An Overview of the Integrative Research Review

The impact of midwife/nurse-led psychosocial interventions on parents experiencing perinatal bereavement: An integrative review

BACKGROUND

Perinatal loss is a traumatic event associated with a high risk of parents experiencing negative psychological outcomes. Despite most parents being in regular contact with midwives and nurses during the perinatal period, there is a lack of evidence which hampers these professionals from using effective psychosocial interventions with parents.

AIM

This study aims to synthesise the existing evidence on the types of psychosocial interventions delivered by midwives/nurses for parents with perinatal bereavement, their impacts on bereaved parents' mental health and the experiences of midwives and nurses in delivering psychosocial interventions for parents experiencing perinatal loss.

DESIGN

An integrative review of the literature.

METHODS

Whittemore and Knafl's five-stage integrative review framework guided this review. A systematic literature search of the Medline, PsycINFO, Embase, CINAHL and ASSIA, Cochrane Library and ProQuest databases was conducted from inception to January 2023, with no language or geographical limiters set due to the paucity of research published in this subject area. Two researchers independently screened and reviewed each study's data extraction and methodological quality using the Joanna Briggs Institute and Mixed Method Appraisal Tool. Results were analysed and synthesised using narrative synthesis.

RESULTS

A total of 21 studies met the inclusion criteria. From these, we identified nine types of psychosocial interventions for perinatal bereavement that can be delivered by midwives and nurses. The positive impacts of midwife/nurse-led psychosocial interventions on grief, anxiety, depression posttraumatic stress disorder and other psychosocial outcomes amongst parents experiencing perinatal loss have been demonstrated. In addition, we identified the useful components of these interventions and the experiences of midwives and nurses in delivering psychosocial interventions, thereby highlighting barriers such as lack of knowledge and skills, stressful working environments and inadequate emotional support.

CONCLUSION

Our findings demonstrate that midwife/nurse-led psychosocial interventions have the potential to improve grief, anxiety, depression, posttraumatic stress disorder symptoms and other psychosocial outcomes for parents experiencing perinatal loss. Thus, future research should consider training, workload, time cost and emotional support for midwives/nurses when developing midwife/nurse-led psychosocial interventions for parents with perinatal loss.

REGISTRATION NUMBER

CRD42022369032.

TWEETABLE ABSTRACT

Midwife/nurse-led psychosocial interventions have the potential to improve mental health amongst parents experiencing perinatal loss.

Plastic litter affected by heat or pressure: A review of current research on remoulded plastic litter

Pyroplastic, plastiglomerates, anthropogenic rocks, plasticrusts, pebble clasts, plastitar, plastisoil and anthropoquinas are examples of terms that have been used to describe the secondary products of plastic litter that have been melted, moulded, pressed, or cemented together with other plastic litter and/or minerogenic sediments or organic matter, either naturally or anthropogenically. Such processes may also favor the formation of new geological features containing plastics, such as coastal landforms or sedimentary rocks. Further research and classification of this secondary plastic litter is critical for understanding the implications of this emerging contaminant as well as to create well-targeted measures to reduce it. The literature review as presented includes 32 peer-reviewed articles published between 1997 and June 2023, all of which describe various burnt or otherwise remoulded plastic litter from around the world. Based on our review we propose a new umbrella term for the different forms of secondary plastic litter that have been modified by heat or pressure: Remoulded Plastic Litter (RPL). If accepted by the research community, important steps for future research and policy will be to implement RPL into the OSPAR protocol for monitoring and assessment of marine litter and thereby fill knowledge gaps of the geographic distribution of RPLs and their potential toxicities to nature and humans. It is clear that the distribution of RPL research spans the globe, however, studies in Africa, Oceania, large tracts of the polar regions, and terrestrial areas in general, are scarce to absent, as are ecotoxicological studies and recommendations for policy development.

Multidisciplinary collaboration on exoskeleton development adopting user-centered design: a systematic integrative review

Purpose: The world population is ageing, along with an increasing possibility of functional limitations that affect independent living. Assistive technologies such as exoskeletons for rehabilitative purposes and daily activities assistance maintaining the independence of people with disabilities, especially older adults who wish to ageing-in-place. The purpose of this systematic integrative review was threefold: to explore the development team compositions and involvement, to understand the recruitment and engagement of stakeholders, and to synthesise reported or anticipated consequences of multidisciplinary collaboration.Methods: Databases searched included PubMed, CINAHL Plus, PsycINFO, Web of Science, Scopus, and IEEE Xplore. A total of 34 studies that reported the development of exoskeleton adopting user-centered design (UCD) method in healthcare or community settings that were published in English from 2000 to July 2022 were included.Results: Three major trends emerged from the analysis of included studies. First, there is a need to redefine multidisciplinary collaboration, from within-discipline collaboration to cross-discipline collaboration. Second, the level of engagement of stakeholders during the exoskeleton development remained low. Third, there was no standardised measurement to quantify knowledge production currently.Conclusion: As suggested by the synthesised results in this review, exoskeleton development has been increasing to improve the functioning of people with disabilities. Exoskeleton development often required expertise from different disciplines and the involvement of stakeholders to increase acceptance, thus we propose the Multidisciplinary Collaboration Appraisal Tool to assess multidisciplinary collaboration using the UCD approach. Future research is required to understand the effectiveness of multidisciplinary collaboration on exoskeleton development using the UCD approach.IMPLICATIONS FOR REHABILITATIONGlobal trend of population ageing causes a higher risk of disability in older adults who require rehabilitation and assistance in daily living.Assistive technologies such as exoskeletons have the potential to contribute to rehabilitation training and daily activity assistance demand closer multidisciplinary collaboration.A Multidisciplinary Collaboration Appraisal Tool using user-centered design approach (MCAT) is proposed to understand the effectiveness as well as limitations and barriers associated with multidisciplinary collaboration in developing exoskeletons.

Motivational characteristics of recreational drug use among emerging adults in social settings: an integrative literature review

Introduction

Recreational drug use by emerging adults has been identified as an increasingly normalized trend in social contexts. It has been documented that the consumption of these substances regularly occurs at music festivals, raves, nightlife and party settings. While it is known that emerging adults participate in these risk-taking behaviors, what is not known is their motivational characteristics for use. The aim of this review to identify and review literature describing the motivations for recreational drug use and drug choice (excluding alcohol, cannabis and tobacco) by emerging adults in social settings to inform selection of appropriately aligned harm reduction education and health messaging interventions.

Methods

Whittemore and Knafl's (2005) integrative approach was used to conduct the review. This integrative review was based on a three-step search strategy identifying 2,772 articles published between 2000 and 2022. Eleven studies were included in the review. This review explores the following areas: drug use settings, concurrent drug use, consumer drug knowledge, motives of use including likes and dislikes and peer influence.

Results

A range of factors influence motivations of emerging adults to participate in recreational drug use. Similar to the consumption of alcohol, the use of recreational drugs by emerging adults is motivated by their perceived benefits and personal motivations to achieve euphoria, emotional intimacy, social benefits, peer influence, increased confidence and to decrease inhibitions. The review findings suggest that motivational factors that reinforce recreational drug use correlate with the desire to break away from the mundane by seeking pleasure and for the opportunity to create novel experiences. Beliefs about the positive and negative impacts of drug use, together with the desire to achieve emotional satisfaction influence drug taking activity.

Conclusion

Recreational drug use has become an increased societal norm amongst drug using peer groups and cannot be entirely prevented. It is to be noted that emerging adults have a basic understanding concerning recreational drugs, however, consumer drug knowledge and interventions that target illicit substances is lacking and should be addressed in future research. Festivals, raves and nightlife settings provide opportunity to implement health promotion as it reaches large number of vulnerable individuals in a short period of time.

Black Americans Receiving the COVID-19 Vaccine and Effective Strategies to Overcome Barriers: An Integrative Literature Review

BACKGROUND

Black Americans have a greater likelihood of serious morbidity or mortality from contracting the coronavirus and represent the lowest percentage of vaccinated individuals by race. This integrative literature review aims to identify the major barriers to Black Americans receiving the COVID-19 vaccine and proposed solutions to improve vaccination rates among this population.

