review using PubMed, Embase, Biblioteca Virtual da Saúde, grey literature, and websites of key international and national institutions, including the Cochrane Collaboration, Joanna Briggs Institute, Center for Reviews and Dissemination, Campbell Collaboration, and REBRATS, with searches completed through November 13, 2024. Studies were included if they identified or proposed theories and/or methodologies for evidence synthesis at international or national levels, with eligibility limited to studies published in English, Spanish, or Portuguese and no restrictions on publication year. Title and abstract screening was conducted independently by ten reviewers working in pairs, with a third reviewer resolving conflicts as needed, and full-text copies of potentially relevant articles were retrieved for further analysis.

RESULTS

The review included 99 studies employing a variety of evidence synthesis methods. A total of 71 terminologies for types of evidence synthesis were identified and grouped by conceptual and methodological similarities, resulting in 16 categories of evidence synthesis, each with clear differences in concepts and methods.

CONCLUSIONS

The lack of standardization in defining and classifying review types challenges the scientific community by hindering study comparisons and appropriate methodology selection. Future research should explore the relationships between different review types and their outcomes, as well as the applicability of new methodologies across various fields.

Perspectives of general psychiatric inpatient care for persons with anorexia nervosa: an integrative literature review

OBJECTIVES

Persons diagnosed with anorexia nervosa (AN) may receive care in general psychiatric inpatient care (GPIC) for several reasons including severity of their condition, comorbidities and lack of access to specialised inpatient care. However, scant research has explored how this specific setting may impact persons with AN, either positively or negatively. Additionally, there is limited evidence regarding the most effective form of care for AN within GPIC. This integrative literature review provides a comprehensive overview of research focusing on care for AN in GPIC settings, shedding light on person-centred care and power within this specific context.

DESIGN

The review was conducted according to the methods of Whittemore and Knafl. We searched the academic databases PubMed, CINAHL and PsycInfo, with the latest search conducted in March 2025, in accordance with a specific search strategy and analysed the data using a constant comparison method. The review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist for systematic reviews.

RESULTS

The synthesis revealed three perspectives of care for persons with AN in the context of GPIC: management of the symptoms, treatment of the patient and support for the person. Overall, the findings suggest that GPIC can aid in weight gain, but the impact on recovery is unclear.

CONCLUSION

Research indicates that GPIC possesses the biomedical knowledge necessary to save lives, but there is a lack of research focusing on the perspectives of persons with AN. This gap in understanding may affect treatment outcomes, the possibility of recovery and the personal experience of care for those with AN in this context.

PROSPERO REGISTRATION NUMBER

CRD42023426095.

Impact of memory clinics on carers of people living with dementia: An integrative review

People living with dementia and their carers require ongoing support in the community. Memory clinics can provide a range of supports including education, respite and symptom management. While these clinics improve consumer outcomes, their impact on the carers of people living with dementia is unclear. This review sought to identify and critically synthesise the literature on the effectiveness of memory clinics in supporting carers. An integrative review process was used to identify papers from CINAHL and Medline databases. Of the eight included papers, two were qualitative and six were quantitative studies. Three themes were identified, namely; psychological heath, carer burden and satisfaction with memory clinics. Four studies found decreases in caregiver burden, distress, and psychological symptoms such as anxiety and worry. Satisfaction with the clinic model was discussed as a source of support by carers, highlighting the memory clinics. The variable outcomes seen in this review require further research to elucidate the impacts of memory clinics on carers along the dementia trajectory.

Primary care follow-up of patients after attending a fracture liaison service: an integrative review

Based on a small number of predominantly low-to-moderate quality studies with moderate-to-high risk of bias, the FLS-to-primary care transition is portrayed as a challenging time for patients, GPs, and FLS clinicians, who experience numerous barriers to care continuation and coordination at this care juncture.

PURPOSE

Continuity and coordination of care between fracture liaison services (FLS) and primary care is required for optimal long-term osteoporosis care. This study aims to explore (1) how patients and healthcare providers (HCPs) experience the FLS to primary care transition, (2) the barriers and facilitators to primary care follow-up after FLS, and (3) interventions that enhance integration of FLS with primary care.

METHODS

An integrative review was performed and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) Statement 2020. Online bibliographic databases were searched using the terms "osteoporosis", "primary care", and "fracture liaison services" and related terms for original English-language studies conducted between January 1, 2003 and December 29, 2023. Manuscripts were assessed for relevance using pre-defined criteria, and for quality and bias using validated instruments. Thematic analysis was used to extract key themes relevant to each research question.

RESULTS

Overall, 14 relevant manuscripts were identified. Among the four studies that addressed patient and HCP experience of the FLS-to-primary care transition, five key themes emerged: (1) time and workload pressures, (2) limited confidence in primary care follow-up, (3) GP knowledge gaps, (4) siloed or disconnected care, and (5) communication issues. Twelve studies addressed barriers and facilitators to primary care follow-up after FLS, which fell into five themes: (1) patient knowledge and understanding (2) miscommunication and misinformation, (3) understanding roles and responsibilities, (4) GP engagement, and (5) GP-patient relationship. Additionally, single studies suggested healthcare policies and funding, accessing primary care from residential facilities, and GP gender influenced primary care follow-up. Five studies detailed interventions to enhance FLS-to-primary care integration. GP education and patient reminders, delivered as part of a multifaceted intervention, appeared to improve integration of acute and primary post-fracture care; however, the contribution of these individual interventions to outcomes remains unclear. While telephone coaching and bone marker monitoring were identified as potential interventions, there was insufficient evidence to conclude they are effective.

CONCLUSION

Available evidence was generally low-to-moderate quality with moderate-to-high risk of bias. Integration of the available evidence portrays the FLS-to-primary care transition as a challenging time for patients, GPs, and FLS clinicians, who experience a multitude of barriers to care continuation and coordination. There is insufficient data to support any single intervention as effective for enhancing care coordination beyond those considered standard components of FLS models. Knowledge gaps exist regarding the patient experience of the FLS-to-primary care transition, facilitators to primary care follow-up, interventions to support FLS integration with primary care, and how such information may be integrated to optimise care for patients with osteoporosis.

Effects of Mindfulness on Postoperative Pain, Anxiety, and Opioid Use: An Integrative Review

OBJECTIVES

This integrative review describes using mindfulness to reduce pain and anxiety during the perioperative period in surgical patients. As an exploratory aim, the relationship between mindfulness and opioid use after surgery was also explored.

