The effectiveness of nurse‐led interventions for preventing urinary tract infections in older adults in residential aged care facilities: A systematic review

Using real-time Delphi methods to develop a consensus-based framework to improve nursing assessment in residential aged care

OBJECTIVES

Evidence-based tools are needed to support aged care nurses in recognising and responding to changes in residents' conditions and clinical deterioration. Systematised emergency nursing frameworks such as HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) assist nurses in accurately assessing and documenting a patient's condition and identifying and prioritising care needs. This study aimed to adapt the HIRAID® emergency nursing framework for use in the residential aged care setting.

METHODS

A real-time Delphi method was employed to contextually adapt the HIRAID® framework. Twelve expert health-care clinical leaders with understanding of patient assessment and residential aged care management were recruited through purposive sampling. Panel consensus was established a priori at 80%. A secondary measure of panel stability was used to understand panel consensus.

RESULTS

Consensus was reached after two survey rounds. In Round 1, 105 (88%) of 119 items were accepted after reaching consensus. In Round 2, all remaining 29 items reached consensus, whereby 20 were accepted and nine rejected. Key modifications were identified for 'History', which needed to consider more comprehensive and adaptive techniques, and 'Interventions' and 'Diagnostics', where differences arose in the scope of practice of aged care nurses compared to their acute care counterparts.

CONCLUSION

The study demonstrated how a small expert multidisciplinary health-care panel can be stable and reach consensus to adapt and contextualise an emergency care framework to the aged care setting. These findings will form the content to scaffold educational resources to support learning and practice change.

Preventing urinary tract infection in older people living in care homes: the 'StOP UTI' realist synthesis

BACKGROUND

Urinary tract infection (UTI) is the most diagnosed infection in older people living in care homes.

OBJECTIVE

To identify interventions for recognising and preventing UTI in older people living in care homes in the UK and explain the mechanisms by which they work, for whom and under what circumstances.

METHODS

A realist synthesis of evidence was undertaken to develop programme theory underlying strategies to recognise and prevent UTI. A generic topic-based search of bibliographic databases was completed with further purposive searches to test and refine the programme theory in consultation with stakeholders.

RESULTS

56 articles were included in the review. Nine context-mechanism-outcome configurations were developed and arranged across three theory areas: (1) Strategies to support accurate recognition of UTI, (2) care strategies for residents to prevent UTI and (3) making best practice happen. Our programme theory explains how care staff can be enabled to recognise and prevent UTI when this is incorporated into care routines and activities that meet the fundamental care needs and preferences of residents. This is facilitated through active and visible leadership by care home managers and education that is contextualised to the work and role of care staff.

CONCLUSIONS

Care home staff have a vital role in preventing and recognising UTI in care home residents.Incorporating this into the fundamental care they provide can help them to adopt a proactive approach to preventing infection and avoiding unnecessary antibiotic use. This requires a context of care with a culture of personalisation and safety, promoted by commissioners, regulators and providers, where leadership and resources are committed to support preventative action by knowledgeable care staff.

Unlocking the potential of primary healthcare nurse practitioners globally: A concept analysis of their added value

BACKGROUND

Primary healthcare nurse practitioners (PHCNPs) are expanding globally to meet rising healthcare demands. Despite positive outcomes, their added value remains underexplored.

PURPOSE

To clarify and refine the added value PHCNPs bring.

METHODS

Building on a previous concept analysis of the added value of nurse practitioners, we analyzed 37 systematic reviews focusing on PHCNPs' roles across various settings, using Rodgers' evolutionary approach.

FINDINGS

Attributes include PHCNPs' skills and competencies, activities, positive outcomes, and professional autonomy. Antecedents involve PHCNP characteristics and structural and institutional factors, while consequences highlight improved patient outcomes, satisfaction, professional dynamics, and system efficiency.

DISCUSSION

Understanding PHCNPs' added value is crucial for policy development, role implementation, and healthcare optimization. Clear regulatory frameworks and supportive policies are needed to maximize their impact.