METHOD

Databases CINAHL and LitCovid from the National Library of Medicine were utilized to find the articles included in this review.

RESULTS

A total of seven articles were identified indicating five barriers preventing Black Americans from being vaccinated against COVID-19 that included (1) mistrust of the medical establishment, (2) uncertainty in vaccine safety, (3) limited access to healthcare, (4) inequitable access to resources, and (5) lower health literacy. The studies also indicated five strategies to increase the desire of Black Americans to be vaccinated including (1) utilizing trusted community leaders, (2) acknowledgment of the history of discrimination and trauma, (3) building more representative clinical trial cohorts, (4) continual investment into community-based organizations, and (5) mobile vaccine clinics.

CONCLUSION

The medical establishment in the USA has significant work to do to gain the trust of Black Americans. Many of the strategies to increase vaccine uptake among Black Americans have yet to be implemented which limits the conclusions that can be drawn from them. A future study should examine the outcomes of these proposed solutions to see if they do indeed work as intended and increase vaccination rates among this population.

Factors Influencing the Acceptability, Acceptance, and Adoption of Conversational Agents in Health Care: Integrative Review

BACKGROUND

Conversational agents (CAs), also known as chatbots, are digital dialog systems that enable people to have a text-based, speech-based, or nonverbal conversation with a computer or another machine based on natural language via an interface. The use of CAs offers new opportunities and various benefits for health care. However, they are not yet ubiquitous in daily practice. Nevertheless, research regarding the implementation of CAs in health care has grown tremendously in recent years.

OBJECTIVE

This review aims to present a synthesis of the factors that facilitate or hinder the implementation of CAs from the perspectives of patients and health care professionals. Specifically, it focuses on the early implementation outcomes of acceptability, acceptance, and adoption as cornerstones of later implementation success.

METHODS

We performed an integrative review. To identify relevant literature, a broad literature search was conducted in June 2021 with no date limits and using all fields in PubMed, Cochrane Library, Web of Science, LIVIVO, and PsycINFO. To keep the review current, another search was conducted in March 2022. To identify as many eligible primary sources as possible, we used a snowballing approach by searching reference lists and conducted a hand search. Factors influencing the acceptability, acceptance, and adoption of CAs in health care were coded through parallel deductive and inductive approaches, which were informed by current technology acceptance and adoption models. Finally, the factors were synthesized in a thematic map.

RESULTS

Overall, 76 studies were included in this review. We identified influencing factors related to 4 core Unified Theory of Acceptance and Use of Technology (UTAUT) and Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) factors (performance expectancy, effort expectancy, facilitating conditions, and hedonic motivation), with most studies underlining the relevance of performance and effort expectancy. To meet the particularities of the health care context, we redefined the UTAUT2 factors social influence, habit, and price value. We identified 6 other influencing factors: perceived risk, trust, anthropomorphism, health issue, working alliance, and user characteristics. Overall, we identified 10 factors influencing acceptability, acceptance, and adoption among health care professionals (performance expectancy, effort expectancy, facilitating conditions, social influence, price value, perceived risk, trust, anthropomorphism, working alliance, and user characteristics) and 13 factors influencing acceptability, acceptance, and adoption among patients (additionally hedonic motivation, habit, and health issue).

CONCLUSIONS

This review shows manifold factors influencing the acceptability, acceptance, and adoption of CAs in health care. Knowledge of these factors is fundamental for implementation planning. Therefore, the findings of this review can serve as a basis for future studies to develop appropriate implementation strategies. Furthermore, this review provides an empirical test of current technology acceptance and adoption models and identifies areas where additional research is necessary.

TRIAL REGISTRATION

PROSPERO CRD42022343690; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343690.

An integrative review on the acceptance of artificial intelligence among healthcare professionals in hospitals

Artificial intelligence (AI) in the domain of healthcare is increasing in prominence. Acceptance is an indispensable prerequisite for the widespread implementation of AI. The aim of this integrative review is to explore barriers and facilitators influencing healthcare professionals' acceptance of AI in the hospital setting. Forty-two articles met the inclusion criteria for this review. Pertinent elements to the study such as the type of AI, factors influencing acceptance, and the participants' profession were extracted from the included studies, and the studies were appraised for their quality. The data extraction and results were presented according to the Unified Theory of Acceptance and Use of Technology (UTAUT) model. The included studies revealed a variety of facilitating and hindering factors for AI acceptance in the hospital setting. Clinical decision support systems (CDSS) were the AI form included in most studies (n = 21). Heterogeneous results with regard to the perceptions of the effects of AI on error occurrence, alert sensitivity and timely resources were reported. In contrast, fear of a loss of (professional) autonomy and difficulties in integrating AI into clinical workflows were unanimously reported to be hindering factors. On the other hand, training for the use of AI facilitated acceptance. Heterogeneous results may be explained by differences in the application and functioning of the different AI systems as well as inter-professional and interdisciplinary disparities. To conclude, in order to facilitate acceptance of AI among healthcare professionals it is advisable to integrate end-users in the early stages of AI development as well as to offer needs-adjusted training for the use of AI in healthcare and providing adequate infrastructure.

Change fatigue in nursing: An integrative review

AIMS

To synthesize the empirical and theoretical literature on change fatigue in nursing, including how change fatigue affects nurses, the nursing profession and strategies to prevent and overcome it.

BACKGROUND

Change fatigue refers to the overwhelming feelings of stress, exhaustion and burnout associated with rapid and continuous change across healthcare organizations. Change fatigue can affect nurses' wellbeing, yet there is a distinct lack of literature which synthesizes the relationship between cumulative organizational change and nurses' wellbeing.

DESIGN

Integrative review following Toronto and Remington and Whittemore and Knafl methodology.

DATA SOURCES

Searches were conducted in CINAHL, Embase, Medline, APA PsycInfo, Scopus, Business Source Complete and ProQuest Dissertations & Theses Global in January 2022.

REVIEW METHODS

A comprehensive search was conducted to identify literature on change fatigue in nursing. Included literature were critically appraised for methodological quality. Data from each article were abstracted and thematically analysed.

RESULTS

Twenty-six articles were included in this review, including 14 empirical studies, 10 theoretical papers and two literature reviews. Five main themes described in the literature included: definitions, preceding factors, associated behaviours, consequences and mitigation strategies for change fatigue.

CONCLUSION

This review highlights the impact of rapid and continuous change on nurses and nursing practice. Further research is needed to explore the relationship between change fatigue and burnout, understand how and why nurses withdraw or avoid change, and to develop a metric to measure change fatigue when considering new change initiatives.

IMPACT

Findings from this review generated an improved understanding of how change fatigue affects nurses, the nursing profession and strategies to prevent and overcome it. This paper provides practical recommendations for future research, direction for nursing educators and leaders, and encourages nurses to practice political agency with change management.

PATIENT OR PUBLIC CONTRIBUTION

This project was an integrative review of the literature therefore no patient or public contribution was necessary.

Barriers and Facilitators of Pain Self-Management Among Patients with Cancer: An Integrative Review

BACKGROUND

Defining the main barriers and facilitators of cancer pain self-management are essential to improve patients' overall quality of life.

AIM

The main purpose of this review was to identify the main barriers and facilitators for cancer pain self-management.

METHOD

An integrative review guided by the five-stages framework that was identified by Souza et al. (2010) was used: (1) preparing the guiding question; (2) searching or sampling the literature; (3) data collection; (4) critical analysis of the studies; and (5) discussion of results. A comprehensive literature review was conducted using the electronic databases of PubMed/MEDLINE, CINAHL, Scopus, and Psych INFO.

RESULTS

Twenty-two studies were identified. The main facilitators that foster the process of cancer pain self-management were supportive ambiances including family caregivers as well as health care providers, active participation of patients with cancer in health care including self-discovery and self-awareness, acquiring pain knowledge, and using a pain diary. The main barriers include concerns regarding the use of pain medications, knowledge deficit, negative beliefs and attitudes, unsupportive ambiance, and psychological distress. Some patients' characteristics could be related to these barriers such as age, sex, race, marital status, educational level, level of pain, and presence of comorbidity.