METHODS

CINAHL, PubMed and EMBASE databases were queried to identify articles examining the relationship between mindfulness, postoperative pain and opioid consumption, and preoperative anxiety in patients undergoing surgery. Seventeen studies were included in the review, encompassing 1,454 patients.

RESULTS

Twelve articles focused on postoperative pain as the primary outcome and 11 of these reported that mindfulness decreased pain scores, mainly after postoperative day seven. Of these 12, seven studies measured opioid consumption and two reported an association between mindfulness and reduction in the use of opioid pain medications. Five articles focused on preoperative anxiety as the primary outcome, and two demonstrated that mindfulness was associated with a statistically significant reduction in anxiety.

CONCLUSIONS

Evidence suggests that mindfulness has a significant impact on postoperative pain, particularly pain more than one week after surgery. There was limited evidence supporting the use of mindfulness to reduce opioid consumption postoperatively. Similarly, mixed effects were reported describing the use of mindfulness to reduce anxiety before surgery. More research is needed to investigate the impact of mindfulness on pain after surgery and opioid consumption, as well as its impact on anxiety before surgery.

NURSING PRACTICE IMPLICATIONS

Integrating mindfulness into surgical pathways could have positive effects on pain and anxiety for patients during the perioperative and postoperative phases of care.

Integrative Review of the Influence of Support Groups on Breastfeeding Duration Beyond 6 Months

OBJECTIVE

To review the literature regarding the influence of support groups on extending breastfeeding duration beyond 6 months.

DATA SOURCES

PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases.

STUDY SELECTION

We included reports of qualitative and quantitative studies on breastfeeding support groups and reported breastfeeding durations beyond 6 months. The articles were peer-reviewed, written in English, and published from 2013 to 2023. We identified 1748 articles, removed 145 duplicates, screened 1603 titles and abstracts, and conducted a full-text review on the remaining 66. To maintain our focus on sustained breastfeeding, we excluded articles on breastfeeding durations of less than and up to 6 months. A total of 19 articles met the eligibility criteria.

DATA EXTRACTION

We extracted the following data from the included articles: study design, sample size, purpose, type of breastfeeding support received, and reported breastfeeding duration.

DATA SYNTHESIS

We used the social ecological model as a conceptual framework. The key influences created from the included articles were aligned with the four levels of the model: individual, relationships, community, and societal. We defined key influences as concepts that were discussed in three or more articles.

CONCLUSION

Breastfeeding support groups helped participants in the included studies to sustain breastfeeding through key influences that aligned with the four levels of the social ecological model. Support groups provided individual, relationship, community, and societal benefits that holistically supported sustained breastfeeding.

Assessment and Scoring of Intrinsic Capacity in Older Adults: An Integrative Literature Review

PURPOSE

Promotion and maintenance of healthy aging is of utmost importance given the growing number of older adults worldwide. Fluctuation in intrinsic capacity (IC), defined as mental and physical functions, can be assessed objectively with an assigned score to predict health outcomes. The goal of the current review was to identify common measurement tools for IC assessment and evaluate IC scoring approaches.

METHOD

Seventeen studies met inclusion criteria for assessing five domains: vitality, locomotion, cognitive, psychological, and sensory.

RESULTS

Reviewed studies used diverse instruments with inconsistent scoring approaches. Scoring ranged from simple additive scores to complex item response theory models.

CONCLUSION

Establishing consistency in assessment and scoring for IC will ensure usability of scores in clinical practice to promote healthy aging and identify older adults at risk for disability or care dependence. Additional research is needed to establish consensus in standardized scoring, assessment, and measurement of IC. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Defining three principles for credible evidence synthesis and reviews in health professions education

As reviews become increasingly central to informing educational practice and guiding research in health professions education, the need for methodological clarity and quality has grown. This Commentary highlights three foundational principles - alignment, rigor, and transparency - that underpin high-quality reviews, regardless of type. We illustrate how these principles apply across commonly used review types, including systematic, scoping, realist, and narrative reviews. By aligning the research question with the appropriate review methodology, employing rigorous processes for evidence collection and synthesis, and maintaining transparency in methodological reporting, review teams can produce credible, transferable, and dependable findings. Embracing these principles not only enhances the trustworthiness of reviews but also supports stakeholders in applying synthesized knowledge effectively, ultimately advancing evidence-informed decision-making in health professions education.

Interventions to Reduce Burnout Among University Lecturers: A Systematic Literature Review

The teaching profession is widely recognized as highly challenging due to its intense workload, emotional demands, and ongoing stressors. This Systematic Literature Review (SLR) aims to identify and evaluate various interventions that have been implemented to address lecturer burnout over the past five years. A thorough review of 21 studies published between 2020 and 2024 was conducted across five major databases: Web of Science, Scopus, PubMed, ERIC, and APA PsycINFO. Relevant search terms were used to explore the effectiveness of different interventions aimed at reducing lecturer burnout. Articles were extracted, reviewed, collated, and thematically analyzed to synthesize the findings. Seven distinct interventions were identified as effective in reducing burnout. The most commonly studied intervention was social support, followed by training programs. Other interventions demonstrating positive results include supportive work environments, Rational Emotive Behavior Therapy (REBT), and psychological capital. Additionally, interventions that balanced work and life conditions, facilitated teaching transitions, helped lecturers reevaluate major work demands, and encouraged the utilization of character strengths were also found to yield beneficial outcomes. The implementation of targeted, school-based interventions is crucial for reducing burnout and enhancing the overall well-being of university lecturers. Policymakers, administrators, and educational leaders should prioritize the implementation of school-based awareness and intervention programs.

Relationships between arts participation, social cohesion, and well-being: an integrative review of evidence

Introduction

Arts and cultural strategies have increasingly been engaged by the public health sector to enhance social cohesion, health, and well-being, as well as to address the significant health risks posed by social isolation and loneliness. While numerous studies document relationships between arts participation and social cohesion or well-being, few studies have investigated the relationships between all three and, to date, no evidence synthesis has been conducted on this topic.

Methods

To address this gap, this integrative review aimed to identify, describe, and synthesize research on arts participation, social cohesion, and well-being in a community context by addressing the question: what is the evidence base regarding relationships between arts participation, social cohesion, and well-being? Literature searches were conducted using 10 databases, and analyses included descriptive statistics, thematic analysis and content-mechanism-outcomes analysis.

Results

A total of 18 articles - 16 original research articles and two reviews - from 12 countries met inclusion criteria. Results provide insights on modes and forms of arts participation used to address social cohesion and well-being and suggest that SC may function as a mechanism for enhancing community well-being. Themes highlight the value of physical engagement in community spaces and culturally-rooted programming, the virtuous cycle of commitment and benefit that can be cultivated by co-creation and social relationships, and how social cohesion can serve as a mechanism for enhancing well-being.