CONCLUSION

This analysis provides and updates the conceptual definition of PHCNPs' added value, offering insights for policy, education, and research to support their critical role in healthcare.

Nurse-Driven Process for the Successful Removal of Urinary Catheters Among Elderly Patients After Hip Fracture Surgery: A Quality Improvement Project

BACKGROUND

Hip fracture is a major health concern and the use of an indwelling urinary catheter (IUC) constitutes a significant burden on elderly patients undergoing hip fracture surgery.

LOCAL PROBLEM

The institution had a high rate of urinary tract infection (UTI) and IUC reinsertion after hip fracture surgery.

METHODS

A pre/post-implementation design was used for this quality improvement initiative.

INTERVENTIONS

A nurse-driven process was developed and implemented to improve the successful removal of IUC among patients after hip fracture surgery.

RESULTS

There was a significant reduction in post-operative urinary retention ( P = .042), UTI rate ( P = .047), and IUC reinsertion ( P = .042) in the post-implementation group. IUC duration decreased by 1.1 days, however this was not significant ( P = .206). Nurse compliance with following the new process was 93.3%.

CONCLUSION

The nurse-driven process designed for elderly patients following hip fracture surgery presents a promising approach to reducing IUC reinsertion rates and UTI.

Improving Situation Awareness to Advance Patient Outcomes: A Systematic Literature Review

Improving nurses' situation awareness skills would likely improve patient status recognition and prevent adverse events. Technologies such as electronic health record dashboards can be a promising approach to support nurses' situation awareness. However, the effect of these dashboards on this skill is unknown. This systematic literature review explores the evidence around interventions to improve nurses' situation awareness at the point of care. Current research on this subject is limited. Studies that examined the use of electronic health record dashboards as an intervention had weak evidence to support their effectiveness. Other interventions, including communication interventions and structured nursing assessments, may also improve situation awareness, but more research is needed to confirm this. It is important to carefully consider the design and content of situation awareness interventions, as well as the specific outcomes being measured, when designing situation awareness interventions. Overall, there is a need for higher-quality research in this area to determine the most effective interventions for improving nurse situation awareness. Future studies should focus on developing dashboards that follow a theoretical situation awareness model information and represent all situation awareness levels.

Nurse Staffing and Veteran Outcomes in the Veterans Health Administration's Community Living Centers

BACKGROUND

The demand for nursing care is rising in the long-term care setting. Nurse staffing is a crucial measure linked to health care quality measure outcomes.

PURPOSE

To assess for associations between nursing hours per patient day (NHPPD) and outcome measures in the Veterans Health Administration Community Living Centers.

METHODS

A retrospective data review of NHPPD and quality measures for 134 community living centers was conducted. Linear regression was used to assess for linear associations between average total NHPPD and 6 quality measures.

RESULTS

A significant linear association was found between average total NHPPD and falls with major injury ( P = .02) and help with activities of daily living ( P = .01). No associations were found between nurse staffing and 4 other quality measures.

CONCLUSIONS

This study adds to the body of literature regarding the impact of nurse staffing on quality measures.

A Systematic Review of the Effects of Second-Eye Cataract Surgery on Motor Function

Cataract removal surgery is one of the most commonly performed surgical procedure in developed countries. The financial and staff resource cost that first-eye cataract surgery incurs, leads to restricted access to second-eye cataract surgery (SES) in some areas, including the United Kingdom. These restrictions have been imposed despite a lack of knowledge about the impact of not performing SES on visuo-motor function. To this end, a systematic literature review was carried out, with the aim of synthesising our present understanding of the effects of SES on motor function. Key terms were searched across four databases, PsycINFO, Medline, Web of Science, and CINAHL. Of the screened studies (K = 499) 13 met the eligibility criteria. The homogeneity between participants, study-design and outcome measures across these studies was not sufficient for meta-analyses and a narrative synthesis was carried out. The evidence from objective sources indicates a positive effect of SES on both mobility and fall rates, however, when considering self-report measures, the reduction in falls associated with SES becomes negligible. The evidence for any positive effect of SES on driving is also mixed, whereby SES was associated with improvements in simulated driving performance but was not associated with changes in driving behaviours measured through in vehicle monitoring. Self-report measures of driving performance also returned inconsistent results. Whilst SES appears to be associated with a general trend towards improved motor function, more evidence is needed to reach any firm conclusions and to best advise policy regarding access to SES in an ageing population. Systematic Review Registration: https://osf.io/7hne6/, identifier INPLASY2020100042.