CONCLUSIONS

Patients with cancer pain experience multiple barriers and facilitators when attempting to take on an active role in managing their pain.

The Benefits, Challenges, and Strategies toward Establishing a Community-Engaged Knowledge Hub: An Integrative Review

Current knowledge creation and mobilization efforts are concentrated in academic institutions. A community-engaged knowledge hub (CEKH) has the potential for transdisciplinary and cross-sectorial collaboration between knowledge producers, mobilizers, and users to develop more relevant and effective research practices as well as to increase community capacity in terms of knowledge production. Objective: To summarize existing original research articles on knowledge hubs or platforms and to identify the benefits, challenges, and ways to address challenges when developing a CEKH. Methods: This study followed a systematic integrative review design. Following a comprehensive search of academic and grey literature databases, we screened 9030 unique articles using predetermined inclusion criteria and identified 20 studies for the final synthesis. We employed thematic analysis to summarize the results. Results: The focus of the majority of these knowledge mobilization hubs was related to health and wellness. Knowledge hubs have a multitude of benefits for the key stakeholders including academics, communities, service providers, and policymakers, including improving dissemination processes, providing more effective community interventions, ensuring informed care, and creating policy assessment tools. Challenges in creating knowledge hubs are generally consistent for all stakeholders, rather than for individual stakeholders, and typically pertain to funding, resources, and conflicting perspectives. As such, strategies to address challenges are also emphasized and should be executed in unison. Conclusions: This study informs the development of a future CEKH through the identification of the benefits, challenges, and strategies to mitigate challenges when developing knowledge hubs. This study addresses a literature gap regarding the comparisons of knowledge hubs and stakeholder experiences.

Improving compliance with swallowing exercise to decrease radiotherapy-related dysphagia in patients with head and neck cancer

Objective

Dysphagia, one of the most common complications in head and neck cancer (HNC) treated with radiotherapy, can severely affect patients' quality of life. Currently, because no "gold standard" treatment exists, swallowing exercise remains the main rehabilitation strategy for dysphagia. However, patients' compliance with long-term swallowing exercise is only 40%, thus, greatly compromising outcomes. This article aims to analyze thefactors influencing swallowing exercise compliance in patients with HNC and explains strategies developed to date for improved rehabilitation outcomes.

Methods

Research studies published between 2005 and 2022 were retrieved from seven databases: PubMed, Cochrane Library, Embase, CINAHL, CNKI, Wan Fang Database, and VIP Database, and 21 articles were shortlisted and systematically reviewed.

Results

The swallowing exercise compliance in patients with HNC undergoing radiotherapy was affected by multiple factors, including socio-demographic factors, illness-associated factors, treatment-associated factors, and psychosocial factors. Regarding the interventions, current strategies mainly address psychosocial issues via developing various education programs.

Conclusions

Different factors influencing swallowing exercise compliance are important and should be observed. Measures including developing multidisciplinary teams, applying innovative equipment, refining the intervention procedure, and applying systematic theory frameworks should be performed to achieve better outcomes of compliance interventions.

Perinatal (Re)experiencing of Post-Traumatic Stress Disorder Symptoms for Survivors of Childhood Sexual Abuse: An Integrative Review

This integrative review aimed to synthesize both qualitative and quantitative research on the (re)experiencing of post-traumatic stress disorder (PTSD) symptoms during the perinatal period for childhood sexual abuse (CSA) survivors. Whittemore and Knafl's framework, which includes problem identification, literature review, data evaluation, data analysis, and results dissemination, was used. A search in four databases (i.e., PsycINFO, MEDLINE, Scopus, and ProQuest Dissertations and Thesis Global) yielded an initial sample of 3420 articles. After screening and deduplication, 16 articles met our inclusion criteria (i.e., history of CSA, minimum 8 weeks pregnant, reported quantitative statistics or qualitative findings, discussed PTSD symptoms) and were retained in the final sample. CSA survivors (re)experienced PTSD symptoms as a result of (1) aspects of their medical care (vaginal examinations, male medical providers, lack of control, and restraint), (2) physical sensations during pregnancy, childbirth, and breastfeeding, and (3) sex of the child (worries over child becoming an abuser/abused, male genitalia). CSA survivor's PTSD symptoms of intrusion, dissociation, avoidance, and hyperarousal were significantly greater throughout the perinatal period compared with individuals without CSA or with other traumas. CSA survivors are at increased risk of (re)experiencing PTSD symptoms throughout the perinatal period, which may be due to several internal and external triggers. Further research is needed to understand external triggers outside of medical care, and how the unique context of pregnancy may differ from other life contexts for survivors of CSA. Findings point to the relevance of adopting trauma-informed practices with CSA survivors during their perinatal period.

Climate Change and Mental Health: A Review of Empirical Evidence, Mechanisms and Implications

Anthropogenic climate change is an existential threat whose influences continue to increase in severity. It is pivotal to understand the implications of climate change and their effects on mental health. This integrative review aims to summarize the relevant evidence examining the harm climate change may have on mental health, suggest potential mechanisms and discuss implications. Empirical evidence has begun to indicate that negative mental health outcomes are a relevant and notable consequence of climate change. Specifically, these negative outcomes range from increased rates of psychiatric diagnoses such as depression, anxiety and post-traumatic stress disorder to higher measures of suicide, aggression and crime. Potential mechanisms are thought to include neuroinflammatory responses to stress, maladaptive serotonergic receptors and detrimental effects on one's own physical health, as well as the community wellbeing. While climate change and mental health are salient areas of research, the evidence examining an association is limited. Therefore, further work should be conducted to delineate exact pathways of action to explain the mediators and mechanisms of the interaction between climate change and mental health.

Study protocol for an integrative theory review of the concept of unidentified pain

INTRODUCTION

Most definitions of pain require individuals experiencing pain to report their pain. There are three groups who may not always report pain including those who: (1) lack the cognitive ability to verbally communicate their pain and also lack a proxy/surrogate to report pain for them; (2) lack the cognitive ability to verbally communicate their pain but have a proxy to report the pain; and (3) have the cognitive ability to verbally report pain but are unable or unwilling to do so. Clinicians may not be able to determine which patients are at risk for unidentified pain. Therefore, in this study, we present a protocol for an integrative review with the aim of identifying existing theoretical approaches to understanding unidentified pain.

METHODS AND ANALYSIS

We propose a systematic overview of the existing theoretical approaches to understanding 'unidentified pain'. We will use Campbell and colleagues' criteria for systematic reviews of theory and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Our search will be broad to cover theoretical approaches to 'unidentified pain' using MEDLINE, CINAHL, Embase and Google Scholar. Covidence systematic review software will be used for data extraction and analysis. Then, qualitative content analysis will take place. The content analysis will be presented as a narrative.

ETHICS AND DISSEMINATION

No human or animal subjects will be involved. The results are to be published in peer-reviewed journals and presented at conferences in the USA and internationally.

An integrative review of the potential of wireless assistive technologies and internet of things (IoT) to improve accessibility to education for students with disabilities

This research paper seeks to examine the challenges and opportunities for wireless technologies and the Internet of Things (IoT) to improve access to education for students with disabilities (SwDs). As technology integration into educational content and learning environments occurs, it becomes paramount for scholars to consider how the needs of students with disabilities are incorporated into these learning spaces. This paper synthesizes existing literature via an integrative review that explores barriers to accessing technology-mediated learning and the classroom. It also assesses the potential for technology-mediated learning to progress forward over the last five years. Finally, this article provides targeted recommendations for actualizing wireless technologies' potential on improving students with disabilities' educational outcomes.

Public policy on the prevention of subsequent adolescent pregnancy: what type of policy prevails?