Discussion

This study's insights related to how the arts can build social cohesion and, in turn, enhance well-being can guide design of community-based programs. Prospective studies are needed to test these relationships as well as the potential role of social cohesion as a mechanism for building well-being in communities through arts participation.

Promoting just culture in nursing education: A systematic integrative review on enhancing patient safety

BACKGROUND

Patient safety education is crucial in nursing to develop a culture of transparency, open communication, and learning from practice errors. A key component is 'Just Culture,' which shifts the focus from individual blame to system level accountability, fostering an environment where errors can be discussed without fear of punishment. Embedding these principles into nursing education helps shape future nurses' attitudes toward patient safety and supports the prevention of harm through continuous improvement. There is a need to integrate international knowledge about 'Just Culture' within nursing education.

OBJECTIVE

To identify and explore the concept of 'Just Culture' within nursing education as perceived by nursing students, educators, and educational institutions.

DESIGN

A systematic integrative review following Whitemore and Knafl's integrative method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed. Database search encompassed PubMed [including Medline], Scopus, CINAHL, ProQuest, Embase, Web of Science, and PsychInfo along with grey literature and hand searches were conducted with no time restrictions up to June 2024. A 'framework for understanding the development of safety culture' was used to identify, analyze, and synthesize the review findings narratively.

RESULTS

The search led to 12 studies. To foster 'Just Culture' in nursing education, enabling factors are 'prioritizing a blame-free environment', 'promoting critical thinking', 'open communication and learning', and 'actively engaging students in understanding safety events without fear of consequences'. Also, enacting behaviors involves 'establishing safety reporting systems', 'promoting teamwork', 'integrating error reporting into the curriculum', and 'implementing follow-up processes to address safety incidents.'

CONCLUSIONS

Establishing 'Just Culture' in nursing education requires a blame-free environment that empowers students to report incidents without fear of repercussions. Also, educating and integrating standardized reporting tools into the curriculum and valuing student inputs are emphasized. Nurse educators and educational systems should promote transparency and open communication about practice errors leading to the improvement of safety culture and healthcare outcomes.

[La coopération intergénérationnelle au travail: une analyse de concept]

Cinq générations doivent actuellement cohabiter sur le marché du travail, ce qui peut entraîner plusieurs bénéfices, mais également un risque de tensions et de conflits susceptibles de nuire à la collaboration des équipes de travail et à la santé des personnes vieillissantes. La coopération intergénérationnelle au travail (CIT) a été relevée dans la littérature comme une avenue intéressante pour diminuer le risque de conflits intergénérationnels, mais elle demeure peu concrètement définie. Cette étude vise à proposer une définition opérationnelle du concept de coopération intergénérationnelle au travail à l'aide de la méthode d'analyse de Walker and Avant (2019). Quarante-huit manuscrits ont été répertoriés, permettant d'identifier huit attributs caractérisant la CIT, sept antécédents et six conséquents du concept. Cette étude fait ressortir le rôle des différents acteurs dans la CIT, met en lumière les bénéfices de la CIT et permet de considérer son rôle en prévention des lésions professionnelles.

Navigating weight stigma: An integrative review of midwives' knowledge, attitudes and beliefs about caring for larger-bodied women

PROBLEM

Women are vulnerable to weight bias during their reproductive years. However, little is known about midwives' knowledge, attitudes and beliefs about caring for larger bodied women.

BACKGROUND

Women have reported experiencing weight stigma during interactions with healthcare providers, including midwives. Weight stigma is associated with reduced quality of health and primary healthcare avoidance. In Australia over half of pregnant women are of a higher weight during their reproductive years.

AIM

To describe what is currently known about midwives' knowledge, attitudes and beliefs relating to caring for larger bodied women across the peripartum period.

METHODS

An integrative review was undertaken, involving a systematic literature search, quality appraisal, and synthesis of findings within the socioecological framework.

FINDINGS

Sixteen articles were included. Across the socioecological levels: individual level themes related to midwives' attitudes and beliefs and midwives' own body size; interpersonal themes related to communication and relationships; community themes related to the influence of cultural norms; organisation/institutional level themes related to BMI and weight checks, the need for training and education, and the role of healthcare practices and guidelines emerged; finally, at the policy level, system level factors and a weight inclusive approach were identified.

DISCUSSION

This review highlighted that some midwives and student midwives hold negative, stigmatising views towards larger bodied women. Midwives are impacted by their own attitudes and beliefs as well as interpersonal, societal, organisational and system level factors.

CONCLUSION

Efforts to reduce weight stigma require a multi-level socio-ecological approach, including educational strategies aimed at shifting current and future midwives' stigmatising attitudes and beliefs towards larger bodied women.

Labor and Delivery Nurse Psychological Trauma: An Integrative Review

BACKGROUND

This integrative review used Whittemore and Knafl's (2005) framework to critique the available quantitative evidence examining multiple types, prevalence, and impact of psychological trauma in labor and delivery nurses. This review synthesizes the quantitative evidence on multiple types of trauma in this population.

METHODS

Inclusion criteria were quantitative and mixed-methods studies of labor and delivery nurses examining types of trauma as defined by Foli's Middle-Range Theory of Nurses' Psychological Trauma. Studies on patient trauma from nursing care were excluded. CINAHL, Scopus, Medline, PubMed, and Web of Science databases were searched for studies electronically available through April 8, 2024. The Joanna Briggs Institute critical appraisal tools facilitated quality and bias assessments. A conceptual model based on Foli's theory contextualizes the findings.

RESULTS

Nine studies (five cross-sectional descriptive, one longitudinal, and three mixed-methods) are included in this review. Across all studies, unique aspects of the labor and birth nurse role were found to contribute to trauma, including exposure to perinatal death and fetal demise, high rates of patient trauma, an increasingly medicalized birth environment, and emotional burnout. Labor and birth nurses experienced psychosomatic symptoms, negative effects on their relationships and quality of life, and increased rates of attrition, although nurses also identified specific system supports to decrease these effects.

DISCUSSION

Limited research exists on the types of and impact of trauma experienced by labor and delivery nurses. This integrative review aims to address this gap in knowledge, while also suggesting implications for future research and policy. There is emerging evidence that post-traumatic growth is possible in this population with system support, yet many nurses are unaware of or have inadequate access to such resources. More research is needed to fully understand the magnitude of this population's psychological trauma and provide effective support strategies.