The effects of a nurse-led couples intervention on marital quality of couples with gynecological cancer: A clinical randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of a nurse-led couples intervention on the marital quality of couples coping with gynecological cancer.

METHODS

Couples coping with gynecological cancer were randomly allocated to the intervention (n = 51) and the control (n = 53) group. The intervention group received the nurse-led couples intervention developed based on the Preliminary Live with Love Conceptual Framework plus routine nursing care. The control group received only routine nursing care. Marital quality, including marital satisfaction, marital communication, and sexual life, were measured using Olson Marital Quality Questionnaire at 3 timepoints (baseline, 2- and 3-months following baseline). Generalized estimating equation was used to examine the effectiveness of the intervention in improving marital quality.

RESULTS

Patients and husbands in the intervention group had significantly improved marital satisfaction scores (Waldχ² = 11.109, P = 0.001; Waldχ² = 4.849, P = 0.028); the interaction between intervention and time had a significant effect on the marital communication of both patients and their husbands (Waldχ² = 6.214, P = 0.045; Waldχ² = 15.460, P < 0.001). Patient-reported and husband-reported sexual life was not significantly influenced by the intervention (Waldχ² = 0.167, P = 0.683; Waldχ² = 3.215, P = 0.073).

CONCLUSIONS

The nurse-led couples intervention based on the Preliminary Live with Love Conceptual Framework improved marital satisfaction and marital communication, but not sexual life, of couples coping with gynecological cancer. The provision of professional sexual health psychology training for nurses may be crucial if nurse-led models are to truly support the sexual health of couples coping with gynecological cancer.

REGISTRATION

Registered with www.chictr.org.cn (ChiCTR2000034232).

Incidence and risk factors of urinary tract infections in hospitalised patients with spinal cord injury

AIMS AND OBJECTIVES

To investigate the incidence of urinary tract infection and analyse its risk factors among hospitalised patients with spinal cord injury.

BACKGROUND

While the incidence of urinary tract infection varies widely according to the healthcare setting and patients' clinical characteristics, formal reports are limited in quantity. There has been no consensus regarding the risk factors for urinary tract infection.

DESIGN

A retrospective descriptive study.

METHODS

Electronic medical records of 964 subjects between 2010-2017 were reviewed. Urinary tract infection status was examined to identify newly occurred cases. Data included demographic and clinical characteristics, hydration status and length of hospitalisation. The reporting of the study followed the EQUATOR Network's STROBE checklist.

RESULTS

Of the sample, 31.7% had urinary tract infection (95% confidence interval: 1.288 to 1.347, p < .001). Sex, completeness of injury, type of bladder emptying, detrusor function and urethral pressure were significant factors affecting urinary tract infection. Patients who were male and those with injury classifications A, B and C had higher risk of urinary tract infection. Patients with urinary or suprapubic indwelling catheters, as well as those with areflexic detrusor combined with normotonic urethral pressure or overactive detrusor combined with normotonic urethral pressure, showed higher risk. Length of hospitalisation in patients with urinary tract infection was greater than that in uninfected patients, which implies the importance of prevention of urinary tract infection.

CONCLUSIONS

Nurses should carefully assess risk factors to prevent urinary tract infection in patients with spinal cord injury in the acute and sub-acute stages of the disease trajectory and provide individualised nursing care.

RELEVANCE TO CLINICAL PRACTICE

This study contributes evidence for up-to-date clinical nursing practice for the comprehensive management of urinary tract infection. This can lead to improvements in nursing care quality and patient outcomes, including length of hospitalisation.