This study aims to conduct a search of public-policy instruments seeking explicit references to subsequent adolescent pregnancy, as well as to discern what kinds of actions have been proposed as part of the international and national agendas to facilitate subsequent adolescent pregnancy prevention and care. During June 2021, we used an integrative review to search and to analyze national and international public policy instruments along with other documents related to subsequent adolescent pregnancy. We observed, for each, the presence of statements on subsequent adolescent pregnancy. The research team was then divided into triads to discuss and to classify each reference under one of the following categories: (a) a symbolic statement, that is, an intention not implying a specific action but rather presenting a vision for the future; (b) a substantive-material statement concerning an action intended to solve a problem; and (c) a procedural-material statement indicating specific actions, processes, budgets, and actors. We analyzed a total of 135 public-policy documents: 102 in Mexico and 33 internationally. Only four national and six international documents contained either symbolic or substantive-material references to the subject of interest and only one specified a procedural-material statement. The prevention and care of subsequent adolescent pregnancy are addressed only secondarily on the public agendas. Only a minimal number of actions comprise specific and standardized measures to prevent subsequent adolescent pregnancy according to the different actors involved. Designing a greater number of procedural-material policies will help to reduce morbidity and mortality in the mother-child binomial and promote a comprehensive development of this population.

The sexuality and sexual experiences of forensic mental health patients: An integrative review of the literature

Introduction

Sexuality is an integral aspect of the human experience that defines an individual. Robust research, substantiated by the World Health Organization, demonstrates that healthy sexuality improves mental health and quality of life. Despite this level of global advocacy and clinical evidence, sexuality and sexual health as determinants of health have been largely overlooked in the mental healthcare of patients being treated under the requirements of a forensic order (forensic patients). In this review, the authors have evaluated the literature related to the sexual development, sexual health, sexual knowledge and risks, sexual experiences, sexual behavior and sexual desires of forensic patients to inform policy and clinical practice. Furthermore, the review explored how forensic patients' sexual healthcare needs are managed within a forensic mental healthcare framework. The paper concludes with recommendations for service providers to ensure that sexual health and sexuality are components of mental health policy frameworks and clinical care.

Methods

An integrative review was utilized to summarize empirical and theoretical literature to provide a greater comprehensive understanding of the sexuality and sexual experiences of forensic patients. This included identifying original qualitative, quantitative, or mixed-method research, case reports, case series and published doctoral thesis pertaining to the research topic.

Results

Twenty-one articles were selected for review. We grouped the review findings into three main themes: 1) Forensic patient themes, 2) Forensic mental health staff themes and 3) Forensic mental health organization themes. The review demonstrated scant information on the sexual healthcare needs of forensic patients or how health services manage these needs while the patient is in a hospital or reintegrating into the community.

Conclusion

There is a dearth of evidence-based, individualized or group approaches which clinicians can utilize to assist forensic patients to achieve a healthy sexual life and it is recommended that such services be developed. Before that however, it is essential to have a clear understanding of the sexual healthcare needs of forensic patients to identify areas where this vulnerable population can be supported in achieving optimal sexual health. Urgent changes to clinical assessment are required to incorporate sexual healthcare as a component of routine mental healthcare.

Insider knowledge as a double-edged sword: an integrative review of midwives' personal childbearing experiences

BACKGROUND

The majority of maternity care is provided by female midwives who have either become mothers or are of childbearing age, but there is limited research exploring midwives' own personal childbearing experiences. This integrative review aims to explore the published literature and research on midwives' own experiences of pregnancy and childbirth.

METHOD

An integrative review of the literature was conducted after relevant articles were identified through a search of: five electronic databases (Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PubMed, Scopus, and Google Scholar), cited reference lists, and networking with peers. Similar and contrasting patterns and relations within the literature were identified and grouped into themes and subthemes.

RESULTS

Twenty articles were included in the review and four overarching themes were identified. Insider knowledge plays a role in decision making encompassed the way midwives used their knowledge to choose; a preferred mode of birth, maternity care provider, model of care, and place of birth. Navigating the childbirth journey demonstrated how some midwives were able to use their insider knowledge to achieve agency, while others had difficulty achieving agency. This theme also revealed the 'midwife brain' that midwives need to manage during their childbearing journey. The theme impact of care on the birth experience described how the type of care the midwives received from maternity care providers affected their overall birth experience. The fourth theme from midwife to mother explains their preparedness for childbirth and their transition to motherhood.

CONCLUSION

For childbearing midwives, there is a potential conflict between their position as knowledgeable experts in maternity care, and their experience as mothers. Whilst they can use their insider knowledge to their advantage, they also experience heightened fear and anxiety through their pregnancy. It is important for maternity care providers to acknowledge and support them and provide balanced and tailored care that acknowledges the woman within the professional midwife and the professional midwife within the woman.

The effect of continuing interprofessional education on improving learners' self-efficacy and attitude toward interprofessional learning and collaboration

We aimed to assess the effect of continuing interprofessional education on collaborative self-efficacy, attitude toward the team, and interprofessional learning in workplace-based learning situations. This was a quasi-experimental study conducted in two educational hospitals. Two hundred and ten participants including nursing and medicine from general medicine, internal medicine, and emergency medicine, entered the study and were categorized in the census's intervention group (n = 97) and control group (n = 113). Continuing interprofessional education interventions included interprofessional rounds and workshops. Attitudes toward the team and interprofessional learning and collaborative self-efficacy were assessed using the Readiness for Interprofessional Learning, Attitudes Toward Health Care Teams, and Interprofessional Collaborator Assessment. Participants' attitude toward the team (p-value <.001), attitude toward interprofessional learning (p-value <.001), and interprofessional collaborative self-efficacy (p-value <.001) were significantly improved compared to participants' scores in the control group. Integrating the principles of continuing education, interprofessional education, and workplace-based learning provided an effective learning situation through interactive relationships and active collaboration of participants. The findings revealed a significant educational effect of the intervention on attitude toward interprofessional learning and the team, and a small effect on self-efficacy of interprofessional collaboration.

Information needs and mHealth applications for carers of people with dementia in managing behavioural and psychological symptoms of care recipients: an integrative review protocol

INTRODUCTION

This integrative review aims to synthesise, appraise and analyse the evidence on informal carers' information needs, features and functions of available mHealth applications, and informal carers' usability and engagement with mHealth applications for managing behavioural and psychological symptoms of dementia (BPSD).

METHODS AND ANALYSIS

This integrative review will include quantitative, qualitative and mixed-methods studies and follow the 'Preferred Reporting for Systematic Reviews and Meta-Analyses 2020' guidelines. Peer-reviewed articles published in English from 2000 to 2021 will be included from Cochrane Library, CINHAL, Embase, MEDLINE, ProQuest and PsycINFO. Five broader concept categories will be included: 'dementia', 'behavioural and psychological symptoms', 'informal carers', '(information need' OR 'mHealth application)'. In title and abstract review, first, the researchers will independently screen 10% of sources for consensus, and one reviewer will screen the rest. In full-text review, two reviewers will conduct the screening process and assess the relevancy of the full-text articles using a two-point scale (high-low) and the methodological quality of included articles using the Mixed Methods Appraisal Tool. Narrative synthesis will be employed to synthesise themes. The findings may identify the need for planning interventions for carers of people with dementia concerning the management of BPSD.

ETHICS AND DISSEMINATION

Ethics approval not required. This review will be published in a peer-review journal and be presented at national and international conferences.

PROSPERO REGISTRATION NUMBER

CRD42021238540.

Clinical teaching practices of nurse educators: An integrative literature review

Clinical teaching practice of nurse educators is important in the development of clinical competence of undergraduate nursing students, but it is often not done according to best practice standards. This study aimed to summarise the best clinical teaching practices of nurse educators teaching undergraduate nursing programmes. An integrative literature review was conducted according to Whittemore and Knafl’s adapted stages. A systematic search of electronic databases, including EBSCOhost and ScienceDirect, for applicable papers from January 2001 to June 2021, was followed by a manual search. The review resulted in selection of 67 papers, and critical appraisal had been completed by two independent reviewers using relevant critical appraisal tools. Papers that were selected revealed six main themes, with sub-themes, outlining best practices for clinical teaching, namely: (1) planning for clinical teaching practice: self-preparation and planning for clinical placement; (2) facilitation of students’ clinical learning: orientation of students, planning for clinical teaching and the clinical teaching process; (3) evaluation of students’ clinical skills: reflection by the nursing student and feedback; (4) modelling professional clinical teaching practice: emotional intelligence, self-evaluation, role modelling and continuous professional development; (5) work-based assessment in the clinical environment: clinical assessment process and clinical assessment tools and (6) clinical teaching in the simulation laboratory. The six identified best practices could assist nurse educators to provide comprehensive clinical teaching.