An integrative review of post-traumatic stress disorder in pediatric nurses

PROBLEM

Post-Traumatic Stress Disorder (PTSD) is a concern for healthcare professionals including pediatric nurses. A lack of understanding of the prevalence rates and factors associated with work-related PTSD in pediatric nurses exists.

ELIGIBILITY CRITERIA

Articles published in peer-reviewed journals, written in English, focusing on pediatric registered nurses working in inpatient direct-care settings that answered the research questions: (1) describe the prevalence of PTSD in direct-care inpatient pediatric nurses (2) identify factors associated with work-related PTSD were included in this review.

METHODS/SAMPLE

An integrative review method was used. Literature searches within the databases PubMed, CINAHL, Psyc Info, and Cochrane Databases were conducted. Data quality assessment was independently performed by two reviewers.

RESULTS

Eleven articles met criteria for review. PTSD prevalence rates in pediatric nurses ranged from 7.3 % to 37.5 %. Four different tools were utilized to measure PTSD symptomology. Three major themes emerged from the synthesis of objective two: Workforce Factors, Healthcare Environment Factors, and Protective Intrapersonal Factors.

CONCLUSIONS

This review highlights PTSD as a concern for nurses working in the pediatric specialty. Thematic analysis and associated subthemes provide a framework for the design of interventions to reduce the risk of PTSD symptom development among nurses working in the pediatric specialty.

IMPLICATIONS

Awareness about PTSD in the profession should be further disseminated to direct-care nurses, healthcare leaders, educators, and researchers in the hopes of mitigating future and current PTSD symptomology. Multitargeted efforts directed at the organizational, interpersonal, and intrapersonal factors identified in this review may help mitigate the harmful impacts of PTSD in pediatric nurses.

Nurse-Delivered Telehealth in Home-Based Palliative Care: Integrative Systematic Review

BACKGROUND

Telehealth technologies can enhance patients' and their families' access to high-quality resources in home-based palliative care. Nurses are deeply involved in delivering telehealth in home-based palliative care. However, no previous integrative systematic reviews have synthesized evidence on nurses' roles, facilitators, and barriers to implementing nurse-delivered telehealth in home-based palliative care.

OBJECTIVE

This integrative systematic review aimed to provide a comprehensive understanding of the roles of nurses and the multilevel facilitators and barriers to implementing nurse-delivered telehealth in home-based palliative care, which could inform future policy development, research, and clinical practice.

METHODS

This integrative systematic review was conducted using Joanna Briggs Institute methodological guidance. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We systematically searched articles published from January 1, 2014, to May 2024 in PubMed, Embase, Web of Science, CINAHL, and Cochrane Library. We included English-language; peer-reviewed; original; and qualitative, quantitative, and mixed methods studies that centered on nurse-delivered telehealth in home-based palliative care. We used the Mixed Methods Appraisal Tool to assess the quality of the included articles. Furthermore, 3 authors independently assessed eligibility, extracted data, and assessed the quality of articles. The entities to extract were identified by research questions of interest regardless of the type of study. We applied a convergent synthesis approach to integrate quantitative and qualitative data. Guided by the updated Consolidated Framework for Implementation Research (CFIR) 2.0, we synthesized the facilitators and barriers to implementing nurse-delivered telehealth in home-based palliative care.

RESULTS

This integrative systematic review identified 4819 unique articles, including 34 papers encompassing 29 unique primary research studies. Innovations were mainly delivered by nurses (n=8) and nurse-involved multiprofessional teams (n=18). The roles of nurses in telehealth home-based palliative care involve palliative care nurses, community nurses, nurse coordinators, nurse coaches or nurse navigators, and nurse case managers. Guided by CFIR 2.0, facilitators and barriers to implementing nurse-delivered, telehealth, home-based palliative care were identified to 6 implementation levels and 20 constructs. The key facilitators included the COVID-19 pandemic, cost avoidance to the health care system, engagement of patients and their family caregivers, and so on. The barriers included a lack of reimbursement and payment mechanisms, technical problems, insufficiently trained health care providers, and so on.

CONCLUSIONS

This integrative systematic review synthesizes evidence on nurses' evolving roles in telehealth home-based palliative care and identifies multilevel facilitators and barriers to nurse-delivered, home-based palliative care implementation. With the empowerment of telehealth technologies, nurses could establish a stronger professional identity and develop leadership in home-based palliative care. Nurses should leverage influence to promote nursing practice, clinical management, and policy support in the implementation of telehealth home-based palliative care.

TRIAL REGISTRATION

PROSPERO CRD42024541038; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024541038.

Self-management Behaviors and Associated Factors in Adult Cancer Survivors: An Integrative Review

BACKGROUND

Despite numerous systematic reviews on self-management interventions for cancer survivors, little is known about survivors' daily self-management practices and the influencing factors.

OBJECTIVE

To identify self-management behaviors and related factors among cancer survivors.

METHODS

Six databases were searched for primary quantitative, qualitative, and mixed-methods studies on self-management behaviors in cancer survivors that were published in English-language, peer-reviewed journals between 2012 and July 2022. The methodological quality of the included studies was evaluated using the Mixed Methods Appraisal Tool. The data extracted using a predetermined form were analyzed using qualitative content analysis.

RESULTS

A total of 22 articles were included in the review; the majority were qualitative research, and half had moderate to high quality of evidence. Nine domains of self-management behaviors were identified, namely, physical activity/exercise, diet, emotional management, complementary and alternative medicine, symptom management, religiosity/spirituality, attending regular follow-ups, adjustment of other lifestyles, and medication management. Four categories of factors were associated with self-management behaviors in cancer survivors: (1) personal factors (demographic and psychological), (2) health status, (3) family factors, and (4) healthcare system. However, the relationships between self-management behaviors and these factors were mainly identified from qualitative studies or addressed in single studies.

CONCLUSIONS

Self-management behaviors in cancer survivors are multifaceted. There is an urgent need for quantitative exploration of factors associated with self-management in cancer survivors.

IMPLICATIONS FOR PRACTICE

This review provides nurses with a comprehensive basis for designing self-management support interventions for cancer survivors.

"You need to be supported": An integrative review of nurses' experiences after death in neonatal and paediatric intensive care

BACKGROUND

The death of a child can have a profound impact on critical care nurses, shaping their professional practice and personal lives in diverse, enduring ways. Whilst end-of-life care is recognised as a core component of critical care nursing practice and a research priority, evidence about nurses' experiences after death in neonatal and paediatric intensive care is poorly understood.