In-Hospital Bereavement Services as an Act of Care and a Challenge: An Integrative Review

CONTEXT

Globally, people most often die within hospitals. As such, healthcare providers in hospitals are frequently confronted with dying persons and their bereaved relatives.

OBJECTIVES

To provide an overview of the current role hospitals take in providing bereavement care. Furthermore, we want to present an operational definition of bereavement care, the way it is currently implemented, relatives' satisfaction of receiving these services, and finally barriers and facilitators regarding the provision of bereavement care.

METHODS

An integrative review was conducted by searching four electronic databases, from January 2011 to December 2020, resulting in 47 studies. Different study designs were included and results were reported in accordance with the theoretical framework of Whittemore and Knafl (2005).

RESULTS

Only four articles defined bereavement care: two as services offered solely post loss and the other two as services offered pre and post loss. Although different bereavement services were delivered the time surrounding the death, the follow-up of bereaved relatives was less routinely offered. Relatives appreciated all bereavement services, which were rather informally and ad-hoc provided to them. Healthcare providers perceived bereavement care as important, but the provision was challenged by numerous factors (such as insufficient education and time).

CONCLUSION

Current in-hospital bereavement care can be seen as an act of care that is provided ad-hoc, resulting from the good-will of individual staff members. A tiered or stepped approach based on needs is preferred, as it allocates funds towards individuals-at-risk. Effective partnerships between hospitals and the community can be a useful, sustainable and cost-effective strategy.

Therapeutic Alliance in Cognitive Behavioural Therapy in Child and Adolescent Mental Health-Current Trends and Future Challenges

This extended literature review proposes to present the trends in the therapeutic alliance, outcomes, and measures in the last decade within the premises of individual cognitive behaviour therapy (CBT) and its innovations, used as an interventional measure in the context of child and adolescent mental health setting. A brief background of the rationale for conducting this literature search is presented at the start. This is followed by the methodology and design which incorporates the inclusion and exclusion criteria and the basis for the same. The critical appraisal of the primary studies is presented in the literature review section with a brief description of the summary features of the studies in the study tables followed by the results and discussion of the study findings. To summarise, the literature review of primary studies conducted in the last decade demonstrates the need for further research to be conducted both in the field of CBT in children and therapeutic alliance, competence, and therapy outcomes, integrating perspectives in child development, carer alliance, and the social construct theory in children, to allow for further innovations in CBT in the context of increasing challenges in the current times of exponentially developing technology and its utility without compromising the quality of therapy. In conclusion, recommendations are made as a guideline for future studies and research in this field.

Cancer Survivors, Oncology, and Primary Care Perspectives on Survivorship Care: An Integrative Review

Purpose:

Evidence-based models of cancer survivorship care are lacking. Such models should take into account the perspectives of all stakeholders. The purpose of this integrative review is to examine the current state of the literature on cancer survivorship care from the cancer survivor, the oncology care team, and the primary care team perspectives.

Methods:

Using defined inclusion and exclusion criteria, we conducted a literature search of PubMed, PsycINFO, CINAHL, and Scopus databases to identify relevant articles on the stakeholders’ perspectives on cancer survivorship care published between 2010 and 2021. We reviewed and abstracted eligible articles to synthesize findings.

Results:

A total of 21 studies were included in the review. Barriers to the receipt and provision of cancer survivorship care quality included challenges with communication, cancer care delivery, and knowledge.

Conclusion:

Persistent stakeholder-identified barriers continue to hinder the provision of quality cancer survivorship care. Improved communication, delivery of care, knowledge/information, and resources are needed to improve the quality of survivorship care. Novel models of cancer survivorship care that address the needs of survivors, oncology teams, and PCPs are needed.

Creative arts interventions to enhance adolescent well-being in low-income communities: an integrative literature review

Background: Globally many young people, especially from lower socioeconomic backgrounds, face significant barriers to achieving optimal life chances. Creative arts interventions are a way of reaching out to adolescents in low-income communities, to encourage positive functioning and enhanced well-being. We need information on the efficacy - or otherwise - of such interventions to optimise future efforts.Method: An integrative, descriptive literature review was conducted to explore and describe creative arts interventions for adolescents in low-income communities. Data were synthesised by comparing evidence from 12 studies that met the inclusion criteria, and combining ideas using logical reasoning to present what is known or yet to be known about the study topic.Results: Themes emerged regarding the structure and content of interventions; the characteristics of adolescent participants; the countries and contexts in which interventions were carried out; and overall outcomes for adolescent well-being as well as pedagogy.Conclusion: There are worthy outcomes for adolescents living in low-income communities who participate in structured creative arts interventions. However, research evidence is limited, and more research should be undertaken to investigate the development and evaluation of creative arts interventions for the well-being of adolescents in adverse contexts.

Consumer Marketing Strategy and E-Commerce in the Last Decade: A Literature Review

E-commerce is deemed as the sale and purchase of goods and services through the internet in exchange for money and data transfer to complete the transactions. E-commerce is at the forefront of transforming marketing strategies, based on new technologies, and facilitates product information and improved decision-making. In this way, marketing strategy increasingly require large amounts of information to better understand client needs, which raises the question of choosing the right marketing strategy to better fit consumer expectations. This literature review aims to shed light on both the recent growth of e-commerce literature and its interplay with consumer marketing strategy. Extant research has examined this change in human interaction due to social network building, mostly through the themes of online marketing and social media marketing, also comprehending issues such as cost efficiency, information quality and trust development towards online shopping. Nevertheless, existing research has not shown in full all the research streams, how they interact with each other and its potential knowledge development. Thus, a literature review on consumer marketing strategy for e-commerce in the last decade is opportune. This paper aims to identify research trends in the field through a Systematic Bibliometric Literature Review (LRSB) of research on marketing strategy for e-commerce. The review includes 66 articles published in the Scopus® database, presenting up-to-date knowledge on the topic. The LRSB results were synthesized across current research subthemes. The following findings are presented: Amidst the current competitive global business environment, companies tend to respond with strategies for e-commerce and online businesses that resort to e-commerce platforms and social networking to better understand consumer needs, facilitate consumer marketing strategy and share innovative information. The originality of the paper relies on its LRSB method, together with extant review of articles that have not been categorized so far.

Big Data for Biomedical Education with a Focus on the COVID-19 Era: An Integrative Review of the Literature

Medical education refers to education and training delivered to medical students in order to become a practitioner. In recent decades, medicine has been radically transformed by scientific and computational/digital advances—including the introduction of new information and communication technologies, the discovery of DNA, and the birth of genomics and post-genomics super-specialties (transcriptomics, proteomics, interactomics, and metabolomics/metabonomics, among others)—which contribute to the generation of an unprecedented amount of data, so-called ‘big data’. While these are well-studied in fields such as medical research and methodology, translational medicine, and clinical practice, they remain overlooked and understudied in the field of medical education. For this purpose, we carried out an integrative review of the literature. Twenty-nine studies were retrieved and synthesized in the present review. Included studies were published between 2012 and 2021. Eleven studies were performed in North America: specifically, nine were conducted in the USA and two studies in Canada. Six studies were carried out in Europe: two in France, two in Germany, one in Italy, and one in several European countries. One additional study was conducted in China. Eight papers were commentaries/theoretical or perspective articles, while five were designed as a case study. Five investigations exploited large databases and datasets, while five additional studies were surveys. Two papers employed visual data analytical/data mining techniques. Finally, other two papers were technical papers, describing the development of software, computational tools and/or learning environments/platforms, while two additional studies were literature reviews (one of which being systematic and bibliometric).The following nine sub-topics could be identified: (I) knowledge and awareness of big data among medical students; (II) difficulties and challenges in integrating and implementing big data teaching into the medical syllabus; (III) exploiting big data to review, improve and enhance medical school curriculum; (IV) exploiting big data to monitor the effectiveness of web-based learning environments among medical students; (V) exploiting big data to capture the determinants and signatures of successful academic performance and counteract/prevent drop-out; (VI) exploiting big data to promote equity, inclusion, and diversity; (VII) exploiting big data to enhance integrity and ethics, avoiding plagiarism and duplication rate; (VIII) empowering medical students, improving and enhancing medical practice; and, (IX) exploiting big data in continuous medical education and learning. These sub-themes were subsequently grouped in the following four major themes/topics: namely, (I) big data and medical curricula; (II) big data and medical academic performance; (III) big data and societal/bioethical issues in biomedical education; and (IV) big data and medical career. Despite the increasing importance of big data in biomedicine, current medical curricula and syllabuses appear inadequate to prepare future medical professionals and practitioners that can leverage on big data in their daily clinical practice. Challenges in integrating, incorporating, and implementing big data teaching into medical school need to be overcome to facilitate the training of the next generation of medical professionals. Finally, in the present integrative review, state-of-art and future potential uses of big data in the field of biomedical discussion are envisaged, with a focus on the still ongoing “Coronavirus Disease 2019” (COVID-19) pandemic, which has been acting as a catalyst for innovation and digitalization.