RESEARCH QUESTION

What is the experience of the nurse after death of a patient in neonatal and/or paediatric intensive care?

METHOD

Following registration with Open Science Framework, an integrative review of the empirical literature was undertaken. A combination of keywords, synonyms, and Medical Subject Headings was used across the Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Medline, APA PsycInfo, Scopus, and Embase databases. Records were independently assessed against inclusion and exclusion criteria. All included papers were assessed for quality. Narrative synthesis was used to analyse and present the findings.

FINDINGS

From 13,018 records screened, 32 papers reporting primary research, representing more than 1850 nurses from 15 countries, were included. Three themes were identified: (i) postmortem care; (ii) caring for bereaved families; and (iii) nurses' emotional response, which includes support for nurses. Nurses simultaneously cared for the deceased child and family, honouring the child and child-family relationship. Nurses were expected to provide immediate grief and bereavement support to families. In response to their own emotions and grief, nurses described a range of strategies and supports to aid coping.

CONCLUSION

Recognising neonatal and paediatric critical care nurses' experience after death is key to comprehensively understanding the professional and personal impacts, including the shared grief of a young life lost. Enabling nurses to acknowledge and reflect upon their experiences of death and seek their preferred supports is critically important. Thus, ensuring organisational and system processes similarly align with nurses' preferences is key.

Innovative Exercise for Nursing PhD Students: Addressing Biases During Integrative Literature Reviews

BACKGROUND

Nursing PhD students face the difficulty of conducting integrative literature reviews that may lead to bias and lack of rigor particularly in the literature search, data evaluation, and data analysis stages. This article describes the development and use of an arts-based learning exercise to identify potential biases and improve on the critical and writing skills of students during the integrative literature review process.

METHOD

The exercise consisted of visits to the university's museum, moderated discussions with nursing faculty and the museum educator, visual analyses of artwork, building art portfolios, and writing assignments. The exercise was modified over 3 years based on student feedback.

RESULTS

Students reported the exercise helped in critical and writing skills, in identifying areas of potential bias, and in enhancing the methodological rigor of the review process.

CONCLUSION

Conducting literature reviews is integral in doctoral nursing education and this innovative exercise can facilitate this process. [J Nurs Educ. 2025;64(5):e22-e25.].

A Theory-Guided Literature Review: A Knowledge Synthesis Methodology

BACKGROUND

There are no detailed, step-by-step descriptions of a process for conducting rigorous literature reviews for Doctor of Nursing Practice (DNP) projects.

METHOD

After a search for a theory-guided literature review (TGLR) process for practice projects resulted in no established process, authors created a methodology by review of PRISMA guidelines, nursing theory experts' feedback, and a Think-Aloud process.

RESULTS

A 10-step formal process for conducting a TGLR to support practice change was established.

CONCLUSION

The aims of developing this methodology include providing a formal process for DNP students to apply nursing theories to guide literature reviews and building nursing knowledge from a nursing disciplinary perspective to support practice change projects. [J Nurs Educ. 2025;64(5):279-285.].

An Integrative Review of the Support Needs of Informal Caregivers of Hematological Cancer Patients in the Period Immediately Following Discharge From Inpatient to Outpatient Care

BACKGROUND

Preparing informal caregivers for a patient's transition to outpatient care is an important component of safe, quality hematological cancer care. The development of many novel therapies and emerging treatments has created opportunities to address the needs of informal caregivers following the discharge of patients from inpatient settings.

OBJECTIVE

To review and synthesize the literature on the needs of informal caregivers of patients with a hematological malignancy postdischarge from inpatient care.

INTERVENTIONS/METHODS

Integrative review methodology was used to explore the body of evidence available. This included a quality appraisal of qualitative, quantitative, and mixed-methods research findings, subsequent data extraction, and inductive thematic synthesis.

RESULTS

One thousand eight articles were screened with 10 included in the review. Key insights into the needs of caregivers entering the outpatient setting were identified and grouped into key subheadings: Encountering complex emotions knowing what to know, little time for yourself, and collateral impact.

CONCLUSION

Findings convey the complex and multiple needs of informal caregivers of hematological cancer patients. With a growing population of people with hematological malignancies and innovations in outpatient cancer therapies, there is a pressing need to codesign interventions to support their caregivers.

IMPLICATIONS FOR PRACTICE

This review has identified a need for more robust research to coproduce interventions in collaboration with caregivers. In addition, interventions developed from further research should be tested in quality implementation science studies to determine their feasibility, sustainability, and impact on outcomes that matter to hematological cancer caregivers.

Factors and interventions that positively influence breastfeeding rates at six months postpartum: An integrative literature review

BACKGROUND

Despite the health benefits of breastmilk, many women discontinue breastfeeding prior to six months postpartum. Previous work from 2010 has identified women's breastfeeding intention, self-efficacy, and support as the main modifiable factors that influence breastfeeding at six months postpartum. However, due to societal changes during the past decade, factors influencing women's decision to continue breastfeeding requires further exploration.

AIM

To determine "what modifiable contemporary factors and interventions can positively influence women's decision to continue breastfeeding until six months postpartum?"

METHOD

An integrative literature review was conducted based on Whittemore and Knafl's framework. Databases were searched using combinations of the following main key words: breastfeeding, duration, factors, and interventions. Studies addressing the research question and published in English language since 2010 were included. Interventional studies were limited to only randomised controlled trials.

RESULTS

Women's positive breastfeeding intention, self-efficacy, and support remained the key modifiable factors that could increase breastfeeding rates up to six months postpartum. The main effective interventions included education support or counselling when they targeted women's needs, intention, self-efficacy and support; and were held over multiple sessions commencing antenatally or immediately after birth. Contemporary effective strategies included digital communications such as phone calls, virtual meetings and messaging via social media including FacebookTM, WhatsAppTM and TelegramTM. Main conceptual frameworks were motivational interviewing, planned behaviour theory and cognitive behavioural therapy.

CONCLUSION

Interventions that support breastfeeding up to six months should include contemporary strategies that target the main modifiable factors and are tailored based to women's needs and their sociocultural influences.

"We do not stop being Indigenous when we are in pain": An integrative review of the lived experiences of chronic pain among Indigenous peoples

BACKGROUND

Chronic non-cancer pain is a major burden worldwide. Indigenous communities experience additional inequities in pain care and management influenced by long-standing impacts of colonization, including systemic racism, oppression, and marginalization. Traditional healing knowledges, practices and methods are valued by Indigenous people when managing their pain. However, mainstream health services often disregard this knowledge and fail to provide culturally safe management strategies.