Conducting integrative reviews: a guide for novice nursing researchers

BACKGROUND

Integrative reviews within healthcare promote a holistic understanding of the research topic. Structure and a comprehensive approach within reviews are important to ensure the reliability in their findings.

AIM

This paper aims to provide a framework for novice nursing researchers undertaking integrative reviews.

DISCUSSION

Established methods to form a research question, search literature, extract data, critically appraise extracted data and analyse review findings are discussed and exemplified using the authors' own review as a comprehensive and reliable approach for the novice nursing researcher undertaking an integrative literature review.

CONCLUSION

Providing a comprehensive audit trail that details how an integrative literature review has been conducted increases and ensures the results are reproducible. The use of established tools to structure the various components of an integrative review increases robustness and readers' confidence in the review findings.

IMPLICATIONS FOR PRACTICE

Novice nursing researchers may increase the reliability of their results by employing a framework to guide them through the process of conducting an integrative review.

An integrative review of method types used in the study of medication error during anaesthesia: implications for estimating incidence

To meet the WHO vision of reducing medication errors by 50%, it is essential to know the current error rate. We undertook an integrative review of the literature, using a systematic search strategy. We included studies that provided an estimate of error rate (i.e. both numerator and denominator data), regardless of type of study (e.g. RCT or observational study). Under each method type, we categorised the error rate by type, by classification used by the primary studies (e.g. wrong drug, wrong dose, wrong time), and then pooled numerator and denominator data across studies to obtain an aggregate error rate for each method type. We included a total of 30 studies in this review. Of these, two studies were national audit projects containing relevant data, and for 28 studies we identified five discrete method types: retrospective recall (6), self-reporting (7), observational (5), large databases (7), and observing for drug calculation errors (3). Of these 28 studies we included 22 for a numerical analysis and used six to inform a narrative review. Drug error is recalled by ~1 in 5 anaesthetists as something that happened over their career; in self-reports there is an admitted rate of ~1 in 200 anaesthetics. In observed practice, error is seen in almost every anaesthetic. In large databases, drug error constitutes ~10% of anaesthesia incidents reported. Wrong drug or dose form the most common type of error across all five study method types (especially dosing error in paediatric studies). We conclude that medication error is common in anaesthetic practice, although we were uncertain of the precise frequency or extent of harm. Studies concerning medication error are very heterogenous, and we recommend consideration of standardised reporting as in other research domains.

Living labs for health: an integrative literature review

BACKGROUND

Living labs are user-focused experimental environments in which users and producers co-create innovative solutions in real-life settings. The aim of this study was to review and synthesize health-related studies that used the living labs approach.

METHODS

An integrative literature review of 15 studies was conducted on the application of living lab principles and their usefulness for investing health problems. Three reviewers independently used methodological assessment tools to evaluate the data quality.

RESULTS

Twelve of 15 studies were published during the past 5 years, while 14 of the 15 studies were conducted in Europe. Older adults were the target population in 9 of the 15 studies. The research topics varied, including detecting and monitoring daily life, fall prevention and social support. All the studies applied multi-method approaches and a real-life setting. Use of the living lab approach appeared to improve the quality of life, physical and social health and cognitive function of the target populations.

CONCLUSIONS

The results showed that the living lab approach was more commonly used to investigate health problems in older adult populations. Living lab appears to be an appropriate method for developing innovative solutions to improve the health of vulnerable groups.

Art Therapy in the Digital World: An Integrative Review of Current Practice and Future Directions

Background

Psychotherapy interventions increasingly utilize digital technologies to improve access to therapy and its acceptability. Opportunities that digital technology potentially creates for art therapy reach beyond increased access to include new possibilities of adaptation and extension of therapy tool box. Given growing interest in practice and research in this area, it is important to investigate how art therapists engage with digital technology or how (and whether) practice might be safely adapted to include new potential modes of delivery and new arts media.

Methods

An integrative review of peer-reviewed literature on the use of digital technology in art therapy was conducted. The methodology used is particularly well suited for early stage exploratory inquiries, allowing for close examination of papers from a variety of methodological paradigms. Only studies that presented empirical outcomes were included in the formal analysis.

Findings

Over 400 records were screened and 12 studies were included in the synthesis, pertaining to both the use of digital technology for remote delivery and as a medium for art making. Included studies, adopting predominantly qualitative and mixed methods, are grouped according to their focus on: art therapists’ views and experiences, online/distance art therapy, and the use of digital arts media. Recurring themes are discussed, including potential benefits and risks of incorporating digital technology in sessions with clients, concerns relating to ethics, resistance toward digital arts media, technological limitations and implications for therapeutic relationship and therapy process. Propositions for best practice and technological innovations that could make some of the challenges redundant are also reviewed. Future directions in research are indicated and cautious openness is recommended in both research and practice.

Conclusion

The review documents growing research illustrating increased use of digital technology by art therapists for both online delivery and digital art making. Potentially immense opportunities that technology brings for art therapy should be considered alongside limitations and challenges of clinical, pragmatic and ethical nature. The review aims to invite conversations and further research to explore ways in which technology could increase relevance and reach of art therapy without compromising clients’ safety and key principles of the profession.

Meeting support needs for informal caregivers of people with heart failure: a rapid review

Aims 

To explore whether a support-based intervention for informal caregivers of people with heart failure changes their psychosocial and emotional wellbeing. Background Successful self-management of heart failure includes addressing the psychosocial and emotional wellbeing needs of informal caregivers. However, there is limited evidence of how caregivers are supported in this way.

Methods and results 

A rapid review was conducted searching four electronic databases with restrictions to dates January 1996 – September 2019. Specific inclusion and exclusion criteria were applied, and the first author reviewed articles based on title, abstract and then full text, before articles were assessed for conclusions and outcomes. Six studies met the criteria for review. The key caregiver outcomes were burden, depression/anxiety, and quality of life. Significant reductions in caregiver burden were demonstrated in the three studies that measured this outcome. There were mixed results for the outcome measures of depression/anxiety, as well as quality of life, with some interventions demonstrating either significant reductions in depression or anxiety scores, or increases in quality of life scores.

Conclusion 

With only six studies included in this rapid review, it is not possible to make any definitive conclusions regarding the success, or otherwise, of interventions for caregivers of people with heart failure to improve their psychosocial and emotional wellbeing. Whilst some papers would tend to suggest that such interventions can reduce caregiver burden, there is a need to interrogate further interventions in this area to fill the current gap in the literature.

The Lasater Clinical Judgment Rubric: Implications for Evaluating Teaching Effectiveness

BACKGROUND

Concern with patient safety necessitates valid and reliable measures to evaluate clinical judgment. The purpose of this article is to describe how the Lasater Clinical Judgment Rubric (LCJR) has been used to evaluate the effectiveness of educational interventions to promote clinical judgment and its psychometric properties.