AIM

To understand how Indigenous peoples across the globe make sense of pain when experiencing chronic non-cancer pain.

METHODOLOGY AND METHODS

This integrative literature review is reported according to the PRISMA checklist and CONSIDER statement. We focused on qualitative data reported by Indigenous adults with chronic non-cancer pain in empirical and theoretical studies. Electronic searches were performed in databases from health and humanities scopes, in addition to grey literature, from 1990 to August 2023. We drew from critical theory approaches to thematically analyze data from the included studies, privileging Indigenous perspectives through a Western intellectual framework (Two-Eyed Seeing epistemology). Data extraction and thematic analysis were managed using NVivo. Primary data were mapped according to geography and theoretical framework.

RESULTS

After removal of duplicates, 1352 studies were screened using title and abstract, from which 99 full texts were assessed and 29 studies and 3 dissertations/theses were included. Included studies reported lived experiences of chronic pain among Indigenous peoples from Oceania, North America, and South America. Thematic analysis derived four main themes that indicated pain is entwined with nature, Indigenous identity, historical trauma, and the collective. Our findings suggest that pain is interconnected to a broader scenario of feelings, thoughts, peoples and places.

CONCLUSION

Our findings highlight the layered and complex aspects of the lived experiences of chronic pain among Indigenous people. Indigenous-led alternatives focusing on culturally safe care can guide approaches to clinical pain practice and contribute to achieving health equity.

Outcomes of post-exam reviews for nursing and health sciences students: An integrative review

BACKGROUND

Post-exam reviews allow students to analyze their exams and receive faculty feedback on their performance. Feedback may help avoid attrition in nursing programs, which is important to address in the face of national nursing shortages and because attrition disproportionally affects students from several underrepresented groups.

PURPOSE

The purpose of this integrative review was to synthesize evidence about outcomes of post-exam reviews for nursing and health science students based on Knowles' (1978) theory of adult learning.

METHODS

An integrative review of the literature as described by Whittemore and Knafl (2005) was undertaken. Multiple databases were searched in June 2024; ancestry searching was also used. Data were analyzed using the constant comparison method.

RESULTS

Nine studies met inclusion criteria. Four themes emerged from the data: looking back, looking in, looking forward, and general satisfaction. Most outcomes were positive (such as increased grades), although some potentially negative outcomes (such as incivility) were identified.

CONCLUSIONS

Nursing faculty should seriously consider implementing post-exam reviews in their courses, structuring the reviews to avoid potentially negative outcomes such as incivility.

Quality of life of women with urinary incontinence in the postpartum period: an integrative literature review

Urinary incontinence (UI) during pregnancy and after childbirth can negatively impact women's lifestyles, health, and well-being. It is a common problem that is often normalized by both healthcare professionals and women. This integrative review examines the influence of UI on women's quality of life (QoL) during the postpartum period and identifies the main affected domains. It will also contribute to the discussion of the results of a primary study. Fourteen studies were included in this review, mainly from Brazil and Spain, with most using quantitative methods. The findings indicate that UI negatively affects the QoL of women during the postpartum period, with mixed UI causing greater discomfort despite stress UI being more frequent. The main affected domains are general health perception, physical functioning, daily life activities, psychological/emotional/mental and social aspects, and sexuality. Effective interventions should promote women's self-care and enhance their awareness and recognition of the problem. These interventions should go beyond physical aspects to address emotional and psychological dimensions, such as low self-esteem and self-image, secrecy, embarrassment, and reluctance to seek help. Nurse midwives have specialized skills and can work within multidisciplinary teams to improve the QoL of women with UI at a time of increased vulnerability.

Dance and stress regulation: A multidisciplinary narrative review

BACKGROUND

Physical exercise is known to aid stress regulation, however the effects of specific exercise types are under-researched. Dance uniquely combines several characteristics that are known to have stress regulatory effects, such as music listening. Nonetheless, dance has received only little attention in studies examining the stress regulatory effects of exercise.

OBJECTIVE

We used a multidisciplinary narrative review as a novel approach to explore the complex relationship between dance and stress by integrating psychological, neurobiological, physiological, and socio-cultural findings. In particular, we looked at the effects of music and rhythm; partnering and social contact; and movement and physical activity.

FINDINGS

There is strong empirical evidence for the beneficial stress regulatory effects of music, social contact, and movement, illustrating that dance can promote coping and foster resilience. Neurobiological research shows that these findings can be explained by the effects that music, social contact, and movement have on, amongst others, dopamine, oxytocin, and β-endorphin modulation and their interplay with the stress system. Socio-cultural considerations of the significance of dance help to understand why dance might have these unique effects. They highlight that dance can be seen as a universal form of human expression, offering a communal space for bonding, healing, and collective coping strategies.

DISCUSSION

This review is the first to integrate perspectives from different disciplines on the stress regulatory effects of dance. It shows that dance has a large potential to aid coping and resilience at multiple levels of the human experience. At the same time, we identified that the existing evidence is often still limited by a narrow focus on exercise characteristics such as intensity levels. This hinders a more holistic understanding of underlying stress regulatory mechanisms and provides important directions for future research.

Simulation-Based Learning About Care of People With Disabilities: An Integrative Review

BACKGROUND

An estimated 44.1 million US citizens are living with disabilities. People with disabilities are at higher risk for health problems, affecting their overall quality of life and care experience. Simulation-based learning (SBL) enables students to apply cognitive, affective, and psychomotor competencies through simulated experiential activities in realistic environments. Research is limited on the integration of disability into SBL nursing education.

AIM

To appraise and synthesize extant literature on the integration of disability in SBL in prelicensure nursing programs.

METHODS

This review identified and synthesized 18 research articles describing the implementation of disability SBL in prelicensure nursing programs.

RESULTS

Four themes were identified substantiating the importance of integrating disability into SBL: knowledge and understanding, communication confidence, empathy, and enlightened attitudes.

CONCLUSIONS

Disability SBL strategies are integral to achieving learning outcomes related to patient-centered care. Large well-designed studies are needed to measure its effectiveness.

Associations of Neighborhood Environments and Socioeconomic Status With Subclinical Atherosclerosis: An Integrative Review

BACKGROUND

A limited understanding exists on the associations of neighborhood environment with subclinical atherosclerosis and its progression.

PURPOSE

The purpose of this integrative review was to explore associations of neighborhood environments and socioeconomic status (SES) with subclinical atherosclerosis and its long-term progression.