METHOD

Search terms included nurse, student, clinical judgment, and Lasater Clinical Judgment Rubric in Scopus, ERIC, and CINAHL with EBSCOhost databases. The final review included 20 studies.

RESULTS

Researchers reported alphas for total scales as .80 to .97, subscales as .89 to .93, and students' self-scored as .81 to .82. Themes were: Individual Versus Group Evaluations, Clinical Judgment Scenarios, and Adaptation for Nonobservation Activities.

CONCLUSION

Results of this review indicate that the LCJR can be used to evaluate clinical judgment, but educators need to consider inter- and intrarater reliability, individual versus group evaluation, clinical judgment scenarios, and adapting the rubric for nondirect observation activities. [J Nurs Educ. 2021;60(2):67-73.].

An Integrative Review of Brain-Derived Neurotrophic Factor and Serious Cardiovascular Conditions

BACKGROUND

There is emerging evidence that supports a role for brain-derived neurotrophic factor (BDNF) in the risk and presence of serious cardiovascular conditions. However, few existing literature reviews methodically describe empirical findings regarding this relationship.

OBJECTIVES

The purpose of this integrative review was to (a) evaluate BDNF (serum/plasma BDNF levels, BDNF Val66Met genotype) among humans at risk for or with serious cardiovascular conditions and (b) investigate the relationship between BDNF and risk/presence of serious cardiovascular conditions in humans.

METHODS

An integrative review was conducted. Articles in English included human subjects, a measure of BDNF levels or BDNF gene, serious cardiovascular conditions, and quantitative data analyses. The search resulted in 475 unique titles, with the final sample including 35 articles representing 30 studies. Articles that received "good" or "fair" ratings (n = 31) using the National Heart, Lung, and Blood Institute Study Quality Assessment Tools were included for synthesis.

RESULTS

The retrieved articles were largely nonexperimental, with sample sizes ranging from 20 to 5,510 participants. Overall, BDNF levels were lower in patients with chronic heart failure and stroke, but higher in patients with unstable angina and recent myocardial infarction. Lower BDNF levels were associated with higher incidence of cardiovascular events in patients with a prior history of serious cardiovascular conditions and decreased cardiovascular risk in healthy samples. For BDNF genotype, on average, 36.3% of participants had Met alleles. The frequency of the BDNF Met allele varied across race/ethnicity and cardiovascular conditions and in terms of association with serious cardiovascular condition incidence/risk.

DISCUSSION

These findings indicate an emerging area of science. Future investigation is needed on serious cardiovascular condition phenotypes in relationship to BDNF in the same study conditions. Results also suggest for use of standardized BDNF measurement across studies and additional investigation in cardiovascular inflammatory processes that affect BDNF. Moreover, within specific populations, the frequency of Met alleles may be too low to be detected in sample sizes normally found in these types of studies.

Spiritual Needs of Older Adults during Hospitalization: An Integrative Review

A hospital admission presents various challenges for a patient which often result in high or intense spiritual needs. To provide the best possible care for older adults during hospitalization, it is essential to assess patients’ spiritual needs. However, little research has been done into the spiritual needs of geriatric patients. This article seeks insight into what is known in the literature on the spiritual needs of geriatric patients. This integrative review presents a summary of the articles on this topic. To select eligible studies, the PRISMA Flow Diagram was used. This resulted in ten articles that have been reviewed. Results show (1) a wide interest in researching spiritual needs, using different research designs. In addition, (2) four subcategories of spiritual needs can be distinguished: (a) the need to be connected with others or with God/the transcendent/the divine, (b) religious needs, (c) the need to find meaning in life, and (d) the need to maintain one’s identity. Moreover, results show that (3) assessing spiritual needs is required to provide the best possible spiritual care, and that (4) there are four reasons for unmet spiritual needs. Further research is needed on the definition of spiritual needs and to investigate older patients’ spiritual needs and the relation with their well-being, mental health and religious coping mechanisms, in order to provide the best spiritual care.

Designing virtual communities of practice for informal caregivers of Alzheimer's patients: An integrative review

The main aim of this study is to review the literature to show how ideas around virtual communities of practice (VCoP) offer a model for supporting informal caregivers of Alzheimer's patients (caregivers) to learn how to deal with caregiving demands. Caregivers are individuals who have a significant personal relationship with and provide a broad range of unpaid assistance to an older person or an adult with a chronic or disabling condition outside of a professional or formal framework. This review will examine the current evidence on the needs of caregivers, identify dimensions to be considered in VCoP design and suggest further directions of research. The investigation is an integrative review that builds a bridge between different areas of work. The outcome is eleven dimensions for the design of successful VCoPs for caregivers: Network Structure, Technology, Moderator, Scale, Alignment, Community Design, Sense of Trust, Knowledge Sharing, Sustainability, Ethics and Evaluation. In addition, we propose a Tree Metaphor to present our research results. Well-designed interventions based on VCoP principles have the potential of addressing caregivers' needs.

Aplicações da Psicologia Positiva no Desenvolvimento Infantil: Uma Revisão de Literatura

Resumo O objetivo deste estudo foi realizar uma revisão integrativa da literatura brasileira sobre as aplicações da Psicologia Positiva no desenvolvimento infantil. Efetuou-se uma busca por artigos científicos nas bases de dados SciELO e PePSIC, com os termos psicologia positiva, resiliência, otimismo, habilidades sociais, bem-estar e felicidade articulados aos termos desenvolvimento infantil, crianças e infância. Foram recuperadas 202 publicações entre os anos 2000 e 2019, entre estas 72 foram analisadas. Observou-se o aumento da produção científica, com destaque para o construto habilidades sociais. Houve predomínio de pesquisas empíricas e análises quantitativas. Contudo, verificou-se poucos estudos sobre a eficácia de intervenções. Conclui-se que é importante diversificar os construtos investigados e investir em desenvolvimento e validação de instrumentos de avaliação e intervenções em diferentes contextos, que proporcionem a potencialização das qualidades humanas na infância em caráter de prevenção e promoção de saúde mental ao longo da vida.

The determinants of handwashing behaviour in domestic settings: An integrative systematic review

BACKGROUND

Hygiene promotion interventions are likely to be more effective if they target the determinants of handwashing behaviour. Synthesis of the evidence on the determinants of handwashing behaviour is needed to enable practitioners to use evidence in hygiene promotion programming.

PURPOSE

To identify, define and categorise the determinants of handwashing behaviour in domestic settings and to appraise the quality of this evidence.

METHODS

We conducted an integrative review, searching three databases for terms related to handwashing and behaviour change determinants. Studies were summarised and their quality assessed against a pre-defined set of criteria for qualitative, quantitative and mixed-method studies. Data on determinants were extracted and classified according to a predefined theoretical taxonomy. The effect of each association between a determinant and handwashing behaviour was summarised and weighted based on the quality of evidence provided. Determinants that were reported more than three times were combined into a meta-association and included in the main analysis. Sub-analyses were done for studies conducted during outbreaks or humanitarian crises.

RESULTS

Seventy-eight studies met the criteria. Of these, 18% were graded as 'good quality' and 497 associations between determinants and handwashing behaviour were extracted. We found that 21% of these associations did not clearly define the determinant and 70% did not use a valid or reliable method for assessing determinants and/or behaviour. Fifty meta-associations were included in the main analysis. The determinants of handwashing that were most commonly reported were knowledge, risk, psychological trade-offs or discounts, characteristic traits (like gender, wealth and education), and infrastructure. There was insufficient data to draw conclusions about the determinants of behaviour in outbreaks or crises.

CONCLUSIONS

This review demonstrates that our understanding of behavioural determinants remains sub-optimal. We found that there are limitations in the way behavioural determinants are conceptualised and measured and that research is biased towards exploring a narrow range of behavioural determinants. Hygiene promotion programmes are likely to be most successful if they use multi-modal approaches, combining infrastructural improvement with 'soft' hygiene promotion which addresses a range of determinants rather than just education about disease transmission.