RESULTS

Three themes were identified: environmental exposure affects the natural history of atherosclerosis, neighborhood characteristics are associated with subclinical atherosclerosis, and individual SES is associated with development and progression of subclinical atherosclerosis more so than neighborhood SES. Some variations in results were noted based on the vascular site examined.

CLINICAL IMPLICATIONS

Disadvantaged neighborhoods and low SES are associated with greater subclinical atherosclerosis. Inconsistencies in a few studies seemed to be related to lack of coronary artery progression among the relatively young adults. This suggests further examination is needed of the contextual associations of neighborhood and SES with markers of generalized atherosclerosis, such as carotid intima-media thickness.

How Young Widows and Widowers Experience Grief More Than Two Years Following the Death of Their Spouse: An Integrative Review

BACKGROUND

Grieving the loss of a spouse as a young adult is unthinkable to many, yet a reality for some. Little is known about the grief of young widow(er)s, age 45 and under, and how it is experienced when moving forward in their forever changed lives, several years following the death of a spouse.

PURPOSE

An integrative review was conducted to develop an understanding of what is currently known about the long-term experiences of grief in the young widowed population.

RESULTS

Four themes emerged: (1) Losing More Than a Spouse; (2) Embracing Personal Change and Growth; (3) Maintaining a Lasting Relationship; and, (4) Enduring Grief.

CONCLUSION

These findings provide a foundational understanding of how grief is experienced several years following a death, and support future research in this domain. This valuable information can be used to inform the education and practices of nurses, and other health-care professionals who support bereaved individuals.

Palliative Care in the Intensive Care Unit: An Integrative Review of Intensive Care Unit Health Care Professionals' Views and Experiences

BACKGROUND

It has become more common for patients with long-term diseases or receiving aggressive cancer treatments to need intensive care. Research about palliative care in the intensive care unit (ICU) largely focuses on decision-making in relation to end-of-life care and organ donation. Few studies examine the current evidence about how palliative care in its wider conceptualization is understood by intensive care health care professionals.

OBJECTIVES

To synthesize the literature on ICU health care professionals' experiences and views of providing palliative care in the ICU.

METHODS

This was an integrative review where data were assessed and analyzed using Whittemore and Knafl's approach.

RESULTS

Four themes were identified in the synthesis: the meaning of palliative care, relationships with families, multidisciplinary working, and preparation for providing palliative care.

DISCUSSION

Our findings suggest there is variation in how palliative care in the ICU is conceptualized and interpreted. Intensive care unit professionals need enhanced competencies and training to develop their confidence in providing palliative care and improve role clarity. Such training should focus on serious illness conversations with patients/families and interdisciplinary teamwork. Integration of palliative consultants into the ICU could be further developed.

Strategies used by the nursing team in the care of autistic children and adolescents: An integrative review

PROBLEM

Nurses play a crucial role in monitoring children's growth and development and play a vital role in healthcare facilities, where their presence is constant, providing uninterrupted care and support. The aim of this review to identify the strategies used by the nursing team in caring for autistic children and adolescents METHOD: Integrative literature review, developed in stages, which included: identification of the problem, systematic literature search, quality assessment, data analysis, and presentation of the results. The searches were conducted in seven databases: PubMed, CINAHL, Scopus, Scielo, Embase, Lilacs, and Bdenf, and included articles published in English, Portuguese, and Spanish with no restrictions on period. Controlled descriptors from the Medical Subject Headings (MeSH), CINAHL titles, synonyms, and keywords were used, combined with Boolean operators AND and OR.

RESULTS

The final sample included six articles. Analysis of the studies identified four main strategies adopted by the nursing team in caring for autistic children and adolescents: communication; collaboration with parents and use of sensory objects; preparation of the environment and time management; and, finally, continuing education for professionals FINAL CONSIDERATIONS: This study highlights the importance of including autism in the training of future nurses, emphasizing the need for specific preparation to deal with atypical children and adolescents. The strategies identified provide a practical guide to qualifying the care and support offered to this population IMPLICATIONS FOR PRACTICE: The implementation of these strategies can also help improve the emotional well-being of patients and their families, fostering a holistic approach to care.

Interventions to improve timely cancer diagnosis: an integrative review

Cancer will affect more than one in three U.S. residents in their lifetime, and although the diagnosis will be made efficiently in most of these cases, roughly one in five patients will experience a delayed or missed diagnosis. In this integrative review, we focus on missed opportunities in the diagnosis of breast, lung, and colorectal cancer in the ambulatory care environment. From a review of 493 publications, we summarize the current evidence regarding the contributing factors to missed or delayed cancer diagnosis in ambulatory care, as well as evidence to support possible strategies for intervention. Cancer diagnoses are made after follow-up of a positive screening test or an incidental finding, or most commonly, by following up and clarifying non-specific initial presentations to primary care. Breakdowns and delays are unacceptably common in each of these pathways, representing failures to follow-up on abnormal test results, incidental findings, non-specific symptoms, or consults. Interventions aimed at 'closing the loop' represent an opportunity to improve the timeliness of cancer diagnosis and reduce the harm from diagnostic errors. Improving patient engagement, using 'safety netting,' and taking advantage of the functionality offered through health information technology are all viable options to address these problems.

An integrative review of healthcare professionals' experiences in caring for women who have experienced psychological birth trauma or birth related Post Traumatic Stress Disorder

BACKGROUND

A significant proportion of women worldwide experience childbirth as a traumatic event, which may result in enduring consequences for themselves, their partners and their children. Healthcare professionals have a key role in supporting women with psychological birth trauma and birth related post-traumatic stress disorder through prevention, early detection and supportive practices but evidence indicates that these phenomena, are not recognised by practitioners.

DESIGN

This integrative review followed Whittemore and Knafl's five-stage framework as it facilitates the inclusion of different methodological approaches into an overall synthesis of the evidence. A systematic search of four electronic databases CINAHL, MEDLINE, EMBASE and PsycINFO was conducted between 2003 and 2024, with no geographical limits set due to the paucity of research published in this area.

FINDINGS

Eight studies met the inclusion criteria and were synthesised using thematic synthesis. Two main themes plus sub-themes were identified: (1) Knowledge and Skills (sub-themes: Communication; Clinical skills) and (2) Challenges (sub-themes: Attitudes; Resources).

CONCLUSIONS

Knowledge and skill deficits contribute to the difficulties healthcare professionals face when providing care to women with psychological birth trauma and birth related PTSD. A lack of referral pathways for women to receive the specialised support and treatment they require is also evidenced. This study is the first to our knowledge to examine healthcare professionals experiences of caring for women with psychological birth trauma and birth related post-traumatic stress disorder and make recommendations on how to prevent, identify and support affected women within the perinatal setting.

Accessing HIV care services by key populations - An Ubuntu philosophy reflection

BACKGROUND

 Key populations are disproportionately affected by HIV despite the significant decrease in new HIV infections in Africa. They experience challenges like stigma and discrimination as they interface with the healthcare system. This results in reduced access to HIV care services for key populations. Therefore, the attainment of HIV epidemic control may not be easily realised if these gaps are not addressed.

OBJECTIVES

 To explore and synthesise factors associated with accessing HIV care services by key populations, as well as make a reflection of this process using Ubuntu philosophy.

METHOD

 An integrative literature review was conducted on studies published between 2014 and 2024. An electronic search was performed on several databases. Examples of key phrases that were utilised for the search included Africa, HIV care services, key populations and Ubuntu. The studies included were qualitative and quantitative from peer-reviewed journals and restricted to Africa.

RESULTS

 The following themes emerged: non-inclusive healthcare environment, attitudes of healthcare workers and stigma and discrimination. These findings illustrate the challenges and barriers affecting access to HIV care services for key populations.

CONCLUSION

 The insights from this review call for a paradigm shift in the training programmes of healthcare providers in Southern Africa.Contribution: Given the challenges that affect key populations as they access HIV care services, in-service and pre-service training of healthcare providers should incorporate the humane values of Ubuntu.

Impact of allied health student placements for older clients' health and wellbeing in primary healthcare settings: a systematic integrative review

PURPOSE

Allied health student placements in healthcare settings are complex, constantly evolving, and tailored to real-life environments. The value of student placements in acute and primary healthcare settings is reflected in enhanced student learning, improved service delivery, and positive patient outcomes. This review aims to synthesise the effects of allied health student placements in primary healthcare settings, particularly focusing on older clients' health outcomes and satisfaction with care.

MATERIALS AND METHODS

A systematic integrative review was conducted. The five-step integrative review approach, established by Whittemore and Knafl was used to allow the inclusion of diverse research methodologies. Five major databases, i.e., Medline-EBSCO, PubMed, PROQUEST, CINAHL, and SCOPUS were searched. The CLUSTER model was used to track additional references. Data were extracted as suggested by Whittemore and Knafl and then thematically synthesised.

RESULTS

Eleven papers were reviewed. Despite a lack of rigorous methodologies, five mixed-methods studies, four quantitative studies, one qualitative study, and one cost-benefit analysis were identified exploring the possible effects of allied health student placements for older clients. From these papers, four main themes were identified: student integration in service delivery, older clients' health outcomes, satisfaction with care, and insights into mechanisms to achieving health and well-being outcomes.

CONCLUSION

This review suggests that integration of allied health students into service delivery can provide additional healthcare support for older clients, but further high-quality research is needed to confirm.

Loneliness in Advanced Life-Threatening Illness: An Integrative Review

CONTEXT

To inform supportive interventions, experiences of loneliness must be understood specifically from the perspective of those with advanced life-threatening illness and their caregivers.

OBJECTIVES

To identify the causes, experiences, and impacts of loneliness among adults with advanced life-threatening illnesses and caregivers, and which modifiable factors might mitigate loneliness.

METHODS

Systematic searching of six databases (CINHAL, Web of science, Cochrane central, Medline, HMIC and Proquest) was supplemented by backward citation searching from Jan 2014-Jan2024. This was followed by screening and selection based on the PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. Studies were imported into NVivo version 1.6 for data management. An inductive approach was used to facilitate the synthesis. Quality assessment with diverse studies (QuADS) was used. The review protocol was registered with Prospero, ID: CRD42023493999.

RESULTS

Ninteen observational studies and 6 intervention studies were included in this review. Evidence confirms that the causes, impacts and outcomes of loneliness are multifaceted and interact dynamically. Risk factors on a micro level include psychological and existential factors such as emotional distress and fear of death; potentially modifiable factors include efforts to enhance communication and befriending programs. On meso level physical and social factors are risk factors such as symptom burden and social withdrawal, potentially modifiable factors include utilizing technology to make home an accessible place to maintain social connections. On a macro level environmental and societal risk factors include mobility restrictions and stigma; potentially modifiable factors include increasing societal engagement through community programs CONCLUSION: This integrative review will help healthcare providers, policymakers and the public understand the causes, experiences and impact of loneliness in adults with advanced life-threatening illnesses and their caregivers. The evidence suggests that an integrated approach that combines personal, social, and systemic efforts is needed which includes enhanced communication, targeted interventions, robust support systems, and community engagement. Rigorous research studies are required which include patient and public involvement from inception to completion to ensure that the study designs and methodologies are purposeful for those they intend to serve.

Conceptualizing resilience in public health: a philosophical approach

BACKGROUND

The initial inquiry into the concept revealed its usage as a boundary object and how this facilitated its interdisciplinary utilization. The same feature enabled the shift to literature within other disciplines and then identify its conceptualization in them. This led to the understanding that though many disciplines have used the term resilience to describe a phenomenon with a general understanding of "bouncing back to original position", its multi-disciplinary usage has added a lexical ambiguity to the term. The purpose of the study is to utilize this broad and overlapping nature of resilience to identify those elements, models or pathways that might enable conceptualizing resilience in the context of public health. In this process we uncover the underlying philosophical elements that converge or diverge with the whole conceptualization process of resilience in the discipline of public health.

METHODS

We used a modified integrated review of the body of literature while also reflecting on how the concept of resilience has evolved from a narrow, "Substance Metaphysics," "Reductionist" phenomenon to a more expansive, "Multi-Dimensional," "Intersectional," and "Dynamic phenomenon." Afterwards, existing philosophical theories that converged or diverged with the conceptualization process were used to further validate the entire process that resulted in the definition of resilience in the context of public health emergencies.

RESULTS

The critical evaluation of existing literature led to the identification of two patterns by which resilience has been conceptualized across disciplines. One on the basis of engagement with acute or enduring crisis resulting in trajectories that enables stability or growth and transformation. Another on the basis of the levels at which it was conceptualized by various authors from multiple disciplines. The two approaches were later critically evaluated so as to conceptualize resilience in the context of public health.

CONCLUSION

An integrated response to the crisis may be necessary to preserve people's health and the health of communities in order for them to be resilient. Resilience in public health is a result of the successful engagement of relevant stakeholders responsible for health preservation to current and emerging health inequalities that places them in enabling trajectories of sustenance or growth leading to the development of potential capabilities that are sensitive to diverse health disparities.