Identifying and resolving the frustrations of reviewing the improvement literature: The experiences of two improvement researchers

Background and aims

Summarising quality improvement (QI) research through systematic literature review has great potential to improve patient care. However, heterogeneous terminology, poor definition of QI concepts and overlap with other scientific fields can make it hard to identify and extract data from relevant literature. This report examines the compromises and pragmatic decisions that undertaking literature review in the field of QI requires and the authors propose recommendations for literature review authors in similar fields.

Methods

Two authors (EJ and JF) provide a reflective account of their experiences of conducting a systematic literature review in the field of QI. They draw on wider literature to justify the decisions they made and propose recommendations to improve the literature review process. A third collaborator, (WC) co-created the paper challenging author’s EJ and JF views and perceptions of the problems and solutions of conducting a review of literature in QI.

Results

Two main challenges were identified when conducting a review in QI. These were defining QI and selecting QI studies. Strategies to overcome these problems include: select a multi-disciplinary authorship team; review the literature to identify published QI search strategies, QI definitions and QI taxonomies; Contact experts in related fields to clarify whether a paper meets inclusion criteria; keep a reflective account of decision making; submit the protocol to a peer reviewed journal for publication.

Conclusions

The QI community should work together as a whole to create a scientific field with a shared vision of QI to enable accurate identification of QI literature. Our recommendations could be helpful for systematic reviewers wishing to evaluate complex interventions in both QI and related fields.

Police response to individuals displaying suicidal or self-harming behaviours: An integrative review

Police are increasingly being called upon to respond to people experiencing suicidal crisis. Such incidents are a challenging aspect of modern policing. This paper reports on an integrative review study that aimed to investigate police responses to individuals displaying suicidal or self-harming behaviours. Six electronic databases were searched for peer-reviewed articles published between 2007 and 2017 relating to police responses to individuals in suicidal crisis. The review identified 12 studies that met the inclusion criteria. A content analysis was conducted to identify and describe the key characteristics emerging from the literature, which identified four themes: "characteristics of individuals"; "the use of violence and weapons"; "contact with police prior to suicide"; and, "police officer training". Findings from this study indicate that individuals involved in incidents of suicidal and self-harm crisis with police are often male, aged between 35 and 40 years, single and/or having relationship issues, with a history of mental health issues and in recent contact with police prior to the incident of suicidal crisis-either as a victim or a perpetrator. The results highlight that large proportions of individuals in suicidal crisis within a community located incident are likely to present with violent or aggressive behaviour and in many situations are armed with a weapon used to either threaten or injure police and/or bystanders or self-harm. Training and education can have a positive impact from the perspective of police responding to individuals in suicidal crisis. Limitations in the current evidence are identified and implications for future research are outlined.

Supporting children and young people to assume responsibility from their parents for the self-management of their long-term condition: An integrative review

BACKGROUND

Children and young people with long-term conditions (LTCs) are usually dependent on, or share management with, their families and are expected to develop self-management skills as they mature. However, during adolescence, young people can find it challenging to follow prescribed treatment regimens resulting in poor clinical outcomes. Though reviews have looked at children's and parents' experiences of self-management, none have explicitly examined the parent-to-child transfer of self-management responsibility.

METHODS

An integrative review was conducted with the aim of exploring the parent-to-child transfer of LTC self-management responsibility, through addressing two questions: (a) How do children assume responsibility from their parents for self-management of their LTC? (b) What influences the parent-to-child transfer of this responsibility? Eight databases were searched for papers published from 1995 to 2017. Methodological quality was assessed; included papers were synthesized to identify themes.

RESULTS

Twenty-nine papers were identified. Most papers used qualitative designs and focused on children with diabetes. Participants were predominantly children and/or parents; only two studies included health professionals. Assuming self-management responsibility was viewed as part of normal development but was rarely explored within the context of the child gaining independence in other areas of their life. Children and parents adopted strategies to help the transfer, but there was limited evidence around health professionals' roles and ambivalence around what was helpful. There was a lack of clarity over whether children and parents were aiming for shared management, or self-management, and whether this was a realistic or desired goal for families. Multiple factors such as the child, family, social networks, health professional, and LTC influenced how a child assumed responsibility.

CONCLUSIONS

Evidence suggests that the parent-to-child transfer of self-management responsibility is a complex, individualized process. Further research across childhood LTCs is needed to explore children's, parents', and professionals' views on this process and what support families require as responsibilities change.

Risk Factors for Falls in Adult Cancer Survivors: An Integrative Review

PURPOSE

The aim of the study was to identify risk factors for falls among cancer survivors.

DESIGN

Integrative literature review.

METHODS

We searched PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and PEDro for studies investigating fall risk in cancer. Reports of randomized controlled trials, descriptive studies (quantitative and qualitative), and theoretical papers meeting predetermined criteria were included. Quality ratings of included studies were done, and data were extracted and compiled by two independent reviewers.

FINDINGS

Twenty-nine articles met inclusion criteria. Literature quality was moderate (median quality score: 1.67 out of 3 possible points). Heterogeneity of statistics and reporting methods precluded calculation of summary effect sizes, but physical function, cognitive function, balance/gait, and certain medication types appear to increase fall risk.

CONCLUSIONS AND CLINICAL RELEVANCE

Modifiable risk factors, such as those identified in this review, represent tangible intervention targets for rehabilitation professionals for decreasing the risk of falls among cancer survivors.

Motor skills and internalizing problems throughout development: An integrative research review and update of the environmental stress hypothesis research

BACKGROUND

The Environmental Stress Hypothesis provides a conceptual framework detailing the complex relationship between poor motor skills and internalizing problems.

AIMS

This integrative research aimed to synthesize studies that have evaluated complex pathways posited in the framework.

METHOD

This study followed the four stages of an integrative research review: (i) problem formation and research aims, (ii) literature search and data collection, (iii) data evaluation and analysis, and (iv) results and discussion.

OUTCOMES AND RESULTS

Twelve peer-reviewed, English language studies published within 2010-2018 were identified. These used mostly cross-sectional, correlational methods and provided varying levels of support for relationships posited in the framework in samples spanning early childhood to adulthood. Compared to intrapersonal factors (e.g., self-esteem/ perceived competence), interpersonal factors (e.g., social support, peer problems) were found to more strongly and consistently mediate the relationship between motor skills and internalizing problems.

CONCLUSIONS AND IMPLICATIONS

There is growing empirical support for many of the Environmental Stress Hypothesis pathways. However, research to date is limited in the ability to establish causal relationships between variables, which is integral to the Environmental Stress Hypothesis. Intervention studies provide a useful type of experimental research that could establish causality between variables, while working to improve the physical and psychosocial functioning of people with poor motor skills.

Vessel health and preservation: An integrative review

AIMS AND OBJECTIVES

To describe and synthesise current knowledge on the maintenance and preservation of vessels in patients who need the placement of a vascular access device.

INTRODUCTION

To administer drugs, blood or intravenous fluids, nurses or doctors insert a peripheral vascular access device on the arm using the traditional approach. This approach implies that devices are blindly inserted until flow is satisfactory and all possible sites have been exhausted. A proactive approach would ensure at the outset that the best device is used for each patient, eliminating repeated attempts at cannulation.

DESIGN

An integrative review was conducted using data recorded until July 2017. Searches were conducted in PubMed, Cochrane Library, CINAHL and Scopus.

REVIEW METHOD

A modified version of Cooper's five-stage method and the PRISMA guidelines were used to perform the integrative review.

RESULTS

Nine papers were included in this review. The patients were active participants in a proactive approach to vessel health and preservation. The involvement of each healthcare professional in vessel health and preservation improves outcomes and expands the use of a proactive approach to vascular device management. Because nurses are directly involved in the use of such devices and support patients during the decision-making process, they should take the lead in the use of the proactive approach.

CONCLUSION

Despite the many documented advantages of the proactive approach to preserving vessels in many settings and healthcare systems, it has not been widely tested. Future research is needed to guarantee high-quality vessel health and preservation care, thus contributing to the development and dissemination of the proactive approach.

RELEVANCE TO CLINICAL PRACTICE

The proactive approach preserves vessels for future needs, improves the delivery of the treatment plan and reduces length of stay, costs, risk of infection, complications and pain perceived by patients. This approach also ensures better use of nurses' time and vascular access device